Pre/Intra/Post Operative Care

Question 1

Categories of Surgery

Answer 1

▫️Emergency (Aortic dissection repair- prolonged, often uncontrolled high BP)
▫️Urgent (<48hrs, ectopic pregnancy)
▫️Required (Pace-Maker insertion)
▫️Elective (planned, ex: hysterectomy, knee/hip arthroplasty)
▫️optional (mammoplasty)

Question 2

Types of Surgery

Answer 2

1. Diagnostic
2. Curative/repair
3. Palliative
4. Preventative
5. Explorative
6. Cosmetic

Question 3

A type of Surgery to determine the presence or extent of a pathological abnormality (scope, biopsy)

Answer 3

Diagnostic

Question 4

A type of Surgery, for elimination of pathological condition (removal of appendix) or repair of anatomy (fractured femur)

Answer 4

▫️Curative/Repair

Question 5

A type of Surgery, is for alleviation of symptoms at end of life without curing (to remove/alleviate obstructions caused by tumours; airway- esophageal stent, obstructed bowels -ostomy)

Answer 5

Palliative

Question 6

A type of Surgery, for the removal of pre-malignant (pre-cancerous) tissues.

Answer 6

Preventative

Question 7

A Surgical examination to determine the nature/extent of disease (Laparotomy)

Answer 7

▫️Explorative

Question 8

A type of Surgery for breast re-construction, skin grafting following severe burns

Answer 8

Cosmetic

Question 9

The basic information for nurses in the surgical setting:

Answer 9

▫️know the nature of the disorder necessitating surgery and any coexisting disease processes
▫️identify the individual patient’s response to the stress of surgery
▫️assess the results of appropriate preoperative diagnostic tests
▫️consider the bodily alterations and potential risks and complications associated with the surgical procedure

Question 10

Pre-op assessment

Answer 10

▫️review lab and diagnostic studies
▫️review patients health history
▫️assess physical, psychological and culture needs

Question 11

Legal prep for surgery. All required forms are signed and in chart.

Answer 11

▫️informed consent 
▫️blood transfusions
▫️advance directives
▫️power of attorney 
▫️DNR

Question 12

Who is responsible for obtaining consent before surgery?

Answer 12

▫️Surgeon

Question 13

It’s a Neuromuscular blocking agent:

-pt. will definitely be intubated bcoz the drug suppresses nervous system functioning.

Answer 13

▫️rocuronium “roc”

Question 14

Spinal anaesthesia
Injection of agent into CSF of ____, usually below ____.
Autonomic, sensory and motor blockade

Answer 14

subarachnoid space

L2

Question 15

Epidural block
Injection of agent into epidural space
does not enter _____
Sensory pathway blocked, but ____ fibers intact.

Answer 15

CHF

motor

Question 16

Do sensation test with epidural block using___

Also do movement test____

Answer 16

cold/ice pack

can move extremely, but shouldn’t be able to feel

Question 17

In Spinal and Epidural anaesthesia, observe closely for signs of too much ANS block:

Answer 17

▫️bradycardia
▫️hypotension
▫️nausea and vomiting

Question 18

In the Spinal anaesthesia recovery?

Answer 18

▫️pt. not to move
▫️flat on back, no pillow x 8-12hrs
▫️maintain body alignment 
▫️report c/o headache to nurse
▫️notify charge nurse or physician of wet dressing
▫️frequent B/P checks

Question 19

Criteria for discharge from PACU (phase 1)

Answer 19

▫️oriented 3x
▫️VS stable (priority assessment: ABCs)
▫️no excess bleeding 
▫️pain, nausea and vomiting under control 
▫️O2 saturation 
▫️no respiratory distress
▫️urine output

Question 20

Initial assessment in post operative care (Phase 2)

Answer 20

▫️VS
▫️airway, breathing, circulation (ABC)
▫️rate and quality of respiration
▫️auscultate breath sounds in all fields
▫️assess surgical site

Question 21

Nrsng Mngmt for Cardiovascular complications:

Answer 21

Frequent monitoring of VS
🔺Notify physician if:
▫️BP gradually decreases (worry of bleed somewhere)
▫️irregular cardiac rhythm develops
▫️significant variation from preoperative readings
▫️systolic <90 mmHg or >160mmHg
▫️pulse <60 or >120 bpm
🔺assess skin colour, temperature, and moisture

Question 22

__________ is the most significant general nursing measure to prevent postoperative complications

Answer 22

Early ambulation

Question 23

Urine output for first 24hrs expected postoperatively

Answer 23

800-1500mls

Question 24

discharge criteria day surgery

Answer 24

▫️all PACU discharge criteria have been met
▫️No IV narcotics for the last 30 mins
▫️minimal nausea and vomiting
▫️voided
▫️no excess bleeding or drainage
▫️O2 sats. >90% / no respiratory depression
▫️able to ambulate (age, surgery, disability appropriate)
▫️eaten (toast, plain cookie if not nauseated)
▫️responsible person to pick them up
▫️discharge instructions given and understood
▫️follow up visit with Surgeon or family doctor