Perioperative Prep-U

The nurse is teaching a client who will undergo abdominal surgery to repair a hernia about leg exercises. When the client asks, "Why am I practicing leg exercises when I'm having hernia surgery?" what is the appropriate nursing response?

"Doing this reduces your risk of developing blood clots." Leg exercises help to promote circulation and reduce the risk for formation of a thrombus in the veins. Leg exercises do not help with pain control, facilitate quicker healing, or reduce the risk for respiratory complications.

The nurse is teaching a client who will undergo abdominal surgery to repair a hernia about deep breathing. The client asks, "Why am I practicing breathing when I'm having hernia surgery." What is the appropriate nursing response?

"It decreases the postoperative risk for respiratory complications." Rationale: Deep breathing after surgery reduces the risk for development of postoperative respiratory complications. It does not help with pain control, facilitate quicker healing, or reduce the risk for blood clots.

A postoperative client states "I don't understand why you are checking my skin on my back. My surgery was on my stomach." What is the nurse's best response?

"The operating table is a firm surface; we need to be sure your skin looks okay."

A client who is in the holding area awaiting knee replacement surgery tells the nurse, "I am afraid of getting HIV if I have to have a blood transfusion during this surgery." What is the appropriate nursing response?

"The risk of acquiring a blood-borne disease from a blood transfusion is very small."

The nurse enters a postoperative client's room and finds that the client is bleeding profusely from the surgical incision. What would be the nurse's most appropriate initial response?

Apply pressure to the surgical site to decrease bleeding. Rationale: It is essential that the nurse be prepared to address life-threatening needs of the client. Excessive bleeding is a life-threatening issue.

A group of nursing students is reviewing information about the effects of surgery on thermoregulation. The students demonstrate understanding of the information when they identify which factors as contributing to the client's risk for hypothermia? Select all that apply.

Blood loss resulting from the surgery Decreased ambient temperature of operating room Body surface area exposure Rationale: Normally, body temperature is maintained without difficulty. During surgery, a number of factors, including decreased ambient temperature in the operating room, vasodilation secondary to the use of certain anesthetic agents, blood loss, intravenous (IV) fluid administration, exposure of body surface area, cool skin preparation solutions, and decreased consciousness, can lead to hypothermia. Positive family history is a risk factor for developing malignant hyperthermia.

The nurse is assessing clients for postoperative complications. What is the most commonly assessed postanesthesia recovery emergency?

Respiratory obstruction Respiratory obstruction may occur as a result of secretion accumulation, obstruction by the tongue, laryngospasm (a sudden, violent contraction of the vocal cords), or laryngeal edema.

A nurse is reinforcing wound edges and applying a blinder to the separated incisions of a client after a surgery. Which postoperative complication has the client developed?

dehiscence

A nurse is caring for a client who is admitted to the health care facility for surgery. Which activities take place before inpatient surgery?

prior laboratory tests diagnostic tests meet anesthesiologist

Following a successful coronary artery bypass graft (CABG), a 71-year-old male client has been transferred to the postanesthesia care unit (PACU). What is the priority for the client's nursing care during this stage of his recovery?

protecting and maintaining the client's airway

A nurse from the ambulatory surgical center is preparing discharge instructions for a client who has had pelvic surgery. Which criterion would the client need to demonstrate to ensure that she is ready for discharge?

void normally Rationale: Before discharge from an ambulatory surgical unit, the client should be able to void normally after a pelvic surgery. It is natural for the client to experience pain after surgery; however, the client should also have the comfort level to control it. The client may not be in a position to eliminate nausea and vomiting completely before discharge, but should suffer minimally from them. The client may have some bleeding or drainage, which should not be excessive at the time of discharge from an ambulatory surgical unit.

What is the nurse's role in the informed consent process for a surgical procedure?

witnessing the signed informed consent document

The nurse is educating a client who is preparing for abdominal surgery tomorrow. A teaching demonstration has just been completed by the nurse related to splinting the incision site with a pillow. Which statement by the client best indicates the instructions provided by the nurse were effective?

"I will put the pillow on the incision then cough." Splinting the incision site when moving helps to minimize pain or discomfort postoperatively when coughing or moving. Clients should not hold their breath when trying to cough or move to prevent the Valsalva maneuver, which can change the heart rate and blood pressure of a client. Placing the pillow on the incision site after coughing is ineffective at reducing pain. The pillow should remain over the incision until the coughing exercises are completed.

A nurse is preparing a client for discharge from the ambulatory surgical center. Which client statement would indicate a problem with the client's discharge?

"I'm going to take a taxi home." Rationale: When a person is being discharged from an ambulatory surgical center, a responsible person should be available to accompany the client home

The nurse has entered the room of a client who is postoperative day 1 and finds the client grimacing and guarding her incision. The client refuses the nurse's offer of p.r.n. analgesia and, on discussion, states that this refusal is motivated by his fear of becoming addicted to pain medications. How should the nurse respond to the client's concerns?

"Research has shown that there is very little risk of patients becoming addicted to painkillers after they have surgery."

A nurse is preparing to receive a client in post-anesthesia care unit (PACU). The client is diabetic and has undergone knee surgery. Which information would be most important for the receiving nurse to obtain to develop an appropriate plan of care for this client?

Amount of blood loss To plan care effectively in the postoperative period, the nurse needs to know about the amount of blood lost during the surgery, the type of surgery that was performed on the client, and whether there were any surgical or anesthetic complications. Information on chronic disease history and allergy history are done in the preoperative period, not in the postoperative period. Information on the environment in the operation room is checked by the circulatory nurse during the intraoperative care plan; it is not associated with the postoperative care plan.

A nurse is preparing a postoperative client to get out of bed and move to a chair for the first time. As the nurse assists the client in standing up, the client reports dizziness and becomes pale and diaphoretic. What would be most appropriate for the nurse to do?

Assist the client back into the bed. If a client reports dizziness or feels diaphoretic when ambulating, the client should return to bed to prevent injury. The change in position may be causing the client's blood pressure to drop. Therefore, the bed is the safest place for the client.

A postoperative client is experiencing decreased lung sounds, dyspnea, cyanosis, crackles, restlessness, and apprehension. Which condition would the nurse suspect?

Atelectasis Pneumonia signs and symptoms include a productive cough, fever and chills. Pulmonary embolus include dyspnea, chest pain, cough, cyanosis, rapid respirations, tachycardia, and anxiety. Thrombophlebitis manifests with signs and symptoms that include redness, swelling, and pain in the affected area.

The nurse is preparing to send a client to the operating room for an exploratory laparoscopy. The nurse recognizes that there is no informed consent for the procedure on the client's chart. The nurse informs the physician who is performing the procedure. The physician asks the nurse to obtain the informed consent signature from the client. What is the nurse's best action to the physician's request?

Inform the physician that it is their responsibility to obtain the signature.

A nurse is dressing the wound of a client who is admitted to the outpatient surgical unit. What is a major advantage of outpatient surgery?

It interferes less with the client's daily routine.

A client had an open cholecystectomy (gallbladder removal) 36 hours earlier, and the nurse's assessment this morning confirms that the client has not yet had a bowel movement since prior to surgery. How should the nurse best respond to this assessment finding?

Monitor the client closely and promote fluid intake. Rationale: Bowel function does not typically return immediately after surgery, but it can be promoted by encouraging fluid and fiber intake as appropriate to the client and his surgery. A medical assessment is likely unnecessary at this early postoperative stage and an enema would likely be premature. The nurse may not independently increase the client's IV infusion, and doing so would not necessarily promote a bowel movement.

A nurse is caring for an inpatient client scheduled to undergo a surgery for the removal of a malignant tumor. What risk factors does the nurse identify that increase the occurrence of perioperative complications? Select all that apply.

Obesity, bleeding tendencies, low hemoglobin, smoking, diabetes, cardiopulmonary disease, drug and alcohol use, and diabetes, increase the likelihood of perioperative complications. Raised temperature and anxiety are causes for postponing or cancelling the surgery.

A cleansing enema is prescribed for a client who is scheduled to have colon surgery. What is the rationale for this procedure?

Peristalsis does not return for 24 to 48 hours after surgery. If the client is scheduled for gastrointestinal tract surgery, a cleansing enema is usually ordered. Peristalsis does not return for 24 to 48 hours after the bowel is handled, so preoperative cleansing helps decrease postoperative constipation. Not all surgical clients routinely are given a cleansing enema. Cleansing enemas are not given before surgery per the client's request and enemas do not cause less flatus and discomfort postoperatively.

A nurse in an outpatient surgical center is educating a client on necessary items regarding discharge to home. What information should the nurse include about transportation?

The client is not allowed to drive a car home.

A nurse is caring for an older adult following hip surgery. Which serious complication would the nurse attempt to avoid by encouraging use of the incentive spirometer?

pneumonia Rationale: In the older adult client, postoperative pneumonia can be a very serious complication resulting in death. Therefore, it is especially important to encourage and assist the client in using the incentive spirometer and with deep breathing exercises.

As a circulating nurse caring for a 45-year-old man undergoing left knee arthroscopic exploratory surgery, which task ensures that the team is on the same page and will perform the procedure on the right client and at the right site?

procedural pause (time-out) The procedural pause (time-out) must be done prior to any procedure to ensure client safety and to verify the client identity, staff roles, and procedure being performed.

A nurse is reviewing the intraoperative record of a client who has been admitted to the surgical unit following abdominal surgery. The nurse notes that the client received an injection of a local anesthetic agent into the subarachnoid space. The nurse identifies this as:

spinal anesthesia.

The nurse is talking with a client who wishes to have a tattoo removed. Which client statement indicates that the client understands how the procedure will be accomplished?

"The provider will perform this laser surgery in an ambulatory care setting."

A client postoperative from an appendectomy reports feeling cold and has a temperature of 96.2°F (35.7°C). Which action should the nurse perform first?

Apply warm blankets to the client. The nurse should apply warm blankets to the client because the client is hypothermic with a temperature of 96.2°F (35.7°C). The client can be assessed further by checking vital signs and using an oxygen saturation monitor. The health care provider should be notified about the client's temperature but an intervention should be done first to ensure the client begins warming immediately.

While reviewing the medical record of a client who has had abdominal surgery, the nurse notes that the client has developed a paralytic ileus. The nurse interprets this information as indicative of what?

Bowel functioning is significantly decreased. The nurse knows that when a client has paralytic ileus, the bowel functioning decreases significantly. In some cases, intestinal peristalsis may temporarily cease altogether, but it does not become permanently paralyzed. The bowel does not become deflated, but it does become distended and partially paralyzed. Bowel sounds are usually absent.

The surgeon informs the perioperative nurse that an "urgent" surgery is to be performed for a client. Of the four listes, which surgical procedure might the client require?

Colon resection

An elder adult client underwent a hip replacement and now states to the nurse, "My parents are coming to visit me today. I need to mow the lawn and run errands." The client is trying to get out of the bed. What does the nurse identify is occurring with this client?

Delirium Delirium refers to acute confusion that is reversible. It is common in the acute postoperative period.

A nurse is assessing a client who is experiencing pulmonary embolus. What would be the priority nursing intervention for this client?

Place the client in semi-Fowler's position. Nursing interventions include notifying the physician immediately, calling the medical intervention team, maintaining the client on bed rest in the semi-Fowler's position, assessing vital signs frequently, administering oxygen, administering medications (e.g., anticoagulants, analgesics), and instructing the client to avoid Valsalva maneuver (this prevents increased intrathoracic pressure and, possibly, increased emboli).

A nurse is caring for a female client who will undergo a curative surgery for cholecystectomy. Which precaution should the nurse take before surgery to prevent venous stasis?

Recommend that the client wear antiembolism stockings. The client should wear antiembolism stockings or the client's legs should be wrapped in an elastic roller bandage before surgery to prevent venous stasis. Asking the client to wiggle the toes at regular intervals is a secondary precaution. However, enclosing the client's leg in a pneumatic splint is not correct because pneumatic splints are used to control swelling and bleeding of an injury. If the client wears dentures, some health care agencies remove them to prevent airway obstruction.

Which client in the postanesthesia care unit (PACU) requires the most immediate attention by the nurse?

a 26-year-old client who is exhibiting a crowing sound A client with a crowing sound is exhibiting stridor, which is an indication of an airway obstruction and can be a respiratory emergency. This client needs immediate attention. The client with disorientation needs to be frequently reoriented and observed for safety reasons but is not a priority over respiratory distress.

A client is undergoing surgery for an appendectomy. This would be considered what type of surgery?

emergency surgery

Which nursing intervention occurs in the postoperative phase of the surgical experience?

airway/oxygen therapy/pulse oximetry Airway/oxygen therapy/pulse oximetry occur in the postanesthesia unit in the postoperative phase. Teaching deep breathing exercises and reviewing the meaning of p.r.n. orders for medications occur in the preoperative phase. Putting in IV lines and administering fluids occurs in the intraoperative phase.

Nurses teach clients to restrict food and fluids before surgery. What condition does this measure attempt to avoid?

aspiration Food and fluid are restricted before surgery to ensure that the stomach contains a minimal amount of gastric secretions. This restriction is important to reduce the risk of aspiration.

A nurse teaches deep breathing exercises to a client scheduled for surgery. In which perioperative phase would this action occur?

before surgery Though leg exercises are begun after surgery, such preventive measures should ideally be taught to the client during the preoperative period. In the postanesthesia care areas, the client has just arrived from the operating room where local or general anesthesia has been used. The client will be sedated but arousable and teaching would be inappropriate. Early signs of venous status is too late for leg exercises to begin, as the clot may have formed.

A client with a diagnosis of breast cancer has been scheduled for a unilateral mastectomy during an axillary lymph node dissection. Which categorizations of surgical procedures are represented in this client's case? Select all that apply.

diagnostic curative

The nurse has delegated to the unlicensed assistive personnel (UAP) the application of antiembolism stockings to a client who had an endarterectomy earlier in the day. Which UAP action requires the nurse to immediately intervene?

massages legs prior to application

A nurse is employed in an operative setting. Which of these roles is within the registered nurse (RN) scope of practice?

positioning the client on the operating table counting sponges before and after surgery monitoring the client's vital signs The RN's role is a supportive one for the client, monitoring vital signs and positioning the client on the operating room table. The RN also helps maintain safety by counting sponges and instruments that may have been used during the surgery. The RN is unable to administer anesthetics, such as inhalation agents or regional nerve blocks, without an advanced practice degree.

The nurse recognizes the value of leg exercises in the prevention of postoperative thrombophlebitis. When should the nurse teach the correct technique for leg exercises to a client?

preoperative Exercises and physical activities occurring in the preoperative phase include deep breathing exercises, coughing, incentive spirometry, turning, leg exercises, and pneumatic compression stockings. The intraoperative phase is when the client is in the operating room. In the postoperative area and postanesthesia care unit areas, clients are monitored and deep breathing exercises begin.

A nurse is assessing an older adult client who has undergone major bypass surgery at the health care facility. When developing the plan of care for this client in the postoperative period, what would the nurse identify as a priority assessment in the immediate period and for the first few days after the surgery?

respiratory function Rationale: During the immediate postoperative period and for the first few days after major surgery, assessments should focus on the client's respiratory function, pain, and tissue perfusion. The bowel elimination pattern and the ability to perform self-care and ambulate after discharge are important later in the postoperative course.

A nurse is educating a client about regional anesthesia. Which statement is accurate about this type of anesthesia?

"You will be awake and will not have sensation of the procedure." Regional anesthesia occurs when an anesthetic agent is injected near a nerve or nerve pathway in or around the operative site, inhibiting the transmission of sensory stimuli to central nervous system receptors. The client remains awake but loses sensation in a specific area or region of the body. Monitored anesthesia care is when the client is asleep but may feel some pain during the procedure. Conscious sedation is when the client is awake but will not be aware of the procedure. General anesthesia is when the client is asleep and will not be aware of the procedure.

A nurse is working as part of an intraoperative team and is involved in the surgical verification process for a client. What would the nurse expect to be performed as the last step?

Complete the "time-out" procedure. The goal of the surgical verification process is to prevent avoidable errors by standardizing procedures for all surgical facilities through a universal protocol. This protocol includes the following: correct identification of the surgical client using two separate identifiers; preoperative verification process with review documents (e.g., preoperative checklist, informed consent), diagnostic studies, and laboratory tests in the client record to be sure that they are consistent and agree with the client's verbalization and understanding of the planned procedure; marking of the surgical site, involving the client whenever possible; checking for the presence of implants; checking for the arrival of special instruments or equipment before the surgery begins; and final procedural pause or "time-out" involving all members of the surgical team, whereupon final oral verification occurs, confirming that the correct client is in the room, is positioned correctly, and the site/procedure is agreed upon before the incision is made. Increasingly common is the use of a surgical safety checklist such as the SCOAP (Surgical Care and Outcomes Assessment Program) checklist.

A nurse is taking care of a client during the immediate postoperative period. Which duty performed during the immediate postoperative period is most important?

Monitor the client for complications. The immediate postoperative period refers to the first 24 hours after surgery. During this time, the nurse monitors for complications as the client recovers from anesthesia. Once the client is stable, the nurse prepares a room for the client's return and assesses the client to prevent or minimize potential complications. The nurse ensures the safe recovery of the client after the client has stabilized.

The nurse is preparing a client for a colonoscopy. The nurse is familiar with the colonoscopy procedures at the hospital and is aware that which type of anesthesia is commonly used for this procedure?

conscious sedation Moderate sedation/analgesia is also known as conscious sedation or procedural sedation. It is used for short-term and minimally invasive procedures such as endoscopy procedures (e.g., colonoscopy). Spinal anesthesia, also called spinal block, subarachnoid block, intradural block, and intrathecal block, is a form of regional anesthesia involving the injection of a local anesthetic into the subarachnoid space. Nerve block or regional nerve blockade is any deliberate interruption of signals by an injection traveling along a nerve, often for the purpose of pain relief. Epidural administration is a medical route of administration in which a drug such as epidural analgesia and epidural anesthesia or contrast agent is injected into the epidural space around the spinal cord with use of an epidural catheter.

A nurse working in a PACU is responsible for conducting assessments on immediate postoperative clients. What is the purpose of these assessments?

to prevent complications from anesthesia and surgery Immediate postoperative care in the PACU involves assessing the postoperative client with emphasis on preventing complications from the surgery. The main focus of postoperative care is the respiratory system, which includes breathing and respiration, and not the cardiovascular system. Preoperative vital signs are necessary for the PACU nurse to know, so they can be compared with those taken when the client returns to the previous unit or is to be discharged home. The length of time to recover a client in the PACU is generally 2 hours, but this time can fluctuate depending on when the client's vital signs return to baseline levels.