Perioperative Nursing

Question 1

Three phases of Perioperative care

Answer 1

Perioperative, Intraoperative, postoperative

Question 2

Classification of Surgical procedures: Purpose

Answer 2

diagnostic, ablative, palliative, reconstructive, transplantation, constructive

Question 3

Intraoperative

Answer 3

begins when the patient is transferred to the OR bed until transfer to the postanesthesia care unit (PACU)

Question 4

Perioperative

Answer 4

begins with decision to have surgery, lasts until patient is transferred to operating room or procedural bed

Question 5

Postoperative

Answer 5

lasts from admission to the PACU or other recovery area to complete recovery from surgery and last follow-up health care provider visit

Question 6

Classification of Surgical procedures

Answer 6

Urgency, Risk, Purpose

Question 7

Classification of Surgical procedures: Risk

Answer 7

Minor or major

Question 8

Classification of Surgical procedures: Urgency

Answer 8

elective, urgent, emergency

Question 9

Ablative surgery

Answer 9

Ablative surgery is performed to remove a diseased part.

Question 10

Diagnostic surgery

Answer 10

Diagnostic surgery is performed to make or confirm a diagnosis.

Question 11

Palliative surgery

Answer 11

Palliative surgery is performed to relieve or reduce intensity of an illness.

Question 12

Reconstructive Surgery

Answer 12

performed to restore function to tissue.

Question 13

Types of Anesthesia

Answer 13

General, Moderate sedation/Analgesia, Regional, Topical/local

Question 14

General Anesthesia

Answer 14

administration of drugs by inhalation or intravenous route

Question 15

Moderate sedation/Analgesia

Answer 15

(conscious sedation/analgesia): used for short-term, minimally invasive procedures

Question 16

Regional Anesthesia

Answer 16

anesthetic agent injected near a nerve or nerve pathway or around operative site

*abdominal surgery

Question 17

Topical/local anesthesia

Answer 17

used on mucous membranes, open skin, wounds, burns

Question 18

Three phases of General anesthesia:

Answer 18

Induction, Maintenance, Emergence

Question 19

Three phases of General anesthesia: Induction

Answer 19

from administration of anesthesia to ready for incision

Question 20

Three phases of General anesthesia: Maintenance

Answer 20

from incision to near completion of procedure

Question 21

Three phases of General anesthesia: Emergence

Answer 21

starts when patient emerges from anesthesia and is ready to leave operating room

Question 22

Types of Regional anesthesia

Answer 22

Nerve blocks
Spinal anesthesia
Epidural anesthesia
Intravenous anesthesia with pneumatic tourniquet-ing

Question 23

Informed Consent

Answer 23

Description of procedure and alternative therapies
Underlying disease process and its natural course
Name and qualifications of person performing procedure
Explanation of risks and how often they occur
Explanation that the patient has the right to refuse treatment or withdraw consent
Explanation of expected outcome, recovery, rehabilitation plan, and course of treatment

Question 24

Outpatient/Same-day surgery

Answer 24

Reduces length of hospital stay and cuts costs
Reduces stress for the patient
May require additional teaching and home care services for certain patients
-Older patients, chronically ill patients, patients with no support system

Question 25

Outcomes for the Surgical Patient

Answer 25

Receive respectful and developmentally and culturally appropriate care Be free from injury and adverse effects Be free from surgical site infection Maintain fluid and electrolyte balance; skin integrity, normal temperature Collaborate in management of pain Demonstrate understanding of physiologic and psychological responses to surgery Participate in rehabilitation process

Question 26

Patient Risk Factors and Strengths (8)

Answer 26

Developmental level Medical and surgical history Medication history Nutritional status Use of alcohol, illicit drugs, or other drugs Activities of daily living and occupation Coping patterns and support systems Sociocultural needs

Question 27

Surgical Risks of Medications

Answer 27

-Anticoagulants: precipitate hemorrhage -Diuretics: electrolyte imbalances, respiratory depression from anesthesia -Tranquilizers: increase hypotensive effects of anesthetic agents -Adrenal steroids: abrupt withdrawal may cause cardiovascular collapse -Antibiotics in mycin group: respiratory paralysis when combined with certain muscle relaxants

Question 28

Usual Presurgical Screening Tests

Answer 28

Chest x-ray Electrocardiography Complete blood count (CBC) Basic (BMP) or complete (CMP) metabolic profile Urinalysis

Question 29

Nurse’s Role in Presurgical Testing

Answer 29

-Ensure that tests are explained to the patient -Ensure that appropriate specimens are collected -Ensure that results are recorded in patient records before surgery -Ensure that abnormal results are reported

Question 30

Preparing the Patient Through Teaching

Answer 30

Surgical events and sensations Pain management Physical activities Deep breathing Coughing Incentive spirometry Leg exercises Turning in bed Early ambulation

Question 31

Nursing Interventions for Surgical Patients (5)

Answer 31

Hygiene and skin preparation Elimination Nutrition and fluids Rest and sleep Preparation and safety the day of surgery

Question 32

Typical Preoperative Medications (3)

Answer 32

-Benzodiazepines to alleviate anxiety and produce sedation -Opioids to facilitate sedation and relaxation -Alpha 2-adrenergic receptor agonist to reduce anesthesia requirements

Question 33

Error Prevention

Answer 33

-Preoperative patient identification verification process -Marking the operative site -Final verification just prior to beginning the procedure, referred to as the time-out

Question 34

Postoperative Assessments and Interventions (Every 10 to 15 Minutes) (8)

Answer 34

Respiratory status (airway, pulse oximetry) Cardiovascular status (blood pressure) Temperature Central nervous system status (level of alertness, movement, shivering) Fluid status Wound status Pain management General condition

Question 35

Cardiovascular Complications

Answer 35

Hemorrhage Shock Thrombophlebitis Thromboembolism Deep vein thrombosis Pulmonary embolus

Question 36

Respiratory Complications

Answer 36

Atelectasis Pneumonia Pulmonary embolism

Question 37

Additional Postoperative Considerations

Answer 37

Preventing surgical site complications Promoting a return to health Elimination needs Fluid and nutrition needs Comfort and rest needs Helping the patient cope

Question 38

Interventions to Prevent Respiratory Complications

Answer 38

Monitoring vital signs Implementing deep breathing Coughing Incentive spirometry Turning in bed every 2 hours Ambulating Maintaining hydration Avoiding positioning that decreases ventilation Monitoring responses to narcotic analgesics