Perioperative Nursing, Surgical Asepsis

The nurse is admitting a client who is to undergo an open reduction with internal fixation for a fractured femur. About which comment by the client should the nurse be most concerned?

"I was worried I would have an incision and scar."

eight steps of perop patient's history

1)Exploring the patient's understanding of the need for surgery to be performed 2)Asking about any previous surgeries and anesthetics 3)Asking about the patient's family health history 4)Asking about current medication use, including prescription medications, over-the-counter 5)Asking about medication allergies and intolerances 6)Asking about alcohol and illegal drug use, abuse, and addiction 7)Asking about tobacco use 8)Asking females about the possibility of pregnancy, specifically to determine the date of the patient's last menstrual period

Upon admission to the post-anesthesia care unit at 9:20 a.m., the client's vitals are 97.2-68-12-130/73. The nurse takes vital signs every 10 minutes. Which readings obtained at 10:10 a.m. would be reported to the physician? 1) 98.1-90-16-126/62 2) 99.8-86-14-110/52 4) 98.6-102-20-90/48 5) 99.0- 86-14-120/68

4) 98.6-102-20-90/48

The scrub nurse notes that 2 sponges are missing near the end of an operation. Which action should the nurse take first? 1) ignore it because the sponge will dissolve. 2) search the floor around the operating table. 3) call for an x-ray. 4) perform a second count.

4) perform a second count.

chemical disinfection

A chemical that destroys, neutralizes, or Inhibits the growth of disease-carrying microorganisms. This method is used to kill pathogens on equipment and supplies that cannot be heated

local anesthesia

A very small area of tissue is blocked from sensory perception by injection of a local anesthetic numbing agent such as lidocaine; common uses are dental work, suturing lacerations, and biopsies.

Which intervention should the nurse plan to implement to decrease the client's risk for injury during the intraoperative period?

Assess the client for allergies.

Types of sterilization

Autoclaving Boiling Ionizing radiation Chemical disinfection: Gaseous disinfection

The nurse is assigned a client scheduled for an outpatient colonoscopy in an ambulatory care setting. During which phase of perioperative care would the nurse document the admission vital signs in the recovery room?

During the postoperative phase

The intraoperative nurse is transferring a client from the OR to the PACU after replacement of the right knee. The client is an 83-year-old woman. The nurse should prioritize which of the following actions?

Keeping the client warm

The nurse is caring postoperatively for a patient who had major abdominal surgery. The patient is attempting to perform turn, cough and deep breathing per the nurse's request. Which action is appropriate if during this exercise the nurse notes a large amount of fluid on the patient's gown? Slow the IV fluids. Call the surgeon. Obtain a sterile suture kit for the surgeon. Lie the patient in low fowlers position, knees bent.

Lie the patient in low fowlers position, knees bent

What is the priority action when the circulating nurse is completing a second verification of the surgical procedure and surgical site?

Obtain the attention of all members of the surgical team.

Preoperative Nursing Interventions

Patient safety is a primary concern. NPO Bowel prep and skin prep Immediate preoperative preparation Complete checklist and chart Hospital gown, voiding, removal of dentures, jewelry, contacts, etc. Preoperative medication Attend to family needs

The nurse in the preoperative area has just medicated her client according to the anesthesiologist's orders. What is the nurse's priority action at this time?

Place the side rails in the up position and make sure the call button is in reach.

presurgical assessment

Presurgical assessment includes a preliminary process of assessment and preop testing to ensure that the patient is healthy enough to undergo surgery and anesthesia Safety: The primary goal of the presurgical assessment is patient safety.

Ablative surgery

Removal of a diseased body part EX: appendectomy

A postanesthesia care unit (PACU) nurse is preparing to discharge a client home following ankle surgery. The client keeps staring at the ceiling while being given discharge instructions. What action by the nurse is appropriate?

Review the instructions with the client and an accompanying adult.

The perioperative nurse is constantly assessing the surgical client for signs and symptoms of complications of surgery. Which symptom should first signal to the nurse the possibility that the client is developing malignant hyperthermia?

Tachycardia

Preoperative Patient Teaching

Teach what will happen before, during, and after surgery and how the patient or caregiver can participate in care, common feelings and concerns that patients have about surgery and what patients and families can do to prevent surgical site infection and permote healing

Who answers any and all perop questions about the procedure?

The MDR or HCP

contamination

The introduction of dangerous chemicals, disease, or infectious materials.

Setting Up a Sterile Field

The outer 1 inch of the sterile drape is considered contaminated because you must touch it as you set it up Anything below the surface of the table is considered unsterile because you cannot see it Only sterile items can be placed on the sterile field. If the sterile field becomes damp or wet, it is no longer sterile The exception is a drape that is backed with moisture-proof material.

Who signs the informed consent form prior to surgery?

The patient or authorized person then signs the form granting permission for the surgery. The nurse generally signs it only as a witness to the fact that it was the patient or authorized person's signature

Informed consent includes

The procedure to be performed The expected or desired outcome of the procedure Alternatives that are available in place of the procedure The expected outcomes of the alternatives or of simply not having the procedure at all Risks of the procedure and anesthesia

Sterilization

The process that completely destroys all microbial life, including spores.

The nurse is performing a preadmission assessment of a client scheduled for a bilateral mastectomy. The nurse should be aware of what purpose of the preadmission assessment?

Verifies completion of preoperative diagnostic testing

The perioperative nurse has a number of major responsibilities when a patient is admitted to a surgical unit or center. Which of the following is the most important function?

Verifies that operative consent is signed

cosmetic surgery

a medical operation to improve a person's appearance -ex: a face lift or breast augmentation.

Preoperative Diagnostic Testing

based on the patient's individual history and physical examination, with consideration of the specific surgery to be performed. Also, most facilities have standing orders requiring that certain laboratory tests be performed on all surgical patient

Preoperative checklist

concise summary of preoperative medical and nursing assessment and interventions

A nurse is caring for a client who underwent a skin biopsy and has three stitches in place. This wound is healing by:

first intention.

The postoperative period begins when the surgical patient is transported to the post anesthesia care unit (PACU) and lasts until the client is 1) fully recovered from the effects of anesthesia. 2) discharged from medical care by the surgeon. 3) well enough to be discharged home. 4) returned to the general medical surgical floor.

fully recovered from the effects of anesthesia

You will want to begin your preop assessment with?

obtaining a detailed patient history

Autoclaving

steam under pressure, with heat ranging from 250°F to 270°F, to sterilize instruments that will not be harmed by heat and water under pressure

laparoscopy

visual examination of the abdominal cavity using an endoscope

What time period begins as soon as the client is brought into the operating room and ends when the client is transferred to the post anesthesia care unit (PACU)? 1) Postoperative phase 2) Perioperative phase 3) Preoperative phase 4) Intraoperative phase

4) Intraoperative phase

Surgical Team Members

Anesthesia provider Surgeon First surgical assistant Circulating nurse Scrub nurse

When the nurse observes that a postoperative client demonstrates a constant low level of oxygen saturation via the O2 saturation monitor despite the client's breathing appearing normal, what action should the nurse take first?

Assess the client's heart rhythm and nail beds.

postoperative phase

Begins with the patient's admittance to the PACU and ends with the patient's complete recovery from the surgical intervention

What complication is the nurse aware of that is associated with deep venous thrombosis?

Pulmonary embolism

Preoperative Medications

-Reduce anxiety (anxiolytics) -Promote relaxation (sedatives, hypnotics) -Reduce nasal and oral secretions (anticholinergic agents) -Prevent laryngospasm -Reduce vagal-induced bradycardia -Inhibit gastric secretion (H2 histamine blockers) -Decrease amount of anesthetic needed for induction and maintenance (opioids)

Bier block

Involves the injection of anesthetic agents into the venous circulation of an extremity

The nurse is caring for a client needing emergency surgery. Which preoperative teaching is least important to prepare the client for surgery?

Post-discharge diet

When to use sterile interment always check

Safety: Always check the expiration date and examine the packaging to ensure that it remains intact. The item can no longer be considered sterile if the peel-apart pack is open anywhere or if the expiration date has passed.

The nurse is assessing the postoperative client on the second postoperative day. Which assessment finding requires immediate physician notification?

The client has an absence of bowel sounds.

incentive spirometry

a common postoperative breathing therapy using a specially designed spirometer to encourage the patient to inhale and hold an inspiratory volume to exercise the lungs and prevent pulmonary complications

conscious sedation

a decreased level of consciousness in which the patient is not completely asleep

preoperative phase

period of time from when the decision for surgical intervention is made to when the patient is transferred to the operating room table

SCDs

sequential compression devices

The scrub nurse is aware that needle, sponge, and instrument counts are performed periodically to prevent foreign objects from being left in surgical wounds. Which timing for the counts is correct? Select all that apply. 1. As each sterile package is opened before surgery 2. When additional supplies are added to the sterile field 3. If a scrub nurse is replaced anytime during surgery 4. When the patient is moved to the postanesthesia care unit (PACU) 5. At the closure of each body cavity.

1. As each sterile package is opened before surgery 2. When additional supplies are added to the sterile field 3. If a scrub nurse is replaced anytime during surgery 5. At the closure of each body cavity.

Why is it important to determine a client's current use of medications during a pre-op assessment? 1) Anesthetic agents alter renal and hepatic function, causing toxicity by other drugs. 2) Medications may cause interactions with anesthetics, altering potency and effect of the drug. 3) Medications may interfere with a client's perception about surgery. 4) Routine medications are usually withheld the day of surgery, requiring dosage and schedule adjustments.

2) Medications may cause interactions with anesthetics, altering potency and effect of the drug.

The nurse knows that before a client can have a surgical procedure completed, this must first be completed by their physician. 1) History and Physical 2) Clearance from their Psychiatrist 3) Pre-surgical Clearance 4) Electrocardiogram

3) Pre-surgical Clearance

Anesthesia provider

A health care professional who is licensed to provide anesthesia. Responsible for sustaining the patient's life and ensuring that the patient remains comfortable

Preoperative time out

Anesthesiologist, nurse and patient verify patient , sight (must be marked by surgeon if laterality) procedure, consent signed and witnesses, surgeon in building, room is ready The above must be done prior to giving patient any mind altering medications.

intraoperative phase

Begins with the patient's entry into the operating room and ends with admittance to the postanesthesia care unite (PACU) or recovery room

Continuation to autoclaved package is shown by?

Evidence that the wrapper has been wet appears as a discolored line at the level reached by the fluids. This is referred to as "strike-through."

corrective surgery

is done to repair an anatomical or congenital defect. An example is to repair a cleft palate so that a child can nurse or eat normally

A client is being prepared for a same-day surgical procedure and is discussing with the nurse what potential ramifications this type of surgery has. Which of the following would the nurse correctly identify? Select all that apply.

•The client will leave the hospital sooner than in the past. •Need for teaching is increased. •The client must be prepared to take on more self-care than he or she may have done in the past.

The nurse is caring for a client is having a repair to a cleft palate, this would be considered what type of surgery? 1) Palliative Surgery 2) Cosmetic Surgery 3) Exploratory Surgery 4) Corrective Surgery

4) Corrective Surgery

opening sterile supplies

Check the expiration date for sterility. Check the sterilization tape, if present, for color change—the hash marks should be dark. Check the packaging for any holes or tears Open away from you 1st Stay with the clean 1in boarder Don't cross the field

A PACU nurse is caring for a postoperative client who received general anesthesia and has a hard, plastic oral airway in place. The patient has clear lung sounds, even and unlabored respirations of 16, and 98% oxygen saturation. The client is minimally responsive to painful stimuli. What action by the nurse is most appropriate?

Continue with frequent client assessments.

The nurse is preparing to change a client's abdominal dressing. The nurse recognizes the first step is to provide the client with information regarding the procedure. Which of the following explanations should the nurse provide to the client?

"During the dressing change, I will provide privacy at a time of your choosing, it should not be painful, and you can look at the incision and help with the procedure if you want to."

presurgical clearance

After assessment and testing, a patient judged to be a safe candidate for surgery- done by HCP

Factors that contribute to surgical risk

Age wounds preexisting conditions mental status medications personal habits allergies

Postoperative Pain and Discomfort Control teaching

Explain to the patient that it is always best to keep pain under control by asking for medication before the pain gets too severe. Tell the patient that research shows that the body recovers and heals faster when pain is properly controlled. Explain the pain scale that you will be using to assess the patient's level of discomfort.

First surgical assistant

May be another physician, a physician's assistant, or a registered nurse duties may include controlling hemostasis, assisting with instrumentation, manipulating and incising tissue, and suturing or stapling and closing the incision

During the preoperative assessment, the client mentions allergies to avocados, bananas, and hydrocodone. What is the priority action by the nurse?

Notify the surgical team to remove all latex-based items.

anesthesia

the loss of sensation, with or without loss of consciousness, accomplished by the administration of inhaled or injected medications

ablation

the removal of a body part or the destruction of its function

Stimulation of Lower Extremity Circulation

-Common and serious complication of surgery is formation of a thrombus, or blood clot -Contractions of leg muscles help compress leg veins and stimulate venous return of blood to the heart -Less active, bed-rest, allows blood to pool in veins and eventually coagulate forming clots -Clots are known as DVT's or Deep Vein thrombosis -Pulmonary embolism

can Sterile Technique be delegated to a UAP

No

The nurse observes bloody drainage on the surgical dressing of the client who has just arrived on the nursing unit. Which intervention should the nurse plan to do next?

Outline the drainage with a pen and record the date and time next to the drainage.

perioperative

period of time that includes before, during, and after a surgical procedure

The nurse is physically preparing a client for surgery. What area does the nurse know needs to be addressed before the client is taken to the operating room?

Elimination

The nurse knows that elderly clients are at higher risk for complications and adverse outcomes during the intraoperative period. What is the best rationale for this phenomenon?

Reduced ability to adjust rapidly to emotional and physical stress

PREOPERATIVE CARE OF THE SURGICAL PATIENT

Starts when the pt decided to have surgery to anesthesia

Salvage surgery

Surgery required when CPR is in progress in the way to the operating room gunshot wound or a ruptured aneurysm

urgent surgery

Surgery required within 24 hours of diagnosis to prevent complications that may occur with waiting removal of gallbladder, coronary artery bypass, surgical removal of malignant tumor, colon resection, amputation

An unconscious patient with normal pulse and respirations would be considered to be in what stage of general anesthesia?

Surgical anesthesia

regional anesthesia

Temporary interruption of nerve conduction, is produced by injecting an anesthetic solution near the nerves to be blocked.

informed consent

an ethical principle that research participants be told enough to enable them to choose whether they wish to participate

The nurse is caring for an unconscious trauma victim who needs emergency surgery. The client is a 55-year-old man with an adult son. He is legally divorced and is planning to be remarried in a few weeks. His parents are at the hospital with the other family members. The physician has explained the need for surgery, the procedure to be done, and the risks to the children, the parents, and the fiancé. Who should be asked to sign the surgery consent form?

The son

The nurse is teaching the client about patient-controlled analgesia. Which of the following would be appropriate for the nurse to include in the teaching plan?

Therapeutic drug levels can be maintained more evenly with patient-controlled analgesia.

Gaseous disinfection

This method kills pathogens on supplies and equipment that are heat sensitive or must remain dry.

ionizing radiation

This method kills pathogens on sutures, some plastics, and biological materials that cannot be boiled or autoclaved.

Boiling

This method of boiling instruments and supplies in water for 10 minutes kills non-spore-forming organisms but does not kill spores.

scrub nurse

a nurse who assists surgeons during surgery, wearing sterile attire and handling sterile equipment and supplies- maintains sterile field

circulating nurse

a nurse who assists the scrub nurse and the surgeons during surgery, positioning the patient and equipment, obtaining additional supplies, and adjusting lighting as needed, and documents -calls time out

sterile field

an area that is set up for certain procedures and is free from all organisms

surgery degrees of urgency

how quickly the surgery must be scheduled.

sterile technique is needed if ?

insertion of chest tubes, insertion of an IV line into the subclavian vein, or performing a lumbar puncture, give injections, flush intermittent access devices, insert urinary catheters, suction deep airways

exploratory/ diagnostic surgery

is done to provide further data and determine a diagnosis for a problem. -ex: abdominal pain sometimes requires exploratory surgery to determine the cause

The nurse notes drainage on the surgical dressing when the client is transferred from the PACU to the floor. The nurse should do what task? change the dressing and assess the wound. observe the dressing continuously for the next 15 minutes for an increase in drainage. note and record the type, color, and amount of drainage. notify the surgeon of the drainage type and amount.

note and record the type, color, and amount of drainage

surgical asepsis

techniques used to destroy all pathogenic organisms, also called sterile technique

general anesthesia

the blockage of all body sensations, causing un-consciousness and loss of reflexes.

Postoperative Nursing Care

primary goal of the postoperative period is to maintain airway and stimulate circulation by encouraging movement and preventing stasis within the extremity.

reconstructive surgery

restore appearance or function due to trauma or illness

Turn, Cough, and Deep-Breathing

risk reduction strategy is promotion of optimal ventilation to prevent pneumonia

palliative surgery

surgery that is performed to relieve pain or other symptoms but not to cure the cancer or prolong a patient's life

elective surgery examples

surgery that is recommended but can be omitted or delayed without catastrophic effects tonsillectomy, hernia repair, cataract extraction, scar revision, facelift, mammoplasty

emergency surgery

surgery that must be performed immediately to save the person's life or a body organ Ex- a stable gastrointestinal bleed or subdural hematoma evacuation

-ectomy

surgical removal

cholecystectomy

surgical removal of the gallbladder

-ostomy

surgically create an opening

post op thrombus prevention

teach leg exercises to your patient as a method of preventing clot formation Antiembolism hose or stockings SCD

The nurse is working in the preoperative area with a client going to surgery for a cholecystectomy. The client has histamine2-receptor antagonists ordered preoperatively. The client asks the nurse why these medications are needed. What would be the nurse's best answer?

"These medications decrease gastric acidity and volume."

The nurse is interviewing a patient scheduled for emergency surgery for a kidney stone that is blocking a ureter. Which part of the patient's medical history is least important? 1. Known medication allergies or intolerances 2. Determine the date of the last menstrual period 3. Ask about all medications currently taken 4. Inquire if the reason for surgery is understood

2. Determine the date of the last menstrual period The date of the last menstrual period can help determine if the patient is pregnant; however, this is the least important question due to the emergency status of the surgery.

Which is the first priority when the client initially enters the post anesthesia care unit (PACU)? 1) condition of the surgical site 2) status of fluid and electrolyte balance 3) adequacy of respiratory function 4) client's level of consciousness

3) adequacy of respiratory function

A patient has just arrived in the surgery suite. Which patient interventions does the nurse expect before the induction of anesthesia and the actual surgery? Select all that apply. 1. The patient is left uncovered until sterile drapes are placed. 2. The patient is positioned for the surgical procedure. 3. Cardiac monitor electrodes are placed on the patient. 4. Surgery table straps are used to secure the patient. 5. Grounding pads are applied to the patient's skin.

3. Cardiac monitor electrodes are placed on the patient. 4. Surgery table straps are used to secure the patient. 5. Grounding pads are applied to the patient's skin.

Malignant hyperthermia

A hereditary condition of uncontrolled heat production that occurs when susceptible people receive certain anesthetic drugs.

What measurement should the nurse report to the physician in the immediate postoperative period?

A systolic blood pressure lower than 90 mm Hg

The nurse is concerned that a postoperative patient may have a paralytic ileus. What assessment data may indicate that the patient does have a paralytic ileus?

Absence of peristalsis

Needle, Sponge, and Instrument Counts

As the room is set up before the procedure is started When additional supplies are opened and added to the sterile field When the scrub nurse is replaced by a second scrub nurse at any point during the procedure Before closure of each surgical cavity At the end of the case prior to closure of the surgical incision After skin closure

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.

Disinfection

the process used to kill bloodborne pathogens and the growth of organisms that cause infection. -Clorox wipes or "Sani-wipes"

-otomy

to cut or separate, as in craniotomy (cutting of bones of the cranium or skull

transplant

to transfer (tissue or organ) from one body to another; to uproot and replant

The nurse is discharging a client home from an outpatient surgery center. The nurse has reviewed all of the discharge instructions with the client and her caregiver. What else should the nurse do before discharging the client from the facility? Select all that apply.

•Provide all discharge instructions in writing. •Provide the nurse's or surgeon's contact information. •Give prescriptions to the client.