BN Ch.56 Perioperative Care

Question 1

__________ is a postoperative respiratory complication that develops due to the reluctance of the client to cough or breathe deeply because of pain over the incision area.

Answer 1

Atelectasis

Question 2

__________ care is the term used to describe the nursing care in the operating room, postanesthesia recovery unit, or postanesthesia care unit.

Answer 2

Intraoperative

Question 3

__________ anesthesia is defined as the degree of anesthesia at which an operation can safely be performed and be tolerated by the client.

Answer 3

Surgical

Question 4

In clients with abdominal distention due to gas, nutrition begins with a/an _________ diet to avoid further complications.

Answer 4

progressive

Question 5

___________ is the splitting open or separation of the surgical incision.

Answer 5

Dehiscence

Question 6

Hip joint replacement surgery

Answer 6

General

Question 7

Third molar extractions

Answer 7

Local infiltration

Question 8

Surgeries of lower extremities

Answer 8

Spinal

Question 9

Chronic back pain

Answer 9

Conduction Block

Question 10

Write the correct sequence of steps that occur during the transport of a client from the postanesthesia unit to the recovery room.

1. Notify the client’s family that the client is back in the recovery room.
2. Check the client’s vital signs and compare them with previous recordings for any significant discrepancies.
3. Place the bed in its highest position, and keep the head of the bed flat.
4. Arrange for all necessary equipment before the client arrives in the recovery room.

Answer 10

3. Place the bed in its highest position, and keep the head of the bed flat.
4. Arrange for all necessary equipment before the client arrives in the recovery room.
5. Check the client’s vital signs and compare them with previous recordings for any significant discrepancies.
6. Notify the client’s family that the client is back in the recovery room.

Question 11

How is postoperative hypovolemic shock managed?

Answer 11

Postoperative hypovolemic shock is managed with the following steps:

• Inform the surgeon about the condition.
• Control hemorrhage by applying direct pressure.
• Position the client flat with the feet elevated, unless contraindicated.
• Administer oxygen as advised by the surgeon.
• Administer blood or plasma substitutes as ordered by the surgeon.
• Prepare to administer vasopressors as ordered by the surgeon.
• Place the client under observation

Question 12

Who is a circulating nurse?

Answer 12

• A circulating nurse is a registered nurse who works outside the sterile field when an operation is in progress.
• The function of the circulating nurse is to assist anesthesia personnel in monitoring the condition of the client and also to assist in the opening of sterile packs and delivering sterile supplies and instruments to the sterile team.
• They also help in delivering medications to the scrub person, weighing and labeling specimens, and keeping records during the surgical procedure

Question 13

What are the advantages of using staples to close a surgical incision?

Answer 13

Staples are often preferred for use in closing surgical incisions because they are inert, do not cause infections, and can be quickly inserted.

Question 14

How are postoperative infections managed?

Answer 14

• Postoperative infections are managed by administering antibiotics, increasing the client’s fluid intake, and providing adequate diet to build up resistance.
• If necessary, the infected wound is drained and cleaned by irrigation.

Question 15

What are the symptoms and complications of embolism?

Answer 15

• The symptoms of postoperative embolism vary with the location of the condition.
• Common symptoms are severe pain, shock, and sometimes nausea and vomiting.
• The most severe complication of embolism is the formation of a pulmonary embolism due to the lodging of a blood clot in the small vessels of the lung

Question 16

What are the signs of a pulmonary embolism?

Answer 16

• Signs of a pulmonary embolism include:
  
  • Difficulty breathing
  • Sharp chest pain
  • Cough
  • Cyanosis
  • Rapid respirations and heart rate
  • Severe anxiety.
• A pulmonary embolism can be rapidly fatal

Question 17

A nurse’s role in managing preoperative and postoperative care involves assisting the clients by providing necessary instructions and support.

1. An older adult client is admitted to a health- care facility for surgical removal of the tumor under general anesthesia. The client exhibits
   signs of anxiety and fear.

a. What nursing evaluations should the nurse consider before the surgery?

Answer 17

The nurse needs to make the following evaluations before the surgery:

• The client’s understanding of the proposed surgical procedure (clarify any misperceptions).
• Past experiences with surgery, if any.
• The client’s fears.
• Factors that increase surgical risk or the potential for postoperative complications.
• Adequacy of coping patterns and support systems.
• Pertinent sociocultural factors, such as health beliefs and practices, economic concerns, cultural considerations such as language barrier problems, and ethnic beliefs related to surgery and healing.
• The client’s vital signs on the morning of surgery.
• Accurate height and weight of the client.
• The client’s cardiac and respiratory functions that could place the client at high risk during surgery

Question 18

What preoperative instructions must the nurse provide the client to reduce the client’s fears and anxiety?

Answer 18

• The preoperative instructions provided by the nurse to the client include the following:
  
  • Explain the reasons for the special equipment by the bedside.
  • Describe what equipment is likely to be present for each individual client in the postoperative period.
  • Describe and allow the client to practice how to turn in bed without assistance.
  • Allow the client to practice all procedures, as needed.
  • Describe discomforts to expect and how to alleviate them.
  • Emphasize the use of medications to prevent pain, rather than waiting until pain exists.
  • Show and practice with the client how to splint the incision area.
  • Demonstrate and allow the client to practice deep-breathing exercises.
  • Explain the use of the incentive spirometer, and allow the client to practice with it.
  • Demonstrate and allow the client to practice other exercises that will be performed postoperatively.
  • Describe the amount and kind of ambulation allowed or expected after surgery. Explain the reasons for early ambulation.
  • Provide a description of the operating room and the post-anesthesia care unit.
  • Describe appropriate wound care, and show the client the supplies that will be used.
  • Discuss optimum nutrition.
  • Explain the importance of communication.
  • Provide the client with written instructions, to supplement the verbal instruction.

Question 19

The parents bring an adolescent client to the emergency department. The client is reporting severe abdominal pain. On further
examination, the client is diagnosed with appendicitis that requires emergency surgery.

a. What are the various considerations to be noted in the preoperative checklist?

Answer 19

The various nursing considerations to be checked off in the preoperative checklist include the following:

• Ensure that the identification of assessments, medications, and other physical preparations are completed before the client is anesthetized.
• Before giving any presedation medications, ensure that the client has signed a consent to surgery form.
• Ensure that the surgeon has obtained the client’s consent to perform the surgery.
• Ensure that the client is in the best possible physical and emotional condition for surgery.
• Measure the client’s height and weight and baseline vital signs.
• List any allergies to medication.
• Record the last time voided or that the client is catheterized.

Question 20

What nursing considerations should be employed when caring for a client who is receiving anesthesia?

Answer 20

The nursing considerations employed for a client who is receiving anesthesia include the following:

• Check for allergies in the client before administering any preoperative or postoperative drug. Ensure that the client is wearing an allergy wristband.
• Notify the healthcare provider about any abnormal laboratory results obtained before the procedure.
• Inform the surgeon immediately about any extreme apprehension, either before or after the administration of preoperative medication.
• When using a spinal anesthetic, ensure that the client is positioned flat until the anesthetic has worn off (sometimes as long as 12 hours, or as ordered).
• Observe carefully for signs of respiratory distress after the use of neuromuscular blockers or any type of general anesthesia.
• Watch carefully for signs of circulatory depression after the use of neuromuscular blockers or any general anesthesia.
• Ensure that the client has not taken central nervous system depressants or alcohol.
• If epidural or spinal anesthetics or narcotics have been used, keep naloxone at an easily accessible location for reversal of untoward effects.
• Observe for respiratory depression, and safeguard the intravenous (IV) injection site. (Almost always, the client has a running IV or a heparin/saline lock in place. Ensure that it remains patent.)
• Anticipate the need for pain medication early after recovery from anesthesia.
• Be alert and prepared for any adverse effects of any medication, even with short-acting pain medications or anesthesia.