Nursing Care of the Peri-Operative Patient

Arterial blood gases Rationale: According to the ABC priority-setting framework, the postoperative surgical client may need supplemental oxygen in order to maintain normal blood oxygen levels. The effectiveness of oxygenation is monitored using pulse oximetry and arterial blood gases.

A nurse in the post-anesthesia care unit is caring for a client who is postoperative following a thoracotomy and lobectomy. Which of the following postoperative assessments should the nurse give highest priority to? Arterial blood gases Urinary output Chest tube drainage Pain level

Cover the wound with a moist, sterile gauze dressing. Rationale: The client's wound has dehisced, or opened along the suture line, and is now draining. The primary clinical objective in managing a dehisced wound is to keep it clean and moist, and manage any exudate. The nurse's priority action therefore is to cover the wound with a moist, sterile, saline-soaked gauze dressing.

A nurse is assessing a client who has had staples removed from an abdominal wound postoperatively. The nurse notes separation of the wound edges with copious light-brown serous drainage. Which of the following actions should the nurse perform first? Check the client's vital signs. Assess the client's pain level. Obtain a culture and sensitivity of the wound drainage. Cover the wound with a moist, sterile gauze dressing.

Document the findings in the client's medical record. Rationale: Whenever a nurse collects data from a client, documentation is essential. However, in this case, all these findings are expectations for a client who is preoperative, so there is no need for the nurse to take any action other than documenting.

A nurse is assessing a client who will undergo abdominal surgery in 2 hr. The client reports being nervous about the surgery, last had food and fluids at 2330 the previous evening, and signed the surgical consent 2 days ago. Which of the following is an appropriate nursing action regarding these findings? Call the anesthesiologist to sedate the client. Notify the surgeon of the client's food and fluid consumption. Witness the surgical consent. Document the findings in the client's medical record.

Headache Rationale: When spinal fluid is lost through a leak at the puncture site around the spinal column, a severe headache can occur, which may last several days. This finding is a complication of the anesthesia.

A nurse is caring for a client immediately following a procedure that required spinal anesthesia. Which of the following findings indicates the client is experiencing a complication of the anesthesia? Hiccoughs Numbness in the legs Headache Absence of urge to void

Instruct the client about the use of a sequential compression device. Rationale: The nurse should instruct the client about the use of a sequential compression device to prevent deep-vein thrombosis, a postoperative complication.

A nurse is providing preoperative teaching for a client who is scheduled for a gastrectomy. Which of the following information regarding prevention of postoperative complications should the nurse include in in the teaching? Teach the client how to use the PCA pump. Discuss the visitation policy. Instruct the client about the use of a sequential compression device. Review the pain scale.

WBC count 20,000/mm3 Rationale: This result exceeds the expected reference range for WBC of 5,000 to 10,000/mm3. The client's elevated WBC count indicates infection. The nurse should notify the surgeon.

A nurse is reviewing the diagnostic test results of an older adult female client who is preoperative for a knee arthroplasty. The nurse should notify the surgeon of which of the following results? WBC count 20,000/mm3 Hematocrit 40% Creatinine 0.9 mg/dL Potassium 3.8 mEq/L

"I'll splint my incision with a pillow to cough." Rationale: The client should use a pillow to splint the incision to reduce the pain and discomfort of coughing.

A nurse is teaching a client who is preoperative how to do deep-breathing exercises and cough effectively after surgery. Which of the following statements by the client indicates an understanding of the teaching? "I'll splint my incision with a pillow to cough." "I'll ask for pain medication after I do the exercises." "I'll use the incentive spirometer when I can get out of bed." "I'll breathe deeply and cough every 4 hours."

local anesthesia

Block nerves in peripheral and central nervous system Degree of blockade determined by drug concentration & volume Regional: Spinal, epidural, & peripheral nerve blocks Considered worn off when all 3 systems no longer affected Headache common symptom with spinal

Monitored Anesthesia Care (MAC)

Implies the potential for deeper level of sedation Administered by Anesthesiologist

Malignant hyperthermia

Look out for hypercarbia, sinus tachycardia, rapidly ↑ temp Immediately discontinue anesthesia, provide 100% oxygen & administer dantrolene sodium IV Active cooling

moderate sedation/analgesia

Previously referred to as "conscious sedation" Reduce patient anxiety and control pain Allows for patient to respond to verbal & physical stimuli

informed consent

Voluntary and written informed consent is required for all non-emergency surgeries Ensure the patient or patient's representative is provided all of the information needed to evaluate the proposed surgery before agreeing to it

dantrolene sodium IV

given in malignant hypertonic state, will cool them down - helps relax muscles: when muscles are tight and tense it relaxes those

Phase 1 of postoperative care

immediate recovery phase & intensive nursing care provided

intravenous administration

often used in combination with inhaled; used to achieve lighter sedation

phase 2 of postoperative care

patient is prepared for self care or care in the hospital, or discharge

NPO

prevents aspiration preoperatively; many healthy patients are allowed clear liquids 2-3 hours before surgery

enema and antibiotics

two things given for abdominal or pelvic procedures

surgeon

who is responsible for obtaining informed consent?