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surgical care

Surgery is a part of nursing because some clients may require surgical procedures and it is important to be able to care for them adequately for safety reasons and a quick uncomplicated recovery. Here are a few things to keep in mind when you get questions on post operative care of a client on a nursing exam or on the hesi exit exam. 1. Step 1 Assess the client The first thing to do after a client leaves the surgical room is to assess their vital signs. It is important to make sure that they are responsive, and that their vital signs are within nornmal limits and that their incisions are intact. 2. Step 2 Encourage Deep breathing and coughing exercises Its imporatnt for the client to breathe deeply to prevent collapse of the lungs and to cough to prevent accumulation of secretions. These 2 ( lung collapsing, secretions i.e mucus) conditions could lead to pneumonia hence the importance of coughing and breathing deeply. Remember the client has received anasthesia that may impair the muscles from being fully functional so they can breathe deeply. 3. Step 3 Get the client walking Ambulation( walking ) is important to get the clients blood flowing and to prevent the formation of blood clots which clould cause embolisms that can actually cause death. Laying in bed can cause the blood in the the extremetities( legs) to pool and increase the possibilty foir a blood clot to form. 4. Step 4 Apply Anti embolism stocking In the event that the client cannot get out of bed, The stockings help with circulation and preventing blood clots. 5. Step 5 Monitor INtake and Output Due to anasthesia, the client may have urinary retention or constipation. SO its important to monitor how much they are urinating and drinking and if they are passing gas to make sure that their urinary and bowel fuctions return to normal. 6. Step 6 Pain Management This is very important, if a client has had surgery they most certainly may be in pain so to increase their comfort, ask them if they are in pain and provide pain medication as prescribed. ALso clients who have had abdominal surgery may breathe shallowly due to pain and this could lead to pneumonia. Giving them pain medication will minimize the pain and encourage deep breathing so pneumonia can be avoided. 7. Step 7 Monitor for infection The client may have incisions and they are portals of entry for disease causing organisms so, watch for infection by taking the clients temperature and inspecting the incision site for redness and foul drainage as well as swelling as time goes on. ALdo change dressings using sterile technique to reduce the risk of infection. 8. Step 8 Monitor for pulmonary complications As said before pneumonia is a risk factor to be watched for and prevented. 9. Step 9 Emotional support The client has just gone through something they probably didnt know what the outcome would be, they may be getting used to ostomy bags and things being attached to their bodies. At this time they are really vulnerable, it is your job to provide them with encouragement, praise when they successfully complete what you teach them, your presence and kind words when they are scared or anxious.

hesi review book

The HESI exit exam is one you have to pass to graduate from nursing school and it is not easy to prepare for or pass according to a lot of nursing students. There are different parts to the exams, I think the hardest part would be med surg , fundamentals etc and the easier parts are delegation, prioritization, professional, law and ethical issues. I think if you can pass as many of the easy questions as you can, it will increase your chances of passing the hesi. So here are a few tips on answering delegation and prioritization questions. 1. Step 1 1. It is always safe to narrow down answers to those that give vital signs to the UAP. The UAP can also measure output from a foley catheter. The UAP can also transport patients between departments. So to review a UAP can Feed the client (observe the UAP feeding the client if there is any paralysis involved) Take vital signs Perform range of motion exercises Perform routine grooming and hygiene Measure output from the foley bag Transport patients 2. Step 2 2. The LPN can give medications, reinforce teaching and carry out ROUTINE care. The LPN cannot do anything invasive i.e IV insertion according to HESI and NCLEX! In review the LPN can do more than the UAP which includes the following Give medication plus injections Perform ROUTINE assessments (routine as in the hospital does this every so often without expecting to encounter problems because its just routine)dressing changes, catheter insertion and suctioning. Can assist the physician during procedures if the RN has to leave Cannot do anything in the nursing process 3. Step 3 3. The RN must assess the patient, the RN must receive report about the patient and give report about a patient, the RN must perform patient teaching. Anything invasive and sterile is the job of the RN. The RN cannot delegate any of the above. So The RN cannot delegate pre op assessment or post op assessment Handling invasive line Sterile technique Patient education Triage Assessment, evaluation or monitoring Planning, care plans, interventions or nursing diagnosis 4. Step 4 4. To answer prioritization questions on the HESI, think about the following Time frames: if the patient is freshly post op, you must see that patient first. Stability:If the patient is unstable or in a potentially life threatening situation you must see that

patient first. Unsable patient may men their vitals are off from their baseline so they need monitoring ABC: use airway breathing circulation, the patient with affected or potentially affected airway should be seen first Maslow: always pick physiological integrity before safety and mental issues Safety: if there is the possibility of the patient harming themselves or others see that patient first The discharge patient can be last because they are stable Always give the client who requires the least complex care to the new graduate nurse. Never give the new grad patients about to be discharged because they need teaching or patients newly diagnosed with a disease because they also need teaching This article hopefully should help you answer questions on prioritization and delegation. There are lots of these questions on HESI so the more of them you get right the better for you! The select all that apply questions on Hesi and Nclex require specific knowledge not general nursing knowledge. So in order to answer these questions, you need to know what knowledge is required and if you dont, you need to be able to think critically to answer the question with what you know. Here are a few tips for answering those select all that apply questions on Hesi and nclex. Step 1 First of all read the question and know what it is asking. Is it asking for protocol for diabetic management, is it asking you the clinical presentation of a disease, or is it asking you the steps to doing something or carrying out a procedure 1. Step 2 After finding out what the question is asking, the next thing is to look at the options. The best way to start picking your answer is to group things that are alike together, like signs of hypoxia or signs of thyroid storm. Put things that are alike together and then look at the options you have grouped together and see which group answers the question best then pick that group as your answer 2. Step 3 Keep in mind, these questions can make you lose points : i.e if there are 3 correct ansers out of five and you pick all five , you will gain 3 points for the right answer and lose 2 points out of those 3 points because of the wrong answers. Again if only 1 answer is right and you pick all 5, then you will get 1 point and lose 4 points, so that one point you got wont even count and on top of that you will still lose 3 points. Because of this, its important to pick only the answers that you are sure of. You dont want to be 2 points away from the required passing score becasue you lost points this way. Addendum I recently found out that the select all that apply questions are all or nothing on the NCLEX, it may be that way on the HESI, so please keep this information in mind. 3. Step 4

These are just a few tips for answering select all that apply questions on hesi or nclex Medication administeration will most certainly be on the HESI exit exam because all nurses must administer medication. Therefore, you will be tested on medication administeration, so here are a few tips.

1. Step 1 First of all remember you need two patient identifiers before you give the medication. So you give the medication to the right patient. You also only give medication you prepared yourself. 2. Step 2 For eye medication, put ointment along the length of the lower lid and for drops, put them in the conjuctival sac. To prevent systemic effects, press on the lacrimal ducts. 3. Step 3 For ear drops, pull the ear up and out for an adult and for a child pull the ear down and back. 4. Step 4 For IV administeration, if there is any adverse effect, stop the IV infusion before anything else. For extravasation, inject regitine around the site. 5. Step 5 Always clarify or attempt to clarify confusing orders with the prescribing physician or nurse practioner. Always take orders yourself by phone and make sure you read back telephone orders. If you have been doing Nclex style or HESI style questions, you would have noticed by now that sometimes it is difficult to answer these questions for one reason or the other. Here are a few tips on how to answer those questions. 1. Step 1 First , i want to start with the questions on grief. It may be that someone passed away or the client lost something. It is always okay to let clients grieve before you give them any further information. For these questions, the nurse can leave the clients to grieve or stay with them while they grieve. The nurse may not have to say anything; all she has to do is be present and empathetic. 2. Step 2 Another tip for answering these questions is to never choose an option that has the word "why" in it. It is not therapeutic and makes the client defensive. It is best to always pick answers that are open ended questions. 3. Step 3

Remember that you always have to acknowledge the clients feelings even if the are being belligerent, loud or noisy and then follow up with other statement to explain why you are doing something a certain way or what you are doing. Picking options like 'i understand that you are feeling....' 4. Step 4 Next,be alert for options like Tell me more about... You seem worried about... I can stay with you... I can see that you are upset... Options like this are more therapeutic and these type of answers should be the ones that you are looking for while taking the HESI exit exam. 5. Step 5 In real life,as a real nurse, patients are going to ask you if they are going to die or if they have cancer, so HESI is probably testing to see if you can be therapeutic and in some way reduce the anxiety or improve the self concept of your clients, because they are at a vulnerable time in their lives. These are just a few tips i have for the HESI , hope they help.