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IGGY > Chapter 16 - Preop > Flashcards

Chapter 16 - Preop Flashcards

1
Q

Diagnostic surgery

A

Surgery performed to determine the origin and cause of a disorder or the cell type for cancer

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2
Q

Curative Surgery

A

Performed to resolve a health problem by repairing or removing the cause

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3
Q

Restorative Surgery

A

Performed to improve a patient’s functional ability

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4
Q

Palliative Surgery

A

Performed to relieve symptoms of a disease process, but does not cure.

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5
Q

Cosmetic Surgery

A

Performed primarily to alter or enhance personal appearance

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6
Q

Elective Surgery

A

Planned for correction of a nonacute problem

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7
Q

Urgent Surgery

A

Requires prompt intervention; may be life-threatening if treatment is delayed more than 24-48 hours.

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8
Q

Emergent Surgery

A

Requires immediate intervention because of life-threatening consequences.

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9
Q

Minor Surgery

A

Procedure without significant risk; often done with local anesthesia

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10
Q

Major Surgery

A

Procedure of great risk; usually longer and more extensive than a minor procedure

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11
Q

Simple Surgery

A

Only the most overtly affected areas involved in the surgery

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12
Q

Radical Surgery

A

Extensive surgery beyond the area obviously involved. Directed at finding a root cause.

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13
Q

MIS Minimally Invasive Surgery

A

Surgery performed in a body cavity or body area through one or more endoscopes; can correct problems, remove organs, take tissue for biopsy, re-route blood vessels and drainage systems; is a fast growing and ever changing type of surgery.

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14
Q

Why do cardiac problems put patients at greater risk from having surgery?

A

Cardiac problems impair the patient’s ability to withstand hemodynamic changes and alter the response to anesthesia.

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15
Q

Atelectasis

A

Collapse of alveoli. Reduces gas exchange and causes intolerance of anesthesia. Also a common problem After anesthesia.

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16
Q

What meds put a patient at greater surgical risk or increase the risk for postoperative complications?

A

Antihypertensives
Tricyclic Antidepressants
Anticoagulants
NSAIDs

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17
Q

What prior surgical experiences put patients at greater surgical risk or increase the risk for postop complications?

A

Less-than-optimal emotional reaction. Anesthesia reactions or complications. Postop complications.

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18
Q

What health history puts patients at greater risk or increase the risk for postop complications?

A

Malnutrition or obesity.
Drug, tobacco, or alcohol or illicit substance use or abuse.
Altered coping ability.

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19
Q

What family history puts patients at greater surgical risk or increase the risk for postop complications?

A

Malignant hyperthermia
Cancer
Bleeding disorder

20
Q

What type of surgical procedure planned puts patients at greater surgical risk or increases the risk for postop complications?

A 
Neck, oral, or facial procedures (airway complications).
Chest or high abdominal procedures (pulmonary complications)
Abdominal surgery (paralytic ileus, VTE).
21
Q

What are some specific considerations when planning care of the older preoperative patient?

A
  • Greater incidence of chronic illness.
  • Greater incidence of malnutrition
  • More allergies
  • Increased incidence of impaired self-care abilities
  • Inadequate support systems
  • Decreased ability to withstand the stress of surgery and anesthesia
  • increased risk for cardiopulmonary complications after surgery.
  • risk for a change in mental status when admitted
  • increased risk for fall and resultant injury from anesthesia
22
Q

Why is it important to assess MSKL status prior to surgery?

A

MSKL issues may interfere with positioning during and after surgery.

23
Q

Why should you ask about a history of joint replacement and document the placement of any prostheses?

A

If an electrocautery pad is placed on or near the prosthesis it can cause an electrical burn.

24
Q

What are indications for poor fluid or nutritional status?

A
  • Brittle nails
  • Muscle waste
  • Dry or flaky skin
  • Decreased skin turgor and hair changes (dull, sparse, dry).
  • Orthostatic hypotension
  • Decreased serum protein levels and abnormal serum electrolyte levels
25
Q

Why should hypokalemia be reported to the anesthesia team and the surgeon before surgery?

A

It increases the risk for toxicity if the patient is taking digoxin, slows recovery from anesthesia and increases cardiac irritability.

26
Q

Why should hyperkalemia be reported to the anesthesia team and the surgeon before surgery?

A

Increased risk for dysrhythmias, especially with the use of anesthesia.

27
Q

As part of the cardiopulmonary assessment, what should be reported to the anesthesia team and surgeon?

A 
Hyper/hypotension
Heart rate less than 60 or more than 120 bpm
Irregular heart rate
Chest pain
SOB or dyspnea
Tachypnea
Pulse oximetry reading of less than 94%
28
Q

As part of the preop assessment report and signs or symptoms that could contraindicate surgery including:

A

Increased PTT, INR, or PT.

29
Q

Assess for and report other clinical conditions that may need to be assessed by a physician or advanced practice nurse before proceeding with surgery including:

A
  • Change in mental status
  • Vomiting
  • Rash
  • Recent administration of an anticoagulant drug
30
Q

Patients at greater risk for VTE are:

A
  • Obese
  • Older than 40 years
  • Have cancer
  • Have decreased mobility or are immobile
  • have a spinal cord injury
  • Have a history of VE, PE, varicose veins, or edema.
  • Taking oral contraceptives
  • Smokers
  • Have decreased cardiac output
  • Have hip fracture or total hip or total knee surgery.
31
Q

The nurse is educating a preop client about colostomy surgery. The colostomy surgery is categorized as what type of surgery?

A

Palliative

32
Q 
In going through the preoperative checklist, the nurse notices that the client's armband does not match the handwritten name on the informed consent, but it matches the stamped name. What does the nurse do first?
A. Calls admissions 
B. Cancels the surgery 
C. Contacts the surgeon 
D. Talks to the operating team
A

Talks to the operating team

33
Q 
As the nurse obtains the informed consent, the client asks, "Now what exactly are they going to do to me?" What is the nurse's response?
A. Contacts the anesthesiologist 
B. Contacts the surgeon 
C. Explains the procedure 
D. Has the client sign the form
A

Contacts the surgeon

34
Q

The nurse is educating the client who is about to undergo cardiac surgery with general anesthesia. Which statement by the client indicates the need for further instruction?
A. “I will wake up with a tube in my throat.”
B. “I will have a bandage on my chest.”
C. “My family will not be able to see me right away.”
D. “Pain medication will take away my pain.”

A

“Pain medication will take away my pain”

35
Q

The older client’s adult child tells the nurse that the client does not want life support. What does the nurse do first?
A. Calls the legal department to draft the paperwork
B. Documents this in the chart
C. Thanks the person and does nothing
D. Talks to the client

A

Talks to the client

36
Q

The preoperative client smokes a pack of cigarettes a day. What is the nurse’s teaching priority for the best physical outcomes?
A. Instructs the client to quit smoking
B. Teaches about the dangers of tobacco
C. Teaches the importance of incentive spirometry
D. Tells the client where the smoking lounge is

A

Teaches the importance of incentive spirometry

37
Q 
During a preoperative assessment, which statement by the client requires further investigation by the nurse to assess risk?
A. "I am taking vitamins." 
B. "I drink a glass of wine a night." 
C. "I had a heart attack 4 months ago." 
D. "I don't like latex balloons."
A

I had a heart attack 4 months ago.

38
Q

The nurse completes the preoperative checklist on the client scheduled for general surgery. Which factor contributes the greatest risk for the planned procedure?
A. Age of 59 years
B. General anesthesia complications experienced by the client’s brother
C. Diet-controlled diabetes mellitus
D. Ten pounds over the client’s ideal body weight

A

Diet-controlled diabetes mellitus.

39
Q 
Which electrolyte laboratory result does the nurse report immediately to the anesthesiologist?
A. Creatinine, 1.9 mg/dL
B. Fasting glucose, 80 mg/dL 
C. Potassium, 3.9 mEq/L 
D. Sodium, 140 mEq/L
A

Creatinine, 1.9 mg/dL

40
Q

The client is being prepared for gastrointestinal surgery and undergoes a bowel preparation. Why is this preoperative procedure done?
A. Decreases expected blood loss during surgery
B. Eliminates any risk of infection
C. Ensures that the bowel is sterile
D. Reduces the number of intestinal bacteria

A

Reduces the number of intestinal bacteria.

41
Q 
What information about the postoperative client does the nurse include in the report to the postanesthesia care unit (PACU) nurse?
A. Confirmation of informed consent 
B. Estimated blood loss 
C. Type of surgical instruments used 
D. Type of suture material used
A

Estimated blood loss

42
Q

The nurse is instructing the client about the use of antiembolism stockings. Which statement by the client indicates the need for further teaching?
A. “I will take off my stockings one to three times a day for 30 minutes.”
B. “My stockings are too loose.”
C. “These stockings will prevent blood clots.”
D. “These stockings help promote blood flow.”

A

These stockings will prevent blood clots.

43
Q

Which task would be best for the charge nurse to assign to the LPN/LVN working in the surgery admitting area?
A. Provide preoperative teaching to a client who needs insertion of a tunneled central venous catheter.
B. Insert a retention catheter in a client who requires a flap graft of a sacral pressure ulcer.
C. Obtain the medical history from a client who is scheduled for a total hip replacement.
D. Assess the client who is being admitted for an elective laparoscopic cholecystectomy.

A

Insert a retention catheter in a client who requires a flap graft of a sacral pressure ulcer.

44
Q

At 8 AM, the registered nurse is admitting to the outpatient surgery department a client who is scheduled for sinus surgery. Which information given by the client would be of most immediate concern to the nurse?
A. The client has an allergy to iodine and shellfish.
B. The client was nauseated after a previous surgery.
C. The client had a small glass of juice at 7 AM.
D. The client expresses anxiety about the surgery.

A

The client had a small glass of juice at 7 am.

45
Q

A diabetic client who is scheduled for vascular surgery is admitted on the day of surgery with several orders. Which orders should the registered nurse accomplish first?
A. Use electrical clippers to cut hair at the surgical site.
B. Start an infusion of lactated Ringer’s solution at 75 mL/hr.
C. Administer one half of the client’s usual lispro insulin dose.
D. Draw blood for glucose, electrolyte, and complete blood count values.

A

Draw blood for glucose, electrolyte, and complete blood count values.

IGGY (5 decks)

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