Exam #1 - Perioperative

Type of surgery done to determine cause of illness and/or make confirm a diagnosis:

Diagnostic

The nurse is monitoring the patient who is 24 hours post-opt from surgery. Which finding requires intervention?

24-hour urine output of 300 ml; The nurse needs to watch the patient's urinary output closely. Urinary output within a 24-hour period should be at least 30 ml/hr. In this case, the patient is only urinating 12.5 ml/hr.

The nurse is preparing to discharge a client from the PACU using a PACU room scoring guide. With what score can the client be transferred out of the recovery room?

7

What type of surgeries are pre-planned? Delay of surgery has no ill-effects. These can be scheduled in advance based on the client's choice. Examples: tonsillectomy, hernia repair, cataract extraction, mammoplasty, face lift, and cesarean section.

Elective

What type of surgeries must be done immediately to preserve the client's life, body part of body function. Examples: Control of hemorrhage, perforated ulcer, intestinal obstruction, repair of trauma, tracheostomy

Emergent

A patient reports he hasn't had a bowel movement or passed gas since surgery. On assessment, you note the abdomen is distended and no bowel sounds are noted in the four quadrants. You notify the MD. What non-invasive nursing interventions can you perform without a MD order:

Encourage ambulation, maintain NPO status, and monitor intake & output; This patient is most likely experiencing a paralytic ileus which is failure for the bowels to move its contents

After surgery your patient starts to shiver uncontrollably. What nursing intervention would you do FIRST?

Apply warm blankets & continue oxygen as prescribed ; Shivering is an early sign that the patient is starting to experience hypothermia. Immediately, the nurse would need to control the shivering by applying warm blankets and continue oxygen. When the patient starts to experience hypothermia, vital organs are not receiving as much oxygenated blood due to the vasoconstriction. Therefore, oxygen would need to be continued. Then the nurse would take the patient's temperature.

Which stage of anesthesia is referred to as surgical anesthesia?

Stage I is beginning anesthesia, where the client breathes in the anesthetic mixture and experiences warmth, dizziness, and a feeling of detachment. Stage II is the excitement stage, which may be characterized by struggling, singing, laughing, or crying. Stage III may be maintained for hours with proper administration of the anesthetic. Stage IV is a state of medullary depression and is reached when too much anesthesia has been administered.

A nurse is caring for a client who is three hours post op from open abdominal surgery. During routine assessment, the nurse notes the previously stable client now appears anxious, apprehensive, and has a blood pressure of 90/56. What does the nurse consider is the most likely cause of the client's change in condition?

The client is displaying early signs of shock

What kind of surgeries are necessary for the client's health, usually done within 24 to 48 hours. Examples: Removal of gallbladder, amputation, colon resection, coronary artery bypass, surgical removal of tumor

Urgent

What labs are drawn prior to surgery?

CBC, Liver/Kidney function, urinalysis, (ABGs), electrolytes; thyroid, nutritional studies, electrocardiogram (ECG), BUN (blood urea nitrogen), glucose,

Type of surgery performed to remove a diseased part or organ. Examples include: gastrectomy (partial or full removal of stomach), thyroidectomy, and appendectomy:

Ablative/Curative

You are completing the history of a patient who is scheduled to have surgery. What health history increases the risk for surgery for the patient?

Abuse of street drugs; can interact with other meds given during surgery

When assessing your patient who is post-opt, you notice that the patient's right calf vein feels hard, cord-like, and is tender to the touch. The patient reports it is aching and painful. What would NOT be an appropriate nursing intervention for this patient?

Allow the patient to dangle the legs to help increase circulation and alleviate pain; The patient should NOT dangle the legs because this causes blood to pool in the lower extremities which will put the patient at risk for another blood clot formation.

When does the preoperative phase begin?

Begins when the decision for surgical intervention is made and ends when the patient is transferred from the operating room.

When does the intraoperative phase begin?

Begins when the patient is admitted or transferred to the surgery department and ends when he or she is admitted to the recovery area.

When does the postoperative phase begin?

Begins with the admission of the patient to the recovery area and ends with a follow-up evaluation in the clinical setting or at home.

As the nurse you are getting the patient ready for surgery. You are completing the preoperative checklist. Which of the following is not part of the preoperative checklist?

Conducting the Time Out; the time out is conducted by the OR nurse prior to surgery

Type of surgery used to improve physical features that are within normal range. Example: breast augmentation:

Cosmetic

Type of surgery used to estimate the extent of the disease or confirmation of diagnosis. Examples: laparotomy, pelvic laparotomy:

Exploratory

What is a potential postoperative concern regarding a patient who has already resumed a solid diet?

Failure to pass stool within 48 hours of eating solid foods

A patient is now in the recovery room after having vaginal surgery. Due to the positioning of the procedure, you would want to assess for what while the patient is in recovery:

Homan's Sign; Vaginal surgeries require the patient to be in the lithotomy position. This position can put the patient at risk for a deep vein thrombosis. Therefore, the nurse would want to check for this by using Homan's sign.

A patient is recovering from surgery. The patient is very restless, heart rate is 120 bpm and blood pressure is 70/53, skin is cool/clammy. As the nurse you would?

Notify the MD as this is an emergency situation and the pt is probably experiencing hemorrhage

Type of surgery performed to relieve symptoms without curing the disease. These include: colostomy, debridement of necrotic tissue

Palliative

On postoperative day 2, a client requires care for a surgical wound using second-intention healing. What type of dressing change should the nurse anticipate doing?

Postoperative surgical wounds that are allowed to heal using second-intention healing are usually packed with a sterile saline-soaked dressing and covered with a dry dressing.

A patient is 6 days post-op from abdominal surgery. The patient is to be discharged later today. The patient uses the call light and asks you to come to his room and look at his surgical site. On arrival, you see that approximately 2 inches of internal organs are protruding through the incision. What intervention would you NOT do?

Put the patient in a prone position with knees extended to put pressure on the site; The patient is experiencing wound evisceration. This is an emergent situation. The patient should be placed in low Fowler's position with the knees bent to prevent abdominal tension.

Type of surgery done to restore function to traumatized or malfunctioning tissue and to improve self concept and include skin graft, plastic surgery, scar revisions:

Reconstructive

A nurse is developing a care plan for a patient who is at risk for developing pneumonia after surgery. Which of the following is not an appropriate nursing intervention?

Repositioning every 3-4 hours; should be repositioned every 1-2 hrs.

Which method of wound healing is one in which wound edges are not surgically approximated and integumentary continuity is restored by granulation?

Second-intention healing

After surgery your patient is semicomatose with vital signs within normal limits. As the nurse, what position would be best for this patient?

Side positioning preferably on the left side to limit aspiration risk and help promote cardiovascular circulation.

Which of the following positions would the nurse expect the client to be positioned on the operating table for renal surgery?

Sim's position

A patient is taking Aspirin 325 mg PO by mouth daily. The patient is scheduled for surgery in a week. What education do you provide the patient with before surgery?

The medication should be discontinued for 48 hours prior to the scheduled surgery date; Aspirin alters the normal clotting factors and increases the patient's chances of hemorrhaging

As a nurse, which statement is incorrect regarding an informed consent signed by a patient?

The nurse is responsible for obtaining the consent for surgery; it is the surgeon's responsibility, not the nurse.

You are observing your patient use the incentive spirometry. What demonstration by the patient lets you know the patient understands how to use the device properly?

The patient inhales slowly on the device and maintains the flow indicator between 600 to 900 level

Which method of healing is one in which surgical approximation of wound edges is delayed and integumentary continuity is restored by bringing opposing granulations together.

Third intention healing

Type of surgery used to replace organs or structures that are diseased or malfunctioning:

Transplant