MedicalSurgical Nursing Care Third Edition CHAPTER 10 Caring

Medical-Surgical Nursing Care Third Edition CHAPTER 10 Caring for Clients Having Surgery Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

® NCLEX-PN Question 1 A client is scheduled for a thyroidectomy. Which of the following terms may be used to describe this type of surgery? Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-PN® Question 1 Choices 1. 2. 3. 4. Reconstructive Emergency Ablative Minor Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-PN® Question 1 Choices 1. 2. 3. 4. Reconstructive Emergency Ablative Minor Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

® NCLEX-PN Rationale Outcome 1. In a thyroidectomy, the diseased thyroid gland is removed (ablation). Because of its location and the nature of the surgery, thyroidectomy is major surgery. Reconstructive surgery is done to restore a part of the body that has been injured. Emergency surgery is that undertaken after a sudden, life-threatening injury or medical event. Minor surgery might require local or conscious sedation (which thyroidectomy would not). Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

® NCLEX-PN Question 2 A man is admitted to the ambulatory surgery unit in preparation for a hernia repair. Which of the following lab results noted by the nurse may require medical intervention? Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-PN® Question 2 Choices 1. 2. 3. 4. hemoglobin 13. 4, hematocrit 44 potassium 2. 8 platelets 280, 000 blood urea nitrogen (BUN) 10 Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-PN® Question 2 Choices 1. 2. 3. 4. hemoglobin 13. 4, hematocrit 44 potassium 2. 8 platelets 280, 000 blood urea nitrogen (BUN) 10 Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

® NCLEX-PN Rationale Outcome 3. Potassium level of 2. 8 is below normal and places the client at risk for cardiac arrhythmias. The other values are within normal range. Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

® NCLEX-PN Question 6 The client’s surgical incision is healing by primary intention. Which assessment finding should the nurse expect? Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-PN® Question 6 Choices 1. 2. 3. 4. Wound edges are approximated. Wound exudate is present. The wound is large, gaping, and irregular. Granulation tissue is evident. Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-PN® Question 6 Choices 1. 2. 3. 4. Wound edges are approximated. Wound exudate is present. The wound is large, gaping, and irregular. Granulation tissue is evident. Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

® NCLEX-PN Rationale Outcome 3, 5. Primary intention is normal wound healing. The wound edges are approximated and closed by staples or sutures. Wound is not the expected finding with primary intention healing; the nurse does expect approximated wound edges. A large, gaping, and irregular wound is healing by secondary intention. Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

® NCLEX-PN Question 9 A older adult client had a right total hip replacement 1 day ago. The LPN/LVN notes that the client is now slightly confused and disoriented. The MOST important action by the nurse at this time would be to: Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-PN® Question 9 Choices 1. 2. 3. 4. document the findings. notify the physician. keep the client on complete bed rest. assist the client to put on his glasses and hearing aids. Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

NCLEX-PN® Question 9 Choices 1. 2. 3. 4. document the findings. notify the physician. keep the client on complete bed rest. assist the client to put on his glasses and hearing aids. Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

® NCLEX-PN Rationale Outcome 6. The older adult may develop confusion or disorientation related to sensory deprivation if vision and hearing aids are not provided after surgery. Documenting the confusion does not help to correct it. The physician would not be notified until the nurse has taken actions to help the client reduce confusion. Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Learning Outcomes 1. Describe the classifications of surgical procedures. 2. Discuss the meaning and implications of informed consent, including the nurse’s responsibilities related to informed consent. 3. Describe interdisciplinary perioperative care, including laboratory and diagnostic tests and related nursing responsibilities. Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Learning Outcomes 4. Describe nursing implications for medications prescribed for the surgical client. 5. Discuss appropriate nursing care for the client in the preoperative, intraoperative, and postoperative phases of surgery. 6. Identify variations in perioperative care for the older adult. Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Learning Outcomes 7. Describe principles of pain management for postoperative pain control. 8. Compare and contrast outpatient and inpatient surgery. Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Classification of Surgical Procedures • Purpose-Diagnostic, Pallative, Transplant, ect • Risk factors-Minor(removal of skin lesion), Major(CABG) • Urgency-Elective(pt wants done, cosmetic, cataract), Urgent (need to be done in next 2 days, CABG, Hip fx), Emergency(immediately, bowel obstruction, ruptured aneurysm) Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Types of Surgeries • Inpatient – Admitted to hospital before and after surgery • Outpatient – Performed outside of the hospital – Under local or general anesthesia – Same day surgery can be done in a hospital but is still outpatient surgery – May go home after procedure without any help Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Phases of Perioperative Nursing • Preoperative phase - holding • Intraoperative phase - OR • Postoperative phase – recovery, PACU, home Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Preoperative Phase • • • Time frame-decision to OR Assessment with Risk Assessment Contest is signed Skin prepped, shaved IV, foley-if ordered Diagnostic tests Pre-medicate Teaching NPO-8 hrs to decrease risk of aspiration Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Preoperative Phase • Remove-jewelry, fingernail polish, dentures, hairpins, corrective lenses, artificial eye • Keep hearing aid in-tell OR nurse • Empty bladder • Look at surgical checklist-pg 208, box 10 -2 Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Informed Consent • Legal document required for procedures or therapeutic measures – no abbr (pun intended) • Who is responsible for getting the informed consent signed? • Protects the client, nurse, physician, health care facility • What does the nurse’s witness signature mean on the informed consent? Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Informed Consent • Most states require 18 years of age or older to sign • Married minors and emancipated minors may sign consent • Spouses, children, significant other cannot sign instead of a capable adult unless of course they are the POA or legal guardian • Emergency-MD become “legal guardian” in next of kin is not located and pt can’t give consent Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Informed Consent • Pt needs to understand – Reason for procedure and Dx – Benefits and risk – Likelihood for success – Alternative tx – Risk if not done – Right to refuse Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Laboratory/Diagnostic Studies (Preoperative) • Complete blood count (CBC) )-infection/immune status, anemia, fluid status • Serum electrolytes • Coagulation studies (PT/INR, PTT) – usually you have to hold all anticoagulants a day before the surgery • Urinalysis – infection • Chest x-ray – heart or lung disease • Electrocardiogram (ECG) – everyone over 40 has to have one from at most 6 mo ago • Blood type and crossmatch • These are baseline readings that will be used for comparison if something goes wrong (in addition to checking the patient if they are a candidate for the surg and what type of anesthesia to use) • Table 10 -3 Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Preoperative Assessment • • Medical history Accurate height and weight Assistance after the surgical procedure Understanding of surgical procedure Informed consent Vital signs-within 4 hrs of surgery Complete medication list-may interfere with anesthesia • Alcohol-is a blood thinner • Smoking-interferes with breathing Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Surgical Risk Factors • Advanced age-greater risk • Obesity-impact on anesthesia, wound healing • Malnutrition-delay wound healing • Dehydration/electrolyte imbalance-dysrhythmias • Cardiovascular disorders-DVT, PE, stroke, fluid volume overload, HTN • Respiratory disorders-COPD • Diabetes mellitus-decrease intestinal motility, delayed wound healing Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby • Renal and liver dysfunction-altered drug metabolism, elimination • Alcoholism • Smoking • Medications • Anticoagulants-increase bleeding time • Diuretics • Antihypertensives/ antidepressants Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Physical Preparation of Client for Surgery • Skin preparation – hibiclens shower, shampoo, hair removal(clippers only), antiseptic soap in surgical suitecontains iodine so check for allergy to iodine or seafood • Insertion of indwelling urinary catheter – not required for all surgeries, patients may develop urinary retention • Bowel preparation – for certain surgeries (Go. Lytely, enemas) • Withholding of food and fluids – NPO after midnight (not even ice chips or they will send your pt back) • No insulin if NPO • Marking the site-visible, clear, no X Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Psychological Preparation of Client and Family for Surgery • Significant and stressful event that produces anxiety • Listen actively to verbal and nonverbal communication – address concerns • Establish trusting relationship • Use of therapeutic communication Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Preoperative Medications • Antibiotics-decrease risk of infection. Cefazolin • Benzodiazepine-decrease anxiety-check respiration rate, BP-Ativan, Versed • Opioid-decrease anxiety, helps anesthesia -check respiration, N/V, BP, Pruritus(itching)-Morphine • H 2 Antagonists-decrease gastric volume, check for confusion/dizziness-Prilosec Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Preoperative Medications • Proton Pump Inhibitors-suppress acidcheck for rash, dizziness-Prilosec • Antimetics-Enhance gastric emptyingcheck sedation, extrapyramidal reactions(involuntary movement, muscle tone changes, abnormal posture)-Reglan • Anticholinergics-decrease oral and respiratory secreations-check for confusion-Atropine Sulfate Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Preoperative Teaching • Location of waiting area • Procedure for transfer to recovery room • Anticipated postoperative routine and devices or equipment • Postoperative pain control Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Preoperative Teaching • • Laboratory and diagnostic tests Prescribed preparations Time to arrive at the hospital Preparations for day of surgery Medication taken night before Informed consent Timetable for surgery and recovery room Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Preoperative teaching • Coughing exercise-diaphragmatic breathing, split abdomen with pillow, take 3 deep breaths and cough while contracting abdominal muscles, repeat 5 x every 2 hrs • IS-incentive spirometer • Leg, ankle, foot exercises-pg 209 • Turning in bed every 2 hrs • Post op care-wounds, diet, activity, tubes , drains -what they are going to look like after surgery Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

BOX 10 -2 (continued) NURSING CARE CHECKLIST Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

BOX 10 -2 (continued) NURSING CARE CHECKLIST Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Surgical Team • Surgeon • Surgical assistant-works with surgeon-not always present • Anesthesiologist-administers anesthesia and assumes responsibility for the pt’s general well being • Circulating nurse-RN oversees physical aspects of OR and equipment, transferring, site prepped, everyone remain sterile, assist with others documentation • Scrub nurse-hands instruments to surgeon (surg tech) Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Surgical Team Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Intraoperative Phase • Time frame-admitted to OR to admitted into PACU • Universal Protocol – Right pt, right procedure, right site – Pre-op verification process-procedure, consent, labs, ect – Site marked-correct – “Time Out”-final verification-check client, site, procedure Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Intraoperative Medications • General anesthesia- most dangerous; inhalant or IV-produces CNS depression (decrease LOC, no pain, skeletal muscle relax, reflexes diminish) • Regional anesthesia-instilled around the peripheral nerves to block transmission on nerve impulses in a particular area. Awake and conscious but does not percieve pain-spinal • Conscious sedation-provide analgesia and amnesia but allows the pt to remain consciousversed Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Antidotes for reversal of effects • flumazenil, reverses the effects of benzodiazepines • naloxone (Narcan) reverses the effects of opioids • neostigmine, helps reverse the effects of non-depolarizing muscle relaxants • sugammadex, new agent that is designed to bind rocuronium therefore terminating its action Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Nursing Interventions to Prevent Perioperative Complications • Surgical attire figure 10 -4 • Surgical scrub figure 10 -5 • Client preparation Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

TABLE 10 -5 (continued) Common Surgical Positions Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Postoperative Phase Nursing Interventions • Time frame-admit to PACU • Report-surgery, how are they, VS, pain, Meds given and last dose, tubes/drains, IV drips, over all picture of pt • VS-15 min x 4, 30 min x 2, then 1 hr and then hospitals policy • Check wounds, drains, drips, Urine output, IV fluids • SCD’s, TEDS • BS q 4 hrs • Positioning-q 2 hrs • NPO until gag reflex has returned Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Nursing Interventions • • • Labs Check for bleeding Skin color and condition I/O ever 15 min to hr-at least 30 m. L/hr Signs of hypo and hyper volemia Bladder distention Pain Wounds LOC O 2 levels Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Postoperative Medications • Opioid analgesics-Metabolized in liver, • S/E-check for respiratory depression (stop if less then 12/min), N/V/C (phenergan), decrease in BP (avoid sudden changes in position), sedation (BR), urinary retention (monitor I/O, check bladder for distention) • Opioid overdose triad-coma, respiratory depression, pinpoint pupils-Narcan • Fentanyl-patch takes several hrs to work • Morphine-common • Demerol-IM, cutting this one out Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Postoperative Medications • Nonsteroidal anti-inflammatory drugs • Inflammation suppression, reduce pain, fever reduction • S/E-GI upset (take with food, observe for s/s of bleeding, give prilosec), renal impairment (I/O, labs-bun/creatinine) • Motrian, Toradol, Naproxen Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Nursing Interventions to Promote Wound Healing • Wounds heal by primary (approximated), secondary (gaping, irregular), and tertiary intention (contaminated, not approximated) • Monitor for wound drainage – Serous drainage – Sanguineous drainage – Purulent drainage • Teach client wound care Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Postoperative Complications • Cardiovascular complications – Shock – hypovolemic due to hemorrhage, vomiting, diarrhea – § rapid pulse, low BP, ALOC, thready pulse, tachypnea, pale cool moist, decreased urinary output, decreased bowel sounds – give fluids vasopressors – Hemorrhage – possible internal bleeding – Deep venous thrombosis – § positive Homans’ sign, dull pain at site aggravated by walking, warmth, redness, increased calf sign : TEDS, SCD, positioning, low level anticoagulant – Pulmonary embolism – § SOB, pain, diaphoresis, anxiety, cough, cyanosis, dysrhythmia, and restlessness: positioning, low level anticoagulant Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

DVT Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

PE Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Postoperative Complications • Respiratory complications – Pneumonia § Due to infection or inflammation from foreign substance in the lungs (retained pulmonary secretions) § Fever, rapid pulse and resp, chills, cough, dyspnea, ▼O 2 sat, chest pain, crackles, wheezing – Atelectasis § Incomplete expansion or collapse of lung tissue due to inadequate ventilation of retained pulmonary secretions § Dyspnea, diminished breath sounds, ▼O 2 sat, crackles, cyanosis § IS, cough, turn, deep breathe, sit up Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Atelectasis Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Complications • Elimination complications – Urinary retention § you have to make sure your patient urinates within a few hours of taking out the foley – Altered bowel elimination§ Anesthetics, opiates, dehydration, NPO status all cause constipation and slowing of peristalsis § Assess bowel sounds frequently and for bowel movements – never strain! Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Postoperative Complications • Wound complications – Infection § Redness, warmth and edema, purulent drainage, fever, chills, increased resp rate and pulse – Dehiscence § Figure 10 -7 separation of incision § Cover with sterile dressing moistened with saline, bedrest, notify dr, may need reclosure – Evisceration § Protrusion of organs through dehiscence (this is why they shouldn’t strain) Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Infected Wound Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Dehiscence Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Evisceration Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Postoperative Teaching • Wound care – pt usually have to do own or home health nurse may be visiting them • Manifestations of a wound infection – teach your patient what to look for • How and when to take a temperature – same time each day at same place • Limitations or restrictions on activities – per dr order • Control of pain – don’t wait for pain to be out of control Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Outpatient Surgery • Nonhospitalized client • Administered local or general anesthesia • Discharged immediately after procedure or short time after procedure • More cost effective than inpatient care • Physical care same as inpatient surgery • Teaching and emotional support differ from inpatient surgery Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.

Inpatient Surgery • Hospitalized client • Administered regional, general, or conscious sedation anesthesia • Costly • Teaching and emotional support differ from outpatient surgery Medical-Surgical Nursing Care, Third Edition Burke • Mohn-Brown • Eby Copyright © 2011 by Pearson Education, Inc. All rights reserved.