Med Surg

• Surgery


  The branch of medicine that encompasses pre-operative care, intra-operative judgment, and post-operative care of patients
• Operation


  Procedure on what we do in surgery for correction of deformities and defects, repair of injuries, diagnosis and cure of disease processes, relief of suffering and prolongation of life
• Perioperative nursing


  The nursing functions in the total surgical experience of the patients
• Preoperative phase


  1. Procedures done by nurses before surgery, from the time the decision is made for surgical intervention to the transference of the patient to the operating room

  2. Ensure all laboratory tests be performed

  3. Acquire informed consent

  4. Establish baseline information: previous medical illnesses, or had surgery before, or allergies
• Intraoperative phase


  1. Activities done by nurses when the patient is undergoing surgery, from the time the patient is received in the operating room, to the time of administration of anesthesia, surgical procedure is done until he is admitted to the RR/PACU (recovery room)

  2. Responsibility to keep our patients safe and clean

  3. Apply sterilization
• Postoperative phase


  1. Procedures done by nurses after surgery from the time of admission to the Recovery Room, to the time he is transported back to the surgical unit/ward, discharged from the hospital, until the follow up care

  2. Follow up care can be at home or clinical setting
• Conditions requiring surgery


  • Obstruction
  • Perforation
  • Erosion
  • Tumor
• Types of breast surgery


  • Incision
  • Excision
  • Needle biopsy
• Purposes of surgery


  • Diagnostic
  • Exploratory
  • Curative
  • Palliative
  • Transplant
• Degrees of surgical risk


  • Major
  • Minor
• Surgical urgency


  • Emergency
  • Urgent/Imperative
  • Elective
  • Planned/Required
  • Optional
• Common surgical suffixes


  • Ectomy
  • Rrhaphy
  • Ostomy
  • Otomy
  • Plasty
  • Oscopy
• Common surgical abbreviations


  • TAHBSO - Total Abdominal Hysterectomy Bilateral Salpingo-Oophorectomy
  • TURP - Transurethral resection of the Prostate - removal of prostate
  • TURBT - Transurethral Resection of the Bladder Tumor
  • STSG - Split Thickness Skin Grafting
  • BKA - Below Knee Amputation
  • AKA - Above Knee Amputation
  • ECCE w/ IOL -Extra Capsular Cataract Extraction w/ Intra-Ocular Lens implantation
  • CHOLE w/ IOC -Cholecystectomy w/ Intra-operative Cholangiogram
  • GETA - General Endotracheal Anesthesia
• Surgical root words


  • arthro - joint (arthoplasty)
  • blepharo - eyelids (blepharoplasty)
  • cholecyst - gallbladder (cholecystectomy)
  • colpo - vagina (colporrhaphy)
  • cranio - skull (craniotomy)
  • cysto - urinary bladder (cystectomy)
  • gastro - stomach (gastroscopy)
  • hepato - liver (hepatotomy)
• Surgical risk factors


  • Age
  • Obesity
  • Malnutrition
  • Dehydration/electrolyte imbalance
  • Cardiovascular disorders
  • Respiratory disorders
• Nsg. Implications for age as a surgical risk factor: consider using lesser doses of anesthesia for desired effect, adjust nutritional intake to conform to higher protein and vitamin needs, anticipate problems from long standing chronic disorders
• Nsg. Implications for obesity as a surgical risk factor: promote weight reduction if time permits, monitor closely for complications postoperatively, encourage post op exercises and early ambulation, monitor closely for wound and cardiopulmonary complications postoperatively, encourage coughing, turning and diaphragmatic breathing exercises
• Nsg. Implications for malnutrition as a surgical risk factor: promote weight gain by providing a well-balanced diet high in calories, protein, and vitamin C, administer total parenteral nutrition intravenously, nutritional supplements and tube feedings as prescribed, monitor daily weights and calorie counts
• Nsg. Implications for dehydration/electrolyte imbalance as a surgical risk factor: administer intravenous fluids as ordered, keep a detailed intake and output record, monitor client for evidence of electrolyte imbalance
• Nsg. Implications for cardiovascular disorders as a surgical risk factor: diligently monitor vital signs, closely monitor fluid intake, assess skin color, assess for chest pain, lung congestion, and peripheral edema, observe for signs of hypoxia, and administer oxygen as ordered, encourage early postoperative ambulation and leg exercises, encourage change of position but avoid sudden exertion
• Alcoholism


  • Monitor closely for signs of delirium tremens
  • Encourage a well-balanced diet
  • Monitor for wound complications
  • Administer supplemental nutrients parenterally as ordered
• Anticoagulants and Salicylates (aspirin)


  • Monitor for bleeding
  • Assess PTT/PT values
  • Prothrombin time
  • Clotting time
• Diuretics (Thiazide)


  • Monitor I&O and electrolytes
  • Assess cardiovascular and respiratory status
• Antihypertensives - Phenothiazines


  • Closely monitor blood pressure
• Antidepressants - Monoamine oxidase Inhibitors


  • Closely monitor blood pressure
• Antibiotics


  • Monitor respirations
• Other Factors


  • Nature of the condition
  • Location of the condition
  • Magnitude and urgency of the surgical procedure
  • Mental attitude of the person toward the surgery
  • Caliber of the professional staff health care facilities
• Preoperative Phase


  1. Assessing and correcting physiologic problems that might increase surgical risk

  2. Giving the person and significant others complete learning/teaching guidelines regarding surgery

  3. Instructing and demonstrating exercises that will benefit the person during the post op period

  4. Planning for discharge and any projected changes in lifestyle in surgery
• Fear


  An emotion marked by dread, apprehension and alarm caused by anticipation or awareness of danger and manifested by anxiety
• Causes of Fear of the Preoperative client


  • Fear of the unknown
  • Fear of Anesthesia
  • Fear of pain and discomfort
  • Fear of death
  • Fear of disfigurement, mutilation, loss of a valued body part
  • Threat to sexuality
  • Fear of loss of livelihood
• Manifestations of Fear


  • Anxiousness
  • Bewilderment
  • Anger
  • Tendency to exaggerate
  • Sad, evasive, tearful, clinging
  • Inability to concentrate
  • Short attention span
  • Failure to carry out simple directions
• Nursing Interventions to minimize Anxiety


  1. Explore the client's feelings

  2. Allow clients to speak openly about fears/concerns

  3. Give empathetic support

  4. Consider the person's religious preferences and arrange for visit by priest/minister as desired
• Informed Consent


  A legal document required for certain diagnostics procedures or therapeutic measures, including surgery
• Purposes of Informed Consent


  • To ensure that the client understands the nature of the treatment including the potential complications and disfigurement
  • To indicate that the client's decision was made without pressure
  • To protect the client against unauthorized procedure
  • To protect the surgeon and the hospital against legal action by a client who claims that an unauthorized procedure was performed
• Major Elements of Informed Consent


  • Voluntary
  • Informed
  • The client must be given information to be the ultimate decision maker
• Who Signs the Consent

  • Adults
  • Next of Kin
  • Parent or Legal guardians
  • Emancipated minors
  • Emergency situation
  • Illiterate
• Nursing Responsibility for Informed Consent


  • Witnessing the exchange between the client and the surgeon
  • Witnessing the client's signature
  • Establishing that the client really did understand
• Physiological Preparations


  • Cardiovascular ECG
  • Hematologic (CBC, Hgb and Hct, WBC, PTT & PT, Platelet count)
  • Respiratory (Chest X-ray, Pulmonary Function Test/PFT)
  • Metabolic (FBS, Electrolytes)
  • Genitourinary (Routine Urine Analysis)
• Post Operative Teaching


  1. Deep breathing exercise (diaphragmatic)

  2. Coughing exercise

  3. Turning Exercise

  4. Leg, Ankle, and Foot exercise

  5. Ambulation

  6. Pain Control

  7. Equipment
• Night prior to Surgery

  1. Preparing the GIT (Placing the patient in NPO)

  2. Preparing for Anesthesia (Remind and monitor if pt has followed instructions to avoid drinking alcohol and smoking for the last 24 hours)

  3. Promoting rest and sleep (Administering sedatives as ordered)