Surgical Patients

Question 1

What is the difference between Ambulatory care, surgical daycare and same day admit?

Answer 1

Ambulatory care: quick procedure, only requires partial sedation
Surgical Daycare: doesn’t require hospital bed
Same Day Admit: spend time in the hospital

Question 2

Explain the difference in procedure between Elective surgery and emergency surgery

Answer 2

With an elective procedure, pt arrives in Surgical Daycare (SDC) as planned pre-op, where they head to the OR, then the PACU, and then either inpatient SDC or outpatient SDA, depending on the surgery.
With an emergency procedure, the pt. arrives in the ER, where they head to the OR, then PACU, then SDC or SDA

Question 3

List the 6 purposes of surgery

Answer 3

1. Cosmetic– improvement of physical body
2. Cure or repair– elimination or repair
3. Diagnostic– determine presence or extent
4. Exploration– surgical examination
5. Prevention– removal of…
6. Palliation– symptoms alleviated

Question 4

Explain the difference between Urgent, emergency and salvage surgery.

Answer 4

emergency– scheduled within 2 hrs
urgent– required within 24 hrs
salvage– death is imminent unless pt can be taken to the OR immediately

Question 5

A patient has been admitted as a “stable” GI bleed. What classification for timing will this patient be indentified under?

Answer 5

Emergency surgery

Question 6

What is the role of a circulating nurse?

Answer 6

assist the team to create and maintain a safe environment for the patient
**Must be an RN

Question 7

Explain the difference between unrestricted, semi-restricted and restricted sections of the surgical suite

Answer 7

unrestricted: street clothes, can interact with scrubs
semi-restricted: authorized personnel in surgical attire with head covered
Restricted: authorized personnel in surgical attire with head covered and with masks on

Question 8

What are the most common positions for surgery prep?

Answer 8

supine, lithotomy, sitting, prone, lateral

Question 9

Discharge from the PACU post-op is determined by a scale including what 5 assessments?

Answer 9

1. Patient Mobility
2. Respiratory status
3. Curculation
4. Consciousness
5. Pulse Oximetry

Question 10

What specific complication is associated with laparoscopic surgeries? If my patient presents with this, how can I intervene?

Answer 10

Referred shoulder pain r/t CO2 retention.

• place pt. in Sims’s position (L side with R knee flexed)
• Deep breathing
• Mobilization

Question 11

What are the 3 most common post-op complications to look for?

Answer 11

1. Pain
2. Nausea
3. Atelectasis

Question 12

Post-op Priority assessments

Answer 12

1. ABC’s
2. LOC and full neuro
3. Full set of Vitals
4. Surgical site, drains, tubes, dressings

Question 13

Your patient is c/o severe pain after arriving from the PACU. To determine order of care, create a nursing diagnosis, including appropriate interventions

Answer 13

Acute pain r/t surgical intervention, tissue damage m/b pt. c/o deep, stabbing pain 9/10 on the pain scale

• Dr. Orders for pharmaceuticals
• non-pharmaceuticals (warm blanket, massage)
• management of med. side effects.

Question 14

Define atelectasis

Answer 14

a condition characterized by the collapse of alveoli caused by obstruction from retained secretions or decreased inflation

Question 15

Your patient has just returned from the PACU. When completing your initial set of vitals, her SaO2 is 88%. Write a nursing diagnosis for this situation, and explain how you would intervene.

Answer 15

Impaired gas exchange r/t decreased mobility, pain, hypoventilation, and anesthesia m/b fine crackles, decreased O2 sats and shortness of breath

• Provide oxygen via nasal prongs to achieve and maintain O2 sats of 92% or greater
• Raise Head of Bed
• Deep breathing and coughing 10 times every hour while awake
• Incentive spirometry 10-15 times Q 2-3 hrs
• Mobilization
• Adequate hydration (always check in case pt. is on fluid restrictions)

Question 16

FUN FACT!

Answer 16

** adequate hydration decreases risk of atelectasis in our post-op patients!!**

Question 17

Your patient is presenting with dry membranes, low BP and urine output, tachycardia and excessive thirst. Write a nursing diagnosis, and prioritize care for this patient

Answer 17

Hypotension or Hypovolemia r/t decreased circulating volume, post op nausea and vomiting, effects of anesthetic m/b dry membranes, hypotension, decrease urine output, tachycardia and excessive thirst.

• Assessment and monitoring of Vitals
• Assessment and monitoring of intake/output
• Monitoring of ordered blood work, especially Hgb and electrolytes
• If blood work hasnt been ordered, request it from the Dr.

Question 18

Your patient is POD x 1. In your morning head to toe assessment, you notice his legs are slightly swollen and he c/o calf tenderness, and his feet are cold to the touch. Write a nursing diagnosis for this circumstance and explain what you would do.

Answer 18

Impaired limb circulation or decreased peripheral perfusion r/t decreased mobilization and dehydration m/b pain, redness and swelling to the calf and patient c/o discomfort

• Early mobilization (POD#1 if possible!)
• Leg exercises 10-12 times Q1-2hrs while awake
• SCD’s as per Dr. orders
• LMWH as ordered
• Ensure adequate hydration via IV or PO (As long as it is not contraindicated)

Question 19

Who is at highest risk for Post-op Nausea and vomiting?

Answer 19

• Females
• non-smokers
• opioid use
• Hx of PONV
• Hx of motion sickness
• Longer surgeries

Question 20

What specific procedures put an individual at higher risk for PONV?

Answer 20

laparoscopic
neurosurgery
breast
plastic surgery

Question 21

Your patient had surgery this morning. She just rang her call bell, and as you enter the room, she starts to vomit. After helping her clean up, you realize you must intervene. What might you do?

Answer 21

Post-op nausea and vomiting r/t effects of anesthetic and opioids, pre-op fasting, surgical intervention and delayed gastric emptying

• Anti-emetics around the clock as per dr. orders
• Advancement of diet starting with ice chips, then clear fluids after surgery
• maintain IV fluids
• reduce fowl smells in patient room

Question 22

Which anti-emetic is most effective for chemical induced N&V?

Answer 22

Ondansetron

Question 23

How does metoclopramide work as an anti-emetic?

Answer 23

blocks dopamine receptors in chemoreceptor zone and stimulates GI motility
USED FOR CANCER

Question 24

Your patient is post-op day 2, and is worried because she has not yet had a bowel movement. Write a nursing diagnosis, and plan appropriate nursing interventions

Answer 24

decreased return of bowel motility r/t effects of anesthetic, decreased mobility, side effects of opioids, pain, pre-op fasting m/b lack of flatus and abdominal distention and discomfort

• early and frequent mobilization, at least up in chair for meals and walk in hall 2 times per day
• effective pain management to allow for mobilization
• abdominal assessment
• repositioning in bed
• advancing diet at appropriate speed

Question 25

Your patients urinary output is not sufficient since returning from the PACU yesterday evening. Write a nursing diagnosis, and interventions.

Answer 25

impaired urinary elimination r/t effects of anesthesia and opioids or post of inflammation

• Bladder scan to assess volume
• encourage by running water in the sink
• encourage mobilization to the BR to void
• I&O catheter PRN for retained urine > 400ml as per standing order