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NCLEX-RN 이것만이라도 보고 가자! : General Surgery / Perioperative Nursing │ Nurse Haley

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🩸 Surgery & Perioperative Care by Nurse Haley

Pre · Intra · Post-op 핵심간호 / 합병증 / 환자안전 요약



안녕하세요! 오늘의 간호사 Haley 입니다. 이번 파트는 General Surgery / Perioperative Nursing으로, 시험 당일 꼭 알고 있어야 할 '수술 전·중·후 핵심 간호' 요약입니다. 시험 1-2일 전, 무조건 숙지하세요!

📖 Table of Contents

🩺 Preoperative Care

Focus Key Points Nursing Reminders
Pre-op Preparation Baseline VS, allergy check, consent verification.
Remove dentures, jewelry, nail polish.
NPO 6–8 hrs prior (↓ aspiration risk). 		• Verify consent signed before sedation.
• Educate: deep breathing, IS, leg exercises.
• Void before surgery.
• Pre-med: antibiotics, anticholinergics.
Pre-op Labs & Safety CBC, coagulation, electrolytes, creatinine, type & screen. • Abnormal results → report immediately.
• Blood available before OR.
• Check pregnancy for females.

💉 Postoperative Complications

Complication Early Signs Nursing Intervention
1️⃣ Hemorrhage Restlessness, tachycardia, hypotension, pallor. • Apply pressure, call surgeon.
• Administer IV fluids, blood.
• Maintain airway, oxygen.
2️⃣ DVT / PE Calf pain, swelling, SOB, chest pain. • Early ambulation, leg exercises.
• Sequential compression device (SCD).
• Avoid crossing legs, massage.
• Administer anticoagulants as ordered.
3️⃣ Atelectasis / Pneumonia Fever, crackles, ↓ O₂ sat. • Incentive spirometer q2h.
• Early ambulation.
• Position: semi-Fowler.
• Encourage coughing & deep breathing.
4️⃣ Wound Dehiscence / Evisceration Sudden wound opening, visible organ. • Stay with patient, call surgeon.
• Cover with sterile saline gauze.
• Position: low Fowler, knees bent.
• NPO, prepare for OR.
5️⃣ Urinary Retention No void 6–8 hrs post-op, bladder distention. • Encourage ambulation, warm compress.
• Run water or pour warm water over perineum.
• Straight cath if ordered.
⚠️ NCLEX 핵심포인트:
- “Restlessness + tachycardia” → 가장 초기 출혈 징후
- Evisceration → sterile saline dressing + knees bent!
- Post-op 1일차 Fever → Atelectasis 의심
- Day 3–5 Fever → Infection 의심

🩹 Wound & Drain Management

Type Key Points Nursing Care
JP Drain / Hemovac Closed suction drains remove fluid/blood post-op. • Compress bulb fully before closing.
• Measure output q8h.
• Maintain below wound level.
• Report sudden ↑ drainage or foul odor.
Penrose Drain Open drain with passive flow. • Change dressing frequently.
• Keep safety pin to prevent retraction.
• Use sterile technique.
Wound Care Observe for redness, swelling, drainage, approximation. • Clean from least to most contaminated.
• Sterile dressing changes.
• Hand hygiene before & after.

🛏️ Surgical Positions & Post-op Positioning

Surgery Type Recommended Position Rationale
Abdominal surgery Semi-Fowler Promotes lung expansion, ↓ tension on incision.
Thyroidectomy Semi-Fowler, head midline, avoid neck extension. Prevents strain, protects airway.
Lobectomy Operate side up Promotes expansion of remaining lung.
Craniotomy Elevate HOB 30°, head midline Facilitates venous drainage, ↓ ICP.
Hip / Knee replacement Abduction pillow, no crossing legs Prevents dislocation.
💡 Exam Tip:
- “Fever + rigid abdomen” → suspect peritonitis.
- No pillow under knees → DVT risk ↑.
- Encourage early ambulation, IS use, leg exercises for ALL post-op clients.

정리: 오늘의 간호사 Haley

📌 본문 내용은 오늘의 간호사 Haley의 저작물로 무단 복제·배포를 금합니다.

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