Peri-operative Care

A nurse is caring for a post op patient on POD2. the patient had a large upper abdominal incision. While assessing the patient at the beginning of her shift, the nurse noted decreased breath sounds, crackles, and mild cough. What is the patient most likely experiencing? - Atelectasis - Pneumonia - Acute Bronchitis - Hypoxemia

Atelectasis

Prior to her surgery, a patient states that she is very nervous and really doesn't understand what the surgical procedure is or how it will be performed. The nurse should: - Have the patient sign the consent document and place it in the chart - Call the health care provider to review the procedure with the patient - Explain the procedure to the patient - Provide the patient with a pamphlet explaining the procedure

Call the health care provider to review the procedure with the patient it is the surgeon's responsibility to provide clear and simple explanation surgery will entail prior to the client giving consent

Shock results from hypervolemia. True or False

FALSE Hypovolumic shock comes from a loss of of fluid and that is HYPO - not HYPER

Which of the following describes the postoperative phase: - Starting with admission of the patient to the OR - Starting with the admission of the patient to the PACU and ending when the patient is discharged to the unit or home - Starting with the admission of the patient to the PACU and ending with follow-up evaluation in the clinical setting or home. - Starting with admission to the PACU

Starting with the admission of the patient to the PACU and ending with follow-up evaluation in the clinical setting or home. -the second and third answer are very similar but in the second they just drop kick him to the curb as soon as they send them out of the hospital - the correct answer really does incorporate that post-op and meeting with that decision afterwards

A patient requires a patent airway and spontaneous respirations before being transferred from the PACU? True or False

TRUE The patient does require a patent airway and spontaneous respirations before being transferred from the PACU

Masks are worn at all times in the restricted zone of the OR. True or False

TRUE This question infers that there is more than one zone in the OR Know where the zones are Non-restricted Semi-restricted Restricted zones

Tachycardia is often the first sign of malignant hyperthermia True or False

TRUE We will not go over this concept in depth during 110, however this could occur during surgery so it is reviewed a bit here. When a person develops malignant hyperthermia (it happens in the OR): their HR goes up their temperature goes sky high their fluid and electrolytes are completely off balance they become severe acidodic they are very ill Unfortunately for this condition, most don't know they've had it until they have had surgery (this is why we monitor tachycardia and the patient's temperatures)

Headache may be an after-effect of spinal anesthesia. True or False

TRUE When a person has spinal anesthesia they have a needle inserted in between the vertebrae, through the dura, into the spinal column to administer that anesthetic The needle has a very large gauge/ hole is very large, and when it comes out there is a possibility of CSF leaking out. *When CSF leaks out, it causes a headache due to the hypovolemia *when the spinal anesthesia the patient needs to be on bedrest for 5-8 hours because we want the dura to have time to close up so that when the person does stand up CSF is not leaking out with gravity

Surgical wound healing occurs in: - Two phases: inflammatory and maturation - Three phases: inflammatory, proliferative, and maturation - First, Second, and Third intention wound healing - First and proliferative phase

Three phases: inflammatory, proliferative, and maturation

A recently extubated postoperative patient starts to gag and make vomiting sounds. What action should the nurse do first? - Turn patient on their side. - Provide emesis basin. - Administer antiemetic. - Obtain suction equipment

Turn patient on their side The nurse should turn the client on their side to avoid aspiration. The nurse may need to obtain suction equipment, provide an emesis basin, or administer an antiemetic, but the first priority is protecting the client's airway by preventing aspiration.

The major purpose of withholding food and fluid before surgery is to prevent .

aspiration This is a KEY question - people don't understand it we are putting a tube down someone's trachea we activate the gag reflex the person could vomit - that aspirate could come up and then go down into the trachea this might lodge in the lungs causing aspiration pneumonia If we prevent having anything in the stomach - there is less likelihood of that patient aspirating

The nurse has medicated a post-operative client who reported nausea. Which medication would the nurse document as having been given? - Propofol - Prednisone - Ondansetron - Warfarin

Ondansetron Ondansetron is an antiemetic and one of the most commonly prescribed medications for nausea and vomiting. Warfarin is an anti-coagulant Prednisone is a corticosteroid Propofol is an anesthetic agent

A term used to describe a partial or complete separation of wound edges is - hemorrhage - evisceration - dehiscence - erythema

dehiscence Dehiscence is the partial or complete separation of wound edges. Evisceration occurs when organs protrude through the surgical incision. Erythema refers to redness of the skin. Hemorrhage is excessive bleeding

. is the most common endocrinopathy.

diabetes There are many diabetics in the world and sometimes they need surgery. They need to be handled differently during surgery. We need to monitor their blood sugars throughout surgery. These people fall under the "NPO" nothing by mouth prior to surgery and we need to be very careful with what their blood sugar is.

A registered nurse who is responsible for coordinating and documenting client care in the operating room is a - anethesiologist - scrub nurse - circulating nurse - anesthestist

circulating nurse A circulating nurse is a registered nurse who coordinates and documents client care. A scrub nurse prepares instruments and supplies, and hands instruments to the surgeon during a procedure. An anesthetist is trained to deliver anesthesia and to monitor the client's condition during surgery. An anesthesiologist is a physician trained to deliver anesthesia and to monitor the client's condition during surgery.

A nurse assesses a post-operative client as having abdominal organs protruding through the surgical incision. Which term best describes this assessment? - hernia - evisceration - erythema - dehiscence

evisceration Evisceration is a surgical emergency a hernia is a weakness in the abdominal wall dehiscence refers to the partial or complete separation of wound edges erythema refers to the redness of tissue

A nurse on a surgical team has been assigned the role of scrub nurse. What action by the scrub nurse is appropriate? - handing instruments to the surgeon and assistants - coordinating activities of other personnel - keeping all records and adjusting lights - leading the surgical team in a debriefing session

handing instruments to the surgeon and assistants The responsibilities of a scrub nurse are to assist the surgical team by handing instruments to the surgeon and assistants, preparing sutures, receiving specimens for laboratory examination, and counting sponges and needles. Responsibilities of a circulating nurse include leading the surgical team in a debriefing session, keeping records, adjusting lights and coordinating activities of other personnel.

A client with a skull fracture after falling from a ladder requires surgery. The nurse should anticipate transporting the client to surgery during what time frame? - in 1 week - in 48-72 hours - immediately - in 1 day

immediately Emergent surgery occurs when the client requires immediate attention. A fractured skull is is an indication for emergent surgery. An urgent surgery occurs when the client requires prompt attention, usually within 24-30 hours. Any surgery scheduled beyond 30 hours is classified as required or elective; a fractured skull does not meet the requirements for elective or required surgery.

The . phase begins when the patient is transferred onto the OR table and ends with admission to the PACU.

intra-operative This question infers that there is more than one phase: Pre-op Intra-op Post-op Many nurses are trained in all three areas, sometimes in larger facilities may be specific training

Spinal anesthesia produces anesthesia of the lower extremities, lower abdomen.

perineum Spinal anesthesia is used widely for cesarian sections so that the patient's don't have to be anesthesized generally and can be awake for the birth of their child

The nurse has administered preanesthetic medication. What action should the nurse take next? - place the client on bed rest with the side rails up. - educate the client on discharge instructions - review the client's list of home medications - obtain the client's signature on the consent form

place the client on bed rest with the side rails up Preanesthetic medication can make the client lightheaded and dizzy. Safety is a priority, so the client should remain in bed with the side rails up. The consent form should be signed before the client is medicated. Consents signed after the client is medicated are not legal. Reviewing the home medications and educating the client should take place before the client is medicated.

A client asks why a drain is in a place to pull fluid from the surgical wound. What is the best response by the nurse? - "it will cut down on the number of dressing changes needed." - "the drain will remove necrotic tissue." - "it assists in preventing infection." - "most surgeons use wound drains now."

"it assists in preventing infection." A wound drain assists in preventing infection by removing the medium in which bacteria could grow. The purpose of the wound drain is not to remove necrotic tissue or to decrease the number of dressing changes. Stating that most surgeons use wound drains does not answer the client's question appropriately.

The circulating nurse is documenting all medications administered during a surgical procedure. The anesthesiologist administers an opioid analgesic. What medication would the nurse check as being administered? - Metocurine - Mivacurium - Fentanyl - Etomidate

Fentanyl Fentanyl is an opioid analgesic. Mivacurium and Metocurine are muscle relaxants Etomidate is a anesthetic agent

Intrapleural anesthesia involves the administration of local anesthetic by a catheter between the parietal and visceral pleura. True or False

TRUE It is essential to recall A and P background Pleura - refers to the lungs and there are two protective sacs Visceral and parietal pleura with a little space in between When patients get intrapleural anesthesia it goes in between those two sacs ** Impt: That anesthetic is put in with a needle If that needle happens to nick that pleural sac - the lung will collapse

Organ Donation scenarios - - OR nurses are involved in either or . of organs - OR nurses are dealing with the families on both ends and the emotional toll on each end of this is . - For the RN dealing with the patient who's organs are being donated - VERY - For the RN dealing with the patient whose receiving the donated organs - VERY

- OR nurses are involved in either harvesting or transplanting of organs - OR nurses are dealing with the families on both ends and the emotional toll on each end of this is very different - For the RN dealing with the patient who's organs are being donated - VERY SAD - For the RN dealing with the patient whose receiving the donated organs - VERY HAPPY

In the immediate post-operative period, vital signs are taken at least every - 30 minutes - 45 minutes - 15 minutes - 60 minutes

15 minutes Pulse rate, blood pressure and respiration rate are recorded at least every 15 minutes for the first hour and every 30 minutes for the next 2 hours.

The nurse is completing a pre-operative assessment. The nurse notices the client is tearful and constantly wringing her hands. The client states, "I'm really nervous about this surgery. Do you think it will be ok?" what is the nurse's best response? - "you have nothing to worry about; you have the best surgical team" - "what are your concerns?" - "No one has ever died from the procedure you are having." - "what family support do you have after the surgery?"

"what are your concerns?" Asking the client about their concerns is an open-ended therapeutic technique. It allows the client to guide the conversation and address their emotional state. Asking about family support changes the subject and is not therapeutic. Discussing the surgical team and the low death rate associated with a procedure minimized the client's feelings and is not therapeutic.

•Delores Golden Elk is a 62 year old bus driver with a 55 year history of diabetes mellitus. She was admitted to the vascular unit where you practice nursing for a below the knee amputation on her right leg due to diabetic complications. As you record her history, she outlines that she was a 20 pack year smoker, she enjoys a couple of beers after work several times per week, and she really needs to lose about 50 pounds. - Describe how her health history impacts her surgical risk - Outline how her health history could impact her healing

Describe how her health history impacts her surgical risk - her health history on her surgical risk includes one - she's had a greater risk of hypo or hyper-glycemia during surgery - she has a greater potential for blood clots due to diabetes - her obesity increases the likelihood of wound infection and dehiscence - her obesity and history of tobacco use increase her potential for post surgical pulmonary complications - her alcohol consumption could indicate that she has an alcohol addiction so she might have a possible withdrawal symptoms postoperatively which would occur 48 to 72 hours after her last drink -she might have decreased liver function and this may increase potential for anesthesia difficulties Outline how her health history could impact her healing -diabetes is slower healing due to the diabetes pathology and there's a greater likelihood of infection - there's also decreased circulation and with regard to smoking - her decreased oxygenation of tissues results in lower and slower healing and greater potential for pulmonary complications

A nurse is caring for a postoperative patient who had spinal anesthesia. The patient complains of a headache. Which of the following actions should the nurse take? - Lower the head of the patient's bed. - Keep the patient lying flat, maintain a quiet environment, and keep the patient hydrated. - Encourage the patient to lay on his right side. - Do nothing as this is a normal response to the spinal anesthesia

Keep the patient lying flat, maintain a quiet environment, and keep the patient hydrated. - keep the patient lying flat maintain a quiet environment and keep the patient hydrated - remember that after spinal anesthesia the patients need to be lying flat -lowering the height of the patients head is just wrong B is the global answer, based on the lecture on test taking, patient lying flat, quiet environment and maintain hydration

A client undergoing a perineal surgical procedure. The nurse should place the client in which position? - Trendelenburg - Sims - Dorsal recumbent - Lithotomy

Lithotomy The lithotomy position is used for nearly all perineal, rectal and vaginal surgeries. The Trendelenburg position is usually used for surgery on the lower abdomen and pelvis. The Sims' or lateral position is used for renal surgery. The dorsal recumbent position is the usual position for surgical procedures

A 70 year old elderly patient is admitted into the preoperative unit for a liver resection that is scheduled for 6 hours of surgery. What is one of the basic principles that should guide the pre-op nurse's assessment? - Elderly patients do not experience as much preoperative anxiety as younger patients - The elderly patient has less physiological reserve than the younger patient. - Elderly patients experience less pain - Pre-op pain assessment and teaching should occur following the procedure as the elderly patient may not retain the information

The elderly patient has less physiological reserve than the younger patient. - preoperative pain assessment and teaching are important to the elderly patient - these patients have a combination of chronic illnesses and health issues in addition to specific ones for which surgeries indicated - healthcare staff must remember that the hazards of surgery for the aged are proportional to the number and severity of coexisting health problems and the nature and duration of the operative procedure -it's therefore important to be guided by the principle that the elderly has less physiological reserve which means the ability of an organ to return to normal after a disturbance and it's equilibrium

is a state of narcosis, analgesia, relaxation, and reflex loss.

anesthesia

A 78-year- old client is undergoing surgery to repair a right hip fracture. What nursing action is appropriate during the intra-operative phase? - withhold pain medication due to decreased renal function - appropriately position the client using adequate padding and support - discuss with the anesthesiologist the need for higher doses of anesthetic agents - maintain an operating room temperature of 18 degrees C to prevent hypothermia

appropriately position the client using adequate padding and support Adequate padding and support should be used to prevent positioning injuries. Older adults have lower bone mass, which increases the risk of intra-operative positioning injuries. Pain medication can still be used, just in smaller doses, due to decreased liver and kidney function. For the same reason, lower doses of anesthetic agents are used with older adults. The operating room is usually maintained from 20 degrees C to 24 degrees C; 18 degrees is lower than the recommended temperature and can promote hypothermia in an older adult who already has impaired thermoregulation and is prone to hypothermia.

A client is postoperative day 3 after surgical repair of an open abdominal wound and traumatic amputation of the right lower leg following a motorcycle crash. What is the highest priority nursing intervention? - obtaining dietary consultation for improved wound healing - administering pain medications within 1 hour of the client's request - assessing WBC count, temperature, and wound appearance - educating the client on safe bed-to-chair transfer procedures

assessing WBC count, temperature, and wound appearance The client has an increased risk for infection related to the surgical wound, which is classified as dirty. Assessing the WBC count, temperature and wound appearance allows the nurse to intervene at the earliest sign of infection. The client will have special nutritional needs during wound healing and needs education on safe transfer procedures, but the need to monitor for infection is a higher priority. The client should receive pain medication as soon as possible after asking, but the latest literature suggests tat pain medication should be given on a schedule versus "as needed".

It is important for the nurse to assist a post-surgical client to sit up and turn the head to one side when vomiting in order to - avoid aspiration - maximize comfort - help eliminate inhaled anesthetics - avoid dizziness

avoid aspiration The nurse helps the client to sit up and turn the head to one side when vomiting in order to avoid aspiration. This does not maximize comfort and does not help to avoid dizziness. Encouraging the client to breathe deeply helps eliminate inhaled anesthetics.

A client with a history of alcoholism is scheduled for urgent surgery. The client asks the nurse, "why is everyone so concerned about how much I drink?" What is the best response by the nurse? - "the amount of alcohol you drink determines the amount of pain medication you will need post-operatively" - "we can have counselors available after surgery if it is determined that you need help with your drinking" - it is important for us to know how much and how often you drink to help prevent surgical complications" - "it is a required screening question for all clients having surgery"

it is important for us to know how much and how often you drink to help prevent surgical complications" alcohol use and alcoholism can contribute to serious post-operative complications. If the medical and nursing staff is aware of the use or abuse, measures can be implemented proactively to prevent complications. Although alcohol may interfere with a medication's effectiveness, it does not determine the amount of pain medications that are prescribed after surgery. Even though this is a required screening questions and counselors can be made available for those who want help, those are the best responses to answer the client's questions.

What action should not be allowed when wearing masks in the operating room? - letting masks hang around the neck - changing masks between treating clients - wearing the mask fitted tight - covering the nose and mouth completely

letting the mask hang around the neck masked are changed between clients and should not be worn outside the surgical department. Masks should fit tightly and cover the nose and mouth completely. The mask must be either on or off; it must not be allowed to hang around the neck.

What is the highest priority nursing intervention for a client in the immediate post-operative phase? - monitoring vital signs every 15 minutes - assessing urinary output every hour - assessing hemorrhage -maintaining a patent airway

maintaining a patent airway All interventions listed are correct. The highest priority , however is to maintain a patent airway. Without a patent airway, the other interventions - monitoring vital signs, assessing urinary output, and assessing for hemorrhage - become secondary to the possibility of a lack of oxygen.

A client is at a post-operative hour 8 after an appendectomy and is anxious, stating "Something is not right. My pain is worse than every and my stomach is swollen." Blood pressure is 88/50 pulse is 115 Respirations are 24 and labored The abdomen is soft and distended. No obvious bleeding is noted. What action by the nurse is most appropriate? - notify the physician - ambulate the client to reduce abdominal distention - administer morphine per orders - inform the client this is the normal progression after abdominal surgery

notify the physician The physician should be notified of the findings. The client may be hemorrhaging internally and may need to return to surgery. The client may be in need of pain medication, but morphine will lower the blood pressure further and may cause further complications. Ambulating the client increases the risk of injury because the client ay experience orthostatic hypotension. What the client is experiencing is not the normal progression after abdominal surgery.

Hypothermia may occur as a result of - open body wounds - the infusion of warm fluids - being young - increased muscle activity

open body wounds inadvertent hypothermia may occur as a result of a low temperature in the OR, infusion of cold fluids, inhalation of cold gases, open wounds or cavities, decreased muscle activity, advanced age ,or particular pharmaceutical agents.

You are a postoperative nurse admitting a patient from the PACU. What is the first assessment you would make on this patient? - Heart Rate - Nail perfusion - Core temperature - patency of airway

patency of airway

In which position would a client undergoing a lumbar puncture be placed? - supine - Trendelenburg - semi-fowler's - side-lying, knees to chest

side-lying, knees to chest For the lumbar puncture, the client usually lies on the side in a knees-to chest position. The supine, semi-fowler's and Trendelenburg positions would be inappropriate.

The nurse is educating a client scheduled for elective surgery. The client currently takes aspirin daily. What education should the nurse provide with regard to this medication? - stop taking the aspirin 7 days before the surgery, unless otherwise directed by your physician - take half doses of the aspiring until 1 week after surgery - aspirin should be increased until 3 days before surgery, then it should be discontinued until 3 days after surgery - continue to take the aspirin as needed

stop taking the aspirin 7 days before the surgery, unless otherwise directed by your physician Aspirin should be stopped at least 7-10 days before surgery. The other directions provided are incorrect!

The nurse is preparing an elderly patient for surgery, and the patient is scheduled for a general anesthetic. What complication should the nurse most closely monitor the patient for? - Low body temperature - Peripheral edema - UTI - Increased ability to resist stress

the elderly are more prone to developing low body temperature it is a potential complication for all surgical patients as well, but the risks are especially high among older patients urinary tract infections and peripheral edema are not common intra-operative complications

An example of a curative surgical procedure is - a face lift - tumor excision - placement of gastrostomy tube - a biopsy

tumor excision A biopsy, a face-lift and the placement of a gastrostomy tube are not examples of a curative procedure..