Chapter 17-Preoperative Nursing Management (PrepU)
Clients who have received corticosteroids preoperatively are at risk for which type of insufficiency? Adrenal Thyroid Parathyroid Pituitary
Adrenal Clients who have received corticosteroids are at risk of adrenal insufficiency. Insufficiency related to corticosteroids does not occur in the pituitary, thyroid, or parathyroid glands.
Which nursing assessment finding indicates the preoperative client has not met expected outcomes? Discusses financial concerns with the social worker. Demonstrates how to use incentive spirometry. Remains in bed after receiving preanesthetic medication. Sobs uncontrollably about pending amputation of foot.
Sobs uncontrollably about pending amputation of foot. Expected outcomes for the preoperative client include demonstrating how to use incentive spirometry, remaining in bed after receiving preanesthetic medication, and discussing financial concerns with the social worker. The client who sobs uncontrollably about pending amputation of foot is coping ineffectively.
Nursing assessment findings reveal that the client is afraid of dying during the surgical procedure. Which surgical team member would be most helpful in addressing the client's concern? Anesthesiologist Circulating nurse Registered nurse first assistant Surgeon
Surgeon It is the surgeon's responsibility to explain the benefits, alternatives, possible risks, complications, disfigurement, disability, and removal of body parts in obtaining informed consent from the client.
A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching? Use chest breathing. Exhale through an open mouth. Use diaphragmatic breathing. Make inhalation longer than exhalation.
Use diaphragmatic breathing. In chronic bronchitis the diaphragm is flat and weak. Diaphragmatic breathing helps to strengthen the diaphragm and maximizes ventilation. Exhalation should be longer than inhalation to prevent collapse of the bronchioles. The client with chronic bronchitis should exhale through pursed lips to prolong exhalation, keep the bronchioles from collapsing, and prevent air trapping. Diaphragmatic breathing — not chest breathing — increases lung expansion.
The client is scheduled for a biopsy for suspected cancer of the prostate. The nurse recognizes the purpose of this surgical procedure is: Palliative Diagnostic Curative Reparative
Diagnostic A biopsy is a type of diagnostic surgery.
When a client states, "I know all will go well," what cognitive coping strategy is the client using? Music therapy Distraction Imagery Optimistic self-recitation
Optimistic self-recitation When that patient verbalizes this statement, is an optimistic response. Imagery occurs when the patient concentrates on a pleasant experience or restful scene. Distraction occurs when the patient thinks of an enjoyable story or recites a favorite poem or song. Music therapy would be an incorrect answer.
When the indication for surgery is without delay, the nurse recognizes that the surgery will be classified as emergency. elective. required. urgent.
emergency. Emergency surgery means that the client requires immediate attention and the disorder may be life threatening. Urgent surgery means that the client requires prompt attention within 24 to 30 hours. Required surgery means that the client needs to have surgery, and it should be planned within a few weeks or months. Elective surgery means that there is an indication for surgery, but failure to have surgery will not be catastrophic.
The nurse is assisting the client with imagery as a relaxation strategy. Which statement by the client describes imagery? "I like to listen to classical music." "I am confident the outcome will be positive." "I recite a poem by Emily Dickenson when I feel anxious." "I am lying on the beach in Florida."
"I am lying on the beach in Florida." Imagery requires the client to think of a pleasant or restful experience.
At what point does the preoperative period end? When the client is transferred onto the operating table When the decision is made to proceed with surgery When the client is admitted to the PACU When the client signs the consent form
When the client is transferred onto the operating table The preoperative phase begins when the decision to proceed with surgical intervention is made and ends with the transfer of the client onto the OR table. The intraoperative phase begins when the client is transferred onto the operating table and ends with admission to the PACU.
A physically fit older adult is scheduled for right knee replacement. What factor for the client creates an increased risk for postoperative complications? ability to metabolize medication surgical site current smoking history type of surgery
current smoking history The nurse identifies the client's current smoking status as a risk factor for surgical complications. General risk factors are related to age; nutritional status; use of alcohol, tobacco, and other substances; and physical condition. The type of surgery, the ability to metabolize medication, and surgical site are not a risk factors.
An example of a curative surgical procedure is a biopsy. tumor excision. placement of gastrostomy tube. a face-lift.
tumor excision. An example of a curative surgical procedure is the excision of a tumor. A biopsy, a face-lift, and the placement of a gastrostomy tube are not examples of curative surgical procedures.
What action by the nurse best encompasses the preoperative phase? Shaving the client using a straight razor Monitoring vital signs every 15 minutes Documenting the application of sequential compression devices (SCDs) Educating clients on signs and symptoms of infection
Educating clients on signs and symptoms of infection Educating clients on preventing or recognizing complications begins in the preoperative phase. Applying SCDs and frequently monitoring vital signs happen after the preoperative phase. Only electric clippers should be used to remove hair.
When assessing a postoperative client, the nurse is correct to relate which surgical risk factor that would decrease if the surgical client maintained a blood glucose level under 8.3 mmol/L? Respiratory complications Wound healing Nutrient deficiencies Liver dysfunction
Wound healing In caring for a postoperative client, the nurse is correct to correlate hyperglycemia with an increased risk of surgical incision infections and delayed wound healing. There is no direct correlation between blood glucose levels and nutrient deficiencies, respiratory complications, and liver dysfunction.
A nurse is teaching a client about pain management after surgery. Which client statement indicates the teaching was effective? "I will ask for pain medication when the pain becomes unbearable." "I will need to learn how to give myself pain medication by injection for when I go home." "I will support my incision with my hands when I cough and do my deep breathing exercises." "The pain from my incision will be very similar to my arthritis pain."
"I will support my incision with my hands when I cough and do my deep breathing exercises." Splinting of the incision provides support to the incision and helps to control pain, so this client statement is correct. Clients should take pain medication routinely and frequently after surgery. Pain medications for postoperative clients are given orally at home. Pain is a subjective feeling, so comparison is difficult.
Which nursing statement would best decrease a client's anxiety before an emergency operative procedure? "You will be just fine; the operating room nurses will take good care of you." "Let me explain to you what will happen next." "We will keep your family informed of your progress." "It is best to take deep breaths and relax before the procedure."
"Let me explain to you what will happen next." Many clients feel fearful of knowing little about the operative procedure and what to expect. This fear causes anxiety and can lead to a poorer response to surgery and surgical complications. Explanations of what the client is to expect can help to decrease anxiety. False reassurance of being fine does not diminish anxiety. Deep breathing and relaxation techniques can be helpful to the client, but addressing the source of the anxiety is more beneficial. Keeping the family informed helps the family and is not client focused.
You are the nurse working in an ambulatory surgery center. A teenage son of your clients ask you why so many people have surgery. What would be your best reply? "Many people have diagnostic or short therapeutic surgical procedures." "Lots of people have cancer and need tumors removed." "You know, we have a lot of sick people in the world." "Not everyone has to go to the hospital to have surgery anymore."
"Many people have diagnostic or short therapeutic surgical procedures." Many diagnostic or short therapeutic surgical procedures—such as bone marrow biopsy, endoscopy, or cardiac catheterization—are now performed in outpatient settings and ambulatory surgical centers. Options B, C, and D seem to minimize the teenager's question.
A client has been transported to the operating room for emergent surgery. Which statement by the nurse best supports the need for emergent surgery? "The client was tachycardic, had progressive weight loss, and experienced bouts of insomnia as a result of hyperthyroidism." "The client had severe pain and a laceration to the face with minimal bleeding after being attacked by a dog 1 hour ago." "The client was unresponsive, had a distended abdomen, and had unstable vital signs after a motor vehicle accident." "The client had epigastric abdominal pain, an elevated white blood count, and vomiting for 1 day."
"The client was unresponsive, had a distended abdomen, and had unstable vital signs after a motor vehicle accident." Emergency surgery means that the client requires immediate attention and the disorder may be life threatening. A client with unstable vital signs and a distended abdomen after a motor vehicle accident requires immediate attention. A client with left abdominal pain may not need surgery. Epigastric pain with vomiting for 1 day is usually not an indication for emergent surgery. Lacerations to the face require sutures, not emergent surgery. A thyroidectomy to treat hyperthyroidism is a required surgery, not an emergent one.
The nurse is preparing a patient for surgery. The patient is to undergo a hysterectomy without oophorectomy, and the nurse is witnessing the patient's signature on a consent form. Which comment by the patient would best indicate informed consent? "I know I'll be fine because the health care provider said he has done this procedure hundreds of times." "Because the health care provider isn't taking my ovaries, I'll still be able to have children." "I know I'll have pain after the surgery." "The health care provider is going to remove my uterus and told me about the risk of hemorrhage."
"The health care provider is going to remove my uterus and told me about the risk of hemorrhage." The surgeon must also inform the patient of the benefits, alternatives, possible risks, complications, disfigurement, disability, and removal of body parts as well as what to expect in the early and late postoperative periods. The nurse clarifies the information provided and, if the patient requests additional information, the nurse notifies the health care provider. Clarification of information given may be necessary, but no additional information should be given. The other options do not indicate patient understanding of the procedure.
The nurse has provided preoperative instructions to a client scheduled for surgery at an ambulatory care center. Which statement, made by the client, would indicate that further instruction is needed? "If I do not follow the instructions, my surgery could be cancelled." "The nurse will explain the details of the surgery before I sign a consent." "My medical records will be sent to the ambulatory care center prior to my surgery." "The physician will update my family after the procedure and provide specific discharge instructions."
"The nurse will explain the details of the surgery before I sign a consent." Further instruction would be needed to clarify that the physician, not the nurse, explains the details of the surgery and obtains voluntary consent for the procedure. It is correct that preoperative instructions must be followed prior to surgery for the safety of the client, medical records are present for review prior to surgery, and the physician speaks with the family following the procedure and provides instructions for discharge.
For the client who is taking aspirin, it is important to stop taking this medication at least how many day(s) before surgery? 3 1 7 5
7 Aspirin should be stopped at least 7 to 10 days before surgery. The other time frames are incorrect.
A client having a surgical procedure takes aspirin 325 mg daily for prevention of platelet aggregation. When should the client stop taking the aspirin before the surgery? 7 to 10 days 4 weeks 2 weeks 2 to 3 days
7 to 10 days Aspirin, a common OTC medication that inhibits platelet aggregation, should be prudently discontinued 7 to 10 days before surgery; otherwise, the client may be at increased risk for bleeding.
What is the blood glucose level goal for a diabetic client who will be having a surgical procedure? 150 to 240 mg/dL 80 to 110 mg/dL 250 to 300 mg/dL 300 to 350 mg/dL
80 to 110 mg/dL Although the surgical risk in the client with controlled diabetes is no greater than in the client without diabetes, strict glycemic control (80 to 110 mg/dL) leads to better outcomes. Frequent monitoring of blood glucose levels is important before, during, and after surgery.
The nurse expects informed consent to be obtained for insertion of: A gastrostomy tube A nasogastric tube An intravenous catheter An indwelling urinary catheter
A gastrostomy tube Informed consent is required for invasive procedures that require sedation and are associated with more than usual risk to the client.
A client is scheduled for an invasive procedure. What should the nurse document in the chart regarding the procedure? A report from the dietician A signed consent form from the client A signed consent form from the client's family A detailed urinalysis report
A signed consent form from the client A signed consent is required and is important for initiating invasive procedures. The nurse should therefore check for the signed consent form of the client. Checking a report from the dietitian or a signed consent form from the client's family is not necessary. A urinalysis report might be required if the physician requests it, but is not required before performing an invasive procedure.
Which would be considered to require an urgent surgical procedure? Severe bleeding Loose facial skin Cataract Acute gallbladder infection
Acute gallbladder infection An acute gallbladder infection is considered to require an urgent surgical procedure. Cosmetic surgery and cataract surgery are not considered urgent surgical procedures. Severe bleeding could be considered an emergent surgical procedure.
In preparing the client for transfer to the operating room, which of the following actions by the nurse is inappropriate? Have the client void. Allow the client to wear dentures. Remove all jewelry. Have client wear hospital gown.
Allow the client to wear dentures. Dentures, jewelry, glasses, and prosthetic devices are removed prior to surgery.
A client refuses to remove her wedding band when preparing for surgery. What is the best action for the nurse to take? Allow the client to wear the ring and cover it with tape. Notify the surgeon to cancel surgery. Discuss the risk for infection caused by wearing the ring. Remove the ring once the client is sedated.
Allow the client to wear the ring and cover it with tape. Most facilities will allow a client to wear a wedding band during a surgical procedure. The nurse must secure the ring with tape. Although it is appropriate to discuss the risk for infection, the client has already refused to remove the ring. The surgery should not be canceled and the ring should not be removed without permission.
A patient is scheduled for a surgical procedure. For which surgical procedure should the nurse prepare an informed consent form for the surgeon to sign? An open reduction of a fracture An insertion of an intravenous catheter Irrigation of the external ear canal Urethral catheterization
An open reduction of a fracture Informed consent is necessary in the following circumstances: invasive procedures, such as a surgical incision (such as would be involved in an open reduction of a fracture), a biopsy, a cystoscopy, or paracentesis; procedures requiring sedation and/or anesthesia (see Chapter 18 for a discussion of anesthesia); a nonsurgical procedure, such as an arteriography, that carries more than a slight risk to the patient; and procedures involving radiation. Non-invasive procedures such as insertion of an intravenous or urethral catheter or irrigation of the external ear canal would not require informed consent.
You are caring for a client preoperatively who is very anxious and fearful about their surgery. You know that this client's anxiety can cause problems with the surgical experience. What type of problems can this client have because of their anxiety and fear? Anxiety and fear can affect a client positively during and after surgery. Anxious clients need psychological counseling after surgery. Anxiety and fear increases the need for anesthesia and postoperative medications. Anxious clients have a poor response to surgery and are prone to complications.
Anxious clients have a poor response to surgery and are prone to complications. Anxiety and fear, if extreme, can affect a client's condition during and after surgery. Anxious clients have a poor response to surgery and are prone to complications. The scenario does not indicate an increased need for anesthesia or postoperative medications in the anxious and fearful client. Anxious clients do not generally need psychological counseling after surgery. Anxiety and fear do not affect a client positively during and after surgery.
The nurse is evaluating the client's understanding of diet teaching aimed at promoting wound healing following surgery. The nurse would conclude teaching was ineffective if the client selects which of the following? Baked chicken, mashed potatoes, broccoli, and strawberries Grilled salmon, rice pilaf, green beans, and cantaloupe Turkey breast, baked sweet potato, asparagus, and an orange Cheeseburger, french fries, coleslaw, and ice cream
Cheeseburger, french fries, coleslaw, and ice cream Important nutrients for wound healing include protein; vitamins A, B-complex, C, and K; arginine, magnesium, copper, and zinc; and water. The diet should be sufficient in carbohydrates and low to moderate in fats. The cheeseburger option is high in fat and low in vitamin C.
At which time does the nurse realize that it is best to begin teaching about care needed during the postoperative period? Upon arrival to the surgical unit During the preoperative period Following the surgical procedure At the time of discharge instructions
During the preoperative period The best time to begin teaching about care needed in the postoperative period is during the preoperative time. At this time, the client is more alert and focused on the information provided by the nurse. Clients and family members can better be prepared and participate in the recovery period if they know what to expect. Anxiety is a factor on arrival to the surgical unit that could interfere with learning. Pain could interfere with the learning process, following a surgical procedure. At the time of discharge, both pain and timeliness may be an issue in understanding and obtaining care needed during the postoperative time.
A fractured skull would be classified under which category of surgery based on urgency? Required Urgent Elective Emergent
Emergent Emergent surgery occurs when the client requires immediate attention. An elective surgery is classified as a surgery that the client should have. A required surgery means that the client needs to have surgery. An urgent surgery occurs when the client requires prompt attention.
A gunshot wound would be classified under which category of surgery based on urgency? Required Elective Urgent Emergent
Emergent Emergent surgery occurs when the patient requires immediate attention. An elective surgery is classified as a surgery that the patient should have. A required surgery means that the patient needs to have surgery. An urgent surgery is one which the patient required prompt attention.
A gunshot wound would be classified under which category of surgery based on urgency? Urgent Elective Required Emergent
Emergent Emergent surgery occurs when the patient requires immediate attention. An elective surgery is classified as a surgery that the patient should have. A required surgery means that the patient needs to have surgery. An urgent surgery is one which the patient required prompt attention.
You are admitting an insulin-dependent patient to the same-day surgical suite for carpal tunnel surgery. You know that this patient may be at risk for which metabolic disorder? Hyperglycemia Thyrotoxicosis Impaired acid base balance Adrenal insufficiency
Hyperglycemia The patient with diabetes who is undergoing surgery is at risk for hypoglycemia and hyperglycemia. Hyperglycemia during the surgical procedure is a risk based on the body's defense mechanism to raise the blood sugar in the event of stress. Patients who have received corticosteroids are at risk of adrenal insufficiency. Patients with uncontrolled thyroid disorders are at risk for thyrotoxicosis. Because the kidneys are involved in excreting anesthetic medications and their metabolites and because acid-base status and metabolism are also important considerations in anesthesia administration, surgery is contraindicated when a patient has acute nephritis, acute renal insufficiency with oliguria or anuria, or other renal problems.
A patient with uncontrolled diabetes is scheduled for a surgical procedure. What chief life-threatening hazard should the nurse monitor for? Hypoglycemia Glucosuria Hypertension Dehydration
Hypoglycemia The patient with diabetes who is undergoing surgery is at risk for both hypoglycemia and hyperglycemia. Hypoglycemia may develop during anesthesia or postoperatively from inadequate carbohydrates or excessive administration of insulin. Hyperglycemia, which can increase the risk of surgical wound infection, may result from the stress of surgery, which can trigger increased levels of catecholamine. Other risks are acidosis and glucosuria, but hypoglycemia is a bigger risk. Dehydration is a lesser risk for a patient with diabetes than is hypoglycemia.
An anxious client being prepared for surgery is encouraged to concentrate on a pleasant experience or restful scene. What cognitive coping strategy would the nurse document as being used? Imagery Optimistic self-recitation Progressive muscular relaxation Distraction
Imagery Imagery has proven effective for anxiety in surgical clients. Optimistic self-recitation is practiced when the client recites optimistic thoughts such as, "I know all will go well." Distraction is used when the client is encouraged to think of an enjoyable story or recite a favorite poem. Progressive muscular relaxation requires contracting and relaxing muscle groups and is a physical coping strategy as opposed to a cognitive strategy.
An elderly client is preparing to undergo surgery. The nurse participates in preoperative care knowing that which of the following is the underlying principle that guides preoperative assessment, surgical care, and postoperative care for older adults? Older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients. Neurologic and musculoskeletal complications are the leading cause of postoperative morbidity and mortality for older adults. All older people face similar risks when undergoing surgeries. Aging processes reduce the chances that surgery will be successful for these clients.
Older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients. The underlying principle that guides preoperative assessment, surgical care, and postoperative care is that elderly clients have less physiologic reserve (the ability of an organ to return to normal after a disturbance in its equilibrium) than younger clients. The hazards of surgery for the elderly are proportional to the number and severity of coexisting health problems and the nature and duration of the operative procedure. Respiratory and cardiac complications are the leading causes of postoperative morbidity and mortality in older adults.
A client is scheduled for a cholecystectomy. Which finding by the nurse is least likely to contribute to surgical complications? Urinary tract infection Diabetes Osteoporosis Pregnancy
Osteoporosis Osteoporosis is likely not going to contribute to complications related to a cholecystectomy. Pregnancy decreases maternal reserves. Diabetes increases wound-healing problems and risks for infection. Urinary tract infection decreases the immune system's effectiveness, increasing the chance for infections.
The nurse recognizes that written informed consent is required for insertion of a(n): Urinary catheter. Nasogastric tube. Peripherally-inserted central catheter. Oral airway.
Peripherally-inserted central catheter. Nonsurgical invasive procedures, such as insertion of a peripherally-inserted central catheter, that carry more than a slight risk to the client require written informed consent.
Which health care profession has the ultimate responsibility to provide appropriate information regarding a nonemergent surgery? Certified nurse's aide Case manager Physician Nurse
Physician It is the physician's responsibility to provide appropriate information. It is not the responsibility of the nurse, case manager, or certified nurse's aide to gain informed consent.
You are physically preparing a client for surgery and instruct the person to remove any jewelry. The client refuses to remove a wedding band. What should you do in this situation with approval from your facility? Medicate the client and then remove the ring. Explain that the client cannot go into the operating room with jewelry on. Place gauze under and over the ring and apply adhesive tape over it. Tell the physician and anesthesiologist.
Place gauze under and over the ring and apply adhesive tape over it. If the client is reluctant to remove a wedding band, the nurse may slip gauze under the ring, then loop the gauze around the finger and wrist or apply adhesive tape over a plain wedding band. You would not tell the client that he or she cannot go to the operating room wearing the ring. You would never medicate the client and then remove the ring against his or her will. It is not necessary to tell the physician and the anesthesiologist that the client does not want to remove the wedding band.
When is the ideal time to discuss preoperative teaching Prior to entering the pre-op area When the patient is comfortable and sedated Preadmission visit Day of surgery
Preadmission visit The ideal timing for preoperative teaching is not on the day of surgery but during the preadmission visit, when diagnostic tests are performed. Teaching should be done long before the patient enters the preop area. Preoperative teaching should not be done when the patient is sedated.
A nurse is witnessing a client sign the consent form for surgery. After signing the consent form, the client starts asking questions regarding the risks and benefits of a surgical procedure. What action by the nurse is most appropriate? Place the consent form in the client's medical record. Request that the surgeon come and answer the questions. Notify the nurse manager of the client's questions. Answer the client's questions.
Request that the surgeon come and answer the questions. It is the physician's responsibility to provide information pertaining to risks and benefits of surgery. It is not the responsibility of the nurse or nurse manager to discuss risks and benefits. The consent form should not be placed in the medical record until all of the client's questions are answered fully.
Once the operating team has assembled in the room, the circulating nurse calls for a "time out." What action should the nurse take during the time out? Ensure that sufficient surgical supplies are available. Confirm that informed consent has been obtained. Review the scheduled procedure, site, and client. Check that all surgical personnel are properly attired.
Review the scheduled procedure, site, and client. According to the 2016 National Patient Safety Goals, accurate identification of the client, procedure, and operative site is essential.
A 79-year-old man is scheduled for surgical repair of an inguinal hernia. In light of this patient's age, the nurse will prioritize nursing interventions aimed at preventing: Skin breakdown Early ambulation Hyperglycemia or hypoglycemia Overstimulation
Skin breakdown Skin breakdown is an important nursing consideration when providing care for all surgical patients. However, older adults face an increased risk of this problem due to age-related changes to the integumentary system. Age alone does not create a heightened risk of hyperglycemia or hypoglycemia. Overstimulation should generally be avoided but this is not directly related to age. Early ambulation is beneficial for patients of all ages.
A client is undergoing thoracic surgery. What priority education should the nurse provide to assist in preventing respiratory complications? Deep breathing and coughing exercises may be used as relaxation techniques. Deep breathing and coughing exercises should be completed every 8 hours. Splint the incision site using a pillow during deep breathing and coughing exercises. Pain medication should be taken before completing deep breathing and coughing exercises.
Splint the incision site using a pillow during deep breathing and coughing exercises. Splinting the incision site will help decrease pain and support the incision. This will increase compliance with the deep breathing and coughing exercises that assist in preventing respiratory complications. Pain medication should be taken regularly, not only before deep breathing and coughing exercises. Deep breathing and coughing exercises should be done at least every 2 hours, more frequently if possible. While some clients will find the exercises relaxing, most clients find it painful to complete them.
A nurse is teaching a client about diaphragmatic breathing. What client action indicates that further teaching is needed? The client places the hands on the lower chest to feel the rise and fall with breathing. The client breathes in deeply through the nose and mouth. The client exhales forcefully with a short expiration. The client performs diaphragmatic breathing in a semi-Fowler's position.
The client exhales forcefully with a short expiration. Diaphragmatic breathing should be performed gently and fully. Placing the hands on the lower chest to feel the rise and fall with breathing, performing diaphragmatic breathing in a semi-Fowler's position, and breathing deeply through the nose and mouth are all aspects of diaphragmatic breathing.
The nurse is educating a community group about types of surgery. A member of the group asks the nurse to describe a type of surgery that is curative. What response by the nurse is true? Placement of gastrostomy tube Tumor excision A biopsy A face-lift
Tumor excision An example of a curative surgical procedure is tumor excision. A biopsy, a face-lift, and the placement of a gastrostomy tube are not examples of curative surgical procedures.
Following diagnostic testing, a patient requires a cholecystectomy. This surgical procedure would be categorized as which of the following? Required Urgent Elective Emergent
Urgent Acute gallbladder infection would be categorized as an urgent surgery. Emergent surgeries include severe bleeding, bladder or intestinal obstruction, and a fractured skull. Required surgeries include thyroid disorders and cataracts. Elective surgeries include repair of scars, simple hernia, and vaginal repair.
A client is preparing for a surgical procedure is taking corticosteroids for Crohn's disease. What is most important for the nurse to monitor during the operative experience with the client? obstruction surgical site infection hypoglycemia adrenal insufficiency
adrenal insufficiency Clients who have received corticosteroids are at risk for adrenal insufficiency. They are not at greater risk for obstruction, infection, or hypoglycemia during the operative experience.
A 17-year-old client is having same-day surgery. Solely during the intraoperative phase of perioperative care, the nurse: obtains a surgical consent from the client's mother. continuously monitors the sedated client. assesses how well the client is recovering from anesthesia. performs a complete assessment of the client.
continuously monitors the sedated client. Intraoperative care includes the entire surgical procedure. During sedation, the nurse continuously evaluates the client. Assessment of heart rate, respiratory rate, BP, oxygen saturation, and level of consciousness occurs during all phases of perioperative care. Obtaining consent would occur during the preoperative phase of perioperative care. During the postoperative phase the nurse would assess how the client is recovering from anesthesia.
In advance of a client's scheduled appendectomy, the nurse spends significant time explaining to the client what will happen, both before the procedure and after the procedure is complete. The primary reason the nurse puts so much effort into preoperative teaching is to: increase the likelihood of a successful recovery. absolve the hospital of legal responsibility should complications arise. decrease the client's participation and allow the family to take on the caregiver role. minimize the time that will need to be spent on postoperative questions.
increase the likelihood of a successful recovery. Teaching clients about their surgical procedure and expectations before and after surgery is best done during the preoperative period. Clients and family members can better participate in recovery if they know what to expect. Although preoperative teaching may minimize the time spent postoperatively on questions and help nurses improve their teaching skills, these are not the primary reasons for spending significant preoperative time on teaching. Clients must participate in their recovery process. Education encourages clients to participate in their own care in addition to giving important information to family. Absolving the hospital of legal responsibility would not be a primary nursing goal.
The nurse assesses a client to determine if there is increased risk for complications intraoperatively or postoperatively. Which are general risk factors? Select all that apply. physical condition Ethnicity nutritional status health status age gender
nutritional status age physical condition health status General surgical risk factors are related to age; nutritional status; use of alcohol, tobacco, and other substances; and physical condition.
A perioperative nurse is assigned to complete a preoperative assessment on a client who is scheduled for surgery for kidney stones the next day. What category of surgery does this procedure fall into? emergent elective urgent required
urgent Surgery for kidney or urethral stones is considered urgent; it is usually performed the next day. Emergent surgery is performed without delay. Required surgery is performed within a few weeks or months. Elective surgery refers to procedures that the client plans in advance.
A nurse is assessing a postoperative client with hyperglycemic blood glucose levels. Which client surgical risk factor would decrease if the surgical client maintained strict blood glycemic control? nutrient deficiencies respiratory complications wound healing liver dysfunction
wound healing In caring for a postoperative client, the nurse is correct to correlate hyperglycemia with an increased risk of surgical incision infections and delayed wound healing. Strict control of glycemic blood levels at the therapeutic range of 80-110 mg/dL would reduce this risk factor. There is no direct correlation between blood glucose levels and nutrient deficiencies, respiratory complications, or liver dysfunction.
