Med Surge Spring 2017 Exam 1
How many days prior should aspirin be stopped?
7 - 10 days
The nurse recognizes that which of the following clients is at least risk for perioperative complications?
A 65-year-old Caucasian man who has a history of arthritis A history of arthritis does not increase the risk for complications during the perioperative period.
The nurse is physically preparing a client for surgery. What area does the nurse know needs to be addressed before the client is taken to the operating room?
When physically preparing a client for surgery these areas need to be addressed: skin preparation; elimination; attire/grooming; prosthesis; foods and fluids; and care of valuables. The physical preparation of a client for surgery does not include the areas of medication, activity, or the client's support system.
first intention wound healing
clean incision, early suture, hairline scar wounds made aseptically with a minimum of tissue destruction that are properly closed heal with little tissue reaction by first intention (primary union) granulation tissue is NOT visible and scar formation is minimal postOP = covered with dry sterile dressing, unless a LiquiBand is applied
A significant mortality rate exists for patients with alcoholism who experience delirium tremens postoperatively. When caring for the patient with alcoholism, the nurse should assess for symptoms of alcoholic withdrawal:
On the second or third day The person with a history of chronic alcoholism often suffers from malnutrition and other systemic problems that increase surgical risk. Alcohol withdrawal syndrome or delirium tremens may be anticipated between 48 and 72 hours after alcohol withdrawal and is associated with a significant mortality rate when it occurs postoperatively.
Roles of WBC's
granular - release cell mediators (histamine, bradykinin, prostaglandins) and eating the foreign bodies, or toxins
Emergency Surgery
life or death; without delay i.e severe bleeding, bladder or intestinal obstruction, fractured skull, gunshot/ stab wounds, extensive burns
corticosteroids and wound healing
mask inflammation related to infection
Required Surgery
needed; within a few weeks or months i.e prostatic hyperplagia w/o bladder obstruction, thyroid disorders, cataracts
Optional
patient decides; personal preference i.e liposuction, breast augmentation
Urgent Surgery
prompt attention; within 24-30Hours i.e acute gallbladder infection, kidney or ureteral stones
third intention wound healing
secondary suture used for deep wounds (because they weren't sutured early enough, or break down and re-sutured later) Bringing together two opposing granulation surfaces, postOP packed with moist gauze deeper wider scar
Elective Surgery
should; but not major if you don't i.e simple hernia, vaginal repair
informed consent
the patients autonomous decision about whether to undergo a surgical procedure, based on the nature of the condition, the treatment options, and the risks and benefits involved. must be voluntary and written copy provided
A client is scheduled for a surgical procedure. When planning the client's care, the nurse should consider that which of the following conditions will increase the client's risk of complications after surgery?
As a chronic condition that affects many body systems, diabetes is a risk factor for surgical complications. The client's blood glucose level and insulin requirements need to be closely monitored before and after surgery.
A PACU nurse receives a postoperative patient who received general anesthesia with a hard plastic oral airway in place. The patient has clear lung sounds, even and unlabored respirations of 16, and an oxygen saturation of 98%. The patient is minimally responsive to painful stimuli. What action by the nurse is most appropriate?
Continue with frequent patient assessments An immediate postoperative patient may be transferred to the PACU with a hard plastic oral airway. The airway should not be removed until the patient is showing signs of gagging or choking. The neurological status is appropriate for a patient that received general anesthesia. There is no information provided that requires the patient to have vitals taken more frequently than the standard 15 minutes. The nurse should continue with frequent patient assessments.
Which of the following mobility criteria must a postoperative client meet to be discharged to home?
For a safe discharge to home, clients need to be able to ambulate a functional distance (eg, length of the house or apartment), get in and out of bed unassisted, and be independent with toileting.
During the preoperative assessment, the patient states he is allergic to avocados, bananas, and hydrocodone (Vicodin). What is the priority action by the nurse?
Notify the surgical team to remove all latex-based items.
secondary intention wound healing
wound, increased granulation, late suturing wide a wide scar GRANULATION (healing) occurs in INFECTED wounds (or abscess) with edges that are not approximated. Dead and dying cells are still inside the wound and releasing into the cavity --> drainage tubing, and/or gauze to let the wound healing from the bottom up (don't trap the infection inside)