Pre and post operative care

Question 1

Palliative Surgery purpose

Answer 1

Performed to alleviate symptoms of a disease, but does not cure e.g. colostomy

Question 2

Cosmetic surgery purpose

Answer 2

Performed to correct cosmetic problems e.g. Rhinoplasty

Question 3

Curative surgery purpose

Answer 3

For removing diseased tissue. Often used for cancer.

Question 4

Diagnostic surgery purpose

Answer 4

To determine aetiology (the cause) of the disorder. e.g. biopsy

Question 5

Exploratory surgery purpose

Answer 5

To determine a diagnosis and\or evaluate the extent of a lesion

Question 6

Purpose of general anaesthesia

Answer 6

• Promote unconsciousness
• Analgesia (inability to feel pain)
• amnesia
• muscle relaxation
• inhibit involuntary reflex action

can be given through IV
or through inhalation

Question 7

What is Local/regional anaesthesia and why is it used?

Answer 7

The patient is conscious; the aim is to block the conduction of nerve impulses to and from specific sites in the body.

Question 8

Pre Operative Preparation assessment:

Answer 8

Who is going to theatre?
When?
What procedure?
Has the individual been in hospital before, previous surgery
Do they understand the procedure
Is there any special preparation needed?

Question 9

Purpose of Anti-embolic or TED stockings

Answer 9

Support blood vessels
Prevent stasis
Prevent thrombus (clot) formation

Question 10

Physical prep for surgery

Answer 10

Baseline data - TPR, BP, urinalysis and weight, reporting any sign of infection.

Skin preperation - Clipping, shower, total body wash.

Removal of - makeup, nail polish, hair clips, jewellery. Tape wedding ring

Question 11

Gastro-intestinal preparation -

Answer 11

Fasting prior to surgery - NBM (generally 6 - 8 hours, for young children it may only be for 4 hours)

Question 12

Pre-Operative Check

Answer 12

Vital signs, weight, height
Identification - check arm/leg bands, notes, stickers 
Operation 
Consent - signed and witnessed
Allergies - noted and arm band 
Pre-medication - time given
Voiding - when last voided

Question 13

Early Post-Operative Care Preparing the environment

Answer 13

Preperation of bed 
IV pole 
Hanger for urinary catheter, drain 
Water, glass and straw
Equipment for post-op wash

Question 14

Handover from recovery staff should include:

Answer 14

Operation
Anaesthetic - type 
Special orders 
Pain relief and medications given 
IV, catheter, drain, wound
Patients notes 
Any belongings of the patient

Question 15

Post op Obs

Answer 15

Check once an hour for the first 4 hours. Looking at: 
TPR 
BP 
Colour 
Level of consciousness
Circulation checks
Neurobs 
Fluid balance

Question 16

What is a primary haemorrhage?

Answer 16

Bleeding which occurs within the first 24 hours

Question 17

What is a secondary haemorrhage?

Answer 17

Bleeding which occurs 7-10 days post operatively

Question 18

Presenting problems of haemorrhage

Answer 18

Obvious bleeding around incision site or may be none externally.
Signs of shock, tachycardia, hypotension

Question 19

Presenting problems - respiratory

Answer 19

Dyspnoea
Cyanosis
Pyrexia 
Tachycardia
Limited chest expansion on affected side

Question 20

Nursing actions for respiratory problems

Answer 20

Monitor respirations
Position to enhance breathing
Deep breathing and coughing exercises 
Chest physiotherapy, suction if required
Use of incentive devices - tri flow
Monitor oxygen therapy if ordered - nasal, oxygen mask

Question 21

Venous Thrombosis, what is it?

Answer 21

Venous thrombosis - is the formation of a clot or clots within a vein as a result of venous stasis. Most commonly affects saphenous and femoral veins of leg (DVT)

Question 22

What is an Embolism

Answer 22

Embolism is the condition whereby a clot is dislodged and travels in the bloodstream. It can also consist of air or fat.

Question 23

Symptoms of DVT

Answer 23

May be asymptomatic
Pain, swelling and tenderness of affected limb
Positive Homan’s sign (pain in calf on dorsiflexion)

Question 24

Peripheral Arterial Embolism symptoms

Answer 24

Total arterial occlusion - Loss of pulse and pallor distal to the obstruction, pain
Partial arterial occlusion - Numbness or weakness of the limb

Question 25

Presenting problems of PE

Answer 25

``` Sudden onset of dyspnoea Severe chest pain Cough, blood streaked sputum Cyanosis Sudden circulatory collapse ```

Question 26

Nursing actions towards PE

Answer 26

Assessment of physical and vital signs to observe for respiratory and circulatory complications. Encourage deep breathing and coughing regularly Encourage early ambulation If ambulation is contra-indicated, regular change of position Encourage active, passive and leg exercises Maintain adequate hydration Apply anti-embolic stockings on individuals at risk Intermittent external pneumatic compressions system Medications as ordered - anticoagulants

Question 27

Abdominal distention what is it and symptoms?

Answer 27

Distention results from the accumulation of gas in the intestines due to failure of the intestines to propel gas by peristalsis Symptoms include Sharp abdominal pain Swollen abdomen Inability to pass flatus

Question 28

Paralytic Ileus What is it and symptoms?

Answer 28

Paralysis of intestines, thus absence of peristalsis. May be due to trauma of surgery, handling during surgery, post anaesthetic effect, mechanical obstruction ``` Symptoms Absence of bowel sounds Abdominal pain and/or distension No passage of flatus Nausea and vomiting ```

Question 29

Nursing actions for Abdominal distention and paralytic ileus

Answer 29

``` Observe and record passage of flatus Detect presence of bowel sounds Give measurements Early ambulation Adequate fluids May require insertion of nasogastric tube on low suction ```

Question 30

What is urinary retention and what are the symptoms?

Answer 30

Accumulation of urine in the bladder that occurs post-operatively, usually due to the effect of anaesthesia on bladder muscle tone or due to decreased sensation to void as a result of operative trauma Symptoms Suprapubic discomfort or pain Inability to void

Question 31

Nursing actions on urinary retention

Answer 31

``` Fluid balance chart Adequate fluids Early ambulation Commode instead of pan\urinal Catheter care if catheterisation indicated Bladder scan ```

Question 32

Wound infection Symptoms?

Answer 32

Pain, tenderness, redness and swelling, heat around the wound. Purulent wound discharge. Pyrexia

Question 33

Wound Dehiscence What is it and what are the symptoms?

Answer 33

Poor tissue healing causing the wound to open. Commonly due to wound infection, anaemia, early postoperative removal of sutures/clips/staples or stress on the unhealed incision Symptoms Separation of wound edges Leakage of serosanguineous fluid from the wound

Question 34

Nursing Actions

Answer 34

Observe for signs of wound infection, dehiscence, evisceration Maintain appropriate wound management - aseptic technique Check wound before removal of sutures For evisceration do not push organs back into abdomen - cover with dressing moistened with warm sterile normal saline and report to RN immediately as wound needs to be closed in OT