Chapter 12: nursing care of patients having surgery

Question 1

surgery urgency levels

Answer 1

• emergency
• urgent
• elective
• optional

Question 2

purposes of surgery

Answer 2

• aesthetic
• diagnostic
• exploratory
• preventive
• curative
• reconstructive
• palliative

Question 3

types of surgery

Answer 3

• open incision
• minimally invasive surgery: endoscopic, scope, robotic, laser

Question 4

preoperative

Answer 4

decision for surgery until transfer to surgery

Question 5

intraoperative

Answer 5

transfer to surgery until transfer to perianesthesia care unit

Question 6

postop phase

Answer 6

pacu through recovery

Question 7

LPN role in preoperative phase

Answer 7

• assist in data collection
• reinforce explanations/instructions
• provide emotional/psychological support
• provide family care: comfort, answer questions

Question 8

factors influencing surgical outcomes

Answer 8

• age
• chronic disease
• emotional responses
• nutrition
• smoking, and alcohol and/or drug abuse
• avoid smoking: 24 hours before surgery, 3-4 weeks w/ lung disorders

Question 9

emotional response: fear

Answer 9

• dying
• anesthesia fear
• pain
• body image

Question 10

anesthesia fear

Answer 10

• accidental awareness under general anesthesia
• brain damage
• loss of control
• not waking up after surgery

Question 11

emotional response: fear - interventions

Answer 11

• assist patient w/ coping
• discuss anxiety and fears
• use music and guided imagery
• report extreme fears to surgeon
• encourage patient/anesthesia professional discussion
• patient may request surgery while awake: local anesthesia, involvement in experience provides comfort

Question 12

preadmission surgical patient assessment

Answer 12

• health history
• risk factors
• education
• discharge planning
• referrals
• diagnostic testing: pregnancy test
• advance directives

Question 13

preoperative routines

Answer 13

• date and time of surgery
• admission time
• length of stay
• items to bring and wear
• recovery after surgery
• family information
• discharge criteria: responsible adult for outpatient surgery discharge

Question 14

preoperative instructions

Answer 14

• preps: nasal culture, skin, bowel
• medications
• NPO times
• pain control
• postop exercises

Question 15

postoperative exercises

Answer 15

• deep breathing and coughing
• incentive spirometry
• leg exercises

Question 16

preoperative patient: assessment

Answer 16

• health history
• medications, herbs, and supplements
• physical assessment

Question 17

preoperative nursing diagnoses

Answer 17

• anxiety
• fear
• deficient knowledge

Question 18

preperative consent

Answer 18

patient gives legal permission for surgery
- informed consent surgeon’s responsibility
- no analgesia or sedation before signing
- voluntary
- can withdraw at any time
- valid for 30 days

Question 19

LPN role: witnessing consent

Answer 19

• ensure patient has been informed
• direct patient questions to surgeon
• signature indicates observed voluntary signing of consent

Question 20

preparation for surgery

Answer 20

• preoperative preparation checklist
• preoperative medications

Question 21

holding area

Answer 21

• verifications: patient data, surgical site - patient initials/marks operative site
• time out
• IV insertion
• IV antibiotic
• Prewarming

Question 22

arrival in surgery: explain what to expect

Answer 22

• position
• safety
• tubes placed after anesthesia induction
• skin prep

Question 23

LPN role in intraoperative phase

Answer 23

• scrub nurse
• sterile instrument field
• assist surgeon

Question 24

anesthesia

Answer 24

• general
• local (regional)
• adjunct agents
• procedural sedation and analgesia (formerly conscious sedation)

Question 25

general anesthesia

Answer 25

• loss of sensation, consciousness, reflexes
• IV or inhalation route
• endotrachial intubation
• complication: malignant hyperthermia

Question 26

local (regional) anesthesia

Answer 26

• loss of sensation to body region
• injection of a local agent

Question 27

malignant hyperthermia

Answer 27

• rare hereditary muscle disease
• triggered by some general anesthesia agents/succinylcholine
• potentially fatal
• surgery stopped, anesthesia discontinued
• 100% oxygen give
• cooled w/ ice, iced iv solutions
• dantrolene sodium, IV muscle relaxer given

Question 28

PACU nursing diagnoses

Answer 28

• ineffective airway clearance
• ineffectivev breathing pattern
• risk for aspiration
• deficient fluid volume
• acute pain

Question 29

family visitation

Answer 29

• keep informed
• maintain confidentiality (HIPPA)

Question 30

PACU discharge criteria

Answer 30

• stable vital signs
• oxygen saturation Sa02 > 90%
• awake, baseline LOC
• respirations not depressed
• bleeding controlled

Question 31

safety after transfer

Answer 31

• place bed in lowest position with side rails up
• place call button within patient’s reach
• instruct to call for assistance w/ ambulation
• assist w/ ambulation
• have pt sit on side of bed before standing

Question 32

nursing diagnoses for postop patients

Answer 32

• ineffective breathing pattern
• ineffective airway clearance
• acute pain
• risk for surgical site infection
• deficient fluid volume
• ineffective peripheral tissue perfusion
• urinary retention
• risk for infection
• impaired skin integrity
• imbalanced nutrition
• constipation
• impaired physical mobility

Question 33

wound evisceration interventions

Answer 33

• position in low Fowler position w/ knees flexed
• cover wound w/ sterile dressings or clean towels moistened w/ warm sterile normal saline
• notify surgeon immediately
• monitor vital signs for evidence of shock
• infuse IV fluids as ordered
• prepare for immediate surgery

Question 34

ambulatory surgery discharge criteria

Answer 34

• stable vital signs
• no bleeding
• no nausea/vomitig
• controlled pain
• voided as ordered
• no dizziness when upright
• discharged to a responsible adult

Question 35

ambulatory surgery discharge instructions: teaching

Answer 35

• wound care, medications, complications
• rest 24-48 hours
• no driving, operating machinery
• follow up surgeon’s visit
• written instructions signed by patient
• prescriptions

Question 36

inpatient discharge instructions

Answer 36

• teaching: wound care, medications, complications, equipment, follow up surgeon’s visit
• written instructions/signed
• prescriptions