Perioperative

Question 1

2 types of local anesthetic that are commonly used because they are rapidly absorbed and rapid acting.

Answer 1

Lidocaine and benzocaine

Question 2

2 ways to improve accuracy of pt identification

Answer 2

2 identifiers

make sure pt gets correct blood in transfusion

Question 3

3 steps in obtaining signature on informed consent

Answer 3

Verify
Notify and delay if necessary
Document

Question 4

4 Classifications of Surgery

Answer 4

By body system
by purpose
by degree of urgency
by degree of risk

Question 5

A clot that occludes blood flow to a portion of the lungs; usually a result of clot formation in the lower extremities, which breaks loose and migrates to the lungs. May also be due to venous injuries, hypercoagulable state, use of high-dose estrogen, preexisting circulatory disorders.

Answer 5

Pulmonary Embolus

Question 6

A decrease in the frequency of bowel movements, resulting in the passage of hard stool. Usually related to use of opioids, immobility, inadequate fluid intake, or low-fiber diet.

Answer 6

Constipation

Question 7

a technique in which the anesthetist places a tourniquet on an arm or leg and then injects a local anesthetic agent intravenously below the level of the tourniquet. The tourniquet is maintained at a pressure that limits venous return but continues to allow arterial circulation. The patient feels no pain in the extremity as long as the tourniquet is in place.

Answer 7

Bier (intravenous) block

Question 8

Accumulation of urine in the bladder. May result from poor muscle tone as a result of anesthesia and anticholinergic medications, handling of tissues during surgery, or inflammation in the pelvic region.

Answer 8

Urinary Retention

Question 9

Advantages of conscious sedation

Answer 9

Pain and anxiety are adequately controlled without the risks of general anesthesia. Recovery is rapid.

Question 10

Advantages of General Anesthesia

Answer 10

The patient is unconscious, so she experiences no anxiety that might affect cardiac and respiratory functioning.

The muscles are relaxed, so the patient remains completely motionless during the surgical procedure.

Anesthesia can be adjusted to accommodate age, physical condition, and the length of the procedure.

If surgical complications occur, the anesthesia can be continued for longer than originally planned.

Question 11

advantages of Regional anesthesia

Answer 11

Low in cost, simple to administer, and requires a minimal recovery period. It is especially suitable for minor ambulatory procedures.

Question 12

Airway inflammation caused by inhaling gastric secretions (especially hydrochloric acid from the stomach) because of absent gag reflex secondary to anesthesia

Answer 12

Aspiration Pneumonia

Question 13

Anesthesia is classified as

Answer 13

general, conscious sedation, regional or local

Question 14

are elastic stockings that compress the veins of the legs and increase venous return to the heart (Fig. 40-1). They may be applied preoperatively to prevent venous pooling during surgery and decrease the risk of thrombus formation. Along with prophylactic medications (antithrombotics), antiembolism stockings aid in the prevention of DVT and PE.

Answer 14

Antiembolism Stockings These are also referred to as thromboembolic disorder hose (or “T.E.D. hose”).

Question 15

are serious and costly errors resulting in severe consequences for the patient, and that are mostly preventable.

Answer 15

Never events

Question 16

begins when the client enters the postanesthesia care unit and ends when he has healed from the surgical procedure.

Answer 16

postoperative phase

Question 17

begins when the patient enters the operating suite and ends when she is admitted to the postanesthesia care unit.

Answer 17

intraoperative phas

Question 18

begins with the client’s decision to have surgery and ends when he enters the operating room.

Answer 18

preoperative phase

Question 19

Benefits of adequate pain management are

Answer 19

arly mobilization, shorter hospital stay, reduced hospital costs, and increased patient satisfaction.

Question 20

Bleeding may be internal or external. May be caused by slipped ligature, uncontrolled bleeder, or infection.

Answer 20

Hemorrhage

Question 21

Blood clot and inflammation of a vein or artery, usually in the legs. Results from increased coagulability and venous stasis due to immobility during and after surgery.

Answer 21

Thrombophlebitis

Question 22

Body System examples

Answer 22

GI
Respiratory
Cardiac
GU

Question 23

By purpose surgery examples

Answer 23

Ablative - removal of diseased body part
Diagnostic/exploratory - confirm or rule out diagnosis
Palliative - to relie discomfort w/o cure
reconstructive - to restore function
cosmetic - improve appearance
transplant - replaces a part
procurement - act of harvesting from someone to transplant into another

Question 24

can be used as a surgical anesthetic and to provide postoperative analgesia

Answer 24

Epidural Anesthesia

Question 25

Collapse of alveoli due to hypoventilation, airways blocked by mucous plugs, opioid analgesics, immobility

Answer 25

Atelectasis

Question 26

Decreased blood volume. May be due to blood loss during and after surgery; dehydration; or excess loss through vomiting, diarrhea, or drains.

Answer 26

Hypovolemia

Question 27

Decreased or absent urine output due to hypovolemia, shock, or toxic reaction to medications

Answer 27

Renal Failure

Question 28

Degree of Risk: associated with a high degree of risk, for example, the potential for significant blood loss, a prolonged or complicated procedure, surgery involving vital organs, or a high risk for postoperative complications.

Answer 28

Major surgery

Question 29

Degree of Risk:often performed on an outpatient basis, involves little risk and usually has few complications.

Answer 29

Minor Surgery

Question 30

Describe the typical physical preparation of a client undergoing surgery.

Answer 30

Maintain NPO for 8 hours before surgery. • Shower or scrub the surgical site with an antibacterial solution the evening before surgery and the morning of the surgery. Have the client void before receiving preoperative medications, including prophylactic antibiotics. • Administer any prescribed preoperative medications. • Review daily medications with the anesthesia team. • Remove all artificial body parts, such as dentures, limbs, or contact lenses; wigs, eyeglasses, makeup, and jewelry must also be removed. • Apply antiembolism stockings, if prescribed.

Question 31

Disadvantages of conscious sedation

Answer 31

Not practical for highly anxious patients.

Question 32

Disadvantages of General Anesthesia

Answer 32

The respiratory and circulatory muscles are depressed, so mechanical ventilation is needed while the patient is under the effects of the anesthetic agent(s). These effects predispose the patient to pneumonia and thrombophlebitis in the postoperative period. General anesthesia creates a risk for death, heart attack, stroke, and malignant hyperthermia. Malignant hyperthermia is a rare, often fatal, metabolic condition that can occur during the use of muscle relaxants and inhalation anesthesia. Metabolism increases in the skeletal muscles and they become rigid. The temperature rises rapidly. Predisposition to this condition is inherited. Frequent minor complaints after general anesthesia include sore throat (from intubation), nausea and vomiting (from relaxation of gastrointestinal smooth muscle), headache, uncontrollable shivering, and confusion.

Question 33

disadvantages of Regional anesthesia

Answer 33

May not be practical if the patient is highly anxious or if adequate pain control cannot be achieved. Many patients are apprehensive about being able to see and hear the procedure.

Question 34

Drugs used for __________are of a higher concentration than those for ___________

Answer 34

Epidural Anesthesia Spinal Anesthesia

Question 35

Duties of circulating nurse

Answer 35

client advocate continuously monitors the client and the sterile field. maintains a safe, comfortable environment; communicates with appropriate personnel outside the operating room; and responds to emergencies. attend to the patient during the induction of anesthesia.

Question 36

Embolus in this system -results in symptoms in the area affected (e.g., cerebrovascular accident, myocardial infarction, or loss of circulation to an area).

Answer 36

arterial

Question 37

embolus in venous system often results in

Answer 37

PE - pulmonary embolus

Question 38

Examples of never events

Answer 38

Surgery on the wrong body part Surgery on the wrong patient Wrong surgery on a patient Deep vein thrombosis (DVT) or pulmonary embolism (PE) after total knee or hip replacement Foreign body left in a patient after surgery (e.g., sponge, clip for draping) Surgical site infections after certain elective procedures (e.g., after bariatric surgery for obesity). AORN, The Joint Commission, National Priorities Partnership, and IHI extend that to include all infections that occur after surgery

Question 39

Excess gas within the intestines; may be due to a slow return of peristalsis or from handling of the intestines during surgery.

Answer 39

Abdominal Distention (Tympanites)

Question 40

hospitals are increasingly using ____ ____ ____ and anticoagulation therapy, instead of elastic stockings, to prevent DVT

Answer 40

sequential compression devices

Question 41

How often is a patient typically assessed after surgery -In the postanesthesia care unit (PACU)

Answer 41

every 5 to 15 minutes

Question 42

How often is a patient typically assessed after surgery -In the surgical unit:

Answer 42

* Upon arrival * Every 15 minutes for the first hour * Every 30 minutes for the next 2 hours • Every hour for the next 4 hours * Then every 4 hours

Question 43

Identify topics that should be discussed in preopera- tive teaching.

Answer 43

focused on explaining what will happen before, during, and after surgery and how the client can participate in the care. Part of the teaching plan is also to discuss common feelings and concerns that clients have about surgery.

Question 44

induces amnesia, analgesia, and muscle relaxation or paralysis with anesthesia. His role is to continuously monitor and evaluate the patient’s responses to the anesthetic agent and the surgical procedure.

Answer 44

anesthesiologist or a nurse anesthetist (CRNA)

Question 45

Inflammation of the alveoli due to infection with bacteria or viruses, toxins, or irritants. Caused by hypoventilation secondary to anesthesia and opioid analgesics, and by poor cough effort as a result of aging or weakness.

Answer 45

Pneumonia

Question 46

information you should gather in the preoperative nursing history.

Answer 46

``` Health history. • Physical status. • Allergies. . • Medications. • Mental status. • Knowledge and understanding of the surgery and anesthesia. • Cultural and spiritual factors. • Access to social resources. I • Coping strategies. • Use of alcohol and drugs. ```

Question 47

Informed consent requires that the patient understood the communication and was not coerced (pressured) to consent. There are two important requirements:

Answer 47

The patient must be alert, rational, mentally competent, and not sedated when he signs. The information must be given to him in a language and vocabulary that he can understand.

Question 48

interventions for Abdominal Distention (Tympanites)

Answer 48

Encourage and assist to move in bed and ambulate. Maintain NPO until return of bowel sounds; avoid drinking with a straw. Provide fluids at room temperature.

Question 49

interventions for Aspiration Pneumonia Pre Op? Post Op?

Answer 49

Institute NPO for at least 8 hours prior to surgery. Postoperative: Continue NPO until intestinal motility returns; carefully monitor sedated patient and place in side-lying position.

Question 50

Interventions for Atelectasis

Answer 50

Monitor for clinical signs. Monitor rate, rhythm, depth, and effort of respirations. Monitor ability to cough effectively. Determine need for suctioning by listening for crackles and rhonchi over major airways. Suction, as needed. Auscultate lung sounds after suctioning and other respiratory treatments to determine effectiveness. Encourage deep breathing, coughing, moving in bed, ambulation, use of incentive spirometry.

Question 51

interventions for hypovolemia

Answer 51

Monitor vital signs and I&O. Insert urinary catheter, if appropriate. Monitor skin color, temperature, and moistness; central and peripheral cyanosis. Identify possible causes of changes in vital signs. Administer IV therapy as prescribed. Promote oral intake when tolerated. Prepare to administer blood or blood products, as prescribed.

Question 52

Interventions for pneumonia

Answer 52

Monitor for clinical signs. | Encourage and assist with deep breathing, coughing, moving in bed, ambulation, use of incentive spirometry.

Question 53

Interventions for pulmonary embolus

Answer 53

Prevent thrombophlebitis: Encourage and assist with leg exercises, ambulation, antiembolism stockings, sequential compression devices, hydration. If thrombophlebitis occurs, position and immobilize the limb; do not massage calves.

Question 54

Interventions for Thrombophlebitis

Answer 54

Encourage and assist with leg exercises, ambulation, antiembolism stockings, sequential compression devices, hydration. If thrombophlebitis occurs, position and immobilize the limb; do not massage calves.

Question 55

Interventions fr nausea and vomiting

Answer 55

Have patient remain NPO until return of bowel sounds. Advance diet slowly. Treat pain.

Question 56

involves the care of clients before, during, and after surgery and some other invasive procedures

Answer 56

Perioperative nursing

Question 57

is an RN who applies the nursing process to coordinate all activities in the operating room

Answer 57

circulating nurse

Question 58

is an RN with additional education and training in surgical technique. serves as an assistant to the surgeon, a role that has historically been filled by physicians. may be employed by the surgeon or the hospital.

Answer 58

registered nurse first assistant (RNFA)

Question 59

is often used for surgical procedures in the lower abdomen, pelvis, and lower extremities. This technique allows the patient to remain conscious during the procedure and usually does not depress respirations.

Answer 59

Spinal Anesthesia

Question 60

is responsible for (1) giving the patient the necessary information and (2) determining the patient’s competence to make an informed decision about the surgery

Answer 60

The surgeon

Question 61

is safer than spinal anesthesia because the anesthetic does not enter the subarachnoid space and the depth of anesthesia is not as great.

Answer 61

Epidural Anesthesia

Question 62

is the injection of an anesthetic into and around a nerve or group of nerves (e.g., the facial nerve).

Answer 62

nerve block

Question 63

is the injection of an anesthetic into the cerebrospinal fluid (CSF) in the subarachnoid space . This injection blocks sensation and movement below the level of the injection.

Answer 63

Spinal Anesthesia

Question 64

may be applied topically or injected

Answer 64

Local anesthetic

Question 65

may be prescribed in addition to antiembolism stockings for patients at high risk for thrombophlebitis. is a plastic sleeve with chambers. The sleeve is wrapped around the patient’s legs and connected to an air pump that provides sequential pressure to the chambers of the plastic sleeve.

Answer 65

Sequential Compression Devices (SCDs)

Question 66

Medication safety tips

Answer 66

label medicines not labeled in syringes, cups and basin

Question 67

Movement of a thrombus or foreign body from its original location.

Answer 67

Embolus

Question 68

NPSG goals

Answer 68

prevent infection - hand hygiene improve accuracy of pt identification using medication safely performing time out immediately before procedure

Question 69

NPSG is

Answer 69

National Patient Safety Goals

Question 70

Occasionally a higher level of spinal anesthesia is achieved than intended—that is, the medication may migrate upward in the spinal fluid. Which may(1)_________ then what can you do(2)____________ Also this can decrease suddenly(3) ______ due to(4) _________. These patients often require ventilation and careful(5) _________

Answer 70

1 depress respirations and cardiac rate 2 Placing the patient in Fowler’s position may prevent respiratory paralysis 3 Blood pressure 4 vasodilation 5 monitoring

Question 71

Patients who are unconscious or have a mental disability; who have been judged insane; who cannot read, write, or hear; and those under the influence of sedative drugs or alcohol are generally not competent to give ___________ In most states, who can give consent for the procedure?

Answer 71

consent family member, conservator, or legal guardian

Question 72

postoperative consists of two parts:

Answer 72

recovery from anesthesia and recovery from surgery.

Question 73

prevents pain by interrupting nerve impulses to and from the area of the procedure. The patient remains alert but is numb in the involved area

Answer 73

Regional anesthesia

Question 74

produces loss of pain sensation at the desired site (e.g., a wound to be sutured, a skin growth to be removed). It is typically used for minor procedures

Answer 74

Local anesthesia

Question 75

produces rapid unconsciousness and loss of sensation.

Answer 75

General anesthesia

Question 76

provides intravenous sedation and analgesia without producing unconsciousness., the patient may feel sleepy but is aware of his surroundings, can be easily aroused by touch or speech, and can talk with the surgical team.

Answer 76

conscious sedation

Question 77

pump that administers a continuous, regulated flow of local anesthetic through a thin catheter directly into the patient’s surgical site.

Answer 77

Single-Use, Continuous-Flow Pump/ ON Q

Question 78

requires insertion of a thin catheter into the epidural space . Anesthetic agents are infused through the catheter to produce loss of sensation.

Answer 78

Epidural Anesthesia

Question 79

responsible for verifying that the surgical consent form is signed and witnessed.

Answer 79

nurse

Question 80

s/s of Pneumonia

Answer 80

Productive cough with blood-tinged or purulent sputum, fever, elevated WBC, decreased or absent breath sounds, decreased SaO2, chest pain, tachypnea, dyspnea

Question 81

s/s of Abdominal Distention (Tympanites)

Answer 81

Abdominal discomfort, bloating, hypoactive or absent bowel sounds

Question 82

s/s of Aspiration Pneumonia

Answer 82

Cough, fever, elevated WBC, decreased or absent breath sounds, decreased oxygen saturation (SaO2), tachypnea, dyspnea, blood-tinged sputum.

Question 83

s/s of Atelectasis

Answer 83

Decreased or absent breath sounds, noisy respirations, decreased O2 saturation (SaO2), chest asymmetry, sternal retractions, accessory muscle use, trachea deviated from midline, fever, tachypnea, dyspnea, tachycardia, diaphoresis, pleural pain, increased restlessness, anxiety

Question 84

s/s of hemorrhage

Answer 84

If external: Dressings saturated with bright red blood; increased output in drains or chest tubes If internal: Increased pain, increasing abdominal girth, ecchymosis or swelling around incision, tachycardia, hypotension

Question 85

s/s of hypovolemia

Answer 85

Hypotension, tachycardia, decreased urine output, fatigue, thirst, dehydration

Question 86

s/s of pulmonary embolus

Answer 86

Sudden onset of dyspnea, shortness of breath, chest pain, hypotension, tachycardia, decreased SaO2, cyanosis

Question 87

s/s of Thrombophlebitis

Answer 87

Superficial: Vein is red, hard, and hot to touch. Deep: Limb is pale and edematous; aching, cramping in limb; Homans’ sign (pain in calf when foot is dorsiflexed).

Question 88

sets up the sterile field, prepares the surgical instruments, assists with the sterile draping of the patient, anticipates and responds to the surgeon’s needs, and maintains the integrity of the sterile field.

Answer 88

scrub nurse

Question 89

Side effects of spinal anesthesia include

Answer 89

hypotension, nausea, vomiting, urinary retention, and headache from leakage of CSF. A headache after spinal anesthesia must be closely monitored and may require additional treatment by the anesthesia staff.

Question 90

sign of renal failure

Answer 90

Urine output < 30 mL/hr; rising BUN and creatinine levels

Question 91

signs of urinary retention

Answer 91

Bladder distention, suprapubic pain, diminished urine output or output less than fluid intake, inability to void or small, frequent voidings, hypertension, restlessness

Question 92

The primary goal of _____ ______ ______ is to minimize the dose of medications (to lessen side effects) while still providing adequate pain management.

Answer 92

postoperative pain management

Question 93

Time out is_____, why

Answer 93

an immediate pause prior to procedure by the entire surgical team to assure correct pt, procedure, site and side

Question 94

Types of Degree of Urgency

Answer 94

Emergency - ASAP to preserve life or function Urgent - scheduled within 24-48 hours Elective - condition is not time sensitive

Question 95

Types of Regional Anesthesia

Answer 95

Peripheral Nerve Block Spinal Anesthesia Epidural Anesthesia

Question 96

Under what type(s) of anesthesia does the client remain conscious?

Answer 96

The client remains conscious in all types of anesthesia except general anesthesia.

Question 97

What does it mean to notify and delay if necessary?

Answer 97

If the patient has questions or if you have any questions about the patient’s competence, notify the surgeon and delay sending the patient to surgery.

Question 98

What does it mean to verify signature/consent?

Answer 98

verify with the patient that the physician has explained the procedure and answered all his questions: Ask the patient to state what he was told during the consent process.

Question 99

What factors affect surgical risk?

Answer 99

``` Seven factors affect surgical risk: • Age • Type of wound (potential for infection) • Preexisting conditions • Mental status • Medications • Personal habits • Allergies ```

Question 100

What laboratory tests are most commonly prescribed before surgery?

Answer 100

* A complete blood count, urinalysis, and serum electrolytes (chemistry panel) * An ECG (electrocardiogram) is often required for clients older than 50 years or with a history of cardiac problems

Question 101

What should you document about informed surgical consent?

Answer 101

conversations, questions the patient had and that the surgeon was notified of any additional questions or co ferns

Question 102

What type of physical assessment is performed as part of the preoperative assessment?

Answer 102

Part of the preoperative assessment is a brief head-to- toe assessment. For concerns that have been identified in the nursing history, perform a focused assessment.

Question 103

Who is responsible for obtaining informed consent for the surgical procedure?

Answer 103

Before a surgical procedure can be performed, the surgeon is required by law to provide the necessary information and obtain the client’s consent.

Question 104

Why are sequential compression devices used?

Answer 104

Sequential compression devices are used for clients at high risk for thrombophlebitis. They compress the veins, thereby promoting venous return to the heart and decreasing venous stasis.