Medical and Surgical Study Guide: by April Mae Labrador
Medical and Surgical Study Guide: by April Mae Labrador
Medical and Surgical Study Guide: by April Mae Labrador
HISTORICAL BACKGROUND
BEGINS: IN SURGERY
HISTORICAL BACKGROUND
**Back then, surgical treatment dates back to as early as 10,000 to 5,000 AC.
Originally all medical providers were essentially surgeons as they treated wounds, drained infections,
broken bones, and stopped bleeding by applying hot metal or hot oil to wounds.
In Surgical Instrumentation
Historical Overview:
Archeologist revealing evidence of a surgical procedure known as trephining ( an opening of the
skull) was performed to release the demons believed to be trapped inside the patient.
TREPANATION
Surgical procedure:
is the act of drilling openings into skull to release so called evil spirit from the dates back to the
Mesolithic periods.
While in the period of Hieroglyphic in ancient Egypt and textbooks that were the foundation of
Ayurvedic medicine ( Sushruta Samshita) describe many operations, including CS, rhinoplasty,
craniotomy, and laparoscopy performed while using wine and Cannibis indica as anesthesia.
Trepanation
the act of drillings into the skull to release so- called evil spirits from the body.
The act of drilling openings into skull to release so called evil spirit from the dates back to the
Mesolithic periods.
A sharp flint and hammer were needed to create a hole in the skull, and fine and animal teeth
were used as probes and drainage of abscess.
Definition of Terms:
1. Peri-operative nursing total surgical experience that encompasses with pre-operative, intra-
operative, and post-operative phases of patient care
2. Operating room / Operating theatre room in a health care facility in which patients are
prepared for surgery, undergo surgical procedures, and recover from the anesthetic procedures
required for surgery.
4. Surgical procedure invasive incision into body tissues or minimally invasive entrance into a
body cavity for either therapeutic or diagnostic purposes during which protective reflexes or
self-care abilities are potentially compromised
5. Surgical conscience awareness which develops from a knowledge base of the importance of
strict adherence to principles of aseptic and sterile techniques
6. OR nurse duly licensed registered nurse legally responsible for the nature and quality of the
nursing care patients
8. Sepsis general reaction from the action of bacteria or their products. For sepsis- This need
antibiotics but C/S must be done.
9. Disinfection process of destroying all pathogenic microorganisms except spore bearing ones.
12. Anesthesia insensibility to pain and trauma with or without loss of consciousness. Sometimes
GA/Local/Regional
3 Types of Surgery:
1. Elective surgery
performed when surgery is preferred treatment and improve the client’s life, but not
essential for the health.
This Elective surgery is a Plan surgery for enhancement / Repair / for a better person.
Examples: facial plastic surgery to improve or maxillofacial surgery after the accident ,
hernia repair, hip repair surgery that can be waited.
2. URGENT surgery
essential for the client’s health and may prevent complications.
3. EMERGENCY surgery
must be done immediately to save the client’s life or preserve function of a body
part.
*** One of the most important things to remember in your career and if possible to stand ALONE AND
BE a successful nurse. Have an expected a very good behavior or attitude in your life.
Empathy- ability to identify oneself or understanding.
PREOPERATIVE PHASE
Preoperative nursing care begins with the nurse’s initial contact with the surgical patient.
Objective:
o is to identify individual needs in order that accepted protocols of care can be modified.
Pre-Op Situation:
1. Mrs. Sy, 55yrs old is admitted in the Surgical Ward with the chief complaint of acute right upper
quadrant pain which radiates to the back. She is extremely nauseated and has vomited several
times. She has been diagnosed or tentative diagnosis of Cholelithiasis with Cholecystitis.
Questions:
1. What is Cholelithiasis?
2. What is Cholecystitis?
3. What is open cholecystectomy / laparoscopic cholecystectomy?
4. What are the modifiable and non-modifiable factors?
5. What is/are your Nursing Dx in pre-operative phase / intraoperative / postoperative phase?
6. Labs/Diagnostics/ Operation Performed?
PREOPERATIVE PHASE
Any kind of surgery whether major or minor is always preceded by emotional as well as
physiological changes hence, the need for 3 extensive preparations.
Psychological Care Preparation
Preoperative Teaching Preparation
Physical Care Preparation
Nurses Responsibility with preparation
A. Psychological Preparation
Fears related to surgery ( 2 Types)
1. General fear
fear of the unknown-worst fear of all.
what to expect and what are the consequences of surgery
nursing action: allay anxieties by giving the patient opportunities to express his/her fears.
2. Specific fears
fear of destruction of body image
threat to sexuality
fear of permanent disability
fear of pain
fear of dying
Body image- mastectomy=asset losses, keloids, contractures.
Sexuality-infertility.
Permanent disability – amputation, loss of vision. Loss of job
Fear of pain= pain threshold is weak. Especially the injection, postop
Fear of dying= because of age, be loss in the family children were all young.,
** In taking objective cue: Note PQR highly anxious person may talk rapidly, ask too many questions,
repeat same questions, deny worries, or withdraw & refuse to talk to people, & avoid topics related to
feelings.
Planning
o Should reflect current standards, facilitates the prescribed medical care, & work toward
attainment of desired outcomes
o The scope of plan is determined by assessment data
o Example
patient will demonstrate understanding of the procedure
patient will be injury-free
patient will be infection-free
Implementation
o Plan of care is implemented throughout the perioperative period
o Scientific principles provide the basis for patient care interventions that are consistent
with the plan for continuity of patient care in the perioperative environment
o Suggested interventions
identify concerns if he/she is given opportunities to talk about
** Suggested intervention:
- allowing the patient & the family to participate in decision-making concerning his/her care helps the
patient meet his/her need for control
- fear of the unknown can be partly relieved by providing information
Evaluation
- Continual process of reassuring the patient and his/her responses to implementation of
the plan of care
- Examples
Risk for deficient knowledge – patient verbalizes understanding
B. PHYSIOLOGICAL PREPARATION
Before surgery is performed, the patient undergoes several tests. There are several factors
which may affect the patient’s response to surgery, therefore, it is necessary to obtain the
essential data to identify potential problems. Factors that affects are as follows:
1. Age
Factors that affect surgery under physiological preparation.
2. Nutrition
Dehydration and malnutrition cause potential complications post-operatively.
Parenteral fluids are prescribed to correct fluid & electrolyte deficiencies prior to surgery.
o It is essential for the nurse to identify these baseline data
o nausea, vomiting, anorexia
Malnutrition may be corrected by high caloric diet, protein & vitamin supplements.
Obese people breathe poorly & are prone to pulmonary complications.
o Obesity increases the seriousness of complications to a great extent. Nursing
intervention is diet only to come after a month for possible OR.
o Fatty tissues are prone to infection therefore, dehiscence & wound infections are
common.
3. Presence Of Disease
Cardiovascular disease
o ECG, 2-D-Echo, Stress tests, Blood tests
o CVP measurement for elderly, major
Surgeries
o blood typing and cross-matching
o HPN, Bleeding disorders
Respiratory disease
o CXR, ABGs
o PTB, Pneumonia, COPD
Renal Disease
o Urinalysis, BUN/ Creatinine,
o Acute nephritis, Acute renal insufficiency, UTI
Endocrine disease
o FBS, Thyroid function tests
o Uncontrolled DM, Hypo/hyperthyroidism
C. PHYSICAL PREPARATION
Common preparations:
1. Gastrointestinal Prep: The Eve before OR must have:
light meal the night before surgery
NPO (food & water -post midnight – safe is 6hrs-2 hours b4 is still possible to give a sips
of water.
this order should be carefully explained to patients
3. Urinary
Empty bladder before patient is sent to the OR*
Before giving pre-meds. Pt. must empty his bladder.
4. Circulatory
Anti-embolic stockings for elderly & for long surgeries
skin prep, shaving, oral & body hygiene
o * can reduce the no. of microorganism.
** Circulatory
- stockings or bandages compress superficial veins & increase blood flow through deep vein
pressure preventing venous stasis & thromboembolism.
Nurse’s Responsibility:
Perform/supervise skin prep & cleansing
Notify AMD of drug allergies, severe anxiety, unusual ECG or abnormal lab findings-
Ensure all consent forms are signed ( Gen. & Informed)
Administer pre-op meds on time-1 hour before anesthesia.
Complete pre-op checklist
Check if history & PE database are on chart
Remove dentures, nail polish, hair pins, jewelries
** note drug allergy /allergy cannot lessen through nursing intervention while fear, obesity & smoking
can be.
C. Legal Preparation
2. INFORMED CONSENT
SURGICAL / INFORNMED CONSENT- is a process-not necessary a mere document.
Explanations of the procedure, risks, benefits, and alternative therapy are made verbally
to the patient’s level of understanding.
** A surgeon or anesthesia provider may be held liable for negligence if the patient can prove failure to
disclose significant information that would have influenced a reasonable person’s decision to consent.
Hospital of choice:
This General consent form (House Rules). require the patient or his or her legal guardian to sign a
general consent form on admission. Ex: Rendered day to day treatment, Hosp. charges, info about the
surg, or even package, or medic card etc.
* Note* the patient has the right to waive an explanation of the nature and consequences of the
procedure and the right to
refuse the treatment/ surgery.
** Although, permission for life saving procedures, especially for a minor, may be accepted from a legal
guardian or relatives by phone , fax , txt or other written com. then, two nurses must sign the form. And,
later or upon arrival at the facility the concern person must sign.
Malpractice
o professional misconduct
o illegal or immoral conduct
o unreasonable lack of skill or judgment
o professional misconduct
o illegal or immoral conduct
o unreasonable lack of skill or judgment
Legal Preparation
Doctrine of res ipsa loquitur
o “the thing speaks for itself.”
Court allow the patient’s injury to stand as inference( witness) of negligence
*Before this doctrine can be applied, 3 conditions must exist
1. The type of injury.
2. The injury was caused by the conduct or instrumentality within the exclusive control of
the person or persons being sued
3. The injured person could not have contributed to negligence or voluntarily assumed risk
Legal Preparation
Invasion of privacy
o patient has the right to expect that all communications & records pertaining to
individualized care will be treated as confidential & will not be misused
o right to privacy during interview, examination & treatment
**Example: - NOTE: Surgery schedule bearing the names of the patients should not be posted in a
location where the public or other patients can read it.
- written consent for videotaping or photographing his/her surgical procedure for medical
education or research, w/o a permit is a BIG NO. (just remember the canister case / u tube.)
Legal Preparation
Doctrine of Respondent Superior
o an employer may be liable for an employee’s negligent & conduct.
Assault
o unlawful threat to harm another physically
Battery
o carrying of bodily harm as by touching without authorization or consent
Abandonment
o Leaving the patient for any reason when the patient’s condition is contingent on the
presence of the caregiver
**Abandonment of post if the caregiver leaves the room knowing there is potential need for care
during his/her absence, even under the order of a physician, the caregiver is liable for his/her own
action
Legal Preparation
Surgical conscience for the surgical team
o key elements of perioperative practice caring, conscience, discipline & techniques.
**Be honest. Optimal patient care requires an inherent surgical conscience, selflessness, self-discipline
& the application of principles of asepsis & sterile technique.