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NUR210 > Exam 2 module 3 part 6 > Flashcards

Exam 2 module 3 part 6 Flashcards

Ch 36: Caring for the Surgical Patient

1
Q

What does perioperative nursing involve?

A

Care of clients before, during, and after surgery and other invasive procedures.

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2
Q

What was perioperative nursing historically called?

A

Operating room nursing.

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3
Q

What are the current responsibilities of perioperative nurses?

A

Provide and manage care, teach, and study the care of perioperative patients.

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4
Q

What is the AORN?

A

Association of periOperative Registered Nurses.

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5
Q

What is a significant component of preventing complications in perioperative nursing?

A

Hand hygiene.

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6
Q

What are the consequences of preventable perioperative errors?

A

Surgery-related deaths, unfavorable financial impact on healthcare institutions, physical and emotional harm to patients.

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7
Q

What is one of the three domains under which AORN organizes its perioperative patient outcomes?

A

Perioperative safety.

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8
Q

What specific safety outcomes does AORN focus on?

A

Prevention of injury and freedom from infection.

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9
Q

What do the 2021 National Patient Safety Goals by The Joint Commission include?

A

Preventing infection, improving accuracy of patient identification, using medication safely, performing a time-out before procedures.

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10
Q

What is the aim of the National Quality Partners (NQP) Leadership Consortium?

A

Achieving better care, improved health for people and communities, making quality care more affordable.

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11
Q

What are some current national priorities and goals established by the NQP?

A

Improving medication safety, promoting high-quality home-based healthcare, preventing maternal mortality.

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12
Q

What is the Institute for Healthcare Improvement (IHI)?

A

An independent, not-for-profit organization working to reduce morbidity and death in American healthcare.

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13
Q

What was one goal of the IHI’s 100,000 Lives Campaign?

A

Reduce surgical complications, specifically surgical infections.

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14
Q

When should hand hygiene be performed?

A

Immediately before and after each patient contact
* After removing gloves
* Any time you may have come in contact with blood or potentially infectious substances
* Before and after eating
* After using the restroom

These practices are essential to prevent the spread of infection.

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15
Q

True or False: Wearing gloves substitutes for hand hygiene.

A

False

Gloves must be removed, and hand hygiene should still be performed.

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16
Q

What should be removed before performing hand hygiene?

A

Rings, watches, and bracelets

Wearing rings has been associated with an increase in skin microorganism count.

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17
Q

What is the recommended length for fingernails?

A

Short and clean

Fingernails should not extend beyond the fingertips.

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18
Q

How often should chipped nail polish be replaced?

A

At least every 4 days

Regular replacement helps maintain proper hygiene.

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19
Q

What is the recommendation regarding artificial nails?

A

Do not wear artificial nails

Fungal growth often occurs under artificial nails.

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20
Q

What should be checked on hands before performing hand hygiene?

A

Lesions or breaks in skin integrity

Ensuring skin integrity is crucial for effective hand hygiene.

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21
Q

What are ‘Never Events’?

A

‘Never Events’ are serious and costly errors resulting in severe consequences for the patient, and are mostly preventable.

Medicare no longer reimburses institutions for care related to such complications.

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22
Q

Why are ‘Never Events’ significant in healthcare?

A

‘Never Events’ are significant because they are believed to be reasonably preventable and should never happen in a hospital.

These events lead to severe consequences for patients and increased healthcare costs.

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23
Q

What organization does not reimburse for care related to ‘Never Events’?

A

Medicare

This policy is in place to encourage hospitals to prevent these events.

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24
Q

List three examples of ‘Never Events’ relevant to perioperative care.

A
  • Surgery on the wrong body part
  • Wrong surgery on a patient
  • Foreign body left in a patient after surgery

Other examples include surgery on the wrong patient and DVT or PE after total knee or hip replacement.

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25
Q

What is the preoperative phase?

A

The preoperative phase begins with the client’s decision to have surgery and ends when they enter the operating room.

The duration and patient teaching during this phase depend on the type of surgery and the patient’s overall health status.

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26
Q

What factors influence the length of the preoperative period?

A

The type of surgery and the patient’s overall health status.

These factors determine the extent of patient teaching and preparation.

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27
Q

True or False: Surgical site infections after certain elective procedures are considered ‘Never Events’.

A

True

Specifically referenced in the context of bariatric surgery for obesity.

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28
Q

Fill in the blank: The preoperative period ends when the patient _______.

A

enters the operating room.

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29
Q

Who extends the definition of ‘Never Events’ to include all infections?

A

AORN, The Joint Commission, National Priorities Partnership, and IHI.

These organizations focus on improving patient safety and quality of care.

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30
Q

What does CDC target in relation to ‘Never Events’?

A

Certain antimicrobial-resistant bacterial infections.

This is part of efforts to prevent infections that could lead to ‘Never Events’.

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31
Q

What is Perioperative Nursing?

A

A specialized area of nursing with specific, established standards of care

Focuses on integrating care standards into the nursing process for each patient.

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32
Q

What do caring nurses ensure regarding patients before surgery?

A

That a person is cognitively and psychologically prepared for surgery

This preparation is essential for patient safety and understanding.

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33
Q

What does it mean for a nurse to advocate for patients in a perioperative setting?

A

Stopping the line and placing a HOLD on surgery when an error or risk is identified

This action demonstrates accountability and commitment to patient safety.

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34
Q

What phrase can a nurse use to express concern about a surgical procedure?

A

I have a concern

Other phrases include: ‘We need to stop and verify’ or ‘I cannot send the patient until the surgeon reviews the procedure.’

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35
Q

True or False: Preventing errors and ‘never events’ is solely the responsibility of the surgeon.

A

False

It is everyone’s responsibility in the surgical team.

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36
Q

What does 200% accountability in perioperative care refer to?

A

Taking full responsibility for one’s actions and ensuring patient safety by advocating for necessary changes

This includes speaking up about concerns.

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37
Q

Fill in the blank: A caring nurse strives to integrate _______ into the nursing process.

A

[established standards of care]

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38
Q

What is the focus of nursing care during the preoperative phase?

A

Identifying existing health concerns, planning for intraoperative and postoperative needs, and providing preoperative teaching.

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39
Q

In what settings is preoperative nursing care delivered?

A

Variety of settings, including outpatient settings like endoscopy suites, physicians’ offices, and ambulatory surgery centers.

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40
Q

What percentage of surgeries in the United States are performed in outpatient settings?

A

More than two-thirds.

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41
Q

How are surgeries classified?

A

By body system, purpose, level of urgency, and acuity.

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42
Q

What is the significance of body system classification in surgery?

A

It helps determine the postoperative risk of infection.

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43
Q

Which body systems have a higher risk for infection during surgery?

A

Gastrointestinal (GI), respiratory, and genitourinary tracts.

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44
Q

What is ablative surgery?

A

Removal of a diseased body part.

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45
Q

Provide an example of ablative surgery.

A

Cholecystectomy (removal of a diseased gallbladder).

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46
Q

What is diagnostic (exploratory) surgery?

A

Surgery done to confirm or rule out a diagnosis.

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47
Q

Give examples of diagnostic (exploratory) surgery.

A

Biopsy and invasive tests, such as cardiac catheterization.

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48
Q

What is palliative surgery?

A

Performed to relieve discomfort or disease symptoms without producing a cure.

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49
Q

Provide an example of palliative surgery.

A

Nerve root destruction for chronic pain.

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50
Q

What is reconstructive surgery?

A

Surgery performed to restore function.

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51
Q

Give an example of reconstructive surgery.

A

Rotator cuff repair.

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52
Q

What is cosmetic surgery?

A

Surgery done to improve appearance.

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53
Q

Provide an example of cosmetic surgery.

A

Face-lift.

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54
Q

What is transplant surgery?

A

Replaces a malfunctioning body part, tissue, or organ.

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55
Q

What types of procedures are included in transplant surgery?

A

Joint replacements and organ replacement procedures.

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56
Q

What is procurement surgery?

A

Related to transplant surgery, involving harvesting an organ or tissue from someone brain dead for transplantation.

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57
Q

What is the definition of emergency surgery?

A

Requires transport to the operating suite as soon as possible to preserve the patient’s life or function

Common causes include internal hemorrhage, rupture of an organ, and trauma.

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58
Q

What is the time frame for urgent surgery?

A

Scheduled within 24 to 48 hours

Aimed at alleviating symptoms, repairing a body part, or restoring function.

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59
Q

What characterizes elective surgery?

A

Performed when surgery is recommended but not time sensitive

Allows the client to delay surgery to gather information or consider options.

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60
Q

Provide examples of elective surgery.

A
  • Repair of a torn ligament
  • Removal of rectal polyps
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61
Q

What does the adage ‘the only minor surgery is someone else’s surgery’ imply?

A

Reflects the anxiety that often accompanies surgery

Suggests that all surgery carries some level of risk.

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62
Q

How is surgery categorized by degree of risk?

A

Defined as major or minor based on seriousness or risk associated with the procedure

The degree of risk varies with the client’s condition and the type of surgery.

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63
Q

What is major surgery?

A

Associated with a high degree of risk

Involves significant blood loss, complicated procedures, or vital organs.

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64
Q

Give examples of major surgery.

A
  • Coronary artery bypass graft
  • Nephrectomy (removal of a kidney)
  • Colon resection
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65
Q

What is minor surgery?

A

Involves little risk and usually has few complications

Often performed on an outpatient basis.

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66
Q

Provide examples of minor surgery.

A
  • Breast biopsy
  • Inguinal hernia repair
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67
Q

What are the main factors that affect surgical risk?

A

Patient’s age, general health, personal habits.

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68
Q

Which age groups are at the greatest risk during surgical procedures?

A

Very young and very old.

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69
Q

What are some risk factors for infants during surgery?

A
  • Limited ability to regulate temperature
  • Immature immune, cardiovascular, liver, and renal systems
  • Increased risk for infection
  • Increased risk for excess fluid volume and deficient fluid volume
  • Minor blood loss may represent a substantial portion of total blood
  • Difficulty calming due to inability to understand the situation.
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70
Q

What are common concerns for toddlers undergoing surgery?

A

Anxiety about separation from parents or caregivers, fear of the dark.

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71
Q

What fears do preschoolers commonly have regarding surgery?

A

Fear of damage to body parts, fear of pain, fear of needles.

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72
Q

What concerns might teens have related to surgery?

A

Fear of disfigurement resulting from scars.

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73
Q

What are common anxieties for young adults facing surgery?

A

Anxiety about the cost associated with hospitalization or surgery.

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74
Q

Why are older adults at increased risk during surgical procedures?

A

Less physiological reserve, often have comorbid conditions, physiological changes of aging.

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75
Q

List some physiological changes in older adults that predispose them to surgical risk.

A
  • Decreased kidney function
  • Diminished immune function
  • Decreased bone and lean body mass
  • Increased peripheral vascular resistance
  • Decreased cardiac output
  • Decreased cough reflex
  • Increased time required for wound healing.
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76
Q

What characterizes a clean wound?

A

Uninfected; minimal inflammation; little risk of infection

Clean wounds are typically associated with surgical procedures that do not involve the GI, respiratory, or genitourinary tract.

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77
Q

Which surgical procedures are considered clean surgeries?

A
  • Face-lift
  • Cataract surgery
  • Joint replacement
  • Breast biopsy
  • Tonsillectomy

These procedures are performed in a controlled environment with minimal risk of infection.

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78
Q

True or False: Clean wounds have a high risk of infection.

A

False

Clean wounds are specifically defined by their low risk of infection.

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79
Q

Fill in the blank: A clean wound is _______.

A

[uninfected; minimal inflammation; little risk of infection]

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80
Q

What are clean-contaminated wounds?

A

Not infected, but carry increased risk for infection

These include surgical incisions that enter the GI, respiratory, or genitourinary tract.

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81
Q

What are contaminated wounds?

A

Not infected, but carry high risk for infection

Examples include surgery to repair trauma to open wounds, such as compound fractures, and surgery in which a major break in surgical asepsis occurred.

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82
Q

What defines infected wounds?

A

Evidence of infection, such as purulent drainage, necrotic tissue, or bacterial counts above 100,000 organisms per gram of tissue

This includes a postoperative surgical incision of any type that has evidence of infection.

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83
Q

What may patients with altered cognition be unable to do regarding surgical procedures?

A

Understand preoperative instructions or give informed consent for surgical procedures

Patients with altered cognition may also require medications that interact with anesthetics and analgesics.

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84
Q

What is a potential effect of surgery and anesthesia on patients with preexisting dementia?

A

Aggravate preexisting dementia, confusion, and disorientation

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85
Q

What do acute infections increase the risk of in surgical patients?

A

Various postoperative complications

Especially postoperative pneumonia in patients with upper respiratory tract infections receiving general anesthesia.

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86
Q

What chronic condition affects the heart’s ability to function efficiently?

A

Cardiovascular diseases (e.g., hypertension, congestive heart failure, MI)

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87
Q

What can limit the surgical risk associated with chronic cardiovascular disorders?

A

Well-controlled disorders with BP medications or cardiotonic medications

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88
Q

Chronic respiratory disorders increase the risk of what postoperative complication?

A

Respiratory infection

Conditions such as emphysema, asthma, or bronchitis may be exacerbated by general anesthesia.

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89
Q

What do coagulation disorders increase the risk of during surgery?

A

Hemorrhage and hypovolemic shock

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90
Q

What risk is associated with a hypercoagulation state?

A

Stroke, embolism, or intravascular clotting

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91
Q

How does diabetes mellitus affect surgical outcomes?

A

Delays wound healing and increases the risk of infection and cardiovascular disorders

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92
Q

What does liver disease impair in surgical patients?

A

Ability to metabolize amino acids, carbohydrates, and fat; manufacture prothrombin; detoxify medications

93
Q

What are the risks associated with neurological disorders in surgical patients?

A

Vasomotor instability and potential for wide swings in BP

Patients with seizure disorders are more likely to have seizures in the perioperative period.

94
Q

How can nutritional disorders affect surgical outcomes?

A

Risk for delayed wound healing, infection, and fatigue

95
Q

What additional risks do obese patients face during surgery?

A

Cardiovascular disorders and impaired pulmonary function

96
Q

What does renal disease affect regarding medication in surgical patients?

A

Ability to excrete anesthetic agents and regulate fluid and electrolytes

97
Q

What types of medications may increase surgical risk?

A

Both prescribed and over-the-counter (OTC) medications

Box 36-3 provides specific examples of medications that can increase surgical risk.

98
Q

What is one example of a supplement that may increase surgical risk?

A

High doses of vitamin E

Self-prescribing high doses of vitamin E may lead to an increased risk for bleeding.

99
Q

What effect can certain herbal medications have on cardiac health?

A

Increase the risk for cardiac dysrhythmias secondary to potassium loss

This is one of the potential risks associated with herbal and alternative medications.

100
Q

How can herbal medications interfere with anesthesia?

A

Interfere with metabolism of anesthetics because of their effects on the liver

This can lead to complications during surgical procedures.

101
Q

List three effects of herbal medications on surgical risk.

A
  • Increase the potential for excessive bleeding
  • Decrease cerebral blood flow
  • Cause hypertension
102
Q

What is a potential interaction between herbal medications and opioids?

A

Increase the effects of opioids and sympathetic nervous system stimulants

This can complicate pain management during and after surgery.

103
Q

How does smoking affect surgical risk?

A

Affects pulmonary function

Impaired pulmonary function can lead to complications during surgery.

104
Q

What long-term effect of alcohol use increases surgical risk?

A

Contributes to liver disease, increasing the risk for bleeding

Liver disease can affect the metabolism of anesthetics and other medications.

105
Q

How can alcohol and drugs interact with anesthetic agents?

A

Create adverse effects

This interaction can complicate anesthesia and recovery.

106
Q

What is cross-tolerance in habitual substance abusers?

A

A condition where habitual substance abusers may need higher than normal doses of anesthetic and analgesic agents

This can complicate pain management and anesthesia during surgery.

107
Q

What type of medications may potentiate the action of anesthetic agents?

A

Antibiotics

Certain antibiotics can enhance the effects of anesthetics.

108
Q

Which medications increase the risk for bleeding during surgery?

A

Anticoagulants, Aspirin, NSAIDs, Tranquilizers

These medications inhibit platelet aggregation and affect coagulation.

109
Q

What effect do antidysrhythmics have during anesthesia?

A

May impair cardiac function

Antidysrhythmics can interfere with normal heart rhythms.

110
Q

How do antihypertensives affect surgery?

A

Increase risk for hypotension

These medications may interact with anesthetics to cause bradycardia and impaired circulation.

111
Q

What is a potential effect of corticosteroids on surgical outcomes?

A

Delay wound healing and increase risk for infection

Corticosteroids can suppress the immune response.

112
Q

What impact do diuretics have on patients undergoing surgery?

A

Alter fluid and electrolyte balance

This is particularly true for potassium balance.

113
Q

What risk is associated with opioid use during surgery?

A

Increase the risk of respiratory depression

Opioids can significantly affect respiratory function.

114
Q

Which medications may impair respiratory function during anesthesia?

A

Opioids, Tranquilizers

Both classes of medications can lead to respiratory depression.

115
Q

Fill in the blank: __________ may impair cardiac function during anesthesia.

A

Antidysrhythmics

These drugs can disrupt normal heart rhythms.

116
Q

True or False: NSAIDs can increase the risk of bleeding.

A

True

NSAIDs inhibit platelet aggregation, contributing to bleeding risk.

117
Q

What types of medications may patients be allergic to?

A

Patients may be allergic to medications such as antibiotics (e.g., penicillin) and analgesics (e.g., codeine)

Allergies can also extend to tape, latex, and solutions used in surgery.

118
Q

What does the Perioperative Nursing Data Set (PNDS) describe?

A

The PNDS is a standardized vocabulary designed to describe the care of perioperative patients

It is recognized by the American Nurses Association.

119
Q

What does the latest update of PNDS reflect?

A

The latest update reflects the nursing process, including nursing assessment, diagnoses, identified nursing-sensitive outcomes, nursing interventions, and implementation and evaluation.

120
Q

What are the benefits of the PNDS?

A
  • Promotes better communication among nurses and healthcare providers
  • Increases visibility of nursing interventions
  • Improves patient care
  • Standardizes evaluation of nursing care outcomes

Source: Westra & Peterson, 2016.

121
Q

What model is the PNDS derived from?

A

The PNDS is derived from the AORN’s Perioperative Patient-Focused model.

122
Q

What is the focus of the Perioperative Patient-Focused model?

A

The patient is at the center of the model and is the focus of care.

123
Q

What does the perioperative nurse do within the healthcare system?

A

The perioperative nurse intervenes to assist the patient throughout the perioperative experience.

124
Q

What are the domains involved in the outcomes achieved by the perioperative nurse?

A
  • Health System domain
  • Patient-Centered domains (which include Safety, Physiological Responses to Surgery, and Behavioral Responses to Surgery)
125
Q

What does the Health System domain refer to?

A

The Health System domain refers to the system in which perioperative care is given, involving administrative and structural elements necessary for successful surgical outcomes.

126
Q

What elements are included in the Health System domain?

A
  • Equipment
  • Supplies
  • Staff
  • Policies

These elements are necessary for successful surgical outcomes.

127
Q

What is the purpose of the Pre-Procedure Checklist?

A

To ensure all sections are completed prior to the start of the procedure or surgery.

128
Q

What information is included in the Preparation section?

A

Height, Weight, Height/Weight Last Documented, CXR/KUB Date Completed, EKG Date Completed.

129
Q

Fill in the blank: Last oral fluid intake is documented as _______.

A

[specific time or amount]

130
Q

What are the possible levels of consciousness listed?

A
  • Awake
  • Arousable to Stimuli, Pain
  • Arousable to Stimuli, Tactile
  • Arousable to Stimuli, Verbal
  • Obtunded
  • Unresponsive
  • Unable to Assess
  • Other
131
Q

What must be verified regarding the identification band?

A

It must be on and verified.

132
Q

True or False: The allergy band must also be verified.

A

True

133
Q

What must the physician be informed about before the procedure?

A

Consent must be verified.

134
Q

What does ‘N/A’ stand for in the context of the checklist?

A

Not Applicable

135
Q

What are the types of oxygen delivery methods listed?

A
  • Room Air
  • Aerosol Face Mask
  • Ambu
  • BIPAP
  • CPAP
  • Face Tent
  • High Flow Nasal Cannula
  • Home Ventilator
  • Nasal Cannula
  • Nonrebreather Mask
  • Oxyhood
  • Partial Rebreather Mask
  • Passive
  • Simple Mask
  • T-piece
  • Trach Collar
  • Ventilator
  • VentaMask
  • Other
136
Q

What is required for the Anesthesia Consent?

A

It must be completed and verified.

137
Q

What does ‘H&P’ refer to in the context of the checklist?

A

History and Physical

138
Q

Fill in the blank: Last dialysis is documented as _______.

A

[specific date or time]

139
Q

What are the categories for the status of lab results?

A
  • Yes
  • N/A
  • No
  • Results Normal
140
Q

What is the significance of the ‘Pre Anesthesia Assessment’?

A

It must be completed prior to the procedure.

141
Q

What must be documented regarding medications given?

A
  • Beta Blocker Given
  • Hypoglycemic Given
  • Narcotic Given
  • Antibiotic Given
  • Anticoagulant Given
142
Q

What must be completed prior to the start of a procedure or surgery?

A

All sections must be completed

This includes checking patient identification, allergies, consent, and special needs.

143
Q

What should be verified regarding the identification band?

A

On and verified

This is crucial to ensure patient safety and correct procedure.

144
Q

What should be checked regarding the allergy band?

A

Allergy band on and verified

Confirming allergies is essential to avoid adverse reactions.

145
Q

What is required regarding the H&P or progress note?

A

Must be within 24 hours

Ensures that the patient’s current health status is documented.

146
Q

What should be confirmed if the patient has special needs?

A

Yes or No

This helps tailor the care and preparation needed for the patient.

147
Q

What needs to be documented about a pacemaker?

A

Make/Model

Important for anesthesia and surgical planning.

148
Q

What should be done regarding the procedure(s)/surgery?

A

Enter correct procedure(s)/surgery without abbreviations

This prevents any miscommunication regarding the planned operation.

149
Q

What must be verified about the physician?

A

Physician informed consent verified

Ensures that the physician has obtained informed consent from the patient.

150
Q

What should be noted about the patient’s skin condition?

A

Skin breakdown

Important for preventing post-operative complications.

151
Q

What is required if a patient has a history of obstructive sleep apnea?

A

CPAP or BIPAP settings (if known)

Necessary for managing the patient’s respiratory needs during surgery.

152
Q

What must all surgical patients have regarding scrubs?

A

2 scrubs except in emergent situations

Ensures sterile conditions are maintained.

153
Q

What should be removed from the patient before surgery?

A

Contacts, eyeglasses, dental appliances, loose teeth, makeup, nail polish, prosthetic devices, hair accessories, undergarments, jewelry

These items can interfere with surgical procedures and anesthesia.

154
Q

What is the protocol regarding urinary catheters?

A

Present or not

This is important for managing patient needs during surgery.

155
Q

Fill in the blank: All surgical patients must void on call, yes or _______

A

No

Ensures that the bladder is empty before the procedure.

156
Q

What is the SENC competence related to nursing and interdisciplinary teams?

A

Effective collaboration through open communication, mutual respect, and shared decision making

This ensures safe and effective patient care.

157
Q

What impact do two-minute surgical briefings have?

A

Improve communication and reduce delays and wrong-site surgery

Referenced study by Lee, 2016.

158
Q

Why are surgical briefings important for team dynamics?

A

Encourage team members to speak up when there are misgivings or problems

Supported by findings from Seifert et al., 2017.

159
Q

What factors determine the safety of discharging a surgical client to home?

A

Type of surgery, client’s condition, and support system

Assessment focuses on the client’s ability to care for themselves.

160
Q

What is a key question to assess a client’s ability to manage post-surgery care?

A

Is the client able to take care of themself?

If not, identification of available caregivers is crucial.

161
Q

What should be assessed regarding the caregiver’s ability?

A

Does the caregiver have the necessary skills to provide care?

If not, can these skills be taught before discharge?

162
Q

What home environment features should be evaluated for a client after surgery?

A

Facilitators and inhibitors of the client’s progress

Examples include bathroom accessibility and stair navigation.

163
Q

What follow-up considerations are important after a client’s discharge?

A

How soon should the patient visit the physician? Will there be home nursing care?

These are critical for ongoing recovery.

164
Q

What elements should be included in the optimal preoperative assessment of older adults?

A
  • Cognitive ability
  • Capacity to understand the surgery
  • Nutritional status
  • Risk factors for postoperative delirium and pulmonary complications
  • Patient’s treatment goals and expectations
  • Family and social support system
  • Depression
  • Cardiac status
  • Functional status
  • History of falls
  • Detailed medication history, including polypharmacy
  • Baseline frailty score
  • Diagnostic tests specific to older patients

Guidelines referenced from Mohanty et al., 2016.

165
Q

What is the purpose of preoperative screening tests?

A

To assess a patient’s health status before surgical procedures

The type of testing depends on the patient’s age, health history, and facility policies.

166
Q

What are the standard tests required for patients older than age 50 years before surgery?

A

Complete blood count (CBC), urinalysis (UA), and electrocardiogram (ECG)

Most institutions require a CBC and UA, and an ECG for patients older than age 50 years.

167
Q

Is a routine chest x-ray recommended for all patients prior to surgery?

A

No

Chest radiology incurs extra costs and exposes patients to small risks from radiation exposure.

168
Q

What additional testing might patients with chronic health problems require?

A

Additional diagnostic tests as per their specific health conditions

Refer to the Diagnostic Testing box for Common Preoperative Screening Tests.

169
Q

What is necessary for all preoperative patients besides diagnostic testing?

A

Preoperative teaching

It is not necessary to write a nursing diagnosis of Knowledge Deficit for every patient.

170
Q

How should a nurse approach the diagnosis of anxiety in surgical patients?

A

There is no need to always include a diagnosis of Anxiety

Almost all surgical patients have at least mild anxiety, and routine actions can help relieve it.

171
Q

What should be considered before adding a nursing diagnosis to a care plan?

A

It should be addressed with something other than routine preoperative interventions

KEY POINT: Do not put any nursing diagnosis on the care plan unless you plan to address it.

172
Q

What is the purpose of a urinalysis in preoperative screening?

A

To detect urinary tract infections (UTIs) and the presence of glucose or protein in the urine, which may indicate poorly controlled diabetes or renal disease.

Urinalysis is a common test used to assess kidney function and overall health.

173
Q

What does a CBC measure in preoperative screening?

A

It measures irregularities in hemoglobin (Hgb) and hematocrit (Hct), with low Hgb indicating anemia, which may place the client at risk if significant blood loss occurs.

CBC stands for Complete Blood Count.

174
Q

What is the purpose of an Electrocardiogram (ECG) in preoperative testing?

A

To detect cardiac dysrhythmias and other cardiac pathology.

ECGs are crucial for assessing heart health before surgery.

175
Q

What is detected through a chest x-ray examination in preoperative screening?

A

To detect underlying pulmonary disease and reveal heart size, as an indicator of heart function.

Chest x-rays help in evaluating respiratory and cardiac health.

176
Q

What is the purpose of blood type and crossmatch testing?

A

To identify blood type in the event that blood transfusion becomes necessary.

This test is critical for preventing transfusion reactions.

177
Q

What does the comprehensive metabolic panel include?

A

Electrolytes, blood glucose, liver function tests (ALT, AST), serum albumin and protein, and renal function tests (BUN and creatinine).

This panel is used to detect underlying health problems that may affect surgical risk or outcome.

178
Q

Fill in the blank: A fasting blood sugar test is used to detect _______.

A

[diabetes or poorly controlled diabetes].

Fasting blood sugar levels are essential for diagnosing diabetes.

179
Q

What do serum electrolytes tests measure?

A

Sodium, potassium, chloride, magnesium, calcium, and pH imbalances, which affect cardiac and other organ function and fluid balance.

Maintaining electrolyte balance is crucial for overall health.

180
Q

What does platelet count in a CBC affect?

A

Clotting ability.

Platelet count is important for assessing bleeding risk during surgery.

181
Q

True or False: A low hemoglobin level indicates a risk of anemia.

A

True.

Anemia can increase the risk of complications during surgery.

182
Q

What is the significance of measuring WBC count in a CBC?

A

It serves as an indicator of immune function.

Abnormal WBC counts can indicate infection or other health issues.

183
Q

What is the basis for individualized nursing diagnoses for preoperative patients?

A

They evolve from your assessment of the patient.

184
Q

When should you identify an actual nursing diagnosis for a preoperative patient?

A

Only if the patient has the defining characteristics for it.

185
Q

What is a key point regarding risk (potential) nursing diagnoses?

A

Identify them only if the patient has an underlying condition that places them at higher risk than the average surgical patient.

186
Q

What are the levels of anxiety that may be observed in preoperative patients?

A
  • Mild
  • Moderate
  • Severe
  • Panic level
187
Q

What symptoms might indicate anxiety in a preoperative patient?

A
  • Restlessness
  • Trembling
  • Increased pulse
  • Other defining characteristics
188
Q

What common reactions to surgery may preoperative patients experience?

A

Fear related to unknown outcomes, learning diagnoses, and prospect of pain.

189
Q

What nursing diagnosis is used for patients with a preexisting health problem affecting airway clearance?

A

Airway Clearance Impairment.

190
Q

What can often result in a disturbed sleep pattern in preoperative patients?

A

Anxiety about the upcoming surgery.

191
Q

When is the nursing diagnosis of Ineffective Coping appropriate?

A

For a patient with extreme anxiety and concerns about surgery outcomes.

192
Q

What nursing diagnosis applies to patients with a known allergy to latex?

A

Latex Allergy Reaction.

193
Q

What factors contribute to the Risk for Latex Allergy Reaction diagnosis?

A
  • Multiple surgeries
  • Urinary catheterizations
  • Daily latex exposure
  • History of asthma
  • Allergies to bananas, avocados, kiwi, chestnuts, or poinsettia plants
194
Q

When is it appropriate to use a Knowledge Deficit diagnosis?

A

If the patient may not learn or the information is too complex to remember.

195
Q

What is an example of a problem that could result from a Knowledge Deficit?

A
  • Nonadherence to Therapeutic Regimen related to Knowledge Deficit of postoperative medications and office visits
  • Risk for Infection related to Knowledge Deficit of wound care and asepsis
196
Q

What is a key consideration for older adults over age 70 in nursing diagnoses?

A

They are likely to need individualized nursing diagnoses.

197
Q

What unique risks do older adults present?

A

They often have other illnesses and physiological changes of aging.

198
Q

How do older adults metabolize anesthetic agents compared to younger adults?

A

Differently.

199
Q

What are two potential experiences older adults may have due to their metabolism of anesthetic agents?

A
  • Confusion
  • Gas Exchange Impairment
200
Q

True or False: Physiological changes of aging do not impact the risks for older adults.

A

False

201
Q

Fill in the blank: Older adults may experience _______ due to the different metabolism of anesthetic agents.

A

[Confusion or Gas Exchange Impairment]

202
Q

What is a common condition among older adults related to heart health?

A

Coronary artery disease

Most older adults have at least some degree of coronary artery disease.

203
Q

What potential complication can arise from orthostatic hypotension in older adults?

A

Risk for Falls

Hypotension can lead to falls in older adults.

204
Q

What is one of the most common surgical complications in older adults?

A

Delirium

Delirium is common due to factors like age, functional disabilities, and coexisting conditions.

205
Q

Name a factor that may increase the risk of delirium in older adults.

A

Poor vision and hearing

Other factors include male sex, depressive symptoms, and cognitive impairment.

206
Q

What are some potential complications associated with age-related respiratory changes?

A
  • Pneumonia
  • Atelectasis
  • Gas Exchange Impairment
  • Ineffective Airway Clearance

Age-related changes include decreased chest wall compliance and diaphragmatic strength.

207
Q

What are the age-related skin changes in older adults?

A

Dry, fragile skin; decreased turgor and elasticity

These changes can lead to risks for skin integrity impairment and pressure ulcers.

208
Q

What musculoskeletal changes occur with aging?

A

Decreased bone mass and muscle fiber mass

These changes increase the risk for impaired physical mobility and falls.

209
Q

Which central nervous system comorbidities are more common in older adults?

A

Dementia

Some CNS conditions may be aggravated by surgery and anesthesia.

210
Q

What is a gastrointestinal change associated with aging?

A

Decreased gastrointestinal motility

This can lead to complications such as ileus and aspiration risk secondary to vomiting.

211
Q

Fill in the blank: Delirium can lead to _______.

A

Acute Confusion

Delirium is characterized by acute confusion in older adults.

212
Q

True or False: Age-related skin changes do not affect the risk for pressure ulcers.

A

False

Age-related skin changes increase the risk for pressure ulcers.

213
Q

What is decreased bladder elasticity?

A

A reduction in the ability of the bladder to stretch and hold urine

This can lead to urinary incontinence and increased urgency.

214
Q

What does decreased renal function refer to?

A

A decline in the kidneys’ ability to filter blood and produce urine

This can result in fluid retention and electrolyte imbalances.

215
Q

What are some side effects of medications that can affect genitourinary function?

A

Possible side effects include urinary retention, incontinence, and changes in renal function

Certain medications, especially diuretics and anticholinergics, may exacerbate these issues.

216
Q

What are renal complications?

A

Issues related to impaired kidney function, including acute kidney injury and chronic kidney disease

These complications can arise from various factors, including medication side effects.

217
Q

What is a urinary tract infection (UTI)?

A

An infection that affects any part of the urinary system, including the bladder and kidneys

UTIs are more common in individuals with urinary incontinence.

218
Q

What is the risk for skin integrity related to urinary incontinence?

A

Increased risk of skin breakdown and pressure ulcers due to moisture from incontinence

Maintaining skin integrity is crucial in managing patients with urinary incontinence.

219
Q

What does impairment related to urinary incontinence indicate?

A

A decrease in the ability to control urination, leading to involuntary leakage

This condition can significantly impact quality of life and may require interventions.

220
Q

What is the purpose of the Perioperative Care domain in NIC?

A

To provide routine interventions for all preoperative patients

This domain includes interventions that are essential regardless of the patient’s specific nursing diagnoses.

221
Q

What is involved in Preoperative Coordination?

A

Facilitating preadmission diagnostic testing and preparation of the surgical patient

An example activity is notifying the physician of abnormal diagnostic test results.

222
Q

What does Surgical Preparation entail?

A

Providing care immediately before surgery and verifying required procedures/tests and documentation

An example activity is completing the preoperative checklist.

223
Q

What is the goal of Teaching: Preoperative?

A

Assisting a patient to understand and mentally prepare for surgery and postoperative recovery

An example activity is correcting unrealistic expectations of the surgery.

224
Q

What must be confirmed before a surgical procedure?

A

That surgical consent has been obtained

This is a legal requirement and part of professional standards.

225
Q

Who is responsible for obtaining the patient’s informed consent?

A

The surgeon

The surgeon must provide necessary information and determine the patient’s competence.

226
Q

What does a signed consent form verify?

A

That the surgeon and patient have communicated adequately about the surgery

The signed form becomes part of the patient’s record and accompanies them to the operating room.

227
Q

What is required of the nurse regarding the surgical consent form?

A

To verify that the surgical consent form is signed and witnessed

This is a critical responsibility of the nursing staff.

228
Q

Fill in the blank: The surgeon is responsible for giving the patient the necessary information and determining the patient’s _______.

A

competence to make an informed decision about the surgery.

NUR210 (12 decks)

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