Preoperative Nursing Management

Aspirin, clopidogrel, and other medications that inhibit platelet aggregation

Should be stopped 7-10 days before surgery or else patient in risk of bleeding

A client is being prepared for a same-day surgical procedure, 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 physician schedules an elective surgical procedure for a patient who smokes cigarettes. When should the nurse recommend that the patient cease smoking before the surgical procedure to minimize risks associate with cigarette smoking?

1-2 months Patients who smoke are urged to stop 4 to 8 weeks before surgery to significantly reduce pulmonary and wound healing complications.

A client is scheduled for an invasive procedure. What priority documentation is needed regarding the procedure?

A signed consent form from the client A signed consent is required and is important for initiating invasive procedures. The nurse should therefore check for the client's signed consent form. A health history, medication reconciliation, and postoperative prescriptions are good items to have but are not required before performing an invasive procedure.

What drug causes respiratory depression from an associated electrolyte imbalance during anesthesia

Corticosteroids, insulin, and anticoagulants

emergent surgery

Requires immediate intervention because of life-threatening consequences (no patient consent needed)

Herbal products

Should be stopped 2 weeks before

A client will undergo abdominal surgery. The nurse provides preoperative education regarding the importance of diaphragmatic breathing exercises to prevent postoperative complications.

The nurse will educate the client about the risk for developing pneumonia, bronchospasm, and atelectasis, if the client does not implement diaphragmatic breathing exercises in the postoperative period of care.

Important nutrient for blood clotting

Vitamin K

Preoperative education

is initiated as soon as possible, beginning in the physician's office, in the clinic, or at the time of PAT when diagnostic tests are performed So that patient and family can comprehend, ask questions and all

optional surgery

is not critical to survival or function (cosmetic)

Required surgery

patient needs to have surgery, planned within a few weeks or months

urgent surgery

surgery that is not an emergency, but must be done within 24-30 hours

Which preoperative testing will the nurse anticipate being used to determine the client's risk of developing cardiovascular complications from anesthesia? Select all that apply

Basic metabolic panel Blood pressure screening Electrocardiogram

elective surgery

surgery that is recommended but can be omitted or delayed without catastrophe -A client with osteoarthritis receives a recommendation to have joint replacement surgery

The nurse expects informed consent to be obtained for insertion of:

A gastrostomy tube Informed consent is required for invasive procedures that require sedation and are associated with more than usual risk to the client.

In advance of a client's scheduled appendectomy, the nurse spends significant time explaining to the client what will happen, both before the procedure and after the procedure is complete. The primary reason the nurse puts so much effort into preoperative teaching is to

increase the likelihood of a successful recovery.

The nurse has provided preoperative instructions to a client scheduled for surgery at an ambulatory care center. Which statement, made by the client, would indicate that further instruction is needed?

Further instruction would be needed to clarify that the physician, not the nurse, explains the details of the surgery and obtains voluntary consent for the procedure. It is correct that preoperative instructions must be followed prior to surgery for the safety of the client, medical records are present for review prior to surgery, and the physician speaks with the family following the procedure and provides instructions for discharge.

When is the ideal time to discuss preoperative teaching

Preadmission visit The ideal timing for preoperative teaching is not on the day of surgery but during the preadmission visit, when diagnostic tests are performed. Teaching should be done long before the patient enters the preop area. Preoperative teaching should not be done when the patient is sedated.

Once the operating team has assembled in the room, the circulating nurse calls for a "time out." What action should the nurse take during the time out?

Review the scheduled procedure, site, and client. According to the 2016 National Patient Safety Goals, accurate identification of the client, procedure, and operative site is essential

For the client who is taking aspirin, it is important to stop taking this medication at least how many day(s) before surgery?

7 days Aspirin should be stopped at least 7 to 10 days before surgery. The other time frames are incorrect.

The nurse assesses an older adult patient who complains of dimmed vision. What does this alert the nurse to plan for?

A safe environment Sensory limitations, such as impaired vision or hearing and reduced tactile sensitivity, frequently interact with the postoperative environment, so falls are more likely to occur (Meiner, 2011). Maintaining a safe environment for older adults requires alertness and planning.

The policies and procedures on a preoperative unit are being amended to bring them closer into alignment with the focus of the Surgical Care Improvement Project (SCIP). What intervention most directly addresses the priorities of the SCIP?

Actions aimed at preventing surgical site infections SCIP identifies performance measures aimed at preventing surgical complications, including venous thromboembolism (VTE) and surgical site infections (SSI). It does not explicitly address family participation, interdisciplinary collaboration, or CAM.

Clients who have received corticosteroids preoperatively are at risk for which type of insufficiency?

Adrenal Clients who have received corticosteroids are at risk of adrenal insufficiency. Insufficiency related to corticosteroids does not occur in the pituitary, thyroid, or parathyroid glands.

A client refuses to remove her wedding band when preparing for surgery. What is the best action for the nurse to take?

Allow the client to wear the ring and cover it with tape. Most facilities will allow a client to wear a wedding band during a surgical procedure. The nurse must secure the ring with tape. Although it is appropriate to discuss the risk for infection, the client has already refused to remove the ring. The surgery should not be canceled and the ring should not be removed without permission.

Which domain of perioperative nursing practice focuses on clinical processes and outcomes?

Health care systems The health care system consists of structural data elements and focuses on clinical processes and outcomes. Safety, behavioral responses, and physiological responses reflect phenomena of concern to perioperative nurses and comprise nursing diagnoses, interventions, and outcomes.

A patient is scheduled for a surgical procedure. For which surgical procedure should the nurse prepare an informed consent form for the surgeon to sign?

Informed consent is necessary in the following circumstances: invasive procedures, such as a surgical incision (such as would be involved in an open reduction of a fracture), a biopsy, a cystoscopy, or paracentesis; procedures requiring sedation and/or anesthesia (see Chapter 18 for a discussion of anesthesia); a nonsurgical procedure, such as an arteriography, that carries more than a slight risk to the patient; and procedures involving radiation. Non-invasive procedures such as insertion of an intravenous or urethral catheter or irrigation of the external ear canal would not require informed consent.

You are the nurse working in an ambulatory surgery center. A teenage son of your clients ask you why so many people have surgery. What would be your best reply?

Many people have diagnostic or short therapeutic surgical procedures Many diagnostic or short therapeutic surgical procedures—such as bone marrow biopsy, endoscopy, or cardiac catheterization—are now performed in outpatient settings and ambulatory surgical centers

When a client with a history of chronic alcoholism is admitted to the hospital for surgery, the nurse anticipates that the client may show signs of alcohol withdrawal delirium during which time period?

Up to 72 hours after alcohol withdrawal Alcohol withdrawal delirium is associated with a significant mortality rate when it occurs postoperatively. Onset of symptoms depends on when alcohol was last consumed. Twenty-four hours is too short a time frame to consider alcohol withdrawal delirium as no longer a threat to a chronic alcoholic.

The nurse is caring for a patient with liver disease who had a surgical procedure. When should the nurse alert the physician?

When the patient's blood ammonia concentration reaches 180 mg/dL The liver 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; preoperative improvement in liver function is a goal. Careful assessment may include various liver function tests (see Chapter 49).

same-day surgery. Solely during the intraoperative phase of perioperative care, the nurse

continuously monitors the sedated client Intraoperative care includes the entire surgical procedure. During sedation, the nurse continuously evaluates the client. Assessment of heart rate, respiratory rate, BP, oxygen saturation, and level of consciousness occurs during all phases of perioperative care. Obtaining consent would occur during the preoperative phase of perioperative care. During the postoperative phase the nurse would assess how the client is recovering from anesthesia.

A nurse evaluates the potential effects of a client's medication therapies before surgery. Which drug classification may cause respiratory depression from an associated electrolyte imbalance during anesthesia?

diuretics Diuretics during anesthesia may cause excessive respiratory depression resulting from an associated electrolyte imbalance. Corticosteroids, insulin, and anticoagulants are not known to cause respiratory depression during anesthesia.

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 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.

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." 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. Liver function tests are not done to determine prophylactic antibiotic therapy or to determine if the client had any alcohol before the surgery.

A client is having surgery through an ambulatory surgical center. Which information will the nurse provide to the client's family?

"The client will go to the postanesthesia care unit after the surgery." Ambulatory surgery includes outpatient, same-day, or short-stay surgery not requiring admission for an overnight hospital stay but may entail observation in a hospital setting for 23 hours or less. The nurse needs to be sure that the client and family understand that the client will first go to the preoperative area before going to the OR for the surgical procedure and then will spend some time in the postanesthesia care unit before being discharged home with the family member later that day. The client will not be discharged immediately after the surgery is over. The client will not stay in the ambulatory care center for a day or two before being discharged to home. The client will not be transferred to a hospital after the surgery.

The nurse is caring for a client who has just arrived for surgery. Which assessment finding indicates to the nurse that the client may be experiencing dehydration because of taking nothing by mouth after midnight for the surgery?

Blood pressure 80/50 mm Hg

During the preoperative assessment, the nurse learns that the client has been taking prednisone. The nurse realizes that the client is at risk for:

Cardiovascular collapse. Prednisone, a corticosteroid, can result in cardiovascular collapse if suddenly discontinued. A bolus of corticosteroid may be given intravenously immediately before and after surgery. Hydrochlorothiazide and anesthetics may interact, resulting in respiratory depression. Phenothiazines may potentiate the hypotensive action of anesthetics. Anticoagulants can increase the risk of bleeding.

A client is undergoing thoracic surgery. What priority education should the nurse provide to assist in preventing respiratory complications?

Splint the incision site using a pillow during deep breathing and coughing exercises. Splinting the incision site will help decrease pain and support the incision. This will increase compliance with the deep breathing and coughing exercises that assist in preventing respiratory complications. Pain medication should be taken regularly, not only before deep breathing and coughing exercises. Deep breathing and coughing exercises should be done at least every 2 hours, more frequently if possible. While some clients will find the exercises relaxing, most clients find it painful to complete them.

Nursing assessment findings reveal that the client is afraid of dying during the surgical procedure. Which surgical team member would be most helpful in addressing the client's concern?

Surgeon It is the surgeon's responsibility to explain the benefits, alternatives, possible risks, complications, disfigurement, disability, and removal of body parts in obtaining informed consent from the client.

The nurse should determine that a client is coughing effectively after surgery if the nurse observes which of the following activities?

The client takes a deep abdominal breath and then "huff" or "hack" coughs three or four times. Taking a deep abdominal breath and then "huff" coughing is the most effective manner of coughing. This technique helps facilitate removal of secretions and conserves energy for the client. The client should breathe slowly but not hold her breath. Short, panting breaths and then coughing from the throat do not promote expectoration of sputum from the lungs. Coughing forcefully can cause alveoli to collapse; "huff" coughing prevents this

A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching?

Use diaphragmatic breathing. In chronic bronchitis the diaphragm is flat and weak. Diaphragmatic breathing helps to strengthen the diaphragm and maximizes ventilation. Exhalation should be longer than inhalation to prevent collapse of the bronchioles. The client with chronic bronchitis should exhale through pursed lips to prolong exhalation, keep the bronchioles from collapsing, and prevent air trapping. Diaphragmatic breathing — not chest breathing — increases lung expansion.