23: Perioperative Nursing
A client who came in through the emergency department with a severely fractured leg will be transported to surgery within the hour. When the client asks how long hospitalization will occur after surgery, what is the appropriate nursing response?
"Because you are having inpatient surgery, you will be hospitalized at least 1 day after surgery." Explanation: With a severe fracture, the client will be considered as having inpatient surgery and will be hospitalized at least a day. The nurse should not give a definitive period of time for hospitalization, and the surgeon (not the anesthesiologist) will give the best predictor of length of stay.
The nurse is educating a client who is preparing for abdominal surgery tomorrow. A teaching demonstration has just been completed by the nurse related to splinting the incision site with a pillow. Which statement by the client best indicates the instructions provided by the nurse were effective?
"I will put the pillow on the incision then cough." Explanation: Splinting the incision site when moving helps to minimize pain or discomfort postoperatively when coughing or moving. Clients should not hold their breath when trying to cough or move to prevent the Valsalva maneuver, which can change the heart rate and blood pressure of a client. Placing the pillow on the incision site after coughing is ineffective at reducing pain. The pillow should remain over the incision until the coughing exercises are completed.
A nurse is preparing a client for discharge from the ambulatory surgical center. Which client statement would indicate a problem with the client's discharge?
"I'm going to take a taxi home." Explanation: When a person is being discharged from an ambulatory surgical center, a responsible person should be available to accompany the client home. Thus the statement about going home in a taxi would be problematic. The ability to ambulate, drink fluids, and manage pain are appropriate indicators for discharge.
The nurse is preparing a client for a total hip arthroplasty and is obtaining data preoperatively. Which statement made by the client is most important for the nurse to immediately report to the health care provider?
"I've been taking ibuprofen for my hip pain twice a day." Explanation: The nurse should immediately report the use of ibuprofen twice daily for the hip pain since this medication can cause the complication of postoperative bleeding. The history of hip pain and the inability to perform activities that were previously enjoyed are not relevant in determining complications. The intake of food or fluids is relevant, but the amount of time the client has been NPO is acceptable and reduces the risk of complications from anesthesia.
The nurse is teaching a client who will undergo abdominal surgery to repair a hernia about deep breathing. The client asks, "Why am I practicing breathing when I'm having hernia surgery." What is the appropriate nursing response?
"It decreases the postoperative risk for respiratory complications." Explanation: Deep breathing after surgery reduces the risk for development of postoperative respiratory complications. It does not help with pain control, facilitate quicker healing, or reduce the risk for blood clots.
A client is concerned about taking pain medication after surgery and asks, "Are there other things I can do to alleviate my pain?" Which is the best response by the nurse?
"Positioning and massage can also help to alleviate pain." Explanation: Pain management is an important nursing intervention during the postoperative period. Nonpharmacologic interventions such as positioning, back massage, distraction, and emotional support help the postoperative client feel more comfortable. Clients should move as much as allowed to encourage rehabilitation and prevent complications. Pain medications are administered as needed to control postoperative discomfort. Teaching the client to recognize and report pain is an important part of pain management.
A client will be undergoing outpatient surgery in a few weeks. During this presurgical appointment, the nurse educates the client on necessary items regarding discharge to home after the procedure. What discharge information does the nurse teach the client?
"The center will not allow you to drive a car home. You should ask a responsible person to be available to accompany you home." Explanation: After outpatient surgery, clients are not allowed to drive a car home because during the procedure, the client may have received analgesics and medications that impairs the ability to make decisions and motor function. A responsible person should be available to accompany the client home. This information should be discussed prior to admission so the client has time to make arrangements. Clients are not typically released to leave by themselves as they may still have aftereffects from procedures or anesthesia, therefore taking a taxi or driver service home would not be appropriate. This would be a decision that would be determined by the provider. Clients may go home when they are no longer dizzy or drowsy, have stable vital signs, and have voided.
The nurse is talking with a client who wishes to have a tattoo removed. Which client statement indicates that the client understands how the procedure will be accomplished?
"The provider will perform this laser surgery in an ambulatory care setting." Explanation: Tattoos are often removed via laser surgery in an ambulatory setting. This type of outpatient procedure does not commonly require anesthesia, nor hospitalization.
A client who is in the holding area awaiting knee replacement surgery tells the nurse, "I am afraid of getting HIV if I have to have a blood transfusion during this surgery." What is the appropriate nursing response?
"The risk of acquiring a blood-borne disease from a blood transfusion is very small." Explanation: The nurse will teach that the chance of acquiring a blood-borne disease from a blood transfusion is very small. Giving blood preoperatively may have been ideal, but that does not address the client's immediate concern. Although transfusions are not commonly associated with knee replacement surgery, this does not address the client's concern. Siblings should not donate blood for a client because antigens in the transfused blood sensitizes the client recipient, which would rule them out as a future organ or tissue donor for the client.
A postoperative client asks, "Why is it important to walk and exercise my legs?" Which is the best statement by the nurse?
"Walking and leg exercises will help prevent complications." Explanation: Walking and leg exercises assist in preventing muscle weakness, promote venous return, and decrease complications related to venous stasis. These exercises are not known to increase muscle mass after surgery or decrease the effects of anesthesia.
A young adult client has had an emergency appendectomy that caused the client to be out of work for 8 weeks. The client verbalizes stress over this unexpected situation. Which is the best response by the nurse?
"What have you done in the past to manage stress?" Explanation: Surgery, even a minor procedure, entails significant stress. Coping behaviors and stress tolerance are closely related to how a person defines stress and how that person has managed stress in the past. Nursing interventions should include attempts to identify stress management strategies that were effective for the client in the past because these strategies may be effective again during the perioperative period. By asking the open-ended question of how the client has handled stress in the past, the nurse allows the client to speak openly about coping strategies. Keep in mind that stress tolerance and coping behaviors are individual matters. What is effective for one person may not be effective for another. Other interventions to assist a person in coping and managing stress include identifying and promoting effective stress management strategies and coping behaviors, providing emotional support and instruction for the client and family, and making referrals to other health professionals as necessary.
The nurse is caring for a client after breast augmentation. Before performing a bowel assessment, what education will the nurse provide the client?
"You can have decreased or absent bowel movement, called peristalsis because of administration of anesthetic agents or opioids. By listening for bowel sounds, I can check for a return of peristalsis." Explanation: A postoperative client can typically have decreased or absent peristalsis because of bowel manipulation and/or administration of anesthetic agents or opioids. Auscultation of bowel sounds will help determine a return of peristalsis. Palpating the abdomen would not help with determining peristalsis return; the nurse may feel distention and firmness of the abdomen with decreased peristalsis, but this is not accurate in determining return of peristalsis. The symphysis pubis would be assessed to determine bladder fullness, not peristalsis. Giving the client sips of water would not help determine or promote the return of peristalsis; this also could be a safety issue if the client has decreased peristalsis due to emesis and subsequent potential aspiration.
A postoperative home care client has developed thrombophlebitis in the right leg. What new plan of care will need to be added because of this complication?
Anticoagulant treatment and education about the increased risk of bleeding Explanation: An anticoagulant is a drug (blood thinner) that treats, prevents, and reduces the risk of blood clots breaking off and traveling to vital organs of the body. Thrombophlebitis is an inflammation of a vein associated with thrombus formation. Thrombophlebitis from venous stasis is most commonly seen in the legs of postoperative clients. Antibiotics are used for infection. Antihistamines block the histamine systematically, as in an allergic response and the histamine released by the stomach. An antigen is a toxin or other foreign substance that induces an immune response in the body, especially the production of antibodies.
A nurse is preparing a postoperative client to get out of bed and move to a chair for the first time. As the nurse assists the client in standing up, the client reports dizziness and becomes pale and diaphoretic. What would be most appropriate for the nurse to do?
Assist the client back into the bed. Explanation: If a client reports dizziness or feels diaphoretic when ambulating, the client should return to bed to prevent injury. The change in position may be causing the client's blood pressure to drop. Therefore, the bed is the safest place for the client.
While reviewing the medical record of a client who has had abdominal surgery, the nurse notes that the client has developed a paralytic ileus. The nurse interprets this information as indicative of what?
Bowel functioning is significantly decreased. Explanation: The nurse knows that when a client has paralytic ileus, the bowel functioning decreases significantly. In some cases, intestinal peristalsis may temporarily cease altogether, but it does not become permanently paralyzed. The bowel does not become deflated, but it does become distended and partially paralyzed. Bowel sounds are usually absent.
A nurse is interacting with a client in the outpatient surgical unit intraoperatively. What is the nurse's priority responsibility?
Client safety Explanation: Client safety is the most important nurse responsibility during the intraoperative phase. Safety concerns include equipment, electrical, chemical, radiation, surgical verification, client transport and positioning, and continuous asepsis. Postoperative protocol education is done preoperatively. Establishing a nurse-client rapport and providing emotional support are important, but they are not the most important nursing responsibility during the intraoperative phase.
A nurse is working as part of an intraoperative team and is involved in the surgical verification process for a client. What would the nurse expect to be performed as the last step?
Complete the "time-out" procedure. Explanation: The goal of the surgical verification process is to prevent avoidable errors by standardizing procedures for all surgical facilities through a universal protocol. This protocol includes the following: correct identification of the surgical client using two separate identifiers; preoperative verification process with review documents (e.g., preoperative checklist, informed consent), diagnostic studies, and laboratory tests in the client record to be sure that they are consistent and agree with the client's verbalization and understanding of the planned procedure; marking of the surgical site, involving the client whenever possible; checking for the presence of implants; checking for the arrival of special instruments or equipment before the surgery begins; and final procedural pause or "time-out" involving all members of the surgical team, whereupon final oral verification occurs, confirming that the correct client is in the room, is positioned correctly, and the site/procedure is agreed upon before the incision is made. Increasingly common is the use of a surgical safety checklist such as the SCOAP (Surgical Care and Outcomes Assessment Program) checklist.
The nurse has admitted a client to the postoperative unit following a bowel resection and is providing postoperative health education on coughing and deep breathing. What does the nurse explain to the client about why these actions are important?
If you continue to breathe shallowly or cough ineffectively, this can lead to atelectasis and pneumonia. Explanation: Shallow breathing or an infective cough can lead to mucus plugging, atelectasis, hypoxemia, and pneumonia. Taking deep breaths helps to expand alveoli and an effective cough pushes secretions upward out of the lungs. A client experiencing postoperative pain may be unable or unwilling to take the deep breath needed to cough. Medications used to control pain and splinting the incision by hugging a pillow or blanket increase compliance to deep breathing and coughing exercises. Shallow breathing or ineffective cough does not lead to aspiration pneumonia, inability to ambulate, or DVT. Acute respiratory distress syndrome is caused by sepsis, inhaling harmful substances, injury, and severe pneumonia that has infiltrated all five lobes and is not specific to postoperative-related pneumonia.
After conducting a preoperative health assessment, the nurse documents that the client has physical assessments supporting the medical diagnosis of emphysema. Based on this finding, which is the priority risk of complications in the postoperative period?
Impaired gas exchange Explanation: A nurse should complete a focused assessment on previous medical issues, especially the respiratory system, after surgery. Respiratory disorders, such as emphysema, increase the risk for respiratory depression from anesthesia as well as postoperative pneumonia and atelectasis, causing impaired gas exchange. Impaired physical mobility, constipation and urinary retention would be of concern but not as important as impaired gas exchange related to the diagnosis of emphysema.
A nurse is monitoring a client post cardiac surgery. What action would help to prevent cardiovascular complications for this client?
Implement leg exercises and turn the client in bed every 2 hours. Explanation: Ambulation and leg exercises increase circulation, which prevents cardiovascular complications. The nurse should provide covers, forced warm air, or other warming devices/techniques as necessary to prevent shivering and hypothermia caused by the surgical procedure, the procedure's length, anesthetic agents, a cool environment, the client's age, or the use of cool irrigating/infusion fluids. Pillows placed under the knees can cause venous pooling, leading to thrombophlebitis.
The nurse is preparing to send a client to the operating room for an exploratory laparoscopy. The nurse recognizes that there is no informed consent for the procedure on the client's chart. The nurse informs the physician who is performing the procedure. The physician asks the nurse to obtain the informed consent signature from the client. What is the nurse's best action to the physician's request?
Inform the physician that it is their responsibility to obtain the signature. Explanation: The responsibility for securing informed consent from the client lies with the person who will perform the procedure. The nurse's best action is to inform the physician that it is their responsibility to obtain the signature. Obtaining the signature and then cosigning by another nurse or asking the nurse manager or calling the house officer to sign the consent are all inappropriate.
The nurse is supervising a nursing student who is providing postoperative education to a client with an abdominal incision. The nurse sees the student coaching the client to perform coughing exercises, as pictured above. What is the nurse's best action?
Instruct the student to provide the client with a pillow or folded blanket to hug. Explanation: Because coughing is often painful, the student should teach the client how to splint the incision (i.e., support the incision with a pillow or folded bath blanket). It is not normally necessary to physically support the client, and it may be unsafe for the client to dangle. The client should not be in a supine or in a low Fowler's position, but the client does not necessarily need to be fully upright.
A client is scheduled for liposuction surgery to reduce weight. Which action should the nurse take immediately after surgery?
Listen to bowel sounds Explanation: During the postoperative period, key nursing responsibilities focus on determining that all body systems are functioning adequately. This would include listening to the client's bowel sounds. The surgical dressing is first changed by the surgeon at a future date. Liposuction does not necessarily require a weight loss diet after surgery, thus monitoring the client's weight loss will not be needed.
A client had an open cholecystectomy (gallbladder removal) 36 hours earlier, and the nurse's assessment this morning confirms that the client has not yet had a bowel movement since prior to surgery. How should the nurse best respond to this assessment finding?
Monitor the client closely and promote fluid intake. Explanation: Bowel function does not typically return immediately after surgery, but it can be promoted by encouraging fluid and fiber intake as appropriate to the client and his surgery. A medical assessment is likely unnecessary at this early postoperative stage and an enema would likely be premature. The nurse may not independently increase the client's IV infusion, and doing so would not necessarily promote a bowel movement.
A nurse is taking care of a client during the immediate postoperative period. Which duty performed during the immediate postoperative period is most important?
Monitor the client for complications. Explanation: The immediate postoperative period refers to the first 24 hours after surgery. During this time, the nurse monitors for complications as the client recovers from anesthesia. Once the client is stable, the nurse prepares a room for the client's return and assesses the client to prevent or minimize potential complications. The nurse ensures the safe recovery of the client after the client has stabilized.
Which measure would the nurse implement for prevention of deep vein thrombosis (DVT) in a postoperative client?
Place graduated compression stockings on the client. Explanation: Use of graduated compression stockings and/or pneumatic compression devices on the client will help with prevention of DVT, which is a risk for clients after surgery. Elevating the client's legs will passively improve venous return but not prevent DVT if a client is not up and walking (to more actively promote the venous return). Elevating the head of the bed and using the incentive spirometer help prevent postoperative complications of atelectasis or pneumonia.
A nurse is assessing a client who is experiencing pulmonary embolus. What would be the priority nursing intervention for this client?
Place the client in semi-Fowler's position. Explanation: Nursing interventions include notifying the physician immediately, calling the medical intervention team, maintaining the client on bed rest in the semi-Fowler's position, assessing vital signs frequently, administering oxygen, administering medications (e.g., anticoagulants, analgesics), and instructing the client to avoid Valsalva maneuver (this prevents increased intrathoracic pressure and, possibly, increased emboli).
The nurse is teaching the client who recently experienced abdominal surgery to deep breathe and cough effectively. What observable action serves to best minimize pain that may result from the intervention?
Providing support to abdominal and accessory respiratory muscles Explanation: Coughing and deep breathing uses abdominal and accessory respiratory muscles, which may have been cut during surgery. Splinting, in this case with a pillow, supports the incision and surrounding tissues and reduces pain during coughing and deep breathing exercises. While providing emotional support is appropriate, doing so will not affect physiological pain resulting from the intervention. Exhaling with lips pursed increases resistance in the airways, which helps them stay open during exhalation. Supporting the head and shoulders adds to the client's comfort, but doing so does not address the primary source of pain produced by therapeutic coughing and deep breathing.
The nurse is assessing clients for postoperative complications. What is the most commonly assessed postanesthesia recovery emergency?
Respiratory obstruction Explanation: Respiratory obstruction may occur as a result of secretion accumulation, obstruction by the tongue, laryngospasm (a sudden, violent contraction of the vocal cords), or laryngeal edema. Cardiac distress, wound infection, and dehydration are all possible postoperative complications, but respiratory obstruction is most common.
A nurse is reviewing postoperative protocols with the client, including an explanation and a demonstration of how to use an incentive spirometer. How does the nurse know that the teaching on the use of the incentive spirometer was effective?
The client completes a return demonstration and inhales with lips tightly sealed around the mouthpiece while sitting upright in bed. Explanation: Incentive spirometry improves lung expansion, helps expel anesthetic gases and mucus from the airway, and facilitates oxygenation of body tissues. The client is positioned in high Fowler or sitting position, inhales slowly and deeply through the mouth with lips tightly sealed around the mouthpiece of the spirometer, and exhales slowly while lips are no longer sealed around the mouthpiece. Spirometry is to be performed in the sitting position so conducting this before rising from the bed is inappropriate. Repeating instructions is a valid tool for verbal instructions, however when procedures and protocols are to be conducted the best method for determining understanding is to have the client return demonstration on how to appropriately perform the spirometry.
The nurse is caring for a postoperative client. The nurse monitors the client for thrombus formation. Which factor(s) in the client's health history signals to the nurse that the client is at increased risk? Select all that apply.
The client has limited mobility. The client has fluid restrictions. The client has cognitive impairment. Postoperatively, clients are at risk for developing deep vein thrombosis as a consequence of preoperative fluid restrictions, a decrease in blood volume due to fluid loss during the surgical procedure, and decreased activity following the surgery. Clients with cognitive impairment tend to be at a higher risk for several postoperative complications. It is important for the nurse to be aware of this because the client will have limited independence in following through on activities recommended for postoperative prevention of thrombus formation. Following major surgical procedures, a client typically receives an injectable anticoagulant, such as dalteparin or fondaparinux, to prevent thrombus formation. The client's ability to communicate does not increase the client's risk for thrombus formation.
The nurse is caring for a client who had a procedure under moderate sedation at the ambulatory surgical center. Which assessment finding indicates to the nurse that the client may be ready for discharge to home
The client is alert and oriented with a blood pressure 118/70 mm Hg and respirations 18 breaths/minute, is able to ambulate, is not nauseated or vomiting, pain is controlled with medication, and has no excessive bleeding and drainage is as expected. Explanation: Stable vital signs, being alert and oriented, ability to ambulate, minimal nausea and vomiting, adequate pain control, and no excessive bleeding or drainage may indicate that the client is ready for discharge to home. The ability to void is a criterion after a spinal anesthesia or after pelvic surgery. Dizziness or inadequate pain control indicate that the client still needs to be monitored before discharge. Elevated blood pressure should be monitored and the client should not be discharged until stable.
A female client age 54 years has been scheduled for a bunionectomy (removal of bone tissue from the base of the great toe) which will be conducted on an ambulatory basis. Which characteristic applies to this type of surgery?
The client will be admitted the day of surgery and return home the same day. Explanation: Outpatient surgeries, also known as ambulatory surgeries, are conducted with admission and discharge on the same day. Such surgeries have become increasingly common in recent years, and some surgeries of increasing complexity and risk are conducted on an outpatient basis. General anesthesia is possible and common. This approach is more common for elective surgeries than urgent surgeries.
The nurse is creating the plan of care for a client scheduled for a laparoscopic cholecystectomy under general anesthesia. What is a priority expected outcome for this client intraoperatively?
The client will not sustain neuromuscular injury from positioning. Explanation: During surgery, the client is placed in a specific operative position after anesthesia has produced loss of consciousness and reflexes. The nurse ensures client safety to prevent alterations in integumentary, respiratory, vascular, and neuromuscular function. Adequate anesthesia is not a nursing goal and is nonspecific. Lack of anxiety is not a priority and is an expected response to the unknown. The indwelling catheter is an intervention and not an outcome statement.
The nurse is taking a history on Kumar, who informs her that he has an allergy to adhesive tape. When the nurse asks Kumar to describe his reaction to the tape, he describes it as "blotchy and reddened." What type of allergic reaction is this?
Type IV Explanation: A type IV reaction is characterized by local inflammation, pruritus and erythema.
Which client in the postanesthesia care unit (PACU) requires the most immediate attention by the nurse?
a 26-year-old client who is exhibiting a crowing sound Explanation: A client with a crowing sound is exhibiting stridor, which is an indication of an airway obstruction and can be a respiratory emergency. This client needs immediate attention. The client with disorientation needs to be frequently reoriented and observed for safety reasons but is not a priority over respiratory distress. The client who needs pain medication or the pediatric client requesting a parent are also not priority over a client in respiratory distress.
Which client would a nurse monitor most closely for postoperative respiratory complications?
a 55-year-old client with a history of asthma who had a colon resection Explanation: All of these clients have a potential for respiratory complications, which can occur with chest or abdominal surgery, preexisting cardiovascular or respiratory disease, and in older adults or obese clients. The client who has had abdominal surgery and has preexisting respiratory disease would be at the greatest risk for observation of any respiratory complications (due to having two factors instead of only one). The pediatric client having a tonsillectomy would need to be observed for any airway problems but would not be a greater risk than the client with two risk factors.
Nurses teach clients to restrict food and fluids before surgery. What condition does this measure attempt to avoid?
aspiration Explanation: Food and fluid are restricted before surgery to ensure that the stomach contains a minimal amount of gastric secretions. This restriction is important to reduce the risk of aspiration.
A client is undergoing surgery for an appendectomy. This would be considered what type of surgery?
emergency surgery Explanation: An appendectomy is considered emergency or urgent surgery. Elective surgery can be scheduled in advance, and a delay has no ill effects. Palliative surgery is done to relieve or reduce the intensity of an illness. Diagnostic surgery is done to make or confirm a diagnosis.
A client will be having a surgical procedure requiring general anesthesia. Which desired outcomes of general anesthesia does the nurse expect to observe? Select all that apply.
loss of consciousness analgesia relaxed skeletal muscles depressed reflexes Explanation: The desired actions of general anesthesia are loss of consciousness, analgesia, relaxed skeletal muscles, and depressed reflexes. An outcome of regional anesthesia is loss of sensation in a specific area. Altered mood with some degree of amnesia is an outcome of moderate sedation/analgesia.
An operating room nurse is preparing for a surgical procedure on an infant. The nurse's perioperative care is based on what physiologic factor that puts infants at greater risk from surgery than adults?
lower total blood volume Explanation: Infants are at a greater risk from surgery as a result of various physiologic factors. A major factor is that the infant has a lower total blood volume, making even a small loss of blood a serious consideration. This loss of blood poses a risk for dehydration and the inability to respond to the need for increased oxygen during surgery. The loss of blood would cause a decreased peripheral circulation but physiologically the infant has a normal peripheral circulation. The infant has a small chest expansion due body size and the infant's vascular rigidity is normal.
An operating room nurse is bringing a client to the nurse in the postanesthesia care unit (PACU). Which information would the operating room nurse provide during a hand-off report? Select all that apply.
medications given in operating room length of surgery drains inserted in surgery Explanation: The operating room nurse should give a hand-off report when bringing the client from the operating room and must include several critical pieces of information: medications given, the length of surgery, and any drains inserted. Other data that would be important include presenting condition of the client and any events that occurred during surgery. All personnel present in the operating room would not be an important detail to share; however, this is documented on the operating room record, as well as the time-out that was performed.
A nurse is caring for an older adult following hip surgery. Which serious complication would the nurse attempt to avoid by encouraging use of the incentive spirometer?
pneumonia Explanation: In the older adult client, postoperative pneumonia can be a very serious complication resulting in death. Therefore, it is especially important to encourage and assist the client in using the incentive spirometer and with deep breathing exercises.
A nurse is employed in an operative setting. Which of these roles is within the registered nurse (RN) scope of practice? Select all that apply.
positioning the client on the operating table counting sponges before and after surgery monitoring the client's vital signs Explanation: The RN's role is a supportive one for the client, monitoring vital signs and positioning the client on the operating room table. The RN also helps maintain safety by counting sponges and instruments that may have been used during the surgery. The RN is unable to administer anesthetics, such as inhalation agents or regional nerve blocks, without an advanced practice degree.
As a circulating nurse caring for a 45-year-old man undergoing left knee arthroscopic exploratory surgery, which task ensures that the team is on the same page and will perform the procedure on the right client and at the right site?
procedural pause (time-out) Explanation: The procedural pause (time-out) must be done prior to any procedure to ensure client safety and to verify the client identity, staff roles, and procedure being performed.
A nurse is assessing an older adult client who has undergone major bypass surgery at the health care facility. When developing the plan of care for this client in the postoperative period, what would the nurse identify as a priority assessment in the immediate period and for the first few days after the surgery?
respiratory function Explanation: During the immediate postoperative period and for the first few days after major surgery, assessments should focus on the client's respiratory function, pain, and tissue perfusion. The bowel elimination pattern and the ability to perform self-care and ambulate after discharge are important later in the postoperative course.
When preparing a client who has diabetes mellitus for surgery, the nurse should be aware of what surgical risk associated with this disease?
slow wound healing Explanation: Due to impaired circulation and high glucose levels, the client with diabetes is at an increased risk for slow wound healing. The surgical risk of fluid and electrolyte imbalances is often associated with clients who have kidney and liver disease. The risk of respiratory depression from surgery increases for clients with existing respiratory disorders. Altered metabolism may occur as a result of surgery for clients with kidney and liver diseases.
The nurse recognizes that palliative surgery is performed for what purpose?
to lessen the intensity of an illness Explanation: Palliative surgery is performed to help lessen the intensity of an illness; it is not meant to be curative but will help improve the client's quality of life. A diagnostic surgery makes or confirms a diagnosis such as with a biopsy to check for cancer. A removal of a body part that is diseased is ablative surgery, such as an appendectomy. Restoring function to traumatized tissue is reconstructive surgery, such as with plastic surgery.
A nurse is caring for an older adult client who has been prescribed fluid restriction before surgery. What should the nurse check most carefully to assess the risks of fluid restriction in older adult clients?
vital signs Explanation: The nurse should assess the client's vital signs, weight, and sternal skin turgor prior to fluid restriction to serve as a baseline for comparison. The period of fluid restriction before surgery may be shortened for older adults to reduce their risk of dehydration and hypotension. For most clients, vital signs are more significant than other assessments in determining the risks of fluid restriction.
A nurse from the ambulatory surgical center is preparing discharge instructions for a client who has had pelvic surgery. Which criterion would the client need to demonstrate to ensure that she is ready for discharge?
void normally Explanation: Before discharge from an ambulatory surgical unit, the client should be able to void normally after a pelvic surgery. It is natural for the client to experience pain after surgery; however, the client should also have the comfort level to control it. The client may not be in a position to eliminate nausea and vomiting completely before discharge, but should suffer minimally from them. The client may have some bleeding or drainage, which should not be excessive at the time of discharge from an ambulatory surgical unit.
A nurse is discussing a surgical procedure with a client who needs to sign his informed consent. Which of these tasks is part of the nursing role?
witnessing the client signature with their consent for surgery Explanation: The nursing role with informed consent is to witness the client signature on the form. The procedural physician is responsible for explaining the procedure, any alternative treatment, and the risks and benefits of having the surgery. The nurse may clarify information, but if in-depth explanation is needed, the procedural physician should be notified.
