Ch 17: Preop

- elective - urgent - emergent

3 levels of urgency to surgery are:

- diagnostic: determines origin and cause of disorder - curative: resolves health problem by repairing/removing cause - restorative: improves patient's functional ability - palliative: relieves symptoms of disease, but does not cure - cosmetic: alters or enhances personal appearance

5 reasons for surgery?

during the preoperative period

At which time does the nurse realize that it is best to begin teaching about care needed during the postoperative period?

gastrostomy tube

The nurse expects informed consent to be obtained for insertion of:

preadmission visit

When is the ideal time to discuss preoperative teaching

physician

Which health care profession has the ultimate responsibility to provide appropriate information regarding a nonemergent surgery?

preoperative period

begins when patient is scheduled for surgery; ends at time of transfer to surgical suite for surgery

- anxiolytics (reduce anxiety) - sedatives, hypnotics (promote relaxation) - anticholinergic agents (reduce nasal and oral secretions) - lidocaine, muscle relaxants (prevent laryngospasm) - atropine (reduce vagal-induced bradycardia) - H2 histamine blockers (inhibit gastric secretion) - opioids (decrease amount of anesthetic needed for induction and maintenance of anesthesia)

preoperative medications and their purpose?

- knowledge deficit related to unfamiliarity with surgical procedures and preparation - anxiety related to new or unknown experience, possibility of pain and possible surgical outcomes

priority nursing diagnoses for preoperative patients are:

informed consent

surgeon obtains signed consent before sedation and/or surgery - RN has role of patient advocate, clarifies facts and dispels myths about surgery - if knowledge deficit identified, redirect to surgeon

continuously monitors the sedated client

A 17-year-old client is having same-day surgery. Solely during the intraoperative phase of perioperative care, the nurse:

7-10 days

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?

- the client will leave the hospital sooner than in the past - need for teaching is increased - the client must be prepared to take on more self-care than he or she may have done in the past

A client is being prepared for a same-day surgical procedure and is discussing with the nurse what potential ramifications this type of surgery has. Which of the following would the nurse correctly identify? Select all that apply.

adrenal insufficiency

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?

allow the client to wear the ring and cover it with tape

A client refuses to remove her wedding band when preparing for surgery. What is the best action for the nurse to take?

an open reduction of a fracture

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?

adrenal

Clients who have received corticosteroids preoperatively are at risk for which type of insufficiency?

surgeon

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?

post-discharge diet

The nurse is caring for a client needing emergency surgery. Which preoperative teaching is least important to prepare the client for surgery?

tumor excision

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?

medication elimination care of glasses

The nurse is physically preparing a client for surgery. What immediate pre-operative concerns would the nurse address before the client is taken to the operating room? Select all that apply.

"Leg exercises help prevent blood clots in your legs."

The nurse is teaching leg exercises to the client preoperatively. The client asks why the exercises are important. The best response by the nurse is:

1-2 months

The physician schedules an elective surgical procedure for a patient who smokes cigarettes. When should the nurse recommend that the patient cease smoking before the surgical procedure to minimize risks associate with cigarette smoking?

educating clients on signs and symptoms of infection

What action by the nurse best encompasses the preoperative phase?

80-110 mg/dL

What is the blood glucose level goal for a diabetic client who will be having a surgical procedure?

on the second or third day

When caring for a patient with alcoholism, when should the nurse assess for symptoms of alcoholic withdrawal?

client's ambulatory aids

Which is the least important issue concerning safety for the perioperative team before proceeding to the operating room?

"When is the last time you ate or drank?"

Which question is most important for the nurse to ask the client when obtaining the preoperative admission history?

anxious clients have a poor response to surgery and are prone to complications

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?

expected outcomes include: - patient states understanding of the informed consent and preoperative procedures - patient demonstrates postoperative exercises and techniques for prevention of complications - verbalizes reduced anxiety

evaluation for preop:

- UA - type and screen - CBC (hemoglobin, hematocrit, WBC) - coags (PT, INR, aPTT) - lytes (Na, K, Cl) - serum creatinine and BUN - preg test - chest x-ray - EKG

laboratory assessments prior to surgery?

a history of diabetes

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?

notify the surgeon

A client is undergoing preoperative assessment. During admission paperwork, the client reports having enjoyed a hearty breakfast this morning to be ready for the procedure. What is the nurse's next action?

splint the incision site using a pillow during deep breathing and coughing exercises

A client is undergoing thoracic surgery. What priority education should the nurse provide to assist in preventing respiratory complications?

emergent

A fractured skull would be classified under which category of surgery based on urgency?

diuretics

A nurse evaluates the potential effects of a client's medication therapies before surgery. Which drug classification may cause respiratory depression from an associated electrolyte imbalance during anesthesia?

wound healing

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?

the client exhales forcefully with a short expiration

A nurse is teaching a client about diaphragmatic breathing. What client action indicates that further teaching is needed?

use diaphragmatic breathing (belly breathing)

A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching?

a blood urea nitrogen level of 42 mg/dL

A patient with renal failure is scheduled for a surgical procedure. When would surgery be contraindicated for this patient due to laboratory results?

hypoglycemia

A patient with uncontrolled diabetes is scheduled for a surgical procedure. What chief life-threatening hazard should the nurse monitor for?

urgent

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?

older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients

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?

- the patient avoids communication with the nurse - the patient repeatedly asks questions that have previously been answered - the patient talks incessantly

How does the nurse determine that the patient may have hidden fears about the impending surgical procedure? (Select all that apply.)

allow the client to wear dentures

In preparing the client for transfer to the operating room, which of the following actions by the nurse is inappropriate?

- is the patient using any herbal supplements? - previous surgical history? issues with anesthesia? - obtain baseline vital signs, neurological and musculoskeletal status - focused assessment on problem areas identified in history and all body systems affected by surgical procedure - smoking increases carboxyhemoglobin blood level which decreases O2 delivery - kidney impairment prolongs or inhibits excretion of drugs - NPO status 6-8 hrs before surgery

important things to note/inquire about during preop assessment?

- leg exercises - mobility - sequential compression device (SCD)

methods to prevent cardiovascular complications such as venous thrombosis emboli:

- breathing exercises - incentive spirometry - coughing and splinting (holding incision)

methods to prevent respiratory complications such as atelectasis and pneumonia:

- provide information, educate - ensure informed consent and patient's understanding - implement dietary restrictions - minimize anxiety & reassure

planning and implementation for preop:

decreased - cardiac output, peripheral circulation - vital capacity, blood oxygenation - blood flow to kidneys, glomerular filtration rate increased: - blood pressure - risk for skin damage, infection - sensory deficits - deformities related to osteoporosis/arthritis

surgical risk factors for older adults?