Unit Exam 3: Pre-operative, Intraoperative, and Post-operative

Pre-op check list nursing duties

*Nurse responsible for completing, and signing. *operating room review when patient arrives *Surgery can be delayed if missing checks - make sure patient removes hearing aids, dentures, prosthesis, take off nail polish, take out hair accessories, -make sure the TED/SCD is on -VOID BEFORE SURGERY (already have a question like this) -make sure informed consent is SIGNEd and WITNESSED -make sure labs are created - make sure you their date and time last time they ate or drink -vital signs - fall risks - time the pre op meds were given -then finally a handoff to the intraoperative nurse!!

Potential complications DURING surgery: Field or Nerve Block

- Allergic reaction -injury to anesthetized part of body -system absorption: This can happen when the injection could go into the blood vessel so the side effects are: metallic taste, hypertension, tachycardia, blurred vision, slurred speech, restlessness Interventions for this system absorption problem : (in the book on page 261): open airway, give oxygen, and notifying surgeon. A fast acting barbiturate is needed for treatment!!

Local Anesthesia: Pre procedure assessment

- Allergies: especially drugs ening in "CAINE" - reason for local anesthetic: superficial skin issues (Dr. PImplepopper) and dental work - Patent teaching for safety related to anesthetized area

Potential DURING surgery complications: EPIDURAL

- Hypotension -oversedation/respiratory depression (Narcan maybe needed for reverse it)

Potential Complications AFTER surgery: EPIDURAL

- Hypotension - OVersedation/respiratory depression ((Narcan maybe needed for reverse it) - Infection/abscess formation - Bleeding -Leak of spinal fluid (if meninges are punctured)

Malignant Hyperthermia (Things to Remember):

- MOST common with men that have a lot of muscle mass - begins with skeletal muscle exposed to specific agent -Causes increased muscle metabolism, and calcium serum level increases - elevated serum Ca and K+!! -Leads to acidosis, high temp AND cardiac dysrhythmia

Which Benzos are given before surgery? and what precaution measures should you take?

- Midazolam (Versed) - Lorazepam (Ativan) - Diazepam (Valium) which is ALL an IV dose so it will work VERY quickly and may make them have an altered mental status OR be sedated. -Precaution measures: make sure side rails are up on the stretcher, place call light within easy reach, remind him or her not try to get out oved , place bed in lowest position, (patient will start to get drowsy)

Pre-Procedure assessment: Field or Nerve BLock

- NPO status - Allergies -previous anesthesia history -Vital signs -Neuromuscular assessment of extremities -informed consent

Do you need anesthesia the whole time for no when having an operative surgery with Epidural?

- Needed the whole surgery

Potential Complications AFTER Surgery: Field or Nerve Block

- Nerve damage - Abscess -formation/ infection

Do you need anesthesia the whole time when having a vaginal delivery?

- No, the Labor and Delivery nurses monitor the patient the whole time after giving the epidural.

Preop National PAtient Safety Goals: and how to prevent wrong site surgery prevention?

- Patient indentifcation -**Wrong site surgery Prevention**: Mark the surgical site incision together writing yes or no (physicain and patient) - Prevent falls (check patient's balance) -Critical test results: -patient/family involvement of care: have the right to ask questions, right to receive communication, and know what's going on

Potential complications AFTER surgery: SPINAL

- RIsk of injury do to lack of sensation/movement -Risk of Falls is huge because of the lack of feeling in your lower extremities - infection/abscess formation at a site of injection -Leak of spinal fluid; can cause a HEADACHE

Treatment/ What to do with MH:

- Stop all volatile inhalation anesthetic agents and succinylcholine - intube immediately if endotracheal tube not placed - Ventilate 100% oxygen to flush anesthesia and lower end-tidal CO2 -Administer Dantrolene sodium (Dantrium) IV - IF possible, TERMINATE SURGERY...if not possible then maintain anesthetic agents that doesn't trigger MH - Assess ABGs -Acidosis then give sodium bicarbonate IV - if hyperkalemia, then give regular insulin -use active cooling techniques -insert NG tube and rectal tube -Monitor cory body temperature - Heart Monitor - Inset foly to monitor input and output - monitor urine for presence of blood or myoglobin - transfer to ICU WHEN STABLE -

Administration of anesthetic: SPINAL

- TIME OUT conducted by team administered by continuous spinal injections -performed and monitored by anesthesia service - results in sensory/motor loss below the spinal level performed -ALWAYS CONTINUOUSLY MONITORING

Administration of anesthetic: LOCAL ANESTHESIA

- Topical cream can be used called EMLA prior to IV start (Even when to suture up an incision it can be used) or local infiltration by needle into the gum by the dentist OR when Dr. pimplepopper injects into the lesions -Topical cream can be administered by nurse with physician order - Local infiltration usually done by LIP, NP, or PA - some nurses trained to use local lidocaine before IV start

What is the Universal Protocol: Time out?

- all members pause and do a checklist to make sure it's the CORRECT site, CORRECT procedure, and all equipment is available and in working order - Also document the completion of a time out - This will definitely prevent from having an wrong site, wrong procedure surgery!

Potential Complications: Local Anesthesia

- allergi reactions - Systemic absorption (like field or nerve block) - Risk of injury due to loss of feeling in that area so much more susceptible to heat or cold

Epidural anesthesia most common in:

- anoredctal -vaginal -perineal -hip -and lower extremities

How to prevent VTE complication? (last one for pre op) (Venous thromboembolism)

- ask if they had a blood clot in the past - what are their risk factors for blood clot? like: smoking, use of birth control, obesity, lack of mobility, lengthy surgery, dehydration -TED/SCD (anti embolism stockings to provide graduated compressions of the legs, starting at the end of the foot and ankle ) - also receive a prophylactic preop dose of subq anticoagulant (Heparin or enoxaparin)

How to Prevent Wrong Site Surgery

- confirmation of patient identification (arms bands, patient stating name and birth date) - confirmation of surgical procedure by PATIENT and matched to informed consent - Confirmation of surgical site marking and matched to any diagnostic imaging (Make sure it's the RIGHT side of the brain not the left side that has to be operated on...)

How does a surgical fire occur?

- from an oxidizer: from an O2 source during surgery - from an ignition source: electrical instruments used to cut and cauterize veins - from fuel: from an alcohol-based skin prep, surgical drapes **Really be careful when doing surgery on the upper chest, neck or face because you could get extensive burns if something goes bad** **Use a grounding pad on patient to protect from injury

Pre-procedure assessment of Regional Anesthesia :SPINAL

- gag and cough reflexes stay intact but it would be good to still be NPO ( SO there really isn't a rix of aspiration cause there is no loss of reflexes in this surgery) - Assess Allergies - Vital Signs - Assess the neuromuscular because spinal anesthesia is a loss of motor movements and loss of sensation and numbness present so it's good to assess before AND after. -causing numbness in the lower body usually - Check if they take blood thinners - informed consent always

Administration of anesthetic: FIeld or Nerve Block

- injection directly into nerve by anesthesia OR by a PA or CRNA

Potential DURING surgery complications: SPINAL

- injury to where sensation/movement is lacking (Patient can't feel anything or lack sensation so more prone to injury) -hypotension

Potential complications DURING surgery of General Anesthesia:

- intubation complications such as injury to soft, tissue, teeht, throat, and vocal cord damage -overdose -aspiration -Allergic reaction -malignant hyperthermia

Spinal Anesthesia most common in:

- lower abdominal -pelvic -hip -knee

Safety with positioning during surgery:

- make sure there's no pressure forming so need to use cushions and pillows -position based on TYPE OF SURGERY - patients under anesthesia are VULNERABLE to injury because they can't tell what is hurting because they can't feel anything (insure body alignment)

If Hgb and Hct are low...

- maybe need a transfusion -look at it pre op and compare it to post op

Why are older adults slower to recover from anesthesia?

- more kidney and liver issues (slow to metabolize anesthesia)

general anesthesia (combination of what and what do you lose)?

- most common with a combination of IV meds and inhalation therapy -total loss of reflexes with amnesia so AIRWAY MUST BE SECURE - Anesthesia MUST be present at all times

Safety in the Operating Room:

- must be SURGICAL ASEPSIS ( don't turn around on patient, don't reach over sterile field, and keeping hands above waist level) - all staff have to wear hospital scrub because their regular scrubs can bring in bacteria - hand hygiene: NAILS, HANDS, and scrub up to ELBOW. - skin prep with chlorhexidine or other disinfectant - take cultures of the equipment ROUTINELY -SCRUB MANAGES INSTRUMENTS

Risk Factors for Surgical complications referring to the types of surgery procedures planned

- neck, oral, or facial procedures (airway complications) - Chest or high abdominal procedures (pulmonary complications) - Abdominal surgery (paralytic ileus, venous thromboembolism)

Potential complications AFTER surgery of General Anesthesia:

- oversedation and respiratory depression -DVT -paralytic ileus -urinary retention -falls

How to prevent infection complications pre-surgery?

- skin cleansing (chlorhexidine or betadine) - hair removal (electric clippers) -IF there is any abdominal surgery or bowel surgery, patient NEEDS pre op education on the bowel prep (like when does it start, how do they take it, how do they finish it) we don't want to cut into the bowel and spill GI content into the peritoneal cavity (CAN CAUSE HUGE COMPLICATIONS) - Last thing: patients will receive a prophylactic antibiotic (MUST RECEIVE WITHIN ONE HOUR OF INCISION TIME) This antibiotic reduces the chances of a surgical site infection

Administration of anesthetic for General Anesthesia:

- will be given pre-anesthesia meds including sedatives/hypnotics/ opioids which is administered nurse in hold area - then anesthetic agents administered in combination by anesthesiologist OR CRNA -Time out is done BEFORE surgery but after meds are given

What is a late sign of malignant hyperthermia?

-Fever (up to 111.2 F)

Regional Anesthesia: Field or Nerve block

-Field Block: serious injections AROUND the operative fields, most commonly used for chest surgery, hernia repair, dental surgery, and some plastic surgeries -Nerve Block: Injection of the local anesthetic agent into or around one nerve or group of nerves in the involved area and most common in limb surgery and to relieve chronic pain

Surgical Care Improvement Project (SCIP): What's the rule with beta blocker administration? What is needed to decrease risk of VTE? (Talked about all this before but just a review to quiz you!!)

-Goal has been to reduce surgical complications Examples: - Prophylactic antibiotic therapy: give within 1 hour of surgery -Surgical site preparation: clipping of the ari (NOT SHAVING) and cleansing skin with chlorhexidine or betadine - Surgical Site infections: tracked in post op and look at wound infections -VTE prophylaxis: patient IS SCREENED for risk factors and appropriate prophylaxis started preop which is TED/SCD and dose of heparin or lovenox - beta blocker administration: if patient is taking this regularly then they can take it morning of!

Job of a RN circulator: (many jobs)

-Identify patient -Allergies -NPO -Documents ENTIRE case (maybe alk with family) -Confirmation of surgical procedure with patient - Verification of signed informed consent - Verification of blood transfusion consent -Review of preop assessment for individual needs during surgery -Review of diagnostic testing; results available -Ensures all needed equipment is available based upon the procedure -Reviews method of contacting family/location of family -Documents all aspects of the surgical experience in the HER -Ensures surgical asepsis is maintained

Pre-Procedure Assessment for General Anesthesia:

-MUST be NPO (6-8 hours before surgery) - Assess allergies -Anesthesia/CRNA assess for surgical risk factors - Anesthesia/CRNA does an assessment on mouth/oral cavity due to need for intubation -check IV access -informed consent

Just before the patient is prepared for surgery and just before transport to the operating room, what should the patient do? (consent form is signed already)

-VOID -Rationale: This action prevents incontinence or overdistention and is a starting point for intake and output measurement.

What is the biggest thing we are looking at a complete blound count (CBC)?

-We are looking at the white blood cell count to make sure there isn't an infection -MIGHT have to delay the surgery if there is an infection

When should you count the amount of instruments for surgery?

-before AND after to prevent any retained foreign body go into the patient during surgery -Also count when instruments are added to the procedure -VERIFY ANY INSTRUMENT THAT IS BROKEN TOO - Should be counted audibly!!

Risk Factors for Surgical Complications for Prior Surgical Experiences

-less than optimal emotional reaction -anesthesia reactions or complications -postoperative complications

How to prevent aspiration complications pre-surgery?

-make sure patient is NPO after midnight (no food or water) - given dose of Atropine TO DRY THE SECRETIONS so they don't aspirate on their own saliva when intubated!! - also given a histamine blocker (H2) like pantoprazole, famotidine (pepcid) to decrease the acidity of the stomach (because surgeries can be long and stomach could produce stress ulcers) -And also could be given metoclopramid if rapid emptying of the stomach is NEEDED

What is a type and screen?

-patients blood type is determined and the blood is screened for antibodies, type and cross can be ordered later (incase if transfusion needed)

We already know that Atropine dries the secretions so the patient but what else does it do?

-prevents bradycardia when they intubate the patient because they could have a vagal response (which lowers the HR and BP)

It PT/INR and PTT are elevated..

-then this is something we have to address because high levels of those means the blood is taking longer to clot which is NOT good during surgery

What do patients need know before a surgery? Before signing the consent?

-type of surgery -location of surgery (on the right or left side) -reason for surgery -who will perform -who will be present - what are the risk factors of having it and what are the risk factors of not having it -also need an anesthesia consent!!

What's type and crossmatch?

-typing the patient's blood and actually crossmatching them to a specific unit of blood (from a donor unit)

Surgical Team Members

1) Surgeon 2) Assistant Surgeon 3) RN - Circulating nurse 4) RNFA - first assistant 5) RN/LVN/LPN/Surgical tech 6) Anesthesia care provider *ONLY PERSON WHO CAN GIVE ANESTHESIA* 7) Other technical personnel 8) CRNA: has to be under SUPERVISION of a anesthesiologist

1. What is a unrestricted area? 2. Semi-restricted? 3. Restricted area?

1. all hospital staff can go in and out 2. OR staff in scrub attire with head and shoe covers 3. OR staff in scrub attire with head, shoes covers and surgical mask (OR ROOM IS RESTRICTED TOO)

A nurse is providing preoperative teaching to a client who is to have ad bomdinal surgery, Which of the following statements should the nurse make? (Select all that apply) A. "Take your heart medication with a sip of water before surgery" B. Splint the abdominal incision with a pillow when coughing and deep breathing C. Bed rest is recommended for the first 48 hours D. Anti-embolism stockings are applied before surgery E. You can eat solid foods up to 4 hours before surgery

A,B, and D Rationale: Not C because client needs early ambulation to prevent complications and not E because patient should be NPO 6 hours or more before surgery

The nurse is caring for 4 clients who will undergo surgery today, which client does the nurse recognize as at HIGHEST risk for surgical complication? A. 52 year old who takes aspirin daily B. 58 year old who has well-controlled type II DM C. 64 year old who has just received pre surgical prophylactic antibiotics D. 69 year old who will be discharged after surgery to an extended care facility

A. Rationale: Remember in the preoperative chapter that you have to be really careful about blood thinners because you are already losing a lot of blood during surgery. Aspirin or any other blood thinners need to be stopped at least a week before surgery. Need to be able for the patient's blood to clot fast.

A nurse is caring for a client who is scheduled for an exploratory laparotomy. The client's temperature is 39C (102.2F) orally. Which of the following actions should the nurse take? A. Inform the surgeon of the elevated temperature B. Transfer the client to the preoperative unit C. Apply ice packs to the groin D. Encourage the client to increase intake of clear liquids

A. Rationale: need to ask the provider if surgery should still be done or cancel because you already have a risk of an infection post surgery you don't want an infection right now.

Which electrolyte laboratory result does the nurse report immediately to the anesthesiologist? A. Creatinine, 1.9 mg/dL (168 mcmol/L) B. Fasting glucose, 80 mg/dL (4.4 mmol/L) C. Potassium, 3.9 mEq/L (3.9 mmol/L) D. Sodium, 140 mEq/L (140 mmol/L)

A. Creatinine, 1.9 mg/dL (168 mcmol/L) Rationale: The nurse will immediately report a creatinine of 1.9 mg/dL (168 mcmol/L) to the anesthesiologist. A creatinine of 1.9 mg/dL (168 mcmol/L) is outside the normal range and may indicate renal problems.A fasting glucose of 80 mg/dL (4.4 mmol/L), a potassium level of 3.9 mEq/L (3.9 mmol/L), and sodium level of 140 mEq/L (140 mmol/L) are normal laboratory values.

An unidentified client from the emergency department requires immediate surgery, but he is not conscious and no one is with him. What must the nurse, who is verifying the informed consent, do? A. Ensure written consultation of two non involved physicians B. Read the surgeon's consult to determine whether the client's condition is life threatening C. Sign the Operative Permit D. Withhold surgery until the next of kin's is notified

A. Ensure written Consultation of two non-involved physicians Rationale: In a life-threatening situation in which every effort has been made to contact the person with medical power of attorney, consent is desired but not essential. In place of written or oral consent, written consultation by at least two physicians who are not associated with the case may be requested by the health care provider.It is not within the nurse's role to make a judgment about the client's life-threatening status based on the surgeon's consult. Signing documents on the client's behalf is not legal. Withholding surgery is not in this client's best interests.

Who orders the pre op meds?

Anesthesia (anesthesiologist)

Risk Factors for Surgical complications for Meds: by the way: all the ones I'll be naming is on page 233 table 14-3

Antihypertensives tricyclic antidepressants anticoagulants NSAIDS immunosuppressives

Which emergency care does the nurse recognize that will be implemented for a client with malignant hyperthermia? (select all that applies) A. Removal of endotracheal tube B. Cessation (stopping) of surgery when possible C. Insertion of foley catheter to check input and output D. Transfer patient to ICU until when stabilized E. Assessment of ABGs for respiratory alkalosis F. Use of active cooling techniques such as a cooling blanket and ice packs around the axillae and groin

B, C, D, F Rationale: Not E because you are looking for acidosis not alkalosis in MH. And not A because you need to keep the patient intubated!

Which assessment data finding for a client scheduled for total knee replacement surgery is MOST important for the nurse to communicate to the surgeon and the anesthesia providers before the procedure? (Select all that apply) A. The oxygen saturation is 97% B. The serum potassium level is 3.0 C. Client took a total of 1300mg of aspirin yesterday D. The client requests to talk with a registered dietitian about weight loss E. The client took a regularly scheduled antihypertensive drug with a sip of water 2hrs ago F. After receiving the preoperative medications, the client tells the nurse that he lied on the assessment form and that he really is a current smoker

B,C,F Rationale: There is an electrolyte imbalance with Potassium which can cause many lethal problems especially heart complications. Also, you aren't supposed to take any drugs that will thin your blood like warfarin and aspirin. And finally, tobacco uses increases the risk for pulmonary complications because of changes to the lungs, blood vessels and chest cavity. Why not the other answers?? Oxygen saturation is normal, weight loss question is not a priority at this time, and you aren't supposed to take some antihypertensive drug (found at the top on page 242) but it's okay since the patient took it regularly scheduled and if blood pressure does drop a little during surgery that can be fixed. (Asked Wyatt about it!)

As the nurse obtains informed consent, the client asks, "Now what exactly are they going to do to me?" What is the nurse's response? A. Contact the anesthesiologist B. Contact the surgeon C. Explain the procedure D. Have the client sign the form

B. Contact the surgeon Rationale: The nurse will contact the surgeon to convey the client's question. The nurse is not responsible for explaining or providing detailed information about the surgical procedure. Rather, the nurse's role is to clarify facts that have been presented by the health care provider and dispel myths that the client or family may have heard about the surgical experience.The anesthesiologist is responsible for the anesthesia, not the surgical details. Although the nurse is only witnessing the signature, it is the nurse's role to ensure that the facts are clarified before the consent form is signed.

Which task would be best for the charge nurse to assign to the LPN/LVN working in the surgery admitting area? A. Provide preoperative teaching to a client who needs insertion of tunneled central venous catheter B. Insert a retention catheter in a client who requires a flap graft of a sacral pressure ulcer. C. Obtain the medical history from a client who is scheduled for a total hip replacement. D. Obtain the medical history from a client who is scheduled for a total hip replacement.

B. Insert a retention catheter in a client who requires a flap graft of a sacral pressure ulcer. Rationale: Insertion of a catheter is the best task within the scope of skills approved for the LPN/LVN.Preoperative teaching and physical assessment of a preoperative client are under the scope of the RN. History information would be completed by the RN on the unit.

Why is it so important to make sure the kidneys work properly during surgery?

Because those kidneys try to excrete the anesthesia given (Check BUN/creatinine to check kidney function)

A nurse is assessing a client's laboratory values before surgery. Which of the following results should the nurse report ot the provider? A. Potassium 3.9 B. Sodium 145 C. Creatinine 2.8 D. Blood glucose 235 E. WBC 17,850

C, D, E C: because creatinine levels should be (0.84-1.21) D. Because that's way too elevated of a blood sugar E: because WBC should be 5,000-10,000

A nurse is verifying informed consent for a client who is have a paracentesis. Which of the following actions should the nurse take ? (Select all that apply) A. Explain to the client the purpose of having the procedure B. Inform the client of risks to having the procedure C. Ensure the clients understands information about the procedure D. Witness the client signing the informed consent form E. Determine if the client is capable of understanding the reason for the procedure.

C,D, E Rationale: Not A because the provider is suppose to do that and not B because the provider is suppose to inform the client

What client teaching will the nurse provide regarding post op leg exercises to minimize the risk for development of DVT after surgery? A. Only perform each exercise one time to prevent overuse B. Begin exercises by sitting at a 90 degree angle on the side of the bed C. Point toes of one foot toward bottom of bed, then point toes of same leg toward his or her face. Repeat several times; then switch legs D. Bend knee, and push heel of foot into the bed until the calf and thigh muscles contract. Repeat several times; then switch legs.

C. Rationale: Reference on page 245 on chart 14-5 talks about the exercises and C. is the only one that matches those answers. (And you can find the answer to these NCLEX examination answers to the challenges in the back of the book but no rationale! )

During a preoperative assessment, which statement by a client requires further investigation by the nurse to assess surgical risks? A. "I am taking vitamins." B. "I drink a glass of wine a night." C. "I had a heart attack 4 months ago." D. "I quit smoking 10 years ago."

C. "I had a heart attack 4 months ago." Rationale: The statement by the client that he or she had a heart attack 4 months ago requires further investigation. Cardiac problems increase surgical risks, and the risk for a myocardial infarction during surgery is higher in clients who have heart problems.The type of vitamins the client takes should be assessed, but this is not the highest risk. Moderate alcohol consumption is not considered high-risk behavior. A past history of smoking should be noted, but current or more recent smoking is of greater concern.

The nurse is instructing a client about the use of antiembolism stockings. Which statement by the client indicates the need for further teaching? A. "I will take off my stockings one to three times a day for 30 minutes." B. "My stockings are too loose." C. "It's better if they are too tight rather than too loose." D. "These stockings help promote blood flow."

C. "It's better if they are too tight rather than too loose." Rationale: Antiembolism stockings should fit properly to achieve the desired result. Stockings that are too tight will impede blood flow.Frequent removal of the stockings is appropriate to allow for hygiene and a break from their wear. Stockings that are too loose are ineffective. Anti Embolism stockings may be used during and after surgery to promote venous return.

A client was originally scheduled for surgery at noon. The surgeon is delayed, and the surgery has been rescheduled for 3:00PM. How will the nurse plan to administer the preoperative prophylactic antibiotic? A. Give at noon as originally prescribed B. Cancel orders; preoperative prophylactic antibiotics are given optionally C. Adjust the administration time to be given within 1 hour before surgery D. Hold the preoperative antibiotic so it can be administered immediately following surgery.

C. Adjust the administration time to be given within 1 hour before surgery

The nurse completes the preoperative checklist on a client scheduled for general surgery. Which factor contributes the greatest risk for the planned procedure? A.Age 59 years B. General anesthesia complications experienced by the client's brother C. Diet-controlled diabetes mellitus D. Ten pounds (4.5 kg) over the client's ideal body weight\categorize this client as obese.

C. Diet- Controlled DM Rationale: The client's greatest risk factor is diabetes mellitus. Diabetes contributes an increased risk for surgery or postsurgical complications.Older adults are at greater risk for surgical procedures, but this client is not classified as an older adult. Family medical history and problems with anesthetics may indicate possible reactions to anesthesia, but this is not the best answer. Obesity increases the risk for poor wound healing, but being 10 pounds (4.5 kg) overweight does not categorize this client as obese.

At 8:00 a.m., the registered nurse is admitting a client scheduled for sinus surgery to the outpatient surgery department. Which information given by the client is of most immediate concern to the nurse? A. An allergy to iodine and shellfish B. Being nauseated after a previous surgery C. Having a small glass of juice at 7:00 a.m. D. Expressing anxiety about surgery

C. Having a small glass of juice at 7:00 a.m. Rationale: Clients need to be NPO for a sufficient length of time before surgery to prevent aspiration of fluid into the lungs. Intake of food or fluids may delay the start time of the surgery, so the nurse must notify the surgeon and anesthesiologist for possible rescheduling.The nurse would confirm that all allergies are charted, and that the client has the correct allergy band identification. Many clients experience nausea after surgery; the nurse would document this in the client's information as well. The nurse would talk with the client and explore the anxiety; this is a normal feeling before surgery.

A preoperative client smokes a pack of cigarettes a day. What is the nurse's teaching priority for the best physical outcomes? A. Instruct the client to quit smoking B. Teach about the dangers of tobacco C. Teach the importance of incentive spirometer D. Tell the client that smoking increases postoperative complications

C. Teach the importance of incentive spirometer Rationale: The nurse would first teach the importance of incentive spirometry. Incentive spirometry is good for lung hygiene and it encourages deep breathing.The nurse can suggest quitting or advice about the dangers of tobacco, but it is not therapeutic to instruct it at this time. Telling the client that smoking causes increased complications is not helpful or therapeutic just prior to surgery. BE THERAPEUTIC!!

The nurse is educating a client who is about to undergo cardiac surgery with general anesthesia. Which statement by the client indicates the need for further instruction? A." I will wake up with a tube in my throat" B. " I will have a bandage on my chest" C. "My family will not be able to see me right away" D. "Pain medication will take my pain away"

D. "Pain medication will take my pain away" Rationale: The client's statement that, "Pain medication will take away my pain," indicates the need for further instruction. Pain medication will reduce pain, but will not take it away completely.The client statement about waking up with a tube in the throat is accurate, because the client will be intubated. Following heart surgery, a dressing is placed on the chest. The client will not be able to see family immediately because he or she will go to recovery first.

A diabetic client who is scheduled for vascular surgery is admitted on the day of surgery with several orders. Which order does the nurse accomplish first? A Use electric clippers to cut hair at surgical site B. Start an infusion of Lactated Ringer's solution at 75ml/hr C. Administer one-half of the client's usual Lispro insulin dose D. Draw blood for glucose, electrolyte, and complete blood count values

D. Draw blood for glucose, electrolyte, and complete blood count values Rationale: The blood sample needs to be drawn and sent to the laboratory first to confirm that results are within normal limits. If blood work is abnormal, the surgery may be rescheduled.Removal of hair can be accomplished in the operating room directly before the start of surgery. The IV infusion can be accomplished after the laboratory orders have been completed. The nurse should check blood glucose with the laboratory orders before administration of lispro.

The nurse is providing preoperative care for a client who will have an arthroscopy of the left knee. As part of the Joint Commission National Patient Safety Goals (NPSG), what will the nurse be required to do? A. Ensure that the correct procedure is noted in the client's history. B. Remind the surgeon that the client will have a left knee arthroscopy. C. Verify with the client that a left knee arthroscopy will be performed. D. Mark the left knee site with the client awake and the surgeon present.

D. Mark the left knee site with the client awake and the surgeon present Rationale: The nurse will be required to mark the left knee site with the client awake and the surgeon present. The Joint Commission NSPG requires that the surgical site be marked by an independent licensed professional and should, when possible, involve the client. The surgeon is accountable and should be present.The EMR should identify the correct procedure, but is not a specific JCAHO requirement. The nurse will verify the procedure with the client when possible, but this is not a requirement. Communication with the surgeon is ideal, but is not specifically required.

Colostomy surgery is categorized as what type of surgery? A. Cosmetic B. Curative C. Diagnostic D. Palliative

D. Palliative Rationale: Colostomy surgery is categorized as palliative. Palliative surgery is performed to relieve symptoms of a disease process, but does not cure the disease.Cosmetic surgery is performed primarily to alter or enhance personal appearance. Curative surgery is performed to resolve a health problem by repairing or removing the cause. Diagnostic surgery is performed to determine the origin and cause of a disorder or the cell type for cancer.

A client is being prepared for gastrointestinal surgery and undergoes a bowel preparation. This preoperative procedure is done to... A. decrease expected blood loss during surgery B. eliminate any risk for infection C. ensure that the bowel is sterile D. reduce the number of intestinal bacteria

D. Reduce the number of intestinal bacteria Rationale: Bowel or intestinal preparations are performed to empty the bowel to minimize the leaking of bowel contents, prevent injury to the colon, and reduce the number of intestinal bacteria.Decreasing expected blood loss and sterilizing the bowel are not the goals of a bowel preparation. While the bowel prep may reduce the number of intestinal bacteria, it will not completely eliminate the risk of infection.

An older client's adult child tells the nurse that the client does not want life support. What does the nurse do first? A. Call the legal department to draft the paperwork. B. Document this in the chart. C. Thank the person and do nothing else. D. Talk to the client

D. Talk to the client Rationale: The nurse would first talk to the client in order to determine the client's wishes and state of mind.The nurse should not call the legal department or document in the client's chart before speaking with the client. Doing nothing is not appropriate.

A perioperative nurse is caring for a client who is having a colon resection. which of the following actions should the nurse take? A. Encourage the client to void after preoperative medication administration B. Administer antibiotics 2 hr prior to surgical incision C. Remove hair using a manual razor D. Remove nail polish on fingers and toes

D. because ensure the nail beds are visible for color and circulation by removing nail polish before surgery. Not A because client should void BEFORE med administration Not B because you are suppose to administer within ONE HOUR of antibiotics not 2 hours. Not C because you are suppose to use electric clippers to prevent abrasion.

How to prevent from mixing up anesthesia meds?

LABEL THEM

What's the key thing to look at allergies for pre-operative assessment?

Latex Allergies

Risk Factors for surgical complications of Family History

Malignant hyperthermia Cancer Bleeding disorder Anesthesia reactions or complications

Risk Factors for surgical complications for health history

Malnutrition or obesity Drug, tobacco, alcohol, or illicit substance or abuse altered coping ability herbal use

One of the National Patient Safety Goals with meds before operating is:

Medication Reconciliation: Physician has to review all of patient's current medications and make sure those are addressed in the post op period and discharge.

Is the RN circulator sterile or non sterile?

NON-STERILE and will be documenting to see if anyone in the room breaks sterile field

What is an early sign of Malignant hyperthermia?

Rise in end tidal of CO2

Who visualizes and confirms the count of instruments?

Rn Circulator and the Scrub Nurse

Clinical manifestations of Malignant Hyperthermia

Tachycardia Dysrhythmias Skin mottling Cyanosis Myoglobinuria: muscle proteins in the urine Rise in end tidal carbon dioxide Elevated temperature

Who should you give your valuables to before surgery?

a family member!! (Then obviously the nurse can take your valuables)

We need to get a patient's ___________ before surgery

baseline vitals

Risk Factors for Surgical Complications for Medical History

decreased immunity diabetes pulmonary disease cardiac disease hemodynamic instability anemia dehydration infection hypertension hypotension any chronic disease

Why is important to get a baseline of the patient's neurological assessment?

so they can compare what it was before and check for any surgical complications referring to neuro