SURGERY II TEST #2 |104 QUESTIONS| WITH ALL CORRECT ANSWERS, PASSED!!

perioperative nursing includes care given - ANS before (preoperative), during (intraoperative), after surgery (postoperative) surgical procedures are classified according to - ANS seriousness, urgency, purpose surgical risk factors - ANS smoking, age, nutrition, obesity, obstructive sleep apnea, immunocompetence, fluid & electrolyte balance, depression, pregnancy complication prevention includes - ANS surgical site infection prevention, glycemic control & infection prevention, respiratory & cardiac complications, pressure injury prevention surgical site infection prevention - ANS antibiotic selection, dosing, timing, appropriate preoperative hair removal, proper skin preparation, maintaining normothermia, glucose control, OR traffic control, preoperative bathing with CHG, and reducing unnecessary blood transfusions critical thinking: knowledge base - ANS anatomy and physiology, aseptic technique, pharmacology, and teaching-learning principles critical thinking: attitudes - ANS responsibility and creativity critical thinking: standards - ANS intellectual, professional (AORN, TJC) nursing process: preoperative surgical phase assessment (nursing history) - ANS - interview family if patient is unable to speak or understand english - discuss advance directives nursing process: preoperative surgical phase assessment (medical history) - ANS - includes primary reason for seeking medical care and past illnesses and surgeries - inquire about family history for anesthetic complications - ask woman of childbearing age when their LMP occured malignant hyperthermia - ANS a life-threatening complication resulting in high carbon dioxide levels, tachypnea, tachycardia, heart rhythm irregularities, and muscular rigidity with elevated temperature nursing process: preoperative surgical phase assessment (previous surgeries) - ANS - will reveal if there are physical or psychological responses that may develop during the current planned procedure nursing process: preoperative surgical phase assessment (knowledge) - ANS - assess what a patient knows about surgery in general and what specifically is known about the patient's planned surgery - include an assessment of the patient's readiness and ability to learn nursing process: preoperative surgical phase assessment (medication history) - ANS - review if a patient is taking any medications that predispose the patient to surgical complications nursing process: preoperative surgical phase assessment (allergies) - ANS - allergies to medications, topical agents used to prepare the skin for surgery, and latex - an allergic response is potentially fatal - verify allergies before, during, and after surgery nursing process: preoperative surgical phase assessment (smoking habits) - ANS - patients who smoke are at greater risk for postoperative pulmonary complications than a patient who does not smoke nursing process: preoperative surgical phase assessment (alcohol and controlled substance use and abuse) - ANS - need to be aware of the use of alcohol and controlled substances by patients to prepare for adverse reactions such as withdrawal that may occur perioperatively nursing process: preoperative surgical phase assessment (family support) - ANS - determine if and to what extent a patient will have support from family members or significant others - ask questions to determine the condition of a patient's home environment, the availability of family caregivers and how a patients expected limitations will affect his of her ability to perform ADLs nursing process: preoperative surgical phase assessment (occupation) - ANS - surgery often results in physical alterations that prevent a patient from immediately returning to work, assess patient's occupational history to anticipate the effect surgery will have on convalescence or eventual work performance physical examination: general surgery - ANS - gestures and body movements often reflect decreased energy or weakness caused by illness - preoperative vital signs provide a baseline for later comparisons, detects fluid & electrolyte imbalances performed on the basis of the patient's choice: not essential for health - ANS elective surgery involves extensive reconstruction or alteration in body parts, poses risk to well-being - ANS major surgery relieves or reduces intensity of disease symptoms, will not produce cure - ANS palliative surgery must be done immediately to save life or preserve function of body part - ANS emergency surgery surgical exploration that allows physician to confirm medical status, may involve removal of body tissue for analysis - ANS diagnostic surgery performed to improve personal appearance - ANS cosmetic surgery amputation or removal of diseased body part - ANS ablative surgery performed to replace malfunctioning organs or structures - ANS transplant surgery the patient who smokes cigarettes is at a greater risk for: - ANS bronchospasm or laryngospasm, as well as atelectasis, circulatory and infectious complications, and clot formation postoperative care for a patient who smokes cigarettes will require more aggressive: - ANS pulmonary hygiene (frequent turning, coughing and deep breathing, incentive spirometry, positive expiratory therapy, "huff coughing") what are some medical conditions that may increase a patient's surgical risk? - ANS bleeding disorders, diabetes mellitus, heart disease/ hypertension, upper respiratory tract infection, cancer, renal disease, liver disease, chronic pain, fever, chronic respiratory disease what is malignant hypothermia associated with? - ANS general anesthesia obesity places a patient at greater risk for surgery as a result of: - ANS diminished ventilatory capacity and higher risk of aspiration what are some routine preoperative screening tests that may be ordered for a patient? - ANS CBC, serum electrolyte analysis, coagulation studies, serum creatinine test, urinalysis, 12 lead electrocardiogram, and a chest x-ray what are some commonly used preoperative medications? - ANS sedatives, tranquilizers, narcotic analgesics, anticholinergics sedatives in preoperative use are used for - ANS relaxation and decrease in nausea tranquilizers in preoperative use are used to - ANS decrease anxiety and relax skeletal muscles narcotic analgesics in preoperative use are used to - ANS sedate, decrease pain and anxiety, and reduce the amount of anesthesia needed anticholinergics in preoperative use are used to - ANS decrease mucous secretions in the oral and respiratory passages and prevent laryngospasm the patient is going to receive general anesthesia for the surgical procedure. specify the general NPO criteria: no food or fluids __ hours before surgery - ANS 2 hours what are some appropriate preoperative interventions? - ANS - completing bowel preparation before GI surgery - providing antimicrobial soap for bathing - removing the patient's wig - removing a hearing aid when the patient gets to the operating room identify whether the following task is the responsibility of the circulating nurse or scrub nurse: completion of preoperative assessments/ verification - ANS circulating nuse identify whether the following task is the responsibility of the circulating nurse or scrub nurse: application of sterile drapes - ANS scrub nurse identify whether the following task is the responsibility of the circulating nurse or scrub nurse: establishment of the intraoperative plan of care - ANS circulating nurse identify whether the following task is the responsibility of the circulating nurse or scrub nurse: calculation of blood loss and urinary output - ANS circulating nurse identify whether the following task is the responsibility of the circulating nurse or scrub nurse: provision of sterile equipment for the surgeon - ANS scrub nurse what are some specific nursing interventions to prevent the postoperative complication of pulmonary stasis? - ANS turning every 1-2 hours, coughing, deep breathing, incentive spirometry, positive expiratory pressure therapy, chest physiotherapy what are some specific nursing interventions to prevent the postoperative complication of venous stasis? - ANS leg exercise/ range-of-joint-motion exercises, turning, anti-embolism stockings, sequential compression device, adequate fluids what are some specific nursing interventions to prevent the postoperative complication of wound infection? - ANS sterile technique for dressing changes, standard precautions, adequate nutrition (proteins for wound healing) what are some specific nursing interventions to prevent the postoperative complication of GI stasis? - ANS a gradual progression in dietary intake, promotion of ambulation and exercise, provision of an adequate fluid intake, administration of fiber supplements, stool softeners, enemas, and rectal suppositories as ordered, proper positioning, frequent oral hygiene and meals when patient is rested and free from pain the patient should void within how many hours after the procedure? - ANS 6 hours what should the nurse do if the patient has not voided within 6 hours after surgery? - ANS palpate the area above the symphysis pubis to determine the presence of bladder distention after general anesthesia, postoperative oral intake usually begins with an order for what diet? - ANS clear liquid diet the clear liquid diet is usually followed by which diet? - ANS full liquid diet signs and symptoms of latex allergy - ANS redness, inflammation, and blisters, pruritus, swelling, as hay fever-like symptoms and anaphylaxis what are some appropriate interventions in the postanesthesia care unit (PACU)? - ANS - irrigating an existing NG tube with normal saline - measuring I&O - checking for bleeding at the surgical site - administering analgesics what are some appropriate interventions for the older adult in the postoperative phase? - ANS - verify an order for subcutaneous heparin if the patient is on bedrest for more than 24 hours - place the patient in a bed or room that is closer to the nurses' station - use teaching materials with large print - determine the need for a stool softener and/ or extra fiber to promote wound healing, the patient should have at least how many calories per day along with addition what? - ANS 1500 kcal/ day to maintain energy reserves: additional protein, carbohydrates, zinc and vitamins A, B, C, and K are necessary one of the complications after abdominal surgery can be a loss of function of the intestine, what is this called? - ANS paralytic ileus how can you determine if a patient is having paralytic ileus? - ANS check bowel sounds, patient usually experiences abdominal distention and absent bowel sounds what are some appropriate measures in the postoperative period? - ANS - encourage diaphragmatic breathing - maintain pain control when do patients tend to experience the most pain after surgery? - ANS during the first 24-48 hours what patient signs, symptoms, or behaviors may indicate that the patient is in pain? - ANS restlessness, elevated pulse, respirations and blood pressure, grimaces, guarding the nurse recognizes that informed consent: - ANS indicates that the patient is aware of the procedure and its possible complications a patient is taken to PACU after surgery. a nurse is assessing the patient and is alert to the identification of a posoperative hemorrhage if the patient exhibits: - ANS restlessness the nurse is checking the urinary output of a young child who weighs 50 pounds. based on this measurement, the expected hourly urinary output should be: - ANS 23-46mL a patient has received a spinal anesthetic during the surgical procedure. the nurse is alert to possible complications of the anesthetic and is assessing the patient for a: - ANS headache a patient is being positioned in the PACU after surgery. unless contraindicated, the nurse should place the patient: - ANS on the side with the face turned downward when a patient first arrives at PACU, the nurse will: - ANS provide a warm blanket a nurse is visiting a patient who had surgery 9 hours ago. the nurse asks if the patient has voided, and the patient responds negatively. the bladder scan shows retained urine and the bladder is palpable. at this time, the nurse: - ANS obtains an order for straight catheterization during a patient assessment in the PACU, a nurse finds that the patient's operative site is swollen and appears tight. the nurse suspects: - ANS hemorrhage an immediate postoperative priority in providing nursing care for a patient is: - ANS airway patency a patient has been taking an anticoagulant at home. the patient is going to be admitted for a surgical procedure, and the nurse anticipates that this prescribed medication will be: - ANS discontinued at least 2 days before the procedure a patient is scheduled for surgery, and a nurse is completing the final areas of the preoperative checklist. after administering the preoperative medications, the nurse should: - ANS place the side rails up on the bed or stretcher a nurse is preparing a patient for surgery and recognizes that the greatest risk of bleeding is for the patient with: - ANS thrombocytopenia a patient has an NG tube in place after the surgery and complains to the nurse of nausea. the nurse should first: - ANS irrigate the tube with normal saline a patient's surgeon has previously discussed the procedure with the patient, but she has a few more questions. the best way for the nurse to approach this is to first: - ANS determine what the patient has been told already the nurse is alert for signs of a postoperative wound infection: - ANS 3-6 days after the surgery following surgery, the patient is suspected of having a pulmonary embolism. this is determined by the patient experiencing: - ANS dyspnea, sudden chest pain what patient behavior is an indication of postoperative delirium? - ANS demonstrating quick-changing emotions and irritability nursing process: diagnosis - ANS - anxiety - compromised family coping - ineffective coping - fear - risk for imbalanced fluid volume - risk for infection - deficient knowledge - risk for imbalanced nutrition: less than body requirements what do health promotion activities during the preoperative phase focus on? - ANS prevention of complications, health maintenance, and support of possible rehabilitation needs after surgery common components of a rehabilitation program - ANS medical optimization, physical activity, nutrition plan, strategies to reduce anxiety what does patient education do? - ANS relieves anxiety, increases patient satisfaction, speeds recovery, decreases the amount of perceived pain, and facilitates a more rapid return to work or normal functioning structured teaching influences what kind of postoperative factors? - ANS ventilatory function, physical functional capacity, sense of well-being, length of hospital stay, anxiety about pain and amount of pain medication needed for comfort when is preoperative teaching most useful? - ANS when started the week before admission what is a simple explanation to give a patient and family about the importance of following oral intake instructions for food and liquids? - ANS anesthesia causes the muscles to relax and gastric contents can reflux into the esophagus, the anesthetic eliminates the patient's gag reflex therefore a patient is at risk for aspiration of food or fluids from the stomach into the lungs a patient cannot have any meat or fried foods how long before surgery? - ANS 8 hours what are some sensations that patient's should be informed about that may occur before, during, or after surgery? - ANS blood pressure cuff, blurred vision from ophthalmic ointment, dryness of the mouth or the sensation of a sore throat resulting from an endotracheal tube, pain at the incision site, tightness of the dressings, and feeling cold what is one of the surgical patient's greatest fears? - ANS pain what do preoperative teaching programs of postoperative exercises frequently include? - ANS explanation and demonstration of diaphragmatic breathing, incentive spirometry, controlled coughing, turning, and leg exercises diaphragmatic breathing improves - ANS lung expansion and oxygen delivery without using excess energy incentive spirometry ecourages - ANS forced inspiration what is incentive spirometry therapy effect in preventing? - ANS atelectasis after surgery you should educate a patient to ask for what as needed? - ANS pain medications what should you teach a patient to do in order to minimize pain during coughing? - ANS splint an abdominal or thoracic incision what do many surgical protocols now include that are designed to minimize or prevent hospital-acquired deconditioning? - ANS early mobility guidelines and activity resumption what should you make sure that the patient's diet consists of in high amounts? - ANS protein patients may take oral medications with sips of water IF - ANS ordered by the health care provider when a patient is NPO, what should you instruct them to do regarding oral hygiene? - ANS rinse their mouths with water or mouthwash and brush their teeth but not to swallow anything, even clear liquids why should you instruct patients not to shave the surgical area? - ANS shaving leaves nicks that can harbor infectious microorganisms what is the most common site for microorganisms to grow and multiply? - ANS the skin how are adequate levels of CHG achieved and maintained? - ANS allowing it to dry on the skin what are the routine procedures required before releasing a patient for surgery? - ANS documentation, vital signs, hygiene, preparation of hair and removal of cosmetics, preparation of bowel and bladder, application of anti-embolism devices, promotion of patient's dignity, performing special procedures, safeguarding valuables, administering preoperative medications if a patient does have an enema or cathartic ordered for the morning of surgery, how long before surgery should you give it? - ANS at least 1 hour, this allows time for a patient to defecate without rushing what do antiembolic stockings do? - ANS maintain compression of small veins and capillaries of the lower extremities, the constant compression forces blood into larger vessels which promotes venous return and preventing venous stasis what should you do with a patient's valuable or secure items? - ANS give them to family members for safekeeping in a designated location antibiotics should be administered within what before an incision? - ANS 1 hour how can you determine if a patient and family have adequate preoperative preparation? - ANS asking the patient to describe the surgical procedure, its purpose, and the expected postoperative care what should be included in a postoperative bedside unit? - ANS 1. sphygmomanometer, stethoscope, and thermometer 2. emesis basin 3. clean gown 4. washcloth, towel, and facial tissues 5. IV pole and pump 6. suction equipment 7. oxygen equipment 8. extra pillows for positioning patient comfortably 9. bed pads to protect bed linen from drainage 10. PCA pump and tubing 11. bed raised to stretcher heigh, bed linen turned back, and furniture moved to accommodate the stretcher nursing diagnoses for the intraoperative patient - ANS - risk for aspiration - decreased cardiac output - risk for deficient fluid volume - impaired gas exchange - risk for infection - risk for perioperative positioning injury - impaired skin integrity - risk for latex allergy response proper positioning components - ANS ensuring patient comfort and dignity, maintaining homeostasis, protecting anatomical structures and avoiding complications and injuries, promoting access to the surgery site, promoting access for the administration of IV fluids and anesthetic agents, and promoting access of OR surgical equipment intraoperative nursing care includes - ANS interventions to prevent infection and injury to a patient, maintain fluid and electrolyte balance, and control a patient's temperature general anesthesia - ANS patient loses all sensations, consciousness, and reflexes including gag and blink reflexes, administered during major procedures requiring extensive tissue manipulation or any time that analgesia, muscle relaxation, immobility, and control of the autonomic nervous system are required regional anesthesia - ANS involves loss of sensory and/ or motor function of a specific portion or dermatome of the body by temporarily interrupting normal nerve conduction, administration techniques include peripheral nerve, spinal, epidural, and caudal blocks local anesthesia - ANS administration of an anesthetic agent into the part of the body where the incision is to be made, it involves local infiltration by injection or topical application, used during minor procedures in ambulatory surgery IV moderate sedation/analgesia or conscious sedation - ANS routinely used for diagnostic or therapeutic procedures (colonoscopy or certain laparoscopies) that do not require complete anesthesia but simply a decreased level of consciousness what are some essential abilities for a nurse caring for sedated patients? - ANS the ability to assess, diagnose, and intervene if a complication arises what should you ask a patient that remains conscious during a procedure? - ANS about pain, numbness, and perceived room temperature two phases of postoperative course - ANS the immediate recovery period and convalescence how long does the immediate recovery period last? - ANS 1-2 hours how long does the immediate recovery period last for a hospitalized patient? - ANS a few hours how long does the convalescence period last for a hospitalized patient? - ANS 1 or more days where does the patient go immediately after surgery for close monitoring? - ANS post-anesthesia care unit (PACU) what does the PACU receive from the surgical team in the OR before the patient arrives? - ANS a hand-off report what information does the hand-off report given to the PACU nurse include? - ANS anesthetic agents given during surgery, IV fluids and blood products administered, status of the wound including the presence of drainage devices, and whether the patient had any surgical complications such as excessive blood loss post-anesthesia care in ambulatory surgery: phase 2 - ANS this phase prepares patients for discharge and self care, encourage a patient to gradually sit up on the stretcher or recliner and begin to take ice chips, sips of water, or other clear liquids after regaining full alterness recovery phase - ANS once a patient is stable, usually within 2 to 3 hours, the anesthesia care provider or surgeon transfers the hospitalized patient to a postoperative nursing unit, whereas the ambulatory surgical patient returns home what should assess when patients enter the PACU? - ANS respiratory and circulatory status and attach electronic monitors postoperative assessment: respirations - ANS assess the quality of a patient's respirations and the patency of the airway, assess RR, rhythm, depth, and quality of ventilatory movement, auscultate the lungs for adventitious sounds postoperative assessment: circulatory - ANS assessment of heart rate, rhythm, blood pressure, continuous ECG monitoring, circulatory perfusion either type of hemorrhage is indicated by - ANS decrease in blood pressure, elevated heart and respiratory rates, thready pulse, clammy, cool, pale skin, restlessness postoperative assessment: temperature control - ANS assess if patient feels cold or uncomfortable upon awakening, assess body temperature postoperative assessment: neurological function - ANS assess level of consciousness and orientation, check for pupillary and gag reflexes, hand grasp, and movements of the extremities common postoperative complications: respiratory system - ANS atelectasis, pneumonia, hypoxemia, pulmonary embolism pneumonia - ANS inflammation of alveoli caused by infectious process, usually develops in lower dependent lobes of lung if patient is immobilized signs and symptoms of pneumonia - ANS fever, chills, productive cough, chest pain, purulent mucus, dyspnea atelectasis - ANS collapse of alveoli with retained mucus secretions signs and symptoms of atelectasis - ANS elevated respiratory rate, dyspnea, fever, crackles over involved lobes of lungs, productive cough common postoperative complications: circulatory system - ANS hemorrhage, hypovolemic shock, thrombophlebitis, thrombus, embolus hypovolemic shock - ANS reduced perfusion of tissues and cells from loss of circulatory fluid volume thrombus - ANS formation of clot attached to interior wall of vein or artery, which occludes vessel lumen embolus - ANS piece of thrombus that has dislodged and circulates into bloodstream until it lodges in another vessel, commonly lungs, heart, or brain common postoperative complications: gastrointestinal system - ANS paralytic ileus, abdominal distention, nausea and vomiting common postoperative complications: genitourinary system - ANS urinary retention, urinary tract infection common postoperative complications: integumentary system - ANS wound infection, wound dehiscence, wound evisceration common postoperative complications: nervous system - ANS intractable pain postoperative assessment: fluid and electrolyte balance - ANS assess the patient's hydration status and cardiac and neurological function for signs of electrolyte alterations, routinely inspect IV catheter site to verify patency, monitor and accurately record intake and output to assess fluid balance and renal and cardiac function postoperative assessment: skin integrity and condition of the wound - ANS assess the condition of a patient's skin, observe the appearance of the suture line/ color/ odor/ and consistency of any drainage, amount of drainage, ongoing observation of wound postoperative assessment: genitourinary function - ANS palpate the lower abdomen just above the symphysis pubis for bladder distention, use bladder scanner or ultrasound to determine if urine has accumulated in bladder, monitor output if patient has catheter when assessing a post-op patient's urinary catheter output, what is the expected amount in adults? - ANS at least 30 mL/hr postoperative assessment: gastrointestinal function - ANS ask patient if they are passing flatus (an important sign indicating return of normal bowel function), inspect abdomen for distention, if patient has an NG tube in place for decompression check patency of tube and the color and amount of drainage postoperative assessment: comfort - ANS adequate pain management, assess patient's extent and character of pain and the extent of reduced sensation to an anesthetized area postoperative diagnoses - ANS - ineffective airway clearance - anxiety - disturbed body image - ineffective breathing pattern - risk for deficient fluid volume - risk for infection - impaired physical mobility - nausea - acute pain - delayed surgical recovery typical postoperative orders - ANS 1. frequency of vital signs monitoring and special assessments 2. types of IV fluids and rate of infusion 3. application of compression devices and stockings 4. postoperative medications 5. oxygen therapy or incentive spirometry 6. fluids and food allowed by mouth with progression of diet 7. level of activity that a patient is allowed to resume 8. position that patient is to maintain while in bed 9. intake and output measures 10. diagnostic tests and studies postoperative interventions: respiration - ANS - position patient on one side with the face downward and the neck slightly extended - suction artificial airway and oral cavity for mucus secretions as necessary - begin deep breathing and coughing exercises - administer oxygen as ordered, monitor oxygen saturation postoperative interventions: circulation - ANS - encourage leg exercises at least every hour while awake - apply anti-embolism stockings - encourage early ambulation - administer anticoagulant drugs if ordered - promote adequate fluid intake orally or intravenously what does HOUDINI protocol outline? - ANS when not to remove an indwelling cather HOUDINI protocol - ANS H- hematuria, gross O- obstruction, urinary U- urological surgery D- decubitus ulcer open sacral or perineal wound in incontinent patient I- input and output critical for patient management or hemodynamic instability N- no code, comfort care, hospice care I- immobility because of physical constraints