ch 14 iggy pp

Question 1

Preoperative Period

Answer 1

Begins when patient is scheduled for surgery; ends at time of transfer to surgical suiteNurse functions as educator, advocate, promoter of health and safety

Question 2

Reasons for Surgery

Diagnostic

Answer 2

Determines origin and cause of disorder

Question 3

Curative

Answer 3

resolves health problem by repairing or removing cause

Question 4

restorative

Answer 4

Improves patients functional ability

Question 5

Palliative

Answer 5

Relieves symptoms of disease process, but does not cure

Question 6

Cosmetic

Answer 6

Alters/enhances personal appearance

Question 7

Urgency

Answer 7

Elective
Urgent
Emergent

Question 8

Degree of risk

Answer 8

minor major

Question 9

Extent

Answer 9

simple
radical
minimally invasive(MIS)

Question 10

Interprofessional Collaborative Care
Assessment: Noticing
History and data collection

Answer 10

Age
Drugs, substance use
Medical history (including cardiac and pulmonary)
Complementary/alternative practices
Previous surgical procedures, anesthesia
Blood donations
Discharge planning

Question 11

Physical Assessment

Answer 11

Obtain baseline vital signs
Focus on problem areas identified in history; all body systems affected by surgical procedure
Report abnormal assessment findings to surgeon/anesthesiology personnel

Question 12

System Assessment

Cardiovascular

Answer 12

CAD, MI within 6 months before surgery, angina, hypertension, dysrhythmias

Question 13

Respiratory

Answer 13

Chronic respiratory problems

Smoking increases carboxyhemoglobin blood level, deceases oxygen delivery

Question 14

Renal/urinary

Answer 14

Kidney impairment inhibits drugs/anesthetic agent excretion

Question 15

Neurologic

Answer 15

Determine baseline

Assess level of consciousness (LOC), ability to follow commands

Question 16

Musculoskeletal

Answer 16

*

Question 17

Nutritional status

Answer 17

Malnutrition and obesity increase surgical risk

Question 18

Psychosocial

Answer 18

*

Question 19

Laboratory assessment

Answer 19

Urinalysis
Blood type and screen
CBC or hemoglobin level and hematocrit
Clotting studies (PT, INR, aPTT)
Electrolyte levels
Serum creatinine level
Pregnancy test
Chest x-ray
ECG

Question 20

The priority collaborative problems for preoperative patients are

Answer 20

Knowledge deficit related to unfamiliarity with surgical procedures and preparation Anxiety related to new or unknown experience, possibility of pain and possible surgical outcomes

Question 21

Planning and Implementation:Responding

Answer 21

Providing informationEnsuring informed consent(nurses role-check form-check patient understanding or ask for questions-dont answer-just check-witness consent)
Patient self-determination
Implementing dietary restrictions
Preventing respiratory complications
Preventing cardiovascular complications
Minimizing anxiety

Question 22

Informed Consent

Answer 22

Informed consent
Surgeon obtains signed consent before sedation and/or surgery
Nurse clarifies facts and dispels myths about surgery
Nurse not responsible for providing detailed information about procedure!
Special permits required for some procedures
Patient self-determination

Question 23

Implementing Dietary Restrictions

Answer 23

NPO: Patient not to ingest anything by mouth for 6 to 8 hours before surgery
Decreases risk for aspiration
Give patients written/oral directions to stress adherence
Surgery can be canceled if instructions not followed

Question 24

Administering Regularly Scheduled Medications

Answer 24

Consult with physician and anesthesia provider for instructions
Drugs for certain conditions often allowed with a sip of water
Cardiac disease
Respiratory disease
Seizures
Hypertension

Question 25

Intestinal Preparation

Answer 25

Performed to prevent injury to colon; reduce number of intestinal bacteria Enema or laxative

Question 26

Skin Preparation

Answer 26

Break in the skin increases risk for infection Patient may be asked to shower using antiseptic solution Hair removal by electric clippers, depilatories Shaving of hair creates risk for infection!

Question 27

Preparing for Surgery Tubes of all sorts are common after surgery

Answer 27

TubesDrainsVascular access devices

Question 28

Prepare for Postoperative Procedures Prevention of respiratory complications

Answer 28

Breathing exercisesIncentive spirometryCoughing and splinting

Question 29

Prevention of cardiovascular complications

Answer 29

VTE•Leg exercises•Mobility

Question 30

Older Adults: Changes of Agingas Surgical Risk Factors

Answer 30

Decreased Cardiac output, peripheral circulation Vital capacity, blood oxygenation Blood flow to kidneys, glomerular filtration rate Increased Blood pressure Risk for skin damage, infectionSensory deficits Deformities related to osteoporosis/arthritis

Question 31

Patients at Risk for VTE venous thromboembolism(DVT and pulmonary embolism)

Answer 31

Obese patientsAge 40 or olderHistory of cancer or decreased cardiac outputDecreased mobility, immobile, spinal cord injuryHistory of VTE, PE, varicose veins, edemaOral contraceptivesSmokingHip fracture, total hip/knee surgery

Question 32

Minimizing Anxiety

Answer 32

``` Preoperative teaching Encourage communication Promote rest Use distraction Teach family members ```

Question 33

Preoperative Electronic Health Record Review

Answer 33

Ensure all documentation, preoperative procedures, orders are complete Check surgical consent form and others for completeness Inform patient that area will be marked before procedure begins Document allergies, height, and weight Ensure all laboratory and diagnostic test results are in chart and abnormal results noted

Question 34

Preoperative Patient Preparation

Answer 34

``` Remove most clothing; provide gown Leave valuables with family or lock up Tape rings in place if cannot be removed Ensure patient is wearing ID band Remove Dentures Prosthetic devices Hearing aids Contact lenses Fingernail polish Artificial nails All jewelry ```

Question 35

Preoperative Medications

Answer 35

Reduce anxiety (anxiolytics) Promote relaxation (sedatives, hypnotics) Reduce nasal and oral secretions (anticholinergic agents) Prevent laryngospasm Reduce vagal-induced bradycardia Inhibit gastric secretion (H2 histamine blockers) Decrease amount of anesthetic needed for induction and maintenance (opioids)

Question 36

Evaluation: Reflecting

Answer 36

Evaluate the care of the preoperative patient based on the identified patient problems. The expected outcomes include that the patient States understanding of the informed consent and preoperative procedures Demonstrates postoperative exercises and techniques for prevention of complications Verbalizes reduced anxiety

Question 37

To ensure safe patient care transition from the perioperative nurse to the intraoperative nurse, optimal hand-off communication about the patient includes which elements? (Select all that apply.) A.Providing a recent patient historyB.Communicating vital signs, allergy, and medication updatesC.Verbally verifying that the operating room nurse understands the reportD.Using a standardized hand-off communication tool to provide report (for example, SBAR, Five-Ps, PACE)E.Encouraging the operating room nurse to interrupt to ask questions as the perioperative nurse provides report28

Answer 37

A.Providing a recent patient history B.Communicating vital signs, allergy, and medication updates C.Verbally verifying that the operating room nurse understands the report D.Using a standardized hand-off communication tool to provide report (for example, SBAR, Five-Ps, PACE)(H2T) E.Encouraging the operating room nurse to interrupt to ask questions as the perioperative nurse provides report28 all except E

Question 38

When assessing the laboratory work of a 65-year-old patient scheduled for surgery, the nurse understand which laboratory value may result in cancellation of the surgery?A.Hemoglobin 10.5 g/dLB.Serum potassium 2.7 mEq/LC.Serum sodium level 149 mEq/LD.Fasting blood glucose 120 mg/dL

Answer 38

A.Hemoglobin 10.5 g/dL *B.Serum potassium 2.7 mEq/L C.Serum sodium level 149 mEq/L D.Fasting blood glucose 120 mg/dL study lab values potassium big one-more significant

Question 39

Following surgery, a patient is wearing pneumatic compression devices. The patient asks, “Why do I have to wear these?” What is the most appropriate nursing response? A.“This helps to prevent blood clots.”B.“It will make your legs feel more comfortable.”C.“This prevents skin breakdown from immobility.”D.“It will make it easier on you when you start to ambulate.”

Answer 39

*A.“This helps to prevent blood clots.” B.“It will make your legs feel more comfortable.” C.“This prevents skin breakdown from immobility.” D.“It will make it easier on you when you start to ambulate.”