Med Surg - Chapter 16 - Care of Postoperative Patients

The nurse is in the recovery room caring for a patient who just underwent a surgical procedure. The nurse observes the patient begin to retch, vomit, and become restless. Which nursing interventions should the nurse provide during this stage of emergence? Select all that apply. 1 Provide oxygen therapy 2 Monitor all the vital signs regularly 3 Place warm blankets on the patient 4 Provide the patient bed with gel pads 5 Use suction equipment to prevent aspiration

1 Provide oxygen therapy 3 Place warm blankets on the patient 5 Use suction equipment to prevent aspiration Emergence is the recovery from anesthesia. Retching, vomiting, and restlessness are common manifestations caused due to poor thermoregulation during emergence. Providing oxygen therapy to the patient helps to promote ventilation and prevent hypoxia. The nurse should also provide warm blankets to the patient to prevent hypothermia. Using suction equipment helps to prevent aspiration during emergence. The patient's vital signs should be monitored during all stages of anesthesia. Providing the patient bed with gel pads helps in reducing the pressure sores in bony areas that are at high risk of skin break down. This is not related to the patient emerging from anesthesia.

The nurse is teaching a student nurse about management of anxiety in a preoperative patient. Which statements made by the student nurse indicate effective learning? Select all that apply. 1 "I will provide ample time for the patient to ask questions." 2 "I will continually assess the patient's responses and anxiety levels." 3 "I will provide all the information about the procedure to be performed." 4 "I will move on from a question if it is not answered by the patient." 5 "I will encourage the patient to relax by listening to music before the surgery."

1 "I will provide ample time for the patient to ask questions." 2 "I will continually assess the patient's responses and anxiety levels." 5 "I will encourage the patient to relax by listening to music before the surgery." Providing ample time to answer questions allows the patient to clarify all doubts and helps prevent anxiety. Continuous assessment of the patient's responses and anxiety levels help determine the need for further anxiety-reducing interventions. The patient can be advised to relax by listening to music. Responses to questions should be accurate and any unanswered questions should be referred to the appropriate heath care professional. Care must be taken to avoid giving any information to the patient that may increase anxiety.

The nurse is providing preoperative care to a patient scheduled for cardiac surgery. Which nursing intervention is most critical to this patient? 1 Assessing for venous thromboembolism 2 Explaining the surgical procedure 3 Involving the family in assessment upon the patient's consent 4 Maintaining confidentiality about the patient's health information

1 Assessing for venous thromboembolism Conditions such as hypertension and venous thromboembolism can cause complications such as cardiac arrest during the surgery. Therefore, the nurse should assess for venous thromboembolism during the preoperative care. Explaining the surgical procedure to the patient can reduce anxiety but it is not as critical as assessing for venous thromboembolism. Involving the family in assessment upon the patient's consent can ensure comfort in the patient but it is not as critical as assessing for venous thromboembolism. Maintaining confidentiality about patient's health information ensures comfort in the patient but it is not as critical as assessing for venous thromboembolism.

Which conditions can contribute to impaired wound healing following surgery? Select all that apply. 1 Obesity 2 Diabetes 3 Dysrhythmias 4 Weak immune system 5 Electrolyte imbalances

1 Obesity 2 Diabetes 4 Weak immune system Incisions made during the surgical process typically heal in about 2 weeks. Conditions such as obesity, diabetes, and a weak immune system can delay wound healing. Dysrhythmias and electrolyte imbalances do not interfere with the wound healing process.

If wound dehiscence occurs, a sterile nonadherent dressing may be applied on the wound. Which sterile nonadherent dressing is typically used for this? 1 Telfa 2 Iodoform-soaked gauze 3 Nylon 4 Ace bandage

1 Telfa When dehiscence occurs, the wound has opened. When this happens, a sterile nonadherent dressing such as Telfa or a saline dressing may be applied to the wound. Iodoform-soaked gauze may be applied to a wound that has become infected. The surgeon may use nylon retention sutures in occurrences of wound evisceration (wound opening with protrusion of internal organs). An Ace bandage would not be appropriate to apply to a wound dehiscence because it is not sterile.

Which nursing interventions improve oxygenation and perfusion and promote surgical wound healing? Select all that apply. 1 Using hypoallergenic tape 2 Sliding the patient when repositioning 3 Controlling the patient's room temperature 4 Providing adequate rest throughout the day 5 Maintaining oxygen saturation at greater than 90%

1 Using hypoallergenic tape 3 Controlling the patient's room temperature 4 Providing adequate rest throughout the day To improve oxygenation and perfusion to the surgical wound to promote healing, the nurse should use hypoallergenic tape to prevent rash, control the patient's room temperature to promote vasodilation, and provide adequate rest periods throughout the day to reduce oxygen demand. Reducing oxygen demand makes more oxygen available for perfusion into the surgical wound which promotes healing. The patient should be lifted without sliding during repositioning to prevent injury to the skin. Oxygen saturation should be maintained at greater than 93%.

A patient's nasogastric tube drainage container contained 30 mL in the morning at the start of the shift. The container is marked 545 mL at the end of the shift. If the total amount of drainage recorded is 395 mL, how much irrigant was instilled throughout the shift?____________ mL

120 Actual amount of drainage collected is equal to the difference between drainage in the collection device and the amount of irrigant or saline provided to the patient. The drainage collected in the container is 545 - 30 = 515 mL. Then, the difference between drainage in the collection device and amount of irrigant is 515 - 395 = 120 mL and is equal to the amount of saline infused.

What condition is indicated by the presence of a pulse deficit when assessing the vital signs of a postoperative patient? 1 Dyspnea 2 Dysrhythmia 3 Hypothermia 4 Deep vein thrombosis

2 Dysrhythmia A pulse deficit is a difference between the apical and peripheral pulses. While assessing the vital signs of a patient who is not being monitored continuously, the rate, rhythm, and quality of the apical pulse is compared with the rate, rhythm, and quality of a peripheral pulse. A pulse deficit can indicate a dysrhythmia. The presence of a pulse deficit is not due to dyspnea, or shortness of breath. Hypothermia is not indicated by the difference in the pulse. Deep vein thrombosis is assessed by peripheral vascular assessment before anesthesia.

A patient who received general anesthesia has arrived at the medical-surgical unit after discharge from the postanesthesia care unit. Which parameters need to be assessed by the nurse? Select all that apply. 1 Headache in the occipital region 2 Patient response to verbal stimuli 3 Bleeding or drainage on the dressing 4 Back pain while coughing or straining 5 Color, clarity, and volume of urine output

2 Patient response to verbal stimuli 3 Bleeding or drainage on the dressing 5 Color, clarity, and volume of urine output The nurse should ask appropriate questions to assess the patient response to verbal stimuli, which helps detect alterations in the patient's mental status. Bleeding or drainage on the dressing determines surgical incision site and status. Observing the color, clarity, and volume of urine output provides evidence of returning kidney function and hydration status. A headache in the occipital region that is especially painful when patient sits in upright position indicates postdural puncture headache, which is one of the complications of spinal and epidural anesthesia. Asking the patient about an increase in back pain while coughing or straining helps detect complications of spinal and epidural anesthesia.

How often should a postoperative patient be repositioned to prevent complications associated with immobility?Every ___ hours

2 hours Factors such as location of the surgical incision and drains, and any patient problems such as arthritis and chronic lung disease are considered when positioning the postoperative patient. Assisting and repositioning the patient every 2 hours reduces the risk for complications related to immobility.

Which patient requires immediate attention in the postanesthesia care unit? 1 A patient with a bleeding time of 5 minutes 2 A patient with a body temperature of 98.6° F 3 A patient with urine output of 400 mL per day 4 A patient with blood pressure of 110/80 mm Hg

3 A patient with urine output of 400 mL per day The patient with inadequate urine output of 400 mL per day (normal range: 800-2000 mL per day) must be kept on continuous assessment to reduce complications. The patients with normal bleeding time (3 to 10 minutes), normal body temperature of 98.6° F, and stable blood pressure of 110/80 mm Hg may be discharged upon the primary health care provider's advice.

Which drug is often administered via an epidural to manage pain in the postoperative patient? 1 Ketorolac 2 Acetaminophen 3 Bupivacaine 4 Ibuprofen

3 Bupivacaine Epidural analgesia can be given intermittently by the anesthesia provider or by continuous infusion through an epidural catheter left in place after epidural anesthesia. Drugs given by epidural catheter include the opioids fentanyl, preservative-free morphine, and bupivacaine. Acetaminophen is a non-opioid analgesic often given PO, but is available IV. Ketorolac and ibuprofen are non-opioid analgesic nonsteroidal anti-inflammatory drugs (NSAIDs).

The nurse is caring for a postoperative patient and monitoring healing at the surgical site. What term describes a splitting open of the wound? 1 Drainage 2 Intubation 3 Dehiscence 4 Evisceration

3 Dehiscence Wound dehiscence is a partial or complete separation of the outer wound layers, sometimes described as a splitting open of the wound. Drainage is a normal seepage of fluids from the wound. Intubation is the placement of a tube in the trachea to open the airway. Evisceration is the total separation of all wound layers and protrusion of internal organs through the open wound. It is a surgical emergency; the surgeon is contacted immediately, and the patient returned to the operating room.

Which nursing action will provide comfort to a patient who has developed nausea and vomiting after eye surgery? 1 Administer normal saline 2 Listen for the bowel sounds 3 Encourage side-lying position 4 Advise the patient to cough rapidly

3 Encourage side-lying position After eye surgery, a patient may develop nausea and vomiting due to elevated intraocular pressure. These symptoms may be controlled by positioning the patient in a side-lying position and elevating the head of the bed. Administering normal saline to the patient is beneficial to promote fluid and electrolyte balance but is not the best action to provide comfort for nausea and vomiting. Intestinal peristalsis decreases after gastrointestinal surgery, so monitoring the bowel sounds is important. Coughing may increase the intraocular pressure, resulting in intraocular hemorrhage.

The nurse recognizes that which postoperative condition is considered to be a neuromuscular complication? 1 Sepsis 2 Atelectasis 3 Hypothermia 4 Pressure ulcers

3 Hypothermia Hypothermia is a neuromuscular complication. Sepsis is a cardiovascular complication. Atelectasis is a cardiovascular system complication. A pressure ulcer is a skin complication.

A nursing student is preparing a care plan for preventing the risk of hypoventilation in an intraoperative patient during surgery. Which intervention would lead to complications in this patient? 1 Monitoring heart rate every 5 minutes 2 Monitoring of breathing every 5 minutes 3 Monitoring capnography every 5 minutes 4 Monitoring of blood pressure every 5 minutes

3 Monitoring capnography every 5 minutes Hypoventilation can be prevented by monitoring the vitals in the patient undergoing surgery. Monitoring capnography every 5 minutes does not help prevent the risk of hypoventilation because capnography is monitoring ventilation for non-intubated patients. Monitoring the vital sign such as heart rate helps in monitoring the respiratory rate. Monitoring the patient's breathing helps in regulating the anesthetic effect on gas exchange which in turn decreases the risk of hypoventilation. Blood pressure monitoring helps in preventing the risk of hypoventilation by maintaining the adequate gas exchange.

The nurse is providing postoperative care to a patient. Which medication will be prescribed if the patient experiences nausea and vomiting? 1 Fentanyl 2 Atropine 3 Ondansetron 4 Methotrexate

3 Ondansetron Ondansetron, a serotonin receptor antagonist, is effective in reducing nausea and vomiting. Fentanyl is an opioid local anesthetic and is not used to prevent nausea and vomiting. Atropine is a muscarinic antagonist used as a bronchodilator and an antidote for organophosphate poisoning. Methotrexate is an antineoplastic agent and is useful in the treatment of rheumatoid arthritis.

Which drug is used to reduce prolonged gastrointestinal symptoms in postoperative patients? 1 Morphine 2 Ketorolac 3 Ondansetron 4 Hydromorphone

3 Ondansetron Opioid analgesics used in abdominal surgeries alter the peristaltic movements of intestines. Altered peristalsis results in prolonged nausea and vomiting after surgery. Ondansetron is used to reduce the risk of prolonged gastrointestinal disturbances. Ketorolac, morphine, and hydromorphone are used for managing pain in patients in the postanesthesia care unit (PACU).

After gastric surgery, a patient arrives in the postanesthesia care unit (PACU). Which nursing action is most appropriate for the RN to delegate to an experienced nursing assistant? 1 Monitor respiratory rate and airway patency. 2 Irrigate the nasogastric tube with saline. 3 Position the patient on the left side. 4 Assess the patient's pain level.

3 Position the patient on the left side. Positioning the patient on the left side can be delegated to an unlicensed care provider. Airway patency requires the care of a nurse in case of emergency management requirements. Irrigating the nasogastric tube with saline is a nursing skill and care by a nurse would be required. Pain assessment is also within the scope of a nurse.

Five RNs have been floated to the postanesthesia care unit (PACU) for the day. A 16-year-old diabetic patient has also just arrived from the operating room (OR) after having laparoscopic abdominal surgery. The charge nurse assigns the floating RN with which kind of experience to care for this new patient? 1 RN who usually works on the inpatient pediatric unit 2 RN who provides education to diabetic patients in a clinic 3 RN who has 5 years of experience in the delivery room 4 RN who ordinarily works as a scrub nurse in the OR

3 RN who has 5 years of experience in the delivery room The RN with delivery room experience would have experience with abdominal surgery and with postoperative care of patients with diabetes, and would be aware of possible postoperative complications for this patient. The RN who usually works on the pediatric unit would not be aware of potential complications and routine assessments for this patient. The RN who provides education to diabetic patients in a clinic would be able to provide required care for the patient's diabetes but not the postoperative aspect of care. The RN who works as a scrub nurse would not have the knowledge and understanding of routine postoperative care that is needed for this patient.

Which vital sign is most important for the nurse to monitor in a patient receiving general anesthesia in the postanesthesia care unit? 1 Pulse 2 Blood pressure 3 Respiratory rate 4 Body temperature

3 Respiratory rate A patient receiving general anesthesia must be regularly monitored for respiratory rate because the medication may lead to respiratory depression. Pulse, blood pressure, and body temperature are evaluated and recorded in the patient's medical record but are not the most important vital sign to monitor.

A patient has wounds on several areas of the body. The nurse expects that the wound in which site will heal more quickly than the others? 1 The wound on the leg 2 The wound on the foot 3 The wound on the head 4 The wound on the abdomen

3 The wound on the head Head and facial wounds heal more quickly than abdominal and leg wounds because of the better blood flow to the head and neck. The leg, feet, and abdomen receive less blood flow and therefore heal slower.

A patient who had abdominal surgery 2 days ago is being discharged home. Which statement by the patient indicates a need for further discharge instruction? 1 "I will wash my hands before each dressing change." 2 "I will wait 6 weeks before returning to my job as a package delivery man." 3 "I'll be sure to notify the surgeon if my pain suddenly increases." 4 "I can return to normal activities as long as I don't leave the house."

4 "I can return to normal activities as long as I don't leave the house." Surgery stresses the body, and time and rest are needed for healing. The patient should be instructed to increase activity level slowly, rest often, and avoid straining the wound or the surrounding area. The patient and family members should be instructed on the importance of proper handwashing to prevent infection. A patient whose work involves a moderate amount of physical labor may return to work about 6 weeks after abdominal surgery. The patient should notify the surgeon if pain is not controlled or if the pain suddenly increases.

The charge nurse for a hospital operating room is making patient assignments for the day. Which patient is most appropriate to assign to the least-experienced circulating nurse? 1 20-year-old patient who has a ruptured appendix and is having an emergency appendectomy 2 28-year-old patient with a fractured femur who is having an open reduction and internal fixation 3 45-year-old patient with coronary artery disease who is having coronary artery bypass grafting 4 52-year-old patient with stage I breast cancer who is having a tunneled central venous catheter placed

4 52-year-old patient with stage I breast cancer who is having a tunneled central venous catheter placed The patient with stage I breast cancer is the most stable patient among all scheduled procedures. This assignment would be appropriate for the beginning nurse or one with less experience. The patient who has a ruptured appendix is less stable and at high risk for infection/sepsis; a more experienced nurse is required. The patient with a fractured femur is at high risk for clotting, infection, and aspiration owing to the surgery; a more experienced nurse would be better. The patient with coronary artery disease is having high-risk surgery with risk for multiple complications and requires an experienced operating room (OR) nurse.

The nurse is preparing an older patient for cataract surgery in the ambulatory health care center. How should the nurse address the patient's concern about inadequate support systems after surgery? 1 Teach the patient about postoperative care. 2 Provide the patient with care instructions in large print. 3 Ask the patient to repeat care instructions to confirm understanding. 4 Coordinate with the case manager for postdischarge care.

4 Coordinate with the case manager for postdischarge care. The nurse should coordinate with the case manager to arrange postdischarge care for the patient with an inadequate support system after surgery. Teaching the patient about postoperative care, providing the patient with care instructions in large print, or asking the patient to repeat care instructions to confirm understanding does not help to address the patient's concern about inadequate support systems after surgery.

Which nursing action will help prevent fatigue in a patient diagnosed with a decrease in cardiac output? 1 Encouraging ambulation 2 Providing frequent toileting opportunities 3 Teaching coughing and deep-breathing exercises 4 Determining the patient's normal activity levels

4 Determining the patient's normal activity levels The nurse should determine the patient's normal activity levels and identify his or her limits; this will help prevent fatigue associated with decreased cardiac output. Encouraging ambulation helps prevent complications of immobility, but may not prevent fatigue. Frequent toileting should be encouraged to prevent incontinence and falls, but may actually increase fatigue. Coughing and deep-breathing exercises will help prevent pulmonary complications, but may also increase fatigue.

At what time interval is lung functioning assessed in a postoperative patient during the first 24 hours after surgery?Every ___ hours

4 hours The initial assessment of a postoperative patient includes monitoring for respiratory depression and occurrence of hypoxemia. Assessment of the lungs is performed to monitor for abnormal breath sounds. Lung functioning should be assessed at least every 4 hours in the first 24 hours after surgery, and every 8 hours thereafter.

The nurse is caring for a patient in the postanesthesia care unit (PACU). Arrange the order in which the patient returns to consciousness after general anesthesia. 1. The patient is restless and delirious. 2. The patient is able to feel pain. 3. The patient has the ability to reason and control behavior. 4. The patient experiences muscular irritability.

4, 1, 2, 3 The patient recovering from the effects of general anesthesia first experiences muscular irritability followed by restlessness and delirium. The patient then recognizes the presence of pain. When the anesthetic effect wears off completely, the patient is able to think clearly, reason, and control his or her own behavior.

A patient who works in a warehouse has successfully undergone abdominal surgery. After how many weeks can this patient return to work?Answer: ___ weeks

6 weeks A patient whose work involves a moderate amount of physical labor may return to work about 6 weeks after abdominal surgery. Stress due to physical labor may lead to complications or disability if the patient resumes work before 6 weeks.