Introduction to Medical-Surgical Nursing, 6th ed.
17
Lesson Plans for
Surgical Care
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 17.1:
2. List data to be included in the nursing assessment of the preoperative patient.
4. Outline a preoperative teaching plan.
6. Explain the nursing implications of each type of anesthesia.
Lesson 17.2:
8. List data to be included in the nursing assessment of the postoperative patient.
10. Explain patient needs that should be considered in patient teaching
CHAPTER TEACHING FOCUS
• In this chapter, the student will be introduced to topics related to surgical care, including the purposes
of surgery, the variables affecting surgical outcomes, and the three phases of surgery (preoperative,
intraoperative, and postoperative).
CONCEPTS
The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2013).
Concepts for nursing practice. St. Louis: Elsevier. The specific exemplars chosen and listed below for
each concept have been tailored specifically to correspond to the Linton textbook.
THEME: Protection and Movement
• Concept: Tissue Integrity
• Exemplar: Impaired Tissue Integrity, p. 278
• Figure 17-9 Methods of wound closure, p. 278
• Figure 17-10: Wound Healing, p. 279
• Figure 17-11 Types of surgical drains used to remove fluid from wounds. Passive or gravity drains
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Introduction to Medical-Surgical Nursing, 6th ed.
CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) Surgery conducted for the purpose of diagnosis is called __________.
a) cosmetic
b) curative
c) palliative
d) diagnostic
2) As compared with diagnostic surgery, exploratory surgery __________.
a) is usually more extensive
b) is usually less painful
c) does not require the patient to have medical insurance
d) does not require general anesthesia
3) The person most likely to develop postoperative complications is a __________.
a) 16-year-old boy who plays basketball frequently
b) 35-year-old diabetic patient
c) 50-year-old man who walks 1 mile every day
d) 60-year-old woman who lives alone
4) Epidural anesthesia is an example of __________.
a) general anesthesia
b) regional anesthesia
c) sensory reduction
d) surgery
5) Conscious sedation is used for __________.
a) lung resection surgery
b) exploratory laparotomy surgery
c) diagnostic and therapeutic procedures
d) neurosurgery
6) A patient is usually transferred from the postanesthesia care unit when which of the following criteria
is met?
a) The patient is awake or can be wakened easily.
b) The patient is able to eat solid food.
c) The patient is able to turn from side to side without assistance.
d) The patient no longer requires intravenous fluids.
7) An infected wound that is left open to heal from the bottom up is said to be healing by __________.
a) primary intention
b) secondary intention
c) active intention
d) inactive intention
8) The nurse notices that after the patient ambulated, some of the staples on his incision popped off and
the incision is partially open. She should __________.
a) attempt to put the staples back in
b) cover the wound with sterile gauze moistened with normal saline and notify the physician
c) have the patient continue to walk until seen by the physician
d) document her findings and check the patient in 4 hours
9) A positive Homans’ sign may indicate that the patient has developed __________.
a) shock
b) hypovolemia
c) hypoxia
d) thrombophlebitis
Introduction to Medical-Surgical Nursing, 6th ed.
10) Which of the following is the most appropriate nursing response to a 2-day postoperative patient who
is complaining of incisional pain?
a) “It’s been 2 days since your surgery. Your pain should be decreasing.”
b) “On a scale of 1 to 10 with 1 being mild pain and 10 being the worst possible pain, how would
you rate your pain?”
c) “If you increase the number of times you walk in the hallway, your pain should improve.”
d) “The patient down the hall had the same surgery, and he hardly has any pain.”
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Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
1) d
6) a
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: What are the differences between local and general anesthesia?
Answer: General anesthesia acts on the central nervous system, causing loss of consciousness,
Question: Why is a patient who has had general anesthesia at risk for developing hypoxia in the
immediate postoperative phase?
Answer: A patient in the immediate postoperative phase is at risk for hypoxia, which refers to inadequate
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 17.1
Instructor Preparation
Textbook Objectives Covered
1. State the purpose of each type of surgery: diagnostic, exploratory, curative, palliative, and
cosmetic.
3. Assist in identifying the nursing diagnoses, goals and outcome criteria, and interventions during
the preoperative phase of the surgical experience.
5. List the responsibilities of each member of the surgical team.
6. Explain the nursing implications of each type of anesthesia.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Guest speakers: nurse anesthetist, scrub nurse, or circulating nurse
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying surgical care, including:
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• ablative surgery (p. 256)
• anesthesiologist (p. 267)
• anesthetic (p. 267)
• reconstructive or restorative
surgery (p. 256)
• sanguineous (p. 280)
6 Chapter 17 Surgical Care __________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 17.1
Assignments 2 hours
1
READ – Textbook (pp. 255-256)
ANSWER – Study Guide
• Part IA: 1-7 (p. 95)
• Part IIJ: 8 (p. 99)
2
READ – Textbook (pp. 256-266)
REVIEW
• Table 17-1: Herbs which may pose risk in patients undergoing anesthesia (p. 257)
• Table 17-2: Preoperative fasting recommendations of the American Society of
Anesthesiologists (p. 262)
3
• Part IIJ: 14, 15 (p. 101)
READ – Textbook (pp. 256-266)
ANSWER – Text
• Review Questions for the NCLEX Examination: 2, 9, 10 (pp. 285-286)
ANSWER – Study Guide
• Part IC: 1-3 (p. 96)
• Part IH: 1-10 (p. 97)
4
READ – Textbook (p. 260)
REVIEW
• Figure 17-2: Preoperative teaching prepares the patient for the surgical experience (p. 259)
• Figure 17-3: Surgical consent form (p. 261)
ANSWER – Text
• Review Questions for the NCLEX Examination: 1 (p. 285)
5
READ – Textbook (pp. 266-267)
REVIEW
• Figure 17-1: The nurse provides continuity of care (p. 256)
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 17.1
6
READ – Textbook (pp. 267-269)
REVIEW
• Figure 17-7: Inhalation anesthetic is given through an endotracheal tube (p. 268)
ANSWER – Study Guide
• Part ID: 1-3 (p. 96)
• Part IIJ: 16-22, 27, 43, 47, 48 (pp. 101-103)
50-Minute Lesson Plan
Lecture Outline 20 minutes
Slide 1
Chapter 17
Surgical Care
1
Slide 2
Purposes of Surgery
• Diagnostic
• Ablative
• Palliative
• Reconstructive/restorative
• Procurement for transplant
• Constructive
• Cosmetic
Slide 3
Diagnostic Surgery
• Removal and study of tissue to make an accurate diagnosis
• Biopsy of a skin lesion or a lump in breast tissue
TALKING POINTS:
• Surgical procedures are classified by purpose.
• Where may surgical procedures be performed?
Exploratory Surgery
• Usually requires opening a body cavity to diagnose and determine the extent of a disease
process
Slide 5
Curative Surgery
• Remove diseased tissue or to correct defects
• Ablation refers to removal of tissue
• Removing inflamed appendix curative for appendicitis
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 17.1
Slide 6
Ablative Surgery
• Performed to remove diseased tissue
Slide 7
Palliative Surgery
• Relieves symptoms or improves function without correcting the basic problem
Slide 8
Reconstructive/Restorative Surgery
• Restores function or structure to damaged or malfunctioning tissue
TALKING POINTS:
• Example: breast reconstruction
Slide 9
Cosmetic Surgery
• Corrects serious defects that affect appearance; often the patient wants to change a
physical feature
the size or shape of the breasts
Slide 10
Variables Affecting Surgical Outcomes
• Age
• Nutritional status
• Fluid and electrolyte balance
• Medical diagnosis
• Drugs
• Habits
Age
• People older than age 70 who are frail or have cardiovascular disease or diabetes are at
TALKING POINTS:
• How can the surgical risks be reduced for the older adult?
Slide 12
Nutritional Status
• Malnourished
• At risk for poor wound healing and infection
TALKING POINTS:
• Effective deep-breathing exercises are limited by the excess weight.
• What causes a slower healing process in an obese person?
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 17.1
Fluid Balance
• Adequate fluids necessary to maintain blood volume and urine output
TALKING POINTS:
• Fluid and electrolyte status can have a significant bearing on the outcome of surgery.
• Why are serum electrolyte tests usually ordered before surgery?
Slide 14
Medical Diagnoses During the Perioperative Period
• Bleeding disorders
• At risk for excessive bleeding and must be closely monitored
TALKING POINTS:
• The control of chronic conditions may be disrupted by surgery, which may mandate
• When do patients have the greatest risk of surgical complications?
Drugs
• Many drugs have the potential to interact with anesthetic agents
• Serious adverse effects may result
Slide 16
Smoking
• Increases the risk of pulmonary complications because secretions are more copious and
tenacious and ciliary activity is less effective
Slide 17
Alcohol
• Interacts with many drugs
TALKING POINTS:
• How may liver damage affect anesthesia?
• Patients with liver disease are at an increased risk for bleeding.
10 Chapter 17 Surgical Care __________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 17.1
2
Slide 18
Health History
• Identifying data
• Record identifying data, including the patient’s age
• History of present illness
Review of Systems
• Collect data about each body system, noting any abnormalities. Record any disabilities or
limitations
Functional Assessment
• Describe usual activity pattern, including occupation, roles, and responsibilities
• Determine the usual diet and fluid intake as well as the use of tobacco and alcohol
TALKING POINTS:
• Although some anxiety is normal, be alert for indications of excessive anxiety.
• What symptoms may be displayed by the anxious patient?
Slide 21
Physical Examination
• Height and weight
• Vital signs
• A baseline for evaluating readings following surgery
• Skin
• Color, lesions, bruises, texture, warmth, turgor, moisture
• Thorax
TALKING POINTS:
• Throughout the physical examination, be alert to the patient’s emotional state, ability to
Slide 22
Abdomen
• Inspect the abdomen for distention and scars, and auscultate bowel sounds
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 17.1
Slide 23
Extremities
• Inspect the extremities for skin color, hair distribution, lesions, and deformities
• Assess range of motion while listening for crepitus and noting pain or weakness
Slide 24
Prostheses
• Hearing aids, contact lenses, eyeglasses, dentures, artificial limbs, or other devices used
to maintain appearance or function
3
Slide 25
Interventions
• Anxiety
• Determine presence and level of anxiety, the contributing factors, and the need for
intervention
TALKING POINTS:
Slide 26
Interventions (cont.)
• Deficient knowledge
• Patient teaching in physician’s office, clinic, during preadmission workup, or after
hospital admission
TALKING POINTS:
• What is an appropriate teaching plan based on?
• Verbal instructions should be supplemented with written material.
Slide 27
Interventions (cont.)
• Preparation for surgery
• Starts before or shortly after admission
• Patients admitted for emergency surgery may not have the benefit of preoperative
teaching
• Informed consent
• Patient informed and agrees to procedure, alternative treatments, and risks involved
TALKING POINTS:
• A patient who is confused, mentally incompetent, or under the influence of drugs cannot
give informed consent.
• Why should informed consent have the signature of a witness?
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 17.1
Slide 28
Interventions (cont.)
• Preparation of the digestive tract
• Depends on type of anesthesia and surgery
• Three purposes
• Avoids constipation and straining in the postoperative period
Slide 29
Interventions (cont.)
• Food and fluid restriction
• Fluids and foods restricted for specific period
• Evening meal before the day of surgery may be restricted to fluids
Slide 30
Interventions (cont.)
• Skin preparation
• Reduce number of organisms near the incision site
• Includes scrubbing and removing hair from a wide margin around the planned surgical
site
TALKING POINTS:
• What techniques may be used for hair removal?
Slide 31
Interventions (cont.)
• Dress and grooming
• Provide a clean gown and instruct patient to remove all undergarments unless agency
policy dictates otherwise
• Jewelry should be removed
TALKING POINTS:
• Document the disposition of jewelry and dentures in the patient’s chart.
• Why should nail polish be removed before surgery?
• A patient identification band must be in place on the patient’s wrist on admission.
Slide 32
Interventions (cont.)
being lost or damaged and to prevent causing injury during anesthesia
TALKING POINTS:
• A hearing-impaired patient without a hearing aid may be anxious or unable to cooperate
with postoperative care; therefore, hearing aids often are left in place for surgery.
__________________________________________________________________ Chapter 17 Surgical Care 13
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 17.1
Slide 33
Interventions (cont.)
• Preoperative medications
• Physician’s orders often include a medication to be given shortly before the patient is
transported to surgery or when the patient is in a holding area
TALKING POINTS:
• Why should the patient be asked to void immediately before the preoperative medication
is given?
Slide 34
Interventions (cont.)
• Preoperative checklist
• Must be completed and signed before the patient leaves the unit
• Make sure all laboratory and radiology reports are with the chart; jewelry, prostheses,
given; vital signs have been recorded; and the consent form has been signed
5
Slide 35
The Surgical Team
• Surgeon
• Assistant surgeon
• Registered nurse who circulates
• Registered nurse first assistant
6
Slide 36
Anesthesia
• Local and regional anesthesia
• Regional: using local anesthetics that block the conduction of nerve impulses in a
specific area
• Local: may be administered topically, by local infiltration, and by nerve-blocking
TALKING POINTS:
• How many years has anesthesia been used?
• Anesthetic agents are used to alter sensation so that surgical procedures can be done
painlessly and safely.
14 Chapter 17 Surgical Care __________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 17.1
Anesthesia (cont.)
• Preanesthetic agents
• Antianxiety agents, sedative-hypnotics, anticholinergics, and opioid analgesics
Slide 38
Anesthesia (cont.)
• General anesthesia
• Acts on the central nervous system (CNS), causing loss of consciousness, sensation,
reflexes, pain perception, and memory
TALKING POINTS:
• What is balanced anesthesia?
• For most procedures using inhalation agents, the patient is first induced with a short–
Anesthesia (cont.)
• General anesthesia complications
• Malignant hyperthermia: rare but life-threatening complication
TALKING POINTS:
• Susceptibility to malignant hyperthermia is inherited.
• What is the treatment for malignant hyperthermia?
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 17.1
Slide 40
Question 1
___________ surgery is a more extensive procedure than a biopsy. It usually requires
opening a body cavity to diagnose and to find out the extent of a disease process.
A. Curative
B. Diagnostic
C. Exploratory
D. Palliative
TALKING POINTS:
Slide 41
Question 2
Which of the following statements is true related to surgery?
A. For surgery on the abdomen or the digestive tract, laxatives and enemas are
generally not given.
B. Group classes should not be given for preoperative patients.
C. If the patient has any questions about the surgery, the surgical consent may still be
signed.
D. It is the physician’s responsibility to explain the procedure and risks to the patient.
TALKING POINTS:
16 Chapter 17 Surgical Care __________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 17.1
Activities
Classroom Choose from below to make 30 minutes
Online
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
DISCUSS
• Discuss the main purposes of surgery.
• Discuss the variables that affect surgical
outcomes.
• How should a nurse address these factors
during preoperative patient teaching?
• Divide the class into several groups. Have
each group outline features of different types
of surgery: diagnostic, exploratory, curative,
palliative, and cosmetic. Have each group
present its information to the class.
• Present the following scenario to the class:
• A 64-year-old sedentary, obese man
ASSESS BASELINE
• Post the Pretest and the Background
Assessment online and have your class
complete them. Use the results to guide how
you teach the class.
2
DISCUSS
• Divide the class into small groups. Have
each group refer to Box 17-1. For each item
listed in the table, have the groups discuss
the rationales of including this information in
the health history and physical examination
of a preoperative patient. Have each group
present its findings to the class.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe data
a nurse should collect during the
preoperative assessment. Why do you feel
the elements you have described are
critical?