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

🩸 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
• 💉 Postoperative Complications
• 🩹 Wound & Drain Management
• 🛏️ Surgical Positions

🩺 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.

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💉 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

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🩹 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.

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🛏️ 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.

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정리: 오늘의 간호사 Haley

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

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