Mandy

Perioperative Nursing

all included (before, during, and after) Preoperative - before surgery Intraoperative - during surgery Postoperative - after surgery

A client is to be discharged after a laparoscopic cholecystectomy. What statement indicates to the nurse that the client understands the discharge instructions?

"I may have mild shoulder pain for about a week."

For which clinical indicators should the nurse monitor when caring for a client with cholelithiasis and obstructive jaundice? Select all that apply.

- dark urine - yellow skin - clay-colored stool

A nurse is caring for a client with cholelithiasis and obstructive jaundice. When assessing this client, the nurse should be alert for which findings that are consistent with these conditions? Select all that apply.

- ecchymosis - yellow sclera - pain in the right upper quadrant

Classification of Surgery

1. Seriousness a. Major b. Minor 2. Urgency a. Elective b. Urgent c. Emergency 3. Purpose a. Diagnostic, ablative, palliative, reconstructive/restorative, procurement for transplant, constructive, cosmetic

The nurse is performing an abdominal assessment on a client. Where on the abdomen should the nurse assess for McBurney point?

RLQ (appendix)

An older client's colonoscopy reveals the presence of extensive diverticulosis. Which type of diet should the nurse encourage the client to follow?

high fiber

Which of these is a part of health belief model?

perception of susceptibility to an illness

An older client with a history of chronic constipation develops acute appendicitis. Prior to arrival at the hospital, the client attempted self-care at home. Which self-care measures could potentially lead to rupture of the appendix?

self-administering a small volume enema

A client is scheduled for a cholecystectomy and asks the primary nurse about the function of the gallbladder. What should the nurse identify is the function of the gallbladder when proving preoperative teaching?

stores and concentrates bile

The nurse is caring for a client with peritonitis who had surgery two hours ago due to a ruptured appendix. Which clinical findings should the nurse expect to observe when assessing this client? Select all that apply.

- fever - urinary retention - abdominal muscle rigidity

Care of Surgical Patient: Postoperative

- hand off OR to PACU - assessment - VS: 15 min x2, 30 min x2, hourly x2 - recovery depends of patients condition, type of surgery, and anesthesia used

Which instructions given to a client with renal calculi would be most beneficial? Select all that apply.

- "drink plenty of water" - "substitute lemon juice for tea"

A nursing student is listing the key points that need to be remembered to maintain health and wellness of the client. Which key points listed by the nursing student are accurately stated? Select all that apply.

- "internal and external variables are considered when planning care for the client" - "the health belief model considers the relationship between a person's health beliefs and health behaviors" - "the health promotion model highlights factors that increase individual well-being and self-actualization"

A client is admitted with a diagnosis of acute pancreatitis. The medical and nursing measures for this client are aimed toward maintaining nutrition, promoting rest, maintaining fluid and electrolytes, and decreasing anxiety. Which interventions should the nurse implement? Select all that apply.

- administer analgesics - teach relaxation exercises - monitor cardiac rate and rhythm

Populations at Greatest Risk for Elimination Issues

- children younger than 3 - pregnant women - postmenopausal women - older adults

Care of Surgical Patient: Intraoperative

- circulatory nurse: manages pt care in OR - scrub nurse: sterile; hands instruments to surgeon; makes sure counts are correct with circulating nurse - assessment - safe pt positioning - time out - anesthesia

Care of Surgical Patient: Preoperative

- explain/teach back - head to toe assessment (baseline) - advance directives - medical history - surgical history - pre transfusion type and screen, CBC, CMP, EKG, coagulation studies - nurse take precautions and focus on potential risks

Malignant Hyperthermia

- familial - reaction to inhaled anesthetics within muscles causing temperature to spike, rigid muscles, HR to rise rapidly Treatment: - cardio respiratory supportive care - Dantrolene (skeletal muscle relaxant)

A primary healthcare provider diagnoses a client with acute cholecystitis with biliary colic. Which clinical findings should the nurse expect when performing a health history and physical assessment? Select all that apply.

- intolerance to foods high in fat - pain that radiates to the right shoulder

A client is admitted with the diagnosis of acute pancreatitis. Which clinical manifestations should a nurse assess in the client? Select all that apply.

- jaundice - acute pain - increased amylase

Surgical Nurse Knowledge

- perioperative communication (hand-off) - glycemic control and infection prevention - pressure ulcer prevention

Patient Education

- reduces anxiety - reduces pain - give instruction sheets - time of next visit - medication prescribed - signs to look for a incision site - proper activity or movement needed

Intraoperative Warming

- reduces complications - shivering - cardiac arrest - lower blood loss and mortality rate - lowers infection risk - lowers pain - decreases recovery time hypothermia: core temp <36 C

Consequences of Elimination Issues

- skin breakdown - falls - change in daily activities - changes in social relationships - bladder distention/pain - backflow up ureters causing dilation - pyelonephritis - renal failure

Surgical Risk Factors

- smoking - age - nutrition -obesity -OSA - immunosuppression - fluid and electrolyte imbalances - postoperative nausea and vomiting - venous thromboembolism - medications - allergies - alcohol/drug intake - pregnancy

An emergency department nurse assesses an older client who reports cramping pain in the left lower quadrant, weakness, bloating, and malaise. The client also has a low-grade fever. Which condition does the nurse suspect as the most likely cause of the client's clinical findings?

diverticulitis