NUR 300 Med Surg Final Exam Comprehensive review

COMPREHENSIVE REVIEW AHHHHHHHHH 1. Preoperative Care a. Surgical Risk Factors, Current Medications, Data to Obtain in Health History, & Physical/Psychosocial Assessment i. Health History: Past surgical history and r ...

COMPREHENSIVE REVIEW AHHHHHHHHH 1. Preoperative Care a. Surgical Risk Factors, Current Medications, Data to Obtain in Health History, & Physical/Psychosocial Assessment i. Health History: Past surgical history and reactions, medications the patient is taking. RED FLAG medications include: Anticoagulants: Coumadin, Warfarin, Plavix, Aspirin, Heparin, Herbal Medications that can thin your blood, and corticosteroids because they delay wound healing. ii. Psychosocial Assessment: You want your patient to feel as good as possible. It is a fact supported by evidence that patients that enter surgery with poorer attitudes experience poorer outcomes. iii. Cultural/Spiritual Assessment: “Is there anything about your cultural or spiritual background that I should know that could affect your surgery and care?” iv. Physical Assessment: This will give us a baseline of information with which to compare during and after surgery. v. Labs: Hgb & Hct (H & H), platelets, PTT, aPTT, PT/INR, Blood Type & Cross, BUN, and CR. vi. Diagnostic Tests b. Pre-operative Care i. What medications are commonly used pre-op and why? 1. To reduce anxiety, pain, and the amount of anesthesia needed, i.e. sedatives: atarax/vistaril (hydroxyzine), hypnotics: Ativan (lorazepam), anxiolytics: versed(midazolam), analgesics: morphine, Demerol (merperidine), fentanyl, dilaudid (hydromorphone). 2. To decrease oral and gastric secretions, anticholinergics: atropine (urecholine) and scopolamine. 3. To reduce nausea & vomiting: Phenergan (promethazine), Zofran (Ondansetron), Reglan (Metoclopramide). ii. What sort of precautions take precedence after giving pre-op medications? 1. Patient safety 2. Monitor status, i.e. vitals, affect c. Preoperative Teaching i. When should you do client teaching about the surgery and why? 1. BEFORE the operation. After surgery, patients are in too much pain to care or be able to retain and understand. ii. Why is client teaching important? 1. It helps the patient understand what to expect after surgery. a. Be sure to explain equipment, tubes, drains, vascular access, and the frequent monitoring for vital signs in great detail. 2. It may help to comfort and prepare patients. 3. It reduces anxiety. d. Informed Consent i. When can the patient withdraw consent for surgery?