More experience with "med" than "surg"

[aboucherrn]

I am an experienced med-surg RN who has a strong medical-pulmonary background. I recently moved and started a float/travel position and I am encountering a wide variety of med-surg patients. My orientation was non-existent (such is life as a float nurse), and I find that my assessment skills are a little rusty in certain areas. Does anyone have any good references or resources for brushing up on physical assessments? Maybe some of the newer nurses have some good tips as they are learning to develop their skills?

Also, I have been taking care of quite a few general surgery patients (urology, gyn, nephro, GI) and could use some tips on caring for patients both preop and postop on some of the more common surgeries. I have very little time to research while at work and I am hoping I can get some info here.

Thank you in advance!

[turnforthenurse, MSN, NP]

What assessment skills are you referring to when you say you're rusty in some areas? There are some good physical assessment books out there. When I was in nursing school, we were required to purchase the physical assessment one by Jarvis. Bates also has a great one.

I work in progressive care and we don't get a lot of surgeries....we get a lot of procedures (mainly cardiac cath and stress tests) and sometimes things like thoracentesis/paracentesis. We will occasionally get med-surg overflow patients but this is typically after they have had their surgical procedures. Education is key. At work we can print up education packets for patients undergoing more common procedures/surgeries. I always tell patients what to expect pre and post-procedure. Do all of your pre-procedure teaching - turn/cough/deep breathing, use of the incentive spirometer, splinting the incision site (if applicable), pain management, etc. For patients undergoing cardiac cath, I always tell them what to expect before the procedure (being NPO after midnight, shaving the groin area, pain management/sedation during the procedure) and what to expect afterwards (lay flat for 4-6 hours, frequent vital signs assessment and cath site assessment, they can resume their pre-cath diet afterwards, keeping the affected leg straight, etc). If I have to pull a sheath, I explain to them what I am going to do and prepare them that I will be holding firm pressure at the site that may be uncomfortable, but explain that it is necessary to do so the patient doesn't bleed.

I realize you probably do not take care of patients undergoing those procedures but that is just an example. On your off-days, I would look up some common surgical procedures in a text book or something and brush up on your knowledge that way.