Ch. 14 Perioperative Care

A client scheduled for surgery asks why blood tests are being done to evaluate liver function. Which response will the nurse make? "It is because the anesthesia you will receive is cleared through the liver." "It is to make sure that you haven't had any alcohol before the surgery." "It is just a routine test done before every surgery." "It is done to determine if you need antibiotics prior to surgery."

"It is because the anesthesia you will receive is cleared through the liver." The liver is one body organ that eliminates drugs and toxins and is important in the biotransformation of anesthetic compounds. Disorders of the liver may substantially affect how anesthetic agents are metabolized. Acute liver disease is associated with high surgical mortality. Careful assessment may include various liver function tests. Preoperative liver function tests may be routine but that does not explain the reason for the test to the client.

The nurse is preparing a patient for surgery. The patient is to undergo a hysterectomy without oophorectomy, and the nurse is witnessing the patient's signature on a consent form. Which comment by the patient would best indicate informed consent? "The health care provider is going to remove my uterus and told me about the risk of hemorrhage." "I know I'll have pain after the surgery." "I know I'll be fine because the health care provider said he has done this procedure hundreds of times." "Because the health care provider isn't taking my ovaries, I'll still be able to have children."

"The health care provider is going to remove my uterus and told me about the risk of hemorrhage." The surgeon must also inform the patient of the benefits, alternatives, possible risks, complications, disfigurement, disability, and removal of body parts as well as what to expect in the early and late postoperative periods. The nurse clarifies the information provided and, if the patient requests additional information, the nurse notifies the health care provider. Clarification of information given may be necessary, but no additional information should be given p. 178.

A surgical client has just been admitted to an inpatient nursing unit from the postanesthesia care unit with client-controlled analgesia (PCA). What must the client require for safe and effective use of PCA? A clear understanding of the need to self-dose An understanding of how to adjust the medication dosage An expectation of infrequent need for analgesia A caregiver who can administer the medication as prescribed

A clear understanding of the need to self-dose The two requirements for PCA are an understanding of the need to self-dose and the physical ability to self-dose. The client does not adjust the dose, and only the client should administer a dose, not a caregiver. PCAs are normally used for clients who are expected to have moderate to severe pain with a regular need for set dose analgesiap. 194.

____ is defined as surgery that requires fewer than 24 hours of hospitalization.

Ambulatory surgery

The client's surgery is nearly finished and the surgeon has opted to use tissue adhesives to close the surgical wound. This requires the nurse to prioritize assessments related to what complication? Anaphylaxis Hypothermia Malignant hyperthermia Infection

Anaphylaxis Fibrin sealants are used in a variety of surgical procedures, and cyanoacrylate tissue adhesives are used to close wounds without the use of sutures. These sealants have been implicated in allergic reactions and anaphylaxis. There is not an increased risk of malignant hyperthermia, hypothermia, or infection because of the use of tissue adhesives p. 190.

____ is the partial or complete loss of the sensation of pain with or without anesthesia.

Anesthesia

The nurse is preparing a client for surgery. The client reports being nervous and not really understanding the surgical procedure or its purpose. What is the most appropriate action for the nurse to take? Provide the client with a pamphlet explaining the procedure. Call the health care provider to review the procedure with the client. Have the client sign the informed consent and place it in the chart. Explain the procedure clearly to the client and the family.

Call the health care provider to review the procedure with the client. While the nurse may ask the client to sign the consent form and witness the signature, it is the surgeon's responsibility to provide a clear and simple explanation of what the surgery will entail prior to the client giving consent. The surgeon must also inform the client of the benefits, alternatives, possible risks, complications, disfigurement, disability, and removal of body parts as well as what to expect in the early and late postoperative periods. The nurse clarifies the information provided, and, if the client requests additional information, the nurse notifies the health care provider. The consent form should not be signed until the client understands the procedure that has been explained by the surgeon p. 179.

Wound ____ is the separation of wound edges without the protrusion of organs.

Dehiscence

The anesthesiologist administered a transsacral conduction block. Which documentation by the nurse is consistent with the anesthesia being administered? Yelling and pulling at equipment Denies sensation to perineum and lower abdomen Unresponsive to verbal or tactile stimuli No movement in right lower leg

Denies sensation to perineum and lower abdomen A transsacral block anesthetizes the perineum and occasionally the lower abdomen. Yelling and pulling at equipment can be related to the excitement phase of general anesthesia. Lack of response to verbal or tactile stimuli and no movement in the right lower leg are not consistent with a transsacral conduction block p. 186.

A nurse asks a client who had abdominal surgery 1 day ago if he has moved his bowels since surgery. The client states, "I haven't moved my bowels, but I am passing gas." How should the nurse intervene? Administer a tap water enema. Apply moist heat to the client's abdomen. Encourage the client to ambulate as soon as possible after surgery. Notify the physician.

Encourage the client to ambulate as soon as possible after surgery. The nurse should encourage the client to ambulate as soon as possible after surgery. Ambulating stimulates peristalsis, which helps the bowels to move. It isn't appropriate to apply heat to a surgical wound. Moreover, heat application & tap water enema can't be initiated without a health care provider's order p. 201.

A nurse assesses a postoperative client as having abdominal organs protruding through the surgical incision. Which term best describes this assessment finding? Hernia Dehiscence Erythema Evisceration

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 p. 197.

If the client cannot void within 4 hours after surgery, the nurse notifies the primary provider unless catheterization orders are in place. TRUE FALSE

FALSE

To prevent venous stasis and other circulatory complications, the nurse places pillows under the client's knees or calves. FALSE TRUE

FALSE

The nurse admits a client to the postanesthesia care unit with a blood pressure of 132/90 mm Hg and a pulse of 68 beats per minute. After 30 minutes, the client's blood pressure is 94/47 mm Hg, and the pulse is 110. The nurse documents that the client's skin is cold, moist, and pale. This client is showing signs of what potential issue? Malignant hyperthermia Neurogenic shock Hypovolemic shock Hypothermia

Hypovolemic shock The client is exhibiting symptoms of hypovolemic shock; therefore, the nurse should notify the client's health care provider and anticipate orders for fluid and/or blood product replacement. Neurogenic shock does not normally result in tachycardia, and malignant hyperthermia would rarely present at this stage in the operative experience. Hypothermia does not cause hypotension and tachycardia p. 200.

Sometimes a serious postoperative condition called ____ occurs in which the intestines are paralyzed and, thus, peristalsis is absent.

Paralytic ileus

The nurse is caring for the postoperative client in the postanesthesia care unit. Which of the following is the priority nursing action? Monitor vital signs for early detection of shock. Assess the incisional dressing to detect hemorrhage. Position the client to maintain a patent airway. Administer antiemetics to prevent nausea and vomiting.

Position the client to maintain a patent airway. Maintaining a patent airway is the immediate priority in the PACU p. 192.

A post op client reports severe abdominal pain. The nurse cannot auscultate bowel sounds and notes the client's abdomen is rigid. What is the nurse's priority action? Prepare to insert a nasogastric tube. Call the health care provider. Prepare to administer a stool softener. Re-attempt to auscultate bowel sounds.

Re-attempt to auscultate bowel sounds. Call the health care provider. Explanation: The client presents with a possible paralytic ileus, a serious condition where the intestines are paralyzed and peristalsis is absent. This may occur as a result of surgery, especially abdominal surgery. If the nurse is unable to auscultate bowel sounds and the client has pain and a rigid abdomen, the nurse will suspect an ileus and immediately call the health care provider. Re-attempting auscultation may occur, but only after the health care provider has been notified. Administering a stool softener may make the condition worse p. 198.

The nurse observes that a postsurgical client has hemorrhaged and is in hypovolemic shock. Which nursing intervention will manage and minimize hemorrhage and shock? Rubbing the back Encouraging the client to breathe deeply Elevating the head of the bed Reinforcing dressings or applying pressure if bleeding is frank

Reinforcing dressings or applying pressure if bleeding is frank The nurse should reinforce the dressing or apply pressure if bleeding is frank. The nurse should keep the head of the bed flat unless it is contraindicated p. 192.

The _____ wears a sterile gown and gloves and assists the surgical team by handing instruments to the surgeon and assistants, preparing sutures, receiving specimens for laboratory examination, and counting sponges and needles.

Scrub nurse

Clients must sign a consent form for any invasive procedure that requires anesthesia and has risks of complications. TRUE FALSE

TRUE

Hair usually is not removed before surgery unless it is likely to interfere with the incision. FALSE TRUE

TRUE

Wounds healed by primary intention are sutured together so that the wound edges are well approximated. FALSE TRUE

TRUE

The admitting nurse in a short-stay surgical unit is responsible for numerous aspects of care. What must the nurse verify before the client is taken to the preoperative holding area? That follow-up home care is not necessary That the family understands the client will be discharged immediately after surgery. That preoperative teaching was performed That the family is aware of the length of the surgery

That preoperative teaching was performed The nurse needs to be sure that the client and family understand that the client will first go to the preoperative holding area before going to the OR for the surgical procedure and then will spend some time in the PACU before being discharged home with the family later that day. Other preoperative teaching content should also be verified and reinforced, as needed. The nurse should ensure that any plans for follow-up home care are in place p. 180-181.

A postoperative client is being evaluated for discharge and currently has an Aldrete score of 8. Which of the following is the most likely outcome for this client? The client must be put on immediate life support. The client should be transferred to an intensive care area. The client can be discharged from the PACU. The client must remain in the PACU.

The client can be discharged from the PACU. The Aldrete score is usually 8 to 10 before discharge from the PACU. Clients with a score of less than 7 must remain in the PACU until their condition improves or they are transferred to an intensive care area, depending on their preoperative baseline score p. 192.

A client underwent an open bowel resection 2 days ago, and the nurse's most recent assessment of the client's abdominal incision reveals that it is dehiscing. Which factor should the nurse suspect may have caused the dehiscence? The client used client-controlled analgesia (PCA) until this morning. The client has vomited three times in the past 12 hours. The client's surgical dressing was changed yesterday and today. The client has begun voiding on the commode instead of a bedpan.

The client has vomited three times in the past 12 hours. Vomiting can produce tension on wounds, particularly of the torso. Dressing changes and light mobilization are unlikely to cause dehiscence. The use of a PCA is not associated with wound dehiscence p. 197.

When does the nurse understand the patient is knowledgeable about the impending surgical procedure? The patient discusses stress factors causing the patient to feel depressed. The patient participates willingly in the preoperative preparation. The patient verbalizes fears to family. The patient expresses concern about postoperative pain.

The patient participates willingly in the preoperative preparation. The nurse knows that the patient understands the surgical intervention when the patient participates in preoperative preparation. The other answers pertain to the patient experiencing decreased fear or anxiety, not knowledge about the procedure p. 180.

When should the nurse encourage the postoperative patient to get out of bed? Within 6 to 8 hours after surgery As soon as it is indicated On the second postoperative day Between 10 and 12 hours after surgery

Within 6 to 8 hours after surgery As soon as it is indicated Postoperative activity orders are checked before the patient is assisted to get out of bed, in many instances, on the evening following surgery. Sitting up at the edge of the bed for a few minutes may be all that the patient who has undergone a major surgical procedure can tolerate at first p. 202.

The nurse's assessment of a postop client reveals a temperature of 103.2°F, tachycardia, and client complaints of increased incisional pain. What does the nurse recognize that this client is experiencing? Atelectasis Uncontrolled pain Wound infection Hyperthermia

Wound infection Clinical manifestations of a wound infection include fever, tachycardia, an elevated white blood cell count, and increased incisional pain p. 197.

A client is undergoing a splenectomy. To complete preoperative paperwork, the nurse documents the client's desired outcomes. Which would not be an appropriate nursing goal for a perioperative client? minimizing the client's anxiety before surgery preparing the client physically for surgery assuring the client that he will be free of pain throughout recovery assisting the client in an uncomplicated recovery

assuring the client that he will be free of pain throughout recovery Being totally free of pain throughout recovery is not a realistic outcome. The other options represent appropriate goals for perioperative clients p. 177.

A nurse is assessing a postoperative client with hyperglycemic blood glucose levels. Which post-surgical risk factor would decrease if the surgical client maintained strict blood glycemic control? wound healing respiratory complications liver dysfunction nutrient deficiencies

wound healing In caring for a postoperative client, the nurse is correct to correlate hyperglycemia with an increased risk of surgical incision infections and delayed wound healing. Strict control of glycemic blood levels at the therapeutic range of 80-110 mg/dL would reduce this risk factor. There is no direct correlation between blood glucose levels and nutrient deficiencies, respiratory complications, or liver dysfunction p. 196.