Medical-Surgical Nursing I Lecture Notes (2024-2025) PDF

MEDICAL-SURGICAL NURSING I (Lecture) BSN 3-1 | BSN 3-3 3rd Year, 1st Semester (S.Y. 2024-2025) Prof. Glenn L. Rianzares B. CURATIVE...

MEDICAL-SURGICAL NURSING I (Lecture) BSN 3-1 | BSN 3-3 3rd Year, 1st Semester (S.Y. 2024-2025) Prof. Glenn L. Rianzares B. CURATIVE To resolve a health problem by removing the Topic Outline: Topic I involved tissue Topic II C. RECONSTRUCTIVE Performed to correct deformity, repair injury, or improve functional status MAIN TOPIC D. PALLIATIVE TOPIC Performed to relieve symptoms w/o the SUB-TOPIC intent of cure E. ABLATIVE PERIOPERATIVE NURSING Performed to excise tissue that may Perioperative Nursing contribute to patient's existing medical Application of science and arts of nursing in the care condition of perioperative patients F. COSMETIC Patient Focus Performed for aesthetic purposes Model used in perioperative Nursing Composed of 4 domains 3. ACCORDING TO ANATOMIC SITE 1. Patient Safety ○ By location of body systems, Usually a 2. Health System specialization 3. Physiologic Responses ex. NEURO - BRAIN 4. Behavioral Responses ex. CARDIO - HEART MAJOR TYPES OF PATHOLOGICAL PROCESSES 4. ACCORDING TO DEGREE OF RISK REQUIRING SURGICAL INTERVENTIONS (OPET) A. ELECTIVE 1. OBSTRUCTION Planned, non-essential surgical procedures Impairment to the flow of vital fluids ○ (ex. repair of scars, simple hernia, ○ (ex. CSF) vaginal repair) 2. PERFORATION B. URGENT Rupture of an organ Unplanned surgical procedures and require ○ (ex. Ruptured appendicitis) timely interventions 3. EROSION Performed w/in 24-48 hours Wearing off of a surface or membrane ○ (ex. Hysterectomy, acute ○ (ex. Burns) gallbladder infections, kidney / 4. TUMORS ureteral stones) Abnormal new growths C. EMERGENCY ○ (ex. Neck tumor) To be done immediately to save/ preserve life or limb 1. ACCORDING TO DEGREE OF RISK ○ (ex. Trauma, GSW/SW, fractured A. MAJOR OPERATION skull) Criteria: D. PLANNED REQUIRED ○ Involves higher % of risk Patient needs to have surgery ○ Involves vital organs Necessary for well being B. MINOR OPERATION Plan w/in months Criteria: ○ (ex. BPH w/o bladder obstruction) ○ Less risky 5. OPTIONAL 2. ACCORDING TO PURPOSE Decision rests w/ the patient A. DIAGNOSTIC Usually requested by the patient/personal To determine cause of symptom or origin of preference problem ○ (ex. Cosmetic surgery) 1 1  SURGICAL RISK FACTORS 7. PREVIOUS MEDICATION USE Obtain medication history-prevent drug GENERAL RISK FACTORS interactions 1. Obesity potent drugs (Narcotics, CNS Depressants, 2. Fluid, electrolyte and nutritional problems Steroids) 3. Presence of disease/s OTC (Cough medications, Aspirin) 4. Concurrent or prior pharmacotherapy PHYSICAL PREPARATIONS BEFORE SURGERY EFFECTS OF SURGERY TO THE CLIENT 1. Stress response is elicited BEFORE THE DAY OF THE SURGERY 2. Defense against infection is lowered 3. Vascular system is disrupted 1. CORRECT ALL NEGATIVE FACTORS BASED ON 4. Organ functions are disturbed PHYSIOLOGIC ASSESSMENT 5. Body image may be disturbed 2. TEACHING PRE-OP EXERCISES 6. Lifestyle may change Diaphragmatic breathing 3. FULL BATH GOALS OF THE PRE-OP PHASE To reduce microorganisms 1. Assessing and correcting physiologic and psychologic 4. PREPARING G.I. TRACT problems that might surgical risk NPO status 2. Giving person and significant others complete Enemas, laxatives (as needed) learning/teaching guidelines regarding surgery 5. PREPARING FOR ANESTHESIA 3. Instructing and demonstrating exercises that will Avoid alcohol and cigarette smoking at least benefit person during post op period 24 hours before surgery 4. Planning for discharge and any projected changes in 6. REST AND SLEEP lifestyle due to surgery May administer sedatives as ordered PHYSIOLOGIC ASSESSMENT DAY OF THE SURGERY Morning bath / mouthwash if possible (-) Factors = ↑ risk Provide clean gown a. Health History ○ Always remove underwear b. Physical Examination (Cephalocaudal) Remove hair pins, braid long hairs and cover hair w/ c. Laboratory and Diagnostic Examinations cap Remove dentures, foreign materials (gum) colored 1. NUTRITIONAL AND FLUID STATUS nails, hearing aid, contact lens and jewelry Optimum nutrition Wedding ring 2. RESPIRATORY STATUS ○ Remove and tie with gauze Goal: Optimal respiratory function ○ Fasten around the wrist *Smokers: Urged to stop 2 months before Baseline v/s 1 hour prior to transport surgery Check chart (doctor's orders/lab results) 3. CARDIOVASCULAR STATUS ○ If cardiopulmonary clearance granted Goal: Ensure well-functioning cardiovascular Check identification band system to meet oxygen, fluid and nutritional Perform skin preparation needs during perioperative period Check for special orders (if required) *Assess history of CV disorders ○ Enema 4. HEPATIC AND RENAL FUNCTION ○ NGT Goal: Optimal function of liver and urinary ○ IV line system ○ Blood reservation Liver important for metabolism of anesthetic Check NPO - 6-8 hours NPO prior to surgery drugs Offer spiritual support (regardless of religion) Assess kidney function Pray w/ patient 5. ENDOCRINE FUNCTION Accomplish pre-op care checklist Goal: Optimal function of Endocrine System Have client void before pre-op meds Control DM and thyroid problems Always follow hospital protocols 6. IMMUNE FUNCTION Goal: Determine existence of allergies, including nature of previous allergic reactions and other immune 2  PREOPERATIVE MEDICATIONS HOW TO PREVENT WRONG SITE, WRONG PROCEDURE OR WRONG SURGERY? Goals: 1. PREOPERATIVE PATIENT VERIFICATION 1. Facilitate administration of preanesthetic medications. Ask the patient's name, state the patient's 2. Minimize respiratory tract secretions and changes in name and check w/ the records (at least 2 of heart rate. the ff.) 3. Relax the client and reduce anxiety. a. Door b. Headboard INFORMED CONSENT c. Bracelet Also known as operative permit/surgical consent d. Chart e. Identification system Purpose: 2. SITE MARKING 1. Ensure that the client understands nature of the 3. TIME OUT treatment including potential complications and Brief conference of the medical team disfigurement 2. Indicate that the client's decision was made w/o pressure 3. Protect client against unauthorized procedures 4. Protect surgeon and hospital against legal action by the client who claims that an unauthorized procedure was performed CIRCUMSTANCES REQUIRING A PERMIT 1. Any surgical procedure where a scalpel, scissors, sutures, hemostats or electrocoagulation 2. Entrance into a body cavity 3. General anesthesia, local infiltration, regional block REQUISITES FOR VALIDITY OF CONSENT 1. Patient personally signs the consent if of legal age and mentally capable Written permission is best and legally acceptable 2. Signature is obtained with the client's complete understanding of what is to occur Surgeons must provide a clear and simple explanation of what the ex. Will entail including possible complications Adults sign their own permit Note: OBTAINED BEFORE SEDATION!!! 3. Secured w/o pressure or duress 4. A witness is desirable A nurse, doctor or other authorized persons 5. In an emergency, permission via telephone or fax is acceptable 6. For minors (