NU144- Chapter 18: Intraoperative Nursing Management
After teaching a patient scheduled for ambulatory surgery using moderate sedation, the nurse determines that the patient has understood the teaching based on which of the following statements?
"I'll be sleepy but able to respond to your questions."
The patient asks the nurse how long the local infiltration anesthetic will last. What is the nurse's best response?
"The anesthetic may last for 3 hours."
A client asks the nurse how an inhalant general anesthetic is expelled by the body. What is the best response by the nurse?
"The lungs primarily eliminate the anesthesia."
The surgical unit nurse is developing a postoperative plan of care. In which client's plan of care would the nurse document interventions of coughing and deep breathing, gastrointestinal assessment, and effective regulation of temperature?
A client with gastrointestinal surgery and general anesthesia
The nurse is completing a postoperative assessment for a patient who has received a depolarizing neuromuscular blocking agent. The nursing assessment includes careful monitoring of which body system?
Cardiovascular system
A patient is in the operating room for surgery. Which individual would be responsible for ensuring that procedure and site verification occurs and is documented?
Circulating nurse
A 70-year-old patient who is to undergo surgery arrives at the operating room (OR). The nurse, when reviewing the patient's medical record, understands that this patient will require a lower dose of anesthetic agent because of which of the following?
Decreased lean tissue mass
The anesthesiologist administered a transsacral conduction block. Which documentation by the nurse is consistent with the anesthesia being administered?
Denies sensation to perineum and lower abdomen
A client has been administered ketamine for moderate sedation. What is the priority nursing intervention?
Frequently monitoring vital signs
A medical student scheduled to observe surgery enters the restricted surgical zone wearing jeans, a t-shirt, and tennis shoes. What is the best action by the nurse?
Immediately escort the medical student out of the area.
The operating nurse is caring for a patient who is receiving general anesthesia. Organize the nursing interventions in chronological order of the stages of general anesthesia, beginning with Stage I (1) and ending with Stage IV (4).
Keep discussions about the client to a minimum. Avoid auditory and physical stimuli. Place client into operative position. Prepare for and assist in treatment of cardiac and/or respiratory arrest.
Which position is used for perineal surgical procedures?
Lithotomy
A student nurse is scheduled to observe a surgical procedure. The nurse provides the student nurse with education on the dress policy and provides all attire needed to enter a restricted surgical zone. Which observation by the nurse requires immediate intervention?
Mask is placed over nose and extends to bottom lip.
After teaching a class about agents commonly associated with the development of malignant hyperthermia, the instructor determines that additional teaching is needed when the students identify which drug as a possible cause?
Morphine
A client is administered succinylcholine and propofol for induction of anesthesia. One hour after administration, the client demonstrates muscle rigidity with a heart rate of 180. What should the nurse do first?
Notify the surgical team.
An OR nurse needs to assist a patient to the Trendelenburg position. Which of the following is the correct position?
On his back, with his head lowered, so that the plane of his body meets the horizontal on an angle
Fentanyl is categorized as which type of intravenous anesthetic agent?
Opioid
A nurse is monitoring a client recovering from moderate sedation that was administered during a colonoscopy. Which finding requires the nurse's immediate attention?
Oxygen saturation (SaO2) of 85%
The nurse positions the client in the lithotomy position in preparation for
Perineal surgery
The circulating nurse is unsure whether proper technique was followed when an object was placed in the sterile field during a surgical procedure. What is the best action by the nurse?
Remove the entire sterile field from use.
A nurse is working as part of the surgical team in the semi-restricted area. Which of the following would be appropriate to wear? Select all that apply.
Scrub clothes Caps
The physician is concerned about aspiration during a surgical procedure and orders a medication to increase gastric pH. Which medication would the nurse document as being administered?
Sodium citrate
There are four stages of general anesthesia. Select the stage during which the OR nurse knows not to touch the patient (except for safety reasons) because of possible uncontrolled movements.
Stage II: excitement
The surgical client has been intubated and general anesthesia has been administered. The client exhibits cyanosis, shallow respirations, and a weak, thready pulse. The nurse recognizes that the client is in which stage of general anesthesia?
Stage IV
A nurse is working as a registered nurse first assistant as defined by the state's nurse practice act. This nurse practices under the direct supervision of which surgical team member?
Surgeon
A client at risk for malignant hyperthermia returns to the surgical unit. For what time period will the nurse monitor the client for development of malignant hyperthermia?
The client can develop malignant hyperthermia up to 24 hours after surgery.
Which position should the patient undergoing pelvis surgery be positioned?
Trendelenburg
registered nurse first assistant
a member of the operating room team whose responsibilities may include handling tissue, providing exposure at the operative field, suturing, and maintaining hemostasis
malignant hyperthermia
a rare life-threatening condition triggered by exposure to most anesthetic agents inducing a drastic and uncontrolled increase in skeletal muscle oxidative metabolism that can overwhelm the body's capacity to supply oxygen, remove carbon dioxide, and regulate body temperature, eventually leading to circulatory collapse and death if untreated often inherited as an autosomal dominant disorder
anesthesia
a state of narcosis or severe central nervous system depression produced by pharmacologic agents
laparoscope
a thin endoscope inserted through a small incision into a cavity or joint using fiber-optic technology to project live images of structures onto a video monitor other small incisions allow additional instruments to be inserted to facilitate laparoscopic surgery
surgical asepsis
absence of microorganisms in the surgical environment to reduce the risk of infection
A postoperative client returns to a surgical nursing unit. The nurse assesses the client and notes tachycardia and muscle rigidity. What is the most important nursing action?
administering supplemental oxygen
unrestricted zone
area in the operating room that interfaces with other departments includes patient reception area and holding area
restricted zone
area in the operating room where scrub attire and surgical masks are required includes operating room and sterile core areas
semirestricted zone
area in the operating room where scrub attire is required may include areas where surgical instruments are processed
The nurse recognizes that the older adult is at risk for surgical complications due to:
decreased renal function
moderate anesthesia care
moderate sedation given by an anesthesiologist or certified registered nurse anesthetist (CRNA)
A client is to receive general anesthesia with sevoflurane. What does the nurse anticipate would be given with the inhaled anesthesia?
oxygen
anesthesiologist
physician trained to deliver anesthesia and to monitor the patient's condition during surgery
moderate sedation
previously referred to as conscious sedation, involves the use of sedation to depress the level of consciousness without altering the patient's ability to maintain a patent airway and to respond to physical stimuli and verbal commands
circulating nurse (circulator)
registered nurse who coordinates and documents patient care in the operating room
scrub role
registered nurse, licensed practical nurse, or surgical technologist who scrubs and dons sterile surgical attire, prepares instruments and supplies, and hands instruments to the surgeon during the procedure
anesthetic agent
the substance, such as a chemical or gas, used to induce anesthesia
