Chapter 15- Preop

Case Study The nurse recognizes teaching has been effective by which of the following statements? A. "My neighbor was able to eat right up to the time of her procedure." B. "I know there is nothing you can do about nausea after the procedure." C. "So that IV line will stay in throughout the procedure?" D. "I know I will need blood during this procedure."

C. "So that IV line will stay in throughout the procedure?"

Case Study Because of Maria's smoking history, the nurse understands she is at great risk for which of the following? Select all that apply. A. Increased postoperative pain B. Difficulty with anesthesia C. Respiratory depression during the procedure D. Increased healing time after the procedure E. Deep vein thrombosis after the procedure

C. Respiratory depression during the procedure D. Increased healing time after the procedure E. Deep vein thrombosis after the procedure

The nurse is reviewing Juan's allergies and documents that he is allergic to penicillin. The nurse then reviews the preoperative medication list to ensure that Juan has not been prescribed a penicillin product. What medication should the nurse question?

Cefazolin sodium This is a cephalosporin antibiotic and should be questioned by the nurse. A client with a penicillin allergy is also likely to exhibit an allergic reaction to this drug classification.

What is a formal "time-out"?

Correct patient - Full name as printed on ID bracelet AND at least one identifier (DOB, etc.; NOT ROOM NUMBER!) Correct procedure Correct surgical site - Marked by surgeon

The nurse obtains the wristband and allergy band for a preoperative client, Samuel. He confirms that this information on the bands is correct. The nurse reviews the information on the wristband with the client and asks him to name the procedure and surgical site. What action did the nurse complete?

"time-out"

informed consent

**can only be done by surgeon** - Consent for procedure itself - Name of surgeon to perform surgery - Reason intervention will benefit the patient - Alternative options to surgery - Consent for anesthesia - Consent to administer blood products

Patient Assessment patient history

- Age - Allergies and sensitivities to latex - Current medications, including over-the-counter medications, vitamins, and herbal supplements - Medical history and treatment plans - Surgical history - Previous anesthesia and responses to anesthesia - Last oral intake - Any medical implants or devices - Any piercings - Dental implants - Nutrition deficiencies - Family history - Social history, including smoking and drug and alcohol habits - History of mental illness or abuse - Support system and living conditions - Advance directives

Patient Preparation patient teaching

- Anticipatory guidance - Recovery - DVT prophylaxis - Constipation - Mobility - Anxiety - Preventing pneumonia (Ambulation, incentive spirometry)

Ensure prior to transfer to OR:

- Consents completed - History and assessment complete - Learning needs met - Skin and bowel prep complete - Preoperative medication administered

Nursing Management actions

- Ensure removal of jewelry and prosthetics - Risk of burn or injury - electrocautery in OR - Inform anesthesia and surgical personnel of presence of any implants - Pacemaker: may need to be disabled - Time-out - IV insertion

Patient Assessment last oral intake

- Guidelines dependent upon institution and population - Usually NPO at least 8 hours prior - Full stomach increases risk for aspiration - Preop nurse documents last oral intake - Sips of water for essential medications

Patient Assessment medications

- Identify all home medications - Medications taken prior to surgery - Include herbal remedies and over-the-counter

Patient Assessment surgical/anesthesia history

- Previous surgery - Poor healing - Negatives responses to anesthesia (most common- nausea/vomiting)

Patient Assessment allergies

- Thoroughly document - Medications, food, medical dyes, latex, medical adhesives, environmental conditions - Latex: May schedule as first case to ensure no contamination

Nursing Management assessments

- Vital signs (Baseline prior to procedure) - Physical examination - Laboratory analysis - Last oral intake - Confirm skin and bowel prep completed

Patient Assessment systems assessment

- cardiovascular - respiratory - neurological - liver/renal - integumentary - GI - GU

Nursing Management preop possible nursing diagnoses

- fear and anxiety - knowledge deficit

Patient Assessment physical assessment

- height - weight - vital signs

Nursing Management teaching

What to expect of the OR experience - Helps with anxiety and increases patient comfort How to prevent postoperative complications - Coughing, deep breathing, early ambulation, etc.

Prior to surgery, the nurse is reviewing the client's readiness for surgery. Which observation can be a "show stopper" and requires the surgeon be notified? Select all that apply. a. Hypertension b. Use of aspirin c. Nausea d. Elevated white blood cells e. A new cough

a. Hypertension b. Use of aspirin d. Elevated white blood cells e. A new cough

During the preoperative period, the nurse would notify the healthcare provider of which of the following assessment findings? Select all that apply. a. Increased blood pressure b. Normal sinus rhythm on ECG tracing c. Elevated white blood cell count d. Client taking aspirin daily for pain e. Fever

a. Increased blood pressure c. Elevated white blood cell count d. Client taking aspirin daily for pain e. Fever

The nurse is completing the preoperative checklist for a client scheduled to undergo knee replacement surgery. Which actions must the nurse take? Select all that apply. a. Obtain a full medical history b. Assess client's current health status c. Give client a copy of current lab work d. Hang prescribed intravenous antibiotic e. Perform a "time-out" at the bedside

a. Obtain a full medical history b. Assess client's current health status d. Hang prescribed intravenous antibiotic e. Perform a "time-out" at the bedside

Jason is being prepared for knee surgery. The nurse completes the preoperative checklist, health history, and admitting assessment. A latex allergy is noted. What safety action should the nurse take next?

allergy band

What is the nurse's highest priority of care during the preoperative phase of care? a. Teaching to prevent complications b. Ensuring the client's physiological safety c. Explaining the 0-10 pain assessment scale d. Asking the client about support system

b. Ensuring the client's physiological safety

The preoperative nurse needs further instruction from the nurse manager when which action is observed? a. The nurse places compression stockings on the client's legs before the procedure. b. The nurse asks the client's spouse to witness the surgical consent. c. The nurse prints current lab results and places a copy on the chart. d. The nurse tells the client that early ambulation after surgery is best.

b. The nurse asks the client's spouse to witness the surgical consent.

The nurse reviews the blood work to confirm that all preventive measures are in place before Joe's scheduled orthopedic surgery. It is possible that he will require blood products during surgery. What is the additional requirement for blood delivery?

blood consent

The nurse is admitting Alvin for sinus surgery. Alvin tells the nurse "I've been hospitalized 25 times in my 72 years of life." What information should the nurse collect next?

client history

The nurse conducts client education based on the information collected during the client history and physical assessment process. The nurse suggests DVT prophylaxis. What medication is often given for this?

heparin A surgical client is at risk for the development of deep vein thrombosis (DVT) during the postoperative period. The nurse should include information about preventing DVT during preoperative education, including post-operative prophylaxis.

Melva is scheduled for a heart surgery. The surgeon comes to the preoperative area to review the surgical procedure with her. Alternatives are discussed, along with the benefits and risks associated with the surgery. Melva says she understands everything. What action should the nurse complete next?

informed consent

The nurse notes that Marlene smokes and documents this for the surgical team to review. The surgeon plans to provide pain medication post-operatively. What pain medication should the nurse question?

opioid narcotics Marlene is at an increased risk for experiencing respiratory depression with narcotics as a result of her smoking history. It is important for the nurse to relay this information to the surgical team.

Julie is admitted to a surgical clinic in preparation for breast reduction surgery. During the initial assessment, she informs the nurse of her allergy to penicillin and notes that she smokes 10 cigarettes each day. Her vital signs are obtained. What action should the nurse take next?

preoperative checklist

Patient Assessment privacy

use care when collecting information

Nurse's preoperative checklist

•Documentation •Assessment •Physical preparation •Educational needs

Patient Preparation radiological assessments

•MRI •CT scan •Ultrasound •X-ray •EKG

Patient Preparation lab assessments

•Type and screen •Complete metabolic panel •Coagulation studies •Complete blood count •Urinalysis •Pregnancy test (morning of procedure - all childbearing years regardless of sexual history; age 10+)

The surgeon, after talking to the mother of a 1-year-old infant scheduled for heart surgery, decides to postpone surgery. Which statement made by the infant's mother most likely influenced the surgeon's decision? A. "I fed the infant formula 2 hours ago." B. "I fed the infant an apple 8 hours ago." C. "I fed the infant grape juice 6 hours ago." D. "I fed the infant breast milk 4 hours ago."

A. "I fed the infant formula 2 hours ago."

The registered nurse is teaching about how to prepare a patient before knee surgery. Which statement indicates a need for further teaching? A. "I will use a razor to shave the leg hair of the patient." B. "I will use a sterile electric clipper to cut the hair of the patient." C. "I will shave the hair of the patient after administering anesthesia." D. "I will instruct the patient to have a shower with hexachlorophene soap."

A. "I will use a razor to shave the leg hair of the patient."

Which are roles of a preoperative nurse in the health-care facility? Select all that apply. A. Clarify information and ensure patient understanding. B. Obtain consent for the procedure. C. Witness the consent form even if the patient has not signed it in his or her presence. D. Correct common misconceptions and ease concerns of the patient and family members. E. Collect information and paperwork necessary for the procedure.

A. Clarify information and ensure patient understanding. D. Correct common misconceptions and ease concerns of the patient and family members. E. Collect information and paperwork necessary for the procedure.

Which postoperative complications is the nurse most likely to anticipate in a patient with preoperative anxiety who is scheduled for surgery? Select all that apply. A. Deep vein thrombosis B. Risk of respiratory depression during procedure C. Decreased risk of infection D. Increased postoperative pain E. Decreased response to anesthesia

A. Deep vein thrombosis D. Increased postoperative pain

Which postoperative complications is the nurse most likely to anticipate in a patient with a history of chronic smoking who is scheduled for a surgery? A. Delayed wound healing B. Limited postoperative pain C. Decrease in the response to anesthesia D. Decreased immune system response

A. Delayed wound healing

Which information should the patient be given about the procedure before surgery is performed? Select all that apply. A. Name, type, and reason for surgery B. Name of the apparatus needed to be used for surgery C. Reason that intervention will benefit patient D. Name of all the members present in the operating room E. All alternative options to surgery

A. Name, type, and reason for surgery C. Reason that intervention will benefit patient E. All alternative options to surgery

The registered nurse is performing the steps of a time-out. Which components are acceptable identifiers? Select all that apply. A. Patient stating his/her full name B. Patient stating his/her date of birth C. Patient stating the site of the procedure D. Patient stating his/her social security number E. Patient stating his/her allergies

A. Patient stating his/her full name B. Patient stating his/her date of birth C. Patient stating the site of the procedure D. Patient stating his/her social security number

The nurse reviews the patient's identification band as seen in this image. Which components are acceptable to be used as identifiers? Select all that apply. A. Patient, John Q B. 7/31/1985 C. 9/1/2016 D. 123-45-67 E. 86753099

A. Patient, John Q B. 7/31/1985

Case Study Maria expresses her anxiety about the procedure and anesthesia to her nurse. Which is the most appropriate response? A. Tell her, "It's okay; we do this every day." B. Assure her that her fears are normal and encourage her to use her consultation time with the surgeon and anesthesiologist to address her concerns. C. Share a story about your friend who had similar fears prior to her surgery. D. Document her concerns in the chart so that the PACU nurse will expect her to be anxious during recovery.

B. Assure her that her fears are normal and encourage her to use her consultation time with the surgeon and anesthesiologist to address her concerns.

Which is true regarding informed consent? A. It includes type of instruments used for surgery. B. It includes the reason for the surgery. C. It includes the name of the registered nurse. D. It includes the allergic history of the patient.

B. It includes the reason for the surgery.

Case Study Maria is allergic to latex. What is the appropriate action to prevent an allergic reaction in the patient who is having surgery? A. Terminally clean the OR before her case and remove all latex products. B. Maria should be the first case of the day, and only nonlatex items should be used. C. All surgical suites are latex-free, so this is not a concern. D. Anesthesia should be prepared to intubate and treat her if a reaction occurs because there is no way to ensure a latex-free environment.

B. Maria should be the first case of the day, and only nonlatex items should be used.

The nurse has concerns that there may be a risk for deep vein thrombosis in a patient who is scheduled for hip replacement. Which statement made by the patient most likely supports the nurse's suspicion? A. "I drink two glasses of wine per week." B. "I have been diagnosed with asthma recently." C. "I am allergic to few anesthetic agents." D. "I smoke five packs of cigarettes per day."

D. "I smoke five packs of cigarettes per day."

Case Study What is the priority responsibility of Maria's nurse before the procedure? A. Explaining the procedure and having Maria sign the consent form B. Reviewing the risks of anesthesia C. Marking the surgical site with the patient D. Ensuring completion of the preoperative assessment

D. Ensuring completion of the preoperative assessment

Patient Preparation physical preparations

Intravenous line - Ideally 18-gauge catheter (pink) - minimum size for blood Bowel and bladder preparation - Enema/laxatives self administered prior to procedure at home - document if this was performed - Indwelling catheter (abdominal, GYN, lengthy procedures) - monitor I&O in PACU Skin preparation - Patient shower and wash with Betadine or hexachlorophene soap prior to admission - Surgical shave (sterile electric clippers - no razors due to small nicks/risk of infection) Medications - Preop anxiety: benzodiazepine (midazolam HCl, diazepam, lorazepam) - Antiemetics (metoclopramide or ondansetron)