VN 161 Surgical Nursing
The term used to refer to the revision or molding of tissue is known as
- plasty
The nurse is reviewing the patient's hemoglobin level. The nurse is aware that the surgeon May delay the surgery if the hemoglobin falls below what level?
10 g/dL
The normal recommended frequency of assessments for the patient in the PACU is every
15 minutes
At the close of the shift, the nurse is reviewing the patients intake. The nurse knows the patient ingested 1 & a half cups of ice. What total should be documented on the patient's records?
180 mL
Approximately how much time does the average patient spend in the PACU?
2 to 6 hours
The person most likely to develop postoperative complications is a
35 year old diabetic patient vs, an active 16 year old, or an active 50 year old, or a 60 year old woman that lives alone.
Patients over the age of _____ years will usually have an electrocardiogram ordered before surgery
40 years
After surgery, a patient asked for clarification on the frequency for preforming leg exercises to prevent thrombophlebitis. What information should be provided to the patient?
5 to 10 times every hour while awake
After the return of spontaneous circulation following the resuscitation of a patient who had a cardiac arrest, therapeutic hypothermia is ordered. Which action will the nurse include in the plan of care? Apply external cooling device Rewarm if temperature is < 91F (32.8C) Check mental status every 15 minutes Avoid the use of sedative medications
A
Gastric lavage and administration of activated charcoal are ordered for an unconscious patient who has been admitted to the emergency department (ED) after ingesting 30 lorazepam (Ativan) tablets. Which action should the nurse plan to do first? A. Assist with intubation of the patient. B. Give first dose of activated charcoal C. Prepare a 60-mL syringe with saline. D. Insert a large-bore IV.
A
The nurse cautions that , when cooling down a victim of heat stroke, one must be careful to prevent shivering. Shivering can lead to which complication? A. An increase in temperature B. A seizure C. A paralytic ileus D. Cardiac arrhythmias
A
What is the purpose of pre-op medication prior to surgery?
reduces the amount of anesthesia needed; promote sedation instruct client that he or she will feel drowsy keep client in bed with side rails up after administration Sedatives- for the client to sleep well the night before and stabilize BP and pulse Antibiotics- to prevent post-op infections Narcotics- morning of the surgery, given to relax the client and enhance the anesthesia's effects Drying agents- AKA anticholinergic is given to help inhibit the body secretions reducing risk of aspiration; if a client previously took a beta-blocker, then administering this medication pre-op is important to prevent a cardiac event and mortality
What changes would you expect in wound drainage in the immediate postoperative phase?
You would expect the wound drainage to be bright red or sanguineous immediately post-operative
The nurse is reviewing the scores of the PACU to determine Readiness for discharge back to the nursing unit. What is the name of the scoring system likely in use?
Aldrete
Which action could the post-anesthesia care unit (PACU) nurse delegate to unlicensed assistive personnel (UAP) who help with the transfer of a patient to the clinical unit? Help with the transfer of the patient onto a stretcher. Provide hand off communication to the surgical unit charge nurse Document the appearance of the patient's incision in the chart Clarify the post-operative orders with the surgeon
A
What is dehiscence?
A separation of the wound incision
Explain what procedures of patient dress and gowning you would follow before surgery.
On the morning of surgery provide a clean gown and instruct the patient to remove all undergarments. Remove all jewelry and body piercings.
Which drugs should be held or modified before surgery?
Anticoagulants NSAIDs Aspirin Herbal products such as ginger, garlic, ginkgo, ginseng
The post-operative patient reports feeling nauseated. In addition to medicating the patient as prescribed with antiemetics, what additional actions may be comforting to the patient?
Applying a cool cloth to the back of the neck
Which of the following is the most appropriate nursing response to a 2 day postoperative patient who is complaining of incisional pain
Ask "on a scale from 1 to 10 with 1 being mild pain and 10 being the worst possible pain, how would you rate your pain?
After receiving change -of -shift report about these post-operative patients, which patient should the nurse assess first? A. Patient who has 30 ml of sanguineous drainage in the wound drain 10 hours after hip replacement surgery. B. Obese patient who had abdominal surgery 3 days ago and whose wound edges are separating C. Patient who has by bibasilar crackles and temperature of 100 F (37.8C) On the first postoperative day after chest surgery D. Patient who continues to have incisional pain 15 minutes after hydrocodone and acetaminophen (Vicodin) administration
B
The nurse has been assigned to care for several post-operative patients. Which patient is most likely to develop thrombophlebitis? A. A patient who is 2 days post operative for hernia repair with a history of diabetes B. A patient who is 6 days post operative for total right hip replacement with a history of left-sided stroke C. A patient who underwent major abdominal surgery and was dehydrated upon admission D. A patient status post outpatient cholecystectomy with a history of blood clots
B
Whichdataidentifiedduringtheperioperativeassessmentalertthenurse that special protection techniques should be implemented during surgery? Having a sip of water 3 hours previously History of spinal and hip arthritis Verbalization of anxiety by the patient Stated allergy to cats and dogs
B
Which physiological change(s) explain why the older adult is at greater surgical risk? (Select all that apply.) A. Less psychological stamina B. Greater vulnerability to fluid loss C. Fewer physiologic reserves D. Less tolerance for pain E. Greater probability of a chronic illness
B, C, E
A 19 year old is brought to the emergency department (ED) With multiple lacerations and tissue avulsion of the left hand. When asked about tetanus immunization, the patient denies having any previous vaccinations. The nurse will anticipate giving Tetanus-diphtheria toxoid and pertussis vaccine (Tdap) only Tetanus immunoglobulin (TIG) only. TIG and tetanus-diphtheria toxoid and pertussis vaccine (Tdap) TIG and tetanus-diphtheria toxoid (Td)
C
A 38-year-old female is admitted for an elective surgical procedure.Which information obtained by the nurse during the preoperative assessment is most important to report to the anesthesiologist before surgery? A. The patient's lack of knowledge about postoperative pain control measures B. The patient's concern that she will be unable to care for her children post-operatively C. The patient's statement that her last menstrual period was 8 weeks previously D. The patient's history of a post-operative infection following a prior cholecystectomy
C
A drowning victim is brought to shore and is semiconscious and breathing. The camp counselor recognizes that which positioning is the most appropriate for this victim? A. Prone with head turned to side B. Supine to receive CPR C. On the side in recovery position D. Supine with knees flexed
C
A patient is transferred from the post-anesthesia care unit (PACU) to the clinical unit. Which action by the nurse on the clinical unit should be performed the first? Read the post operative orders Assess the patient's pain Take the patient's vital signs Orient the patient to the unit
C
What is the drug choice to treat anthrax?
Ciprofloxacin
Refresh your memory on what clear liquids, full liquids are
Clear liquids: broth, bouillon, co<ee, tea, clear fruit juices, gelatin & popsicles Full liquids: Clear liquids plus smooth textured dairy products, custards, reSned cooked cereals, vegetable juice, pureed vegetables & all fruit juices
When planning a diet to promote wound healing, adequate amounts of vitamin C should be included. What foods should be incorporated into this menu?
Collard greens
The significant other of a patient scheduled to have surgery the following day ask when he should come to the hospital to see his loved one before the procedure. What should he be told?
Come in 90 minutes before the scheduled start time
Just before a scheduled surgery, the patient tells the nurse he has changed his mind and will not be having the surgery. What initial action by the nurse is indicated?
Contact the nursing supervisor
A post-operative patient states, "I hate doing the incentive spirometer." The patient questions how long the exercise must be continued. What information should be provided to the patient.
Continue to do the activity at least three days after the surgery
The nurse notices that after the patient ambulated, some of the staples on his incision popped off and the incision is partially open. She should?
Cover the wound with a sterile gauze moistened with normal saline and notify the physician
The nurse assesses a patient who had a total abdominal hysterectomy 2 days ago. Which information about the patient is most important to communicate to the health care provider? A. The patient complains of abdominal pain at level 6 (0 to 10 scale) when ambulating, B. The 24-hour oral intake is 600 mL greater than the total output. C. The patient's temperature is 100.3° F (37.9° C). D. The right calf is swollen, warm, and painful.
D
What exactly does the informed consent state?
DISCUSS WHAT IS BEING PROVIDED the reason the treatment or procedure is needed professionals who will be performing/participating in the treatment information on the risks of anesthesia how the treatment or procedure will benefit the client the risks involved if the client chooses to receive treatment or procedure other options to treat the problem including the option of not treating the problem
Name and describe the three complications of wound healing.
Dehiscence is the reopening of the surgical wound. Evisceration is when the body organs protrude through an open wound. Infection is greatest in cases of traumatic injuries
Surgery conducted for the purpose of diagnosis is called
Diagnostic
List the classifications of surgical procedures
Diagnostic Ablative Palliative Restorative Procurement for transplant Constructive Cosmetic
Conscious sedation is used for
Diagnostic and therapeutic procedures
Why might a provider prescribe routine analgesics after surgery rather than as needed?
During the first few days after surgery, promptly medicate the patient for pain. Pain is controlled better if it is treated before it becomes severe. This is why some Physician's order routine analgesics rather than PRN for the first 24 to 36 hours
Describe the classifications of surgery: Minor, Elective, Emergency and Major
ELECTVE- condition is not life-threatening, and client may choose to have surgery or decline the surgery, ex- plastic surgery EMERGENT- requires immediate intervention because of life threatening consequences ex- ruptured appendix, severe internal hemorrhage MINOR- procedure without significant risk; often done with local anesthesia MAJOR- procedure of greater risk, usually longer and more extensive than a minor procedure
If direct pressure doesn't stop a foot from bleeding what's your next action?
ELEVATE above the level of the heart apply indirect pressure to an artery between the wound and the heart if direct pressure does not control bleeding apply a tourniquet as a last resort if bleeding does not stop; tourniquet cuts off the blood flow in the artery completely
What is the three-tier triage system about during a disaster?
EMERGENT (Class I)- HIGHEST priority, life-threatening injuries or limb threatening, but also high possibility of survival once stabilized URGENT (Class II)- second-highest priority, major injuries that are not yet life- threatening; typically can wait 45-60 min NONURGENT (Class III)- next highest is those with minor injuries that are not life threatening and do not need immediate attention
During a disaster think of pts you might encounter, thick of what patients you will attend to first and those you will attend to last.
Emergent: seen first, pt examples- trauma victims, chest pain, limb amputation, cardiac arrest, acute neurological deScits, chemical splashes to the eyes Urgent: seen second, pt examples- simple fx, asthma w/out respiratory distress, fever, renal stone, abdominal pain, hypertension Nonurgent: seen next, pt examples- minor laceration, sprain, or cold symptoms EXPECTANT- expected and allowed to die
When caring for a patient the second postoperative day after abdominal surgery for removal of large pancreatic cyst, the nurse obtains an oral temperature of 100.8F. Which action should the nurse take first? Have the patient use the incentive spirometer Ask the healthcare provider to prescribe a different antibiotic Assess the surgical incision for redness and swelling Administer the ordered PRN acetaminophen (Tylenol)
Have the patient use the incentive spirometer
When providing teaching to a patient preparing for surgery, the patient asks when the wound will heal with a scar. What information can be provided to the patient?
In 4 weeks
What is a consent form and explain the restrictions regarding the patients signing this form.
It's a legal document the patient must sign before surgery. It states that the patient has been informed about the surgical procedure the alternative treatments and the risk involved. It is the physician's responsibility. It must be witnessed.
What type of drug is versed?
Medazolam (Versed) - Short acting Benzodiazpine (sedative) CNS depressant used for conscious sedation before minor procedures such as endoscopy; used for induction of anesthesia; helps patient relax
Subjective complaints associated with a wound infection may include
Nausea
Before the surgical procedure, the patient tells the nurse he had a small amount of liquids, although the physician had ordered him to be NPO. What initial action by the nurse is indicated?
Notify the surgeon
Following an earthquake, patients are triaged by emergency medical personnel and are transported to the emergency department (ED). Which patient will the nurse need to assess first? A patient with a black tag A patient with a yellow tag A patient with a red tag A patient with a blue tag
Red
Epidural anesthesia is an example of
Regional anesthesia
The patient is scheduled to have lysis of adhesions. Based on your knowledge, your understanding the patient will be having which procedure?
Removal of the affected tissue
An infected wound that is left open to heal from the bottom up is said to be healing by
Secondary intention
The post-operative patient has developed hiccoughs. Which intervention May best help the patient manage the episode?
Suck on ice chips for approximately 5 to 7 minutes
The nurse is caring for a patient who had spinal anesthesia. Which drink is the best choice for the nurse to offer the patient? Orange juice Tea Milk Water
Tea
What are "ABCDE's"? Why are they in this order?
The ABCDE principle guides the primary survey Emergency care is guided by the principle of ABCDE- it helps to determine the priority action Airway/cervical spine Breathing Circulation Disability Exposure
What are the initial signs and symptoms of the toxic effects of local anesthesia?
The initial signs and symptoms of toxic effects are excitement and CNS stimulation followed by depression of the CNS and the cardiovascular system
When planning the response to the potential use of smallpox as an agent of terrorism, the emergency department (ED) nurse manager will plan to obtain adequate quantities of? Whole blood Antibiotics Atropine Vaccine
Vaccine
Name the goals of nursing during the preoperative phase?
The nursing goals is for the patient to know what to expect from the surgical experience and to have minimal anxiety.
The patient undergoing surgery must sign a consent form before the procedure. What would negate the ability of a patient to sign a surgical consent?
The patient had narcotic analgesics administered recently
A patient is usually transferred from the postanesthesia care unit when which of the following criteria is met?
The patient is awake or can be wakened easily
Who is responsible for the surgical consent making sure pts understand what is taking place and signed and why?
The provider is responsible for explaining the surgical consent and getting the form signed. The nurse is responsible for witnessing the signing and ensuring the pt understands the procedure
The nurse assesses a patient who has just arrived in the postanesthesia recovery area (PACU) after a blepharoplasty. Which assessment data should be reported to the surgeon immediately? The patient is unable to detect when the eyelids are touched The patient complains of incisional pain The patient's heart rate is 110 beats/minute The skin around the incision is pale and cold when palpated
The skin around the incision is pale and cold when palpated
Who participates in the intraoperative period?
The surgical team includes the surgeon, assistant surgeon, a nurse first assistant, RN's, LVN, or surgical tech, anesthesiologist or nurse anesthetist, other technical personnel with specialized jobs.
A positive Homan's sign may indicate that the patient has developed
Thrombophlebitis
If pts who are post op have "wet" lung sounds what would be your goal?
To encourage the use of an incentive spirometer, deep breathing exercises, and to either be ambulatory or to frequently change position
Why is it we want the post op abdominal pt up ambulating 24 hours after surgery?
To prevent cardiovascular disorders, deep-vein thrombosis (circulation moving), and pulmonary complications, along with respiratory issues or constipation
How many times per year should accredited health care facilities test their emergency plans? Three times Once Twice Four times
Twice
Once you have assessed your pts air way is not obstructed and he is breathing, why are you watching his chest?
once a patient airway is achieved, the presence and effectiveness of breathing should be assessed *to monitor chest expansion, respiratory e<ort and notation of rate and depth of respirations
As compared with diagnostic surgery, exploratory surgery?
is usually more extensive
What does agitation and confusion have to do with low O2 saturation?
less oxygen to the brain this is a sign of hypoxia- not enough oxygen in the blood
What is serosanguineous drainage?
made up of serum (clear, thin, watery) and some blood
