Exam 2 module 3 part 6 Flashcards
Ch 36: Caring for the Surgical Patient
What does perioperative nursing involve?
Care of clients before, during, and after surgery and other invasive procedures.
What was perioperative nursing historically called?
Operating room nursing.
What are the current responsibilities of perioperative nurses?
Provide and manage care, teach, and study the care of perioperative patients.
What is the AORN?
Association of periOperative Registered Nurses.
What is a significant component of preventing complications in perioperative nursing?
Hand hygiene.
What are the consequences of preventable perioperative errors?
Surgery-related deaths, unfavorable financial impact on healthcare institutions, physical and emotional harm to patients.
What is one of the three domains under which AORN organizes its perioperative patient outcomes?
Perioperative safety.
What specific safety outcomes does AORN focus on?
Prevention of injury and freedom from infection.
What do the 2021 National Patient Safety Goals by The Joint Commission include?
Preventing infection, improving accuracy of patient identification, using medication safely, performing a time-out before procedures.
What is the aim of the National Quality Partners (NQP) Leadership Consortium?
Achieving better care, improved health for people and communities, making quality care more affordable.
What are some current national priorities and goals established by the NQP?
Improving medication safety, promoting high-quality home-based healthcare, preventing maternal mortality.
What is the Institute for Healthcare Improvement (IHI)?
An independent, not-for-profit organization working to reduce morbidity and death in American healthcare.
What was one goal of the IHI’s 100,000 Lives Campaign?
Reduce surgical complications, specifically surgical infections.
When should hand hygiene be performed?
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.
True or False: Wearing gloves substitutes for hand hygiene.
False
Gloves must be removed, and hand hygiene should still be performed.
What should be removed before performing hand hygiene?
Rings, watches, and bracelets
Wearing rings has been associated with an increase in skin microorganism count.
What is the recommended length for fingernails?
Short and clean
Fingernails should not extend beyond the fingertips.
How often should chipped nail polish be replaced?
At least every 4 days
Regular replacement helps maintain proper hygiene.
What is the recommendation regarding artificial nails?
Do not wear artificial nails
Fungal growth often occurs under artificial nails.
What should be checked on hands before performing hand hygiene?
Lesions or breaks in skin integrity
Ensuring skin integrity is crucial for effective hand hygiene.
What are ‘Never Events’?
‘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.
Why are ‘Never Events’ significant in healthcare?
‘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.
What organization does not reimburse for care related to ‘Never Events’?
Medicare
This policy is in place to encourage hospitals to prevent these events.
List three examples of ‘Never Events’ relevant to perioperative care.
- 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.
What is the preoperative phase?
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.
What factors influence the length of the preoperative period?
The type of surgery and the patient’s overall health status.
These factors determine the extent of patient teaching and preparation.
True or False: Surgical site infections after certain elective procedures are considered ‘Never Events’.
True
Specifically referenced in the context of bariatric surgery for obesity.
Fill in the blank: The preoperative period ends when the patient _______.
enters the operating room.
Who extends the definition of ‘Never Events’ to include all infections?
AORN, The Joint Commission, National Priorities Partnership, and IHI.
These organizations focus on improving patient safety and quality of care.
What does CDC target in relation to ‘Never Events’?
Certain antimicrobial-resistant bacterial infections.
This is part of efforts to prevent infections that could lead to ‘Never Events’.
What is Perioperative Nursing?
A specialized area of nursing with specific, established standards of care
Focuses on integrating care standards into the nursing process for each patient.
What do caring nurses ensure regarding patients before surgery?
That a person is cognitively and psychologically prepared for surgery
This preparation is essential for patient safety and understanding.
What does it mean for a nurse to advocate for patients in a perioperative setting?
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.
What phrase can a nurse use to express concern about a surgical procedure?
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.’
True or False: Preventing errors and ‘never events’ is solely the responsibility of the surgeon.
False
It is everyone’s responsibility in the surgical team.
What does 200% accountability in perioperative care refer to?
Taking full responsibility for one’s actions and ensuring patient safety by advocating for necessary changes
This includes speaking up about concerns.
Fill in the blank: A caring nurse strives to integrate _______ into the nursing process.
[established standards of care]
What is the focus of nursing care during the preoperative phase?
Identifying existing health concerns, planning for intraoperative and postoperative needs, and providing preoperative teaching.
In what settings is preoperative nursing care delivered?
Variety of settings, including outpatient settings like endoscopy suites, physicians’ offices, and ambulatory surgery centers.
What percentage of surgeries in the United States are performed in outpatient settings?
More than two-thirds.
How are surgeries classified?
By body system, purpose, level of urgency, and acuity.
What is the significance of body system classification in surgery?
It helps determine the postoperative risk of infection.
Which body systems have a higher risk for infection during surgery?
Gastrointestinal (GI), respiratory, and genitourinary tracts.
What is ablative surgery?
Removal of a diseased body part.
Provide an example of ablative surgery.
Cholecystectomy (removal of a diseased gallbladder).
What is diagnostic (exploratory) surgery?
Surgery done to confirm or rule out a diagnosis.
Give examples of diagnostic (exploratory) surgery.
Biopsy and invasive tests, such as cardiac catheterization.
What is palliative surgery?
Performed to relieve discomfort or disease symptoms without producing a cure.
Provide an example of palliative surgery.
Nerve root destruction for chronic pain.
What is reconstructive surgery?
Surgery performed to restore function.
Give an example of reconstructive surgery.
Rotator cuff repair.
What is cosmetic surgery?
Surgery done to improve appearance.
Provide an example of cosmetic surgery.
Face-lift.
What is transplant surgery?
Replaces a malfunctioning body part, tissue, or organ.
What types of procedures are included in transplant surgery?
Joint replacements and organ replacement procedures.
What is procurement surgery?
Related to transplant surgery, involving harvesting an organ or tissue from someone brain dead for transplantation.
What is the definition of emergency surgery?
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.
What is the time frame for urgent surgery?
Scheduled within 24 to 48 hours
Aimed at alleviating symptoms, repairing a body part, or restoring function.
What characterizes elective surgery?
Performed when surgery is recommended but not time sensitive
Allows the client to delay surgery to gather information or consider options.
Provide examples of elective surgery.
- Repair of a torn ligament
- Removal of rectal polyps
What does the adage ‘the only minor surgery is someone else’s surgery’ imply?
Reflects the anxiety that often accompanies surgery
Suggests that all surgery carries some level of risk.
How is surgery categorized by degree of risk?
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.
What is major surgery?
Associated with a high degree of risk
Involves significant blood loss, complicated procedures, or vital organs.
Give examples of major surgery.
- Coronary artery bypass graft
- Nephrectomy (removal of a kidney)
- Colon resection
What is minor surgery?
Involves little risk and usually has few complications
Often performed on an outpatient basis.
Provide examples of minor surgery.
- Breast biopsy
- Inguinal hernia repair
What are the main factors that affect surgical risk?
Patient’s age, general health, personal habits.
Which age groups are at the greatest risk during surgical procedures?
Very young and very old.
What are some risk factors for infants during surgery?
- 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.
What are common concerns for toddlers undergoing surgery?
Anxiety about separation from parents or caregivers, fear of the dark.
What fears do preschoolers commonly have regarding surgery?
Fear of damage to body parts, fear of pain, fear of needles.
What concerns might teens have related to surgery?
Fear of disfigurement resulting from scars.
What are common anxieties for young adults facing surgery?
Anxiety about the cost associated with hospitalization or surgery.
Why are older adults at increased risk during surgical procedures?
Less physiological reserve, often have comorbid conditions, physiological changes of aging.
List some physiological changes in older adults that predispose them to surgical risk.
- 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.
What characterizes a clean wound?
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.
Which surgical procedures are considered clean surgeries?
- Face-lift
- Cataract surgery
- Joint replacement
- Breast biopsy
- Tonsillectomy
These procedures are performed in a controlled environment with minimal risk of infection.
True or False: Clean wounds have a high risk of infection.
False
Clean wounds are specifically defined by their low risk of infection.
Fill in the blank: A clean wound is _______.
[uninfected; minimal inflammation; little risk of infection]
What are clean-contaminated wounds?
Not infected, but carry increased risk for infection
These include surgical incisions that enter the GI, respiratory, or genitourinary tract.
What are contaminated wounds?
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.
What defines infected wounds?
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.
What may patients with altered cognition be unable to do regarding surgical procedures?
Understand preoperative instructions or give informed consent for surgical procedures
Patients with altered cognition may also require medications that interact with anesthetics and analgesics.
What is a potential effect of surgery and anesthesia on patients with preexisting dementia?
Aggravate preexisting dementia, confusion, and disorientation
What do acute infections increase the risk of in surgical patients?
Various postoperative complications
Especially postoperative pneumonia in patients with upper respiratory tract infections receiving general anesthesia.
What chronic condition affects the heart’s ability to function efficiently?
Cardiovascular diseases (e.g., hypertension, congestive heart failure, MI)
What can limit the surgical risk associated with chronic cardiovascular disorders?
Well-controlled disorders with BP medications or cardiotonic medications
Chronic respiratory disorders increase the risk of what postoperative complication?
Respiratory infection
Conditions such as emphysema, asthma, or bronchitis may be exacerbated by general anesthesia.
What do coagulation disorders increase the risk of during surgery?
Hemorrhage and hypovolemic shock
What risk is associated with a hypercoagulation state?
Stroke, embolism, or intravascular clotting
How does diabetes mellitus affect surgical outcomes?
Delays wound healing and increases the risk of infection and cardiovascular disorders
What does liver disease impair in surgical patients?
Ability to metabolize amino acids, carbohydrates, and fat; manufacture prothrombin; detoxify medications
What are the risks associated with neurological disorders in surgical patients?
Vasomotor instability and potential for wide swings in BP
Patients with seizure disorders are more likely to have seizures in the perioperative period.
How can nutritional disorders affect surgical outcomes?
Risk for delayed wound healing, infection, and fatigue
What additional risks do obese patients face during surgery?
Cardiovascular disorders and impaired pulmonary function
What does renal disease affect regarding medication in surgical patients?
Ability to excrete anesthetic agents and regulate fluid and electrolytes
What types of medications may increase surgical risk?
Both prescribed and over-the-counter (OTC) medications
Box 36-3 provides specific examples of medications that can increase surgical risk.
What is one example of a supplement that may increase surgical risk?
High doses of vitamin E
Self-prescribing high doses of vitamin E may lead to an increased risk for bleeding.
What effect can certain herbal medications have on cardiac health?
Increase the risk for cardiac dysrhythmias secondary to potassium loss
This is one of the potential risks associated with herbal and alternative medications.
How can herbal medications interfere with anesthesia?
Interfere with metabolism of anesthetics because of their effects on the liver
This can lead to complications during surgical procedures.
List three effects of herbal medications on surgical risk.
- Increase the potential for excessive bleeding
- Decrease cerebral blood flow
- Cause hypertension
What is a potential interaction between herbal medications and opioids?
Increase the effects of opioids and sympathetic nervous system stimulants
This can complicate pain management during and after surgery.
How does smoking affect surgical risk?
Affects pulmonary function
Impaired pulmonary function can lead to complications during surgery.
What long-term effect of alcohol use increases surgical risk?
Contributes to liver disease, increasing the risk for bleeding
Liver disease can affect the metabolism of anesthetics and other medications.
How can alcohol and drugs interact with anesthetic agents?
Create adverse effects
This interaction can complicate anesthesia and recovery.
What is cross-tolerance in habitual substance abusers?
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.
What type of medications may potentiate the action of anesthetic agents?
Antibiotics
Certain antibiotics can enhance the effects of anesthetics.
Which medications increase the risk for bleeding during surgery?
Anticoagulants, Aspirin, NSAIDs, Tranquilizers
These medications inhibit platelet aggregation and affect coagulation.
What effect do antidysrhythmics have during anesthesia?
May impair cardiac function
Antidysrhythmics can interfere with normal heart rhythms.
How do antihypertensives affect surgery?
Increase risk for hypotension
These medications may interact with anesthetics to cause bradycardia and impaired circulation.
What is a potential effect of corticosteroids on surgical outcomes?
Delay wound healing and increase risk for infection
Corticosteroids can suppress the immune response.
What impact do diuretics have on patients undergoing surgery?
Alter fluid and electrolyte balance
This is particularly true for potassium balance.
What risk is associated with opioid use during surgery?
Increase the risk of respiratory depression
Opioids can significantly affect respiratory function.
Which medications may impair respiratory function during anesthesia?
Opioids, Tranquilizers
Both classes of medications can lead to respiratory depression.
Fill in the blank: __________ may impair cardiac function during anesthesia.
Antidysrhythmics
These drugs can disrupt normal heart rhythms.
True or False: NSAIDs can increase the risk of bleeding.
True
NSAIDs inhibit platelet aggregation, contributing to bleeding risk.
What types of medications may patients be allergic to?
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.
What does the Perioperative Nursing Data Set (PNDS) describe?
The PNDS is a standardized vocabulary designed to describe the care of perioperative patients
It is recognized by the American Nurses Association.
What does the latest update of PNDS reflect?
The latest update reflects the nursing process, including nursing assessment, diagnoses, identified nursing-sensitive outcomes, nursing interventions, and implementation and evaluation.
What are the benefits of the PNDS?
- 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.
What model is the PNDS derived from?
The PNDS is derived from the AORN’s Perioperative Patient-Focused model.
What is the focus of the Perioperative Patient-Focused model?
The patient is at the center of the model and is the focus of care.
What does the perioperative nurse do within the healthcare system?
The perioperative nurse intervenes to assist the patient throughout the perioperative experience.
What are the domains involved in the outcomes achieved by the perioperative nurse?
- Health System domain
- Patient-Centered domains (which include Safety, Physiological Responses to Surgery, and Behavioral Responses to Surgery)
What does the Health System domain refer to?
The Health System domain refers to the system in which perioperative care is given, involving administrative and structural elements necessary for successful surgical outcomes.
What elements are included in the Health System domain?
- Equipment
- Supplies
- Staff
- Policies
These elements are necessary for successful surgical outcomes.
What is the purpose of the Pre-Procedure Checklist?
To ensure all sections are completed prior to the start of the procedure or surgery.
What information is included in the Preparation section?
Height, Weight, Height/Weight Last Documented, CXR/KUB Date Completed, EKG Date Completed.
Fill in the blank: Last oral fluid intake is documented as _______.
[specific time or amount]
What are the possible levels of consciousness listed?
- Awake
- Arousable to Stimuli, Pain
- Arousable to Stimuli, Tactile
- Arousable to Stimuli, Verbal
- Obtunded
- Unresponsive
- Unable to Assess
- Other
What must be verified regarding the identification band?
It must be on and verified.
True or False: The allergy band must also be verified.
True
What must the physician be informed about before the procedure?
Consent must be verified.
What does ‘N/A’ stand for in the context of the checklist?
Not Applicable
What are the types of oxygen delivery methods listed?
- 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
What is required for the Anesthesia Consent?
It must be completed and verified.
What does ‘H&P’ refer to in the context of the checklist?
History and Physical
Fill in the blank: Last dialysis is documented as _______.
[specific date or time]
What are the categories for the status of lab results?
- Yes
- N/A
- No
- Results Normal
What is the significance of the ‘Pre Anesthesia Assessment’?
It must be completed prior to the procedure.
What must be documented regarding medications given?
- Beta Blocker Given
- Hypoglycemic Given
- Narcotic Given
- Antibiotic Given
- Anticoagulant Given
What must be completed prior to the start of a procedure or surgery?
All sections must be completed
This includes checking patient identification, allergies, consent, and special needs.
What should be verified regarding the identification band?
On and verified
This is crucial to ensure patient safety and correct procedure.
What should be checked regarding the allergy band?
Allergy band on and verified
Confirming allergies is essential to avoid adverse reactions.
What is required regarding the H&P or progress note?
Must be within 24 hours
Ensures that the patient’s current health status is documented.
What should be confirmed if the patient has special needs?
Yes or No
This helps tailor the care and preparation needed for the patient.
What needs to be documented about a pacemaker?
Make/Model
Important for anesthesia and surgical planning.
What should be done regarding the procedure(s)/surgery?
Enter correct procedure(s)/surgery without abbreviations
This prevents any miscommunication regarding the planned operation.
What must be verified about the physician?
Physician informed consent verified
Ensures that the physician has obtained informed consent from the patient.
What should be noted about the patient’s skin condition?
Skin breakdown
Important for preventing post-operative complications.
What is required if a patient has a history of obstructive sleep apnea?
CPAP or BIPAP settings (if known)
Necessary for managing the patient’s respiratory needs during surgery.
What must all surgical patients have regarding scrubs?
2 scrubs except in emergent situations
Ensures sterile conditions are maintained.
What should be removed from the patient before surgery?
Contacts, eyeglasses, dental appliances, loose teeth, makeup, nail polish, prosthetic devices, hair accessories, undergarments, jewelry
These items can interfere with surgical procedures and anesthesia.
What is the protocol regarding urinary catheters?
Present or not
This is important for managing patient needs during surgery.
Fill in the blank: All surgical patients must void on call, yes or _______
No
Ensures that the bladder is empty before the procedure.
What is the SENC competence related to nursing and interdisciplinary teams?
Effective collaboration through open communication, mutual respect, and shared decision making
This ensures safe and effective patient care.
What impact do two-minute surgical briefings have?
Improve communication and reduce delays and wrong-site surgery
Referenced study by Lee, 2016.
Why are surgical briefings important for team dynamics?
Encourage team members to speak up when there are misgivings or problems
Supported by findings from Seifert et al., 2017.
What factors determine the safety of discharging a surgical client to home?
Type of surgery, client’s condition, and support system
Assessment focuses on the client’s ability to care for themselves.
What is a key question to assess a client’s ability to manage post-surgery care?
Is the client able to take care of themself?
If not, identification of available caregivers is crucial.
What should be assessed regarding the caregiver’s ability?
Does the caregiver have the necessary skills to provide care?
If not, can these skills be taught before discharge?
What home environment features should be evaluated for a client after surgery?
Facilitators and inhibitors of the client’s progress
Examples include bathroom accessibility and stair navigation.
What follow-up considerations are important after a client’s discharge?
How soon should the patient visit the physician? Will there be home nursing care?
These are critical for ongoing recovery.
What elements should be included in the optimal preoperative assessment of older adults?
- 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.
What is the purpose of preoperative screening tests?
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.
What are the standard tests required for patients older than age 50 years before surgery?
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.
Is a routine chest x-ray recommended for all patients prior to surgery?
No
Chest radiology incurs extra costs and exposes patients to small risks from radiation exposure.
What additional testing might patients with chronic health problems require?
Additional diagnostic tests as per their specific health conditions
Refer to the Diagnostic Testing box for Common Preoperative Screening Tests.
What is necessary for all preoperative patients besides diagnostic testing?
Preoperative teaching
It is not necessary to write a nursing diagnosis of Knowledge Deficit for every patient.
How should a nurse approach the diagnosis of anxiety in surgical patients?
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.
What should be considered before adding a nursing diagnosis to a care plan?
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.
What is the purpose of a urinalysis in preoperative screening?
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.
What does a CBC measure in preoperative screening?
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.
What is the purpose of an Electrocardiogram (ECG) in preoperative testing?
To detect cardiac dysrhythmias and other cardiac pathology.
ECGs are crucial for assessing heart health before surgery.
What is detected through a chest x-ray examination in preoperative screening?
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.
What is the purpose of blood type and crossmatch testing?
To identify blood type in the event that blood transfusion becomes necessary.
This test is critical for preventing transfusion reactions.
What does the comprehensive metabolic panel include?
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.
Fill in the blank: A fasting blood sugar test is used to detect _______.
[diabetes or poorly controlled diabetes].
Fasting blood sugar levels are essential for diagnosing diabetes.
What do serum electrolytes tests measure?
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.
What does platelet count in a CBC affect?
Clotting ability.
Platelet count is important for assessing bleeding risk during surgery.
True or False: A low hemoglobin level indicates a risk of anemia.
True.
Anemia can increase the risk of complications during surgery.
What is the significance of measuring WBC count in a CBC?
It serves as an indicator of immune function.
Abnormal WBC counts can indicate infection or other health issues.
What is the basis for individualized nursing diagnoses for preoperative patients?
They evolve from your assessment of the patient.
When should you identify an actual nursing diagnosis for a preoperative patient?
Only if the patient has the defining characteristics for it.
What is a key point regarding risk (potential) nursing diagnoses?
Identify them only if the patient has an underlying condition that places them at higher risk than the average surgical patient.
What are the levels of anxiety that may be observed in preoperative patients?
- Mild
- Moderate
- Severe
- Panic level
What symptoms might indicate anxiety in a preoperative patient?
- Restlessness
- Trembling
- Increased pulse
- Other defining characteristics
What common reactions to surgery may preoperative patients experience?
Fear related to unknown outcomes, learning diagnoses, and prospect of pain.
What nursing diagnosis is used for patients with a preexisting health problem affecting airway clearance?
Airway Clearance Impairment.
What can often result in a disturbed sleep pattern in preoperative patients?
Anxiety about the upcoming surgery.
When is the nursing diagnosis of Ineffective Coping appropriate?
For a patient with extreme anxiety and concerns about surgery outcomes.
What nursing diagnosis applies to patients with a known allergy to latex?
Latex Allergy Reaction.
What factors contribute to the Risk for Latex Allergy Reaction diagnosis?
- Multiple surgeries
- Urinary catheterizations
- Daily latex exposure
- History of asthma
- Allergies to bananas, avocados, kiwi, chestnuts, or poinsettia plants
When is it appropriate to use a Knowledge Deficit diagnosis?
If the patient may not learn or the information is too complex to remember.
What is an example of a problem that could result from a Knowledge Deficit?
- 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
What is a key consideration for older adults over age 70 in nursing diagnoses?
They are likely to need individualized nursing diagnoses.
What unique risks do older adults present?
They often have other illnesses and physiological changes of aging.
How do older adults metabolize anesthetic agents compared to younger adults?
Differently.
What are two potential experiences older adults may have due to their metabolism of anesthetic agents?
- Confusion
- Gas Exchange Impairment
True or False: Physiological changes of aging do not impact the risks for older adults.
False
Fill in the blank: Older adults may experience _______ due to the different metabolism of anesthetic agents.
[Confusion or Gas Exchange Impairment]
What is a common condition among older adults related to heart health?
Coronary artery disease
Most older adults have at least some degree of coronary artery disease.
What potential complication can arise from orthostatic hypotension in older adults?
Risk for Falls
Hypotension can lead to falls in older adults.
What is one of the most common surgical complications in older adults?
Delirium
Delirium is common due to factors like age, functional disabilities, and coexisting conditions.
Name a factor that may increase the risk of delirium in older adults.
Poor vision and hearing
Other factors include male sex, depressive symptoms, and cognitive impairment.
What are some potential complications associated with age-related respiratory changes?
- Pneumonia
- Atelectasis
- Gas Exchange Impairment
- Ineffective Airway Clearance
Age-related changes include decreased chest wall compliance and diaphragmatic strength.
What are the age-related skin changes in older adults?
Dry, fragile skin; decreased turgor and elasticity
These changes can lead to risks for skin integrity impairment and pressure ulcers.
What musculoskeletal changes occur with aging?
Decreased bone mass and muscle fiber mass
These changes increase the risk for impaired physical mobility and falls.
Which central nervous system comorbidities are more common in older adults?
Dementia
Some CNS conditions may be aggravated by surgery and anesthesia.
What is a gastrointestinal change associated with aging?
Decreased gastrointestinal motility
This can lead to complications such as ileus and aspiration risk secondary to vomiting.
Fill in the blank: Delirium can lead to _______.
Acute Confusion
Delirium is characterized by acute confusion in older adults.
True or False: Age-related skin changes do not affect the risk for pressure ulcers.
False
Age-related skin changes increase the risk for pressure ulcers.
What is decreased bladder elasticity?
A reduction in the ability of the bladder to stretch and hold urine
This can lead to urinary incontinence and increased urgency.
What does decreased renal function refer to?
A decline in the kidneys’ ability to filter blood and produce urine
This can result in fluid retention and electrolyte imbalances.
What are some side effects of medications that can affect genitourinary function?
Possible side effects include urinary retention, incontinence, and changes in renal function
Certain medications, especially diuretics and anticholinergics, may exacerbate these issues.
What are renal complications?
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.
What is a urinary tract infection (UTI)?
An infection that affects any part of the urinary system, including the bladder and kidneys
UTIs are more common in individuals with urinary incontinence.
What is the risk for skin integrity related to urinary incontinence?
Increased risk of skin breakdown and pressure ulcers due to moisture from incontinence
Maintaining skin integrity is crucial in managing patients with urinary incontinence.
What does impairment related to urinary incontinence indicate?
A decrease in the ability to control urination, leading to involuntary leakage
This condition can significantly impact quality of life and may require interventions.
What is the purpose of the Perioperative Care domain in NIC?
To provide routine interventions for all preoperative patients
This domain includes interventions that are essential regardless of the patient’s specific nursing diagnoses.
What is involved in Preoperative Coordination?
Facilitating preadmission diagnostic testing and preparation of the surgical patient
An example activity is notifying the physician of abnormal diagnostic test results.
What does Surgical Preparation entail?
Providing care immediately before surgery and verifying required procedures/tests and documentation
An example activity is completing the preoperative checklist.
What is the goal of Teaching: Preoperative?
Assisting a patient to understand and mentally prepare for surgery and postoperative recovery
An example activity is correcting unrealistic expectations of the surgery.
What must be confirmed before a surgical procedure?
That surgical consent has been obtained
This is a legal requirement and part of professional standards.
Who is responsible for obtaining the patient’s informed consent?
The surgeon
The surgeon must provide necessary information and determine the patient’s competence.
What does a signed consent form verify?
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.
What is required of the nurse regarding the surgical consent form?
To verify that the surgical consent form is signed and witnessed
This is a critical responsibility of the nursing staff.
Fill in the blank: The surgeon is responsible for giving the patient the necessary information and determining the patient’s _______.
competence to make an informed decision about the surgery.
What is the purpose of administering antibiotics prophylactically?
To help prevent postoperative infection
This is particularly important before clean surgery involving the placement of a prosthesis or implant, clean-contaminated surgery, or contaminated surgery.
When should antibiotics be administered in relation to surgery?
Usually within 60 minutes preceding incision
This timing ensures that a bactericidal concentration of the drug will be present in serum and tissues.
How may antibiotics be administered if surgery lasts longer than the duration of the antibiotic?
Given at the start of anesthesia and repeated as needed
What routine medications are often held on the day of surgery?
Many routine medications, including insulin
For example, a patient with insulin-dependent diabetes may hold the morning injection or administer half of the normal dose.
How does NPO status affect insulin requirements?
It keeps the blood sugar lower than usual
Why might a patient receiving warfarin need to stop the medication before surgery?
To reduce the risk of bleeding during surgery
Patients may need to stop warfarin 7 days before surgery.
What must a patient do with artificial body parts before surgery?
Remove all artificial body parts, such as dentures, artificial limbs, or contact lenses
What are antiembolism stockings also known as?
Thromboembolic deterrent hose (TED hose)
What is the function of antiembolism stockings?
Compress the veins of the legs and increase venous return to the heart
What conditions do antiembolism stockings help prevent?
DVT and PE
They are used in conjunction with prophylactic medications (antithrombotics) to aid prevention.
What alternative methods are increasingly used instead of elastic stockings to prevent DVT?
SCDs and anticoagulation therapy
What is the primary purpose of antiembolism stockings?
To compress the veins of the legs and increase venous return to the heart.
Who is most in need of antiembolism stockings?
Older adults and those with risk factors for venous thromboembolism.
What are some risk factors for venous thromboembolism?
- Venous stasis (bedrest, lengthy surgery, varicose veins, heart failure)
- Vascular wall injury (surgery, IV catheter, irritating IV drugs, prior DVT, smoking)
- Hypercoagulability (estrogen therapy, oral contraceptive use, cancer, dehydration, pregnancy)
Why are older adults at higher risk for DVT?
They often have more than one risk factor for venous thromboembolism.
What safety measures can help prevent DVT in older adults?
- Range-of-motion exercises
- Applying antiembolism stockings
What types of antiembolism stockings are available?
- Foot to knee
- Foot to thigh
What does the Institute for Clinical Systems Improvement (ICSI) recommend regarding thigh-high stockings?
Thigh-high stockings should be avoided due to their tendency to roll and restrict circulation.
What feature do some antiembolism stockings have to assess circulation?
An opening at the toes.
Why is correct sizing and application of stockings important?
Stockings must be sized and applied correctly to be effective.
For which patients are antiembolism stockings contraindicated?
Patients with peripheral arterial disease.
What are the safety measures to prevent patient misidentification and wrong-site surgery?
Use a preoperative checklist, verify patient identity, mark the surgical site, take a time-out with all team members
According to The Joint Commission, these measures are essential for patient safety.
What should be used to mark the surgical site?
A permanent marker that will not be removed by the surgical skin prep
Involving the patient in the marking process is also recommended.
What is the purpose of a preoperative checklist?
To confirm that appropriate documents are available and activities have been performed
This step is crucial in ensuring patient safety before surgery.
What is a ‘time-out’ in the context of surgery?
A pause taken with all team members before starting the procedure
This practice is part of ensuring perioperative safety.
True or False: The patient’s identity should be verified after they leave the preoperative area.
False
Verification should occur before the patient leaves the preoperative area.
What is the most common root cause of medical errors?
Communication failure
Referenced studies: Berger et al., 2015; D’Agostino et al., 2017
Why is good communication essential in perioperative care?
For patient safety
What must surgical team members receive to ensure successful communication?
A summary of the plan of care
What should surgical team members do if they have concerns about the procedure?
Speak up and be assertive
What is one way team members can clarify confusion during communication?
Ask questions
What must team members acknowledge to ensure effective communication?
That they have heard and understood
What type of feedback should be asked for and provided?
Critical information feedback (e.g., read back)
What is important to use during communication in the surgical team?
Standard terminology
What was associated with a reduction in morbidity, mortality, and length of in-hospital stay?
Implementation of the WHO Surgical Safety Checklist
Referenced study: Scott & Shafi, 2018
What type of briefings have been found to improve communication before surgery?
Two-minute briefings led by the attending surgeon
What do surgical briefings encourage team members to do?
Talk when there is no problem
True or False: Surgical briefings reduce delays and wrong-site surgery.
True
Referenced study: Lee, 2016
What must accompany the patient during transport to the operative area?
Preoperative checklist and patient’s chart
These documents are crucial for ensuring that all necessary information is available to the surgical team.
What should be done with the patient’s valuables before transport?
Lock up according to agency policy or have the patient’s family keep them
This is to ensure the safety and security of the patient’s personal items.
Can patients wear their glasses or hearing aids to the surgical suite?
Yes, if the patient has a significant sensory deficit
Arrangements should be made in advance with the surgical staff or anesthesia team.
What can children bring to the operating room for comfort?
A favorite toy
This helps to alleviate fears associated with surgery and separation from parents.
Why is it important to keep parents informed before a child’s surgery?
To help them understand what to expect and to provide emotional support
This can reduce anxiety for both the child and the parents.
Fill in the blank: After preoperative care, the patient is ready for transport to the _______.
operative area
What should you do to prepare the postoperative room for a patient’s return after surgery?
Put clean linens on the bed and arrange the supplies and equipment needed
Ensure the bed is raised to stretcher height and the wheels are locked.
What is the intraoperative phase?
Begins when the patient enters the operating suite and ends when the patient is admitted to the postanesthesia care unit (PACU)
This phase involves all activities and care provided during surgery.
Fill in the blank: The intraoperative phase ends when the patient is admitted to the _______.
postanesthesia care unit (PACU)
What is the first action to take when transferring a patient to the surgical suite?
Prepare the postoperative room
This involves setting up clean linens and necessary supplies.
True or False: The wheels of the bed should be unlocked when preparing the postoperative room.
False
The wheels should be locked for safety.
What height should the bed be raised to when preparing for a patient’s return from surgery?
Stretcher height
What chapter provides additional insights on preparing the room for a newly admitted patient?
Chapter 7
Refer to Clinical Insight 7-1 for detailed instructions.
List the key steps to prepare a postoperative room.
- Put clean linens on the bed
- Arrange supplies and equipment
- Raise the bed to stretcher height
- Lock the wheels
What is the term for the personnel who attend the client during the surgical procedure?
Intraoperative team
What are the two types of techniques used by the intraoperative team?
- Sterile technique
- Clean technique
What roles can a registered nurse (RN) fulfill during the intraoperative phase?
- Scrub nurse
- Circulating nurse
- RN first assistant (RNFA)
Who are the sterile team members of the intraoperative team?
- Surgeon
- Surgical assistant
- Scrub person
What is the first step the sterile team members perform before beginning surgery?
Surgical scrub of the hands and arms
What must sterile team members do after performing a surgical scrub?
- Dry with sterile towels
- Don sterile gowns and gloves
What professionals can serve as a scrub nurse?
- RN
- Licensed vocational nurse (LVN)/Licensed practical nurse (LPN)
- Surgical technician
What is one of the primary responsibilities of the scrub nurse?
Set up the sterile field
Fill in the blank: The scrub nurse prepares the surgical instruments and assists with the _______ of the patient.
Sterile draping
What does the scrub nurse maintain during the surgical procedure?
Integrity of the sterile field
True or False: The scrub nurse anticipates and responds to the surgeon’s needs.
True
What is an RNFA?
A registered nurse first assistant with additional education and training in surgical technique.
The RNFA serves as an assistant to the surgeon, a role historically filled by physicians.
Who is allowed to enter the sterile field?
Sterile team members only.
The creation of the operative field is explained in Clinical Insight 36-3.
Who are the members of the Clean Team?
Anesthesiologist or nurse anesthetist, circulating RN, biomedical technicians, radiology technicians.
These personnel abide by clean technique (medical asepsis) and do not enter the sterile field.
What roles do anesthesiologists or CRNAs perform?
Induce amnesia, analgesia, and muscle relaxation or paralysis with anesthesia.
They continuously monitor and evaluate the patient’s responses to the anesthetic agent and the surgical procedure.
What percentage of anesthetics in the United States are administered by CRNAs?
More than half.
CRNAs play a significant role in anesthesia administration.
What is the primary role of the circulating nurse?
Coordinate all activities in the operating room and act as a client advocate.
The circulating nurse continuously monitors the client and the sterile field.
What responsibilities does the circulating nurse have?
- Maintains a safe, comfortable environment
- Communicates with personnel outside the operating room
- Responds to emergencies
- Attends to the patient during the induction of anesthesia.
True or False: The circulating nurse enters the sterile field.
False.
The circulating nurse operates around and beyond the sterile field.
What are the three classifications of anesthesia?
General, conscious sedation, regional
What is the primary effect of general anesthesia?
Rapid unconsciousness and loss of sensation
Who administers general anesthesia?
An anesthesiologist or nurse anesthetist
What types of medications are used in general anesthesia?
Inhaled and IV medications that depress the central nervous system and relax musculature
List some agents used during general anesthesia.
- Muscle relaxants
- Paralyzing agents
- Narcotics
- Barbiturates
- Inhaled gases
What is an advantage of general anesthesia related to patient anxiety?
The patient is unconscious, so they experience no anxiety that might affect cardiac and respiratory functioning
How does general anesthesia affect muscle movement during surgery?
The muscles are relaxed, so the patient remains completely motionless
How can anesthesia be adjusted during a procedure?
It can be adjusted to accommodate age, physical condition, and the length of the procedure
What happens if complications occur during general anesthesia?
The anesthesia can be continued for longer than originally planned
What is a significant disadvantage of general anesthesia?
Mechanical ventilation is needed due to depression of respiratory and circulatory muscles
What risks are associated with general anesthesia?
- Death
- Heart attack
- Stroke
- Malignant hyperthermia
What is malignant hyperthermia?
A rare, often fatal metabolic condition that can occur during the use of muscle relaxants and inhalation anesthesia
What happens to skeletal muscles during malignant hyperthermia?
Metabolism increases, they become rigid, and temperature rises rapidly
Is predisposition to malignant hyperthermia inherited?
Yes, it is inherited
What are common minor complaints after general anesthesia?
- Sore throat
- Nausea and vomiting
- Headache
- Uncontrollable shivering
- Confusion
What is conscious sedation?
Conscious sedation provides IV sedation and analgesia without producing unconsciousness.
During conscious sedation, how aware is the patient?
The patient may feel sleepy but is aware of their surroundings.
How can a patient in conscious sedation be aroused?
The patient can be easily aroused by touch or speech.
What vital signs are monitored during conscious sedation?
BP, heart rate, respiratory rate, and oxygen saturation.
What is commonly administered to the patient during conscious sedation?
The patient usually receives oxygen via nasal cannula.
What effect do many medications used in conscious sedation have on the patient?
The patient may not recall aspects of the procedure afterward.
List two procedures where conscious sedation is commonly used.
- Bronchoscopy
- Cosmetic surgery
What is an advantage of conscious sedation?
Pain and anxiety are adequately controlled without the risks of general anesthesia.
What is a disadvantage of conscious sedation?
Not practical for highly anxious patients.
What is regional anesthesia?
Regional anesthesia prevents pain by interrupting nerve impulses to and from the area of the procedure.
How does a patient feel during regional anesthesia?
The patient remains alert but is numb in the involved area.
How may regional anesthesia be administered?
By infiltration of the surgical site and surrounding tissue with local anesthetics.
Name two local anesthetics used in regional anesthesia.
- Lidocaine
- Bupivacaine
What is the purpose of injecting medications into and around specific nerves in regional anesthesia?
To depress the sensory, motor, and/or sympathetic impulses of a limited area of the body.
What is a key advantage of regional anesthesia?
Low in cost, simple to administer, and requires a minimal recovery period.
What are the disadvantages of regional anesthesia?
May not be practical if the patient is highly anxious or if adequate pain control cannot be achieved.
What is a common concern patients have regarding regional anesthesia?
Many patients are apprehensive about being able to see and hear the procedure.
What is a Peripheral Nerve Block?
The injection of an anesthetic into and around a nerve or group of nerves.
What is a Bier (IV) block?
A nerve block technique where a tourniquet is placed on an arm or leg, and a local anesthetic is injected intravenously below the tourniquet.
What is the purpose of the tourniquet in a Bier (IV) block?
To limit venous return while allowing arterial circulation.
True or False: Patients feel pain in the extremity during a Bier (IV) block as long as the tourniquet is in place.
False
Fill in the blank: A nerve block is the injection of an anesthetic into and around a _______.
[nerve or group of nerves]
What are the advantages of Bier block?
Onset and recovery time are both rapid. The tourniquet decreases bleeding during the surgical procedure and prevents systemic absorption of the local anesthetic.
What are the disadvantages of Bier block?
Potential for systemic absorption of the anesthetic after tourniquet deflation. The tourniquet must not be left in place for more than 2 hours to prevent tissue damage.
What is Spinal Anesthesia?
Injection of an anesthetic into the cerebrospinal fluid (CSF) in the subarachnoid space that blocks sensation and movement below the level of the injection.
What types of surgical procedures is spinal anesthesia often used for?
Procedures in the lower abdomen, pelvis, and lower extremities.
What is a key advantage of spinal anesthesia?
Allows the patient to remain conscious during the procedure and usually does not depress respirations.
What are some disadvantages and side effects of spinal anesthesia?
Medication may migrate upward, potentially depressing respirations and cardiac rate. Side effects include hypotension, nausea, vomiting, urinary retention, and headache from leakage of CSF.
What position may help prevent respiratory paralysis in spinal anesthesia?
Fowler position.
What must be closely monitored after spinal anesthesia, and why?
Headache from leakage of CSF; it may require additional treatment by the anesthesia staff.
What can cause a sudden decrease in blood pressure during spinal anesthesia?
Pervasive vasodilatation due to blocking of sympathetic vasomotor nerves.
What may patients with complications from spinal anesthesia require during surgery?
Ventilation and support of blood pressure; they must be carefully monitored.
What is the primary purpose of epidural anesthesia?
To produce loss of sensation through infusion of anesthetic agents into the epidural space
Epidural anesthesia can be used for surgical anesthesia and postoperative analgesia.
What is a key advantage of epidural anesthesia compared to spinal anesthesia?
It is safer because the anesthetic does not enter the subarachnoid space
The depth of anesthesia with epidural anesthesia is not as great as with spinal anesthesia.
What can occur if epidural medication is inadvertently injected too deeply?
Hypotension and respiratory paralysis
Temporary mechanical ventilation may be necessary in such cases.
Why is epidural anesthesia considered ideal for obstetric procedures?
It allows the mother to remain awake and bond with the newborn
Mobility is limited for only a short time during the procedure.
What is the primary effect of local anesthesia?
Produces loss of pain sensation at a specific site
It is commonly used for minor procedures.
How can local anesthetics be administered?
Topically or injected
Topical anesthetics are applied directly to skin and mucous membranes.
What are commonly used local anesthetics?
- Lidocaine
- Benzocaine
These are preferred for their rapid absorption and rapid action.
Fill in the blank: Epidural anesthesia requires insertion of a thin catheter into the _______.
epidural space
True or False: Local anesthesia is typically used for major surgeries.
False
Local anesthesia is generally used for minor procedures, though it can be used postoperatively.
What is a potential use of local anesthetics after major surgery?
To infiltrate the operative area for postoperative pain relief.
What is spinal anesthesia?
The injection of a local anesthetic into the subarachnoidy space to block sensation and movement.
Spinal anesthesia is commonly used for lower body surgeries.
What is continuous epidural anesthesia used for?
To provide postoperative analgesia.
It allows for pain relief after surgery while preserving motor function.
What is the first step a circulating nurse takes in the preoperative holding area?
Verify that the surgical consent has been signed and witnessed and that the preoperative checklist is complete.
This ensures that all necessary permissions and preparations are in place.
What are the key assessments a circulating nurse performs on a client?
Assess the client’s anxiety level and physical condition, measure vital signs, examine the surgical site, and inspect IV lines, drainage tubes, and catheters.
These assessments help ensure the client’s readiness for surgery.
What action is often taken by the circulating nurse or anesthetist in the holding area?
Starts an IV line if one is not already present.
This is a critical step for administering medications and fluids during surgery.
What should be given in the holding area if prescribed?
Preoperative medication.
This medication may help reduce anxiety or pain before surgery.
How often should vital signs be monitored during the intraoperative period?
Often, or even continuously.
Continuous monitoring helps detect any changes in the patient’s condition promptly.
What does the WHO Surgical Safety Checklist cover?
The three phases of a surgical procedure: ‘sign in,’ ‘time out,’ and ‘sign out.’
This checklist aims to enhance communication, teamwork, and safety.
Who reviews the surgical safety checklist?
The checklist coordinator.
The coordinator verbally checks that each element was completed.
What is the goal of using a surgical checklist?
To enhance communication, teamwork, and safety by addressing key activities in the perioperative process.
This practice is based on recommendations from WHO in 2009.
What is a common nursing interview question regarding the patient’s identity?
What is your name?
What type of surgery are you going to have today?
Type of surgery
What is an important question to ask about the patient’s companions?
Is someone here with you?
What should a nurse inquire about in terms of allergies?
Are you allergic to any medications, latex, or tape?
When is the last time that you had anything to eat or drink?
Last intake time
What should be asked regarding dental or optical prostheses?
Do you have false teeth, contact lenses, or any other prostheses that need to be removed?
What medication-related question should a nurse ask?
Have you taken any medications today?
What is an important question regarding implants?
Do you have any implants, such as metal plates or a pacemaker?
What should a nurse check for on the patient’s body?
Do you have any scratches, bruises, or other wounds on your body at this time?
What are the potential complications of surgery?
- Hypothermia
- Fluid and electrolyte imbalance
- Excessive bleeding or hemorrhage
- Musculoskeletal injury secondary to positioning
What is a potential complication of anesthesia?
Aspiration
Are there any parts of your body that are painful, such as a stiff shoulder or leg?
Pain assessment
What checklist is mentioned for surgical safety?
WHO Surgical Safety Checklist
Fill in the blank: Most intraoperative nursing care consists of standard activities to be used for all patients, as in the _______ phase.
preoperative
What is a potential complication of surgery related to temperature?
Hypothermia
Hypothermia can occur due to exposure in a cool environment and the administration of cool IV fluids.
List some potential complications of surgery.
- Fluid and electrolyte imbalance
- Excessive bleeding or hemorrhage
- Musculoskeletal injury secondary to positioning
What is a potential complication of anesthesia that affects breathing?
Respiratory depression
Respiratory depression can occur due to the effects of anesthesia on the respiratory system.
True or False: Aspiration is a potential complication of anesthesia.
True
What nursing diagnosis is related to exposure in a cool environment and administration of cool IV fluids?
Perioperative Hypothermia
Risk for Aspiration is related to what factors?
Depressed respirations and reflexes
This diagnosis is particularly relevant for patients with weak cough muscles or poor gag reflex.
What nursing diagnosis applies to patients at risk of changes in fluid volume due to NPO status?
Risk for Fluid Volume Alteration
Fill in the blank: Risk for _______ Injury is related to patient factors such as edema and obesity.
Perioperative Positioning
What should be considered before using the nursing diagnosis for Risk for Latex Allergy Response?
Defining characteristics or risk factors
These diagnoses should not be used routinely for all patients.
What is a potential complication of anesthesia that involves blood circulation?
Cardiovascular compromise
True or False: All patients undergoing major surgery require nursing diagnoses.
False
What is a complication of anesthesia that can result in low blood pressure?
Vasomotor instability
List the potential complications of anesthesia.
- Aspiration
- Vasomotor instability
- Respiratory depression
- Cardiovascular compromise
What nursing diagnosis is especially relevant for very young, very old, and very thin patients?
Perioperative Hypothermia
Fill in the blank: Risk for Latex Allergy Response is related to multiple exposures or _______.
history of related allergies
What are the overarching goals in the intraoperative phase for a patient?
Be free from injury, remain physiologically stable, experience optimal surgical outcomes
What are individualized goals/outcome statements based on?
Patient’s nursing diagnoses
Fill in the blank: Maintains body temperature within the _______.
normal range
What is the minimum urine output expected for a patient in the intraoperative phase?
At least 30 mL/hr
What should a patient experience regarding lung sounds and airway during surgery?
Clear lung sounds and patent airway
What is one of the goals concerning skin, tissue, or neuromuscular injury during positioning?
Will have no injury as a result of positioning
What is the aim concerning healthcare-related infection during the intraoperative period?
Will not acquire healthcare-related infection
What does NIC standardized interventions for the intraoperative period include?
Interventions for all intraoperative patients, regardless of their individual nursing diagnoses
Who must perform Anesthesia Administration?
An anesthesiologist or nurse anesthetist
What role does the nurse play in anesthesia administration?
Assists in implementing a number of interventions
List three NIC standardized interventions for the intraoperative period.
- Anesthesia Administration
- Infection Control
- Surgical Assistance
Standard is for every patient
Fill in the blank: Sterile _______ is an important focus in the intraoperative period.
asepsis
What should healthcare providers always be mindful of during the intraoperative period?
Using hand hygiene
Name one intervention related to temperature regulation during the perioperative phase.
Temperature Regulation: Perioperative
What chapter should you review for more information on sterile asepsis?
Chapter 20
What does ‘routine’ mean in the context of nursing interventions?
Activities are planned and performed for all patients
Nursing interventions must always be performed with thought and skill.
What is the purpose of surgical skin preparation?
Reduces the risk of postoperative wound infection by reducing the microbial count at the operative site
When does skin preparation begin?
In the preoperative phase, when the client cleanses the skin with an antimicrobial solution the evening before and the morning of surgery
What should the intraoperative nurse assess during skin preparation?
Assess the skin for signs of infection, rash, or other skin irritation
What should be documented on the intraoperative record?
The condition of the skin
When is hair removal from the surgical site necessary?
Only if there is a large amount of hair or if the surgeon specifies a preference
What risks are associated with hair removal?
Increases the risk of abrasions or nicks in the skin, providing a portal of entry for bacteria
When should hair removal be performed?
In the preoperative holding area immediately before surgery
What methods should be used for hair removal to minimize skin irritation?
Clippers or depilatory cream
True or False: Hair removal should always be performed for all surgical patients.
False
Hair removal is only necessary if specified or if there is a large amount of hair.
What is the first step in preparing a surgical site?
Cleanse the surgical site and surrounding area with an anti-infective solution
Povidone-iodine (Betadine) is commonly used for this purpose.
What should be done if a client is allergic to iodine?
Use an alternative preparation solution
Alternatives to povidone-iodine should be readily available.
What factors determine the positioning of a patient in the operating room?
Factors include:
* Surgical site
* Access to airway
* Monitoring vital signs
* Comfort
* Safety
The ideal position for the surgical site may need to be adjusted based on these factors.
When is the patient usually positioned in the operating room?
After anesthesia has begun
This ensures the patient is comfortable and stable during positioning.
What tools can be used to maintain a patient’s position during surgery?
Tools include:
* Straps
* Wedges
* Pillows
* Surgical table attachments
These help secure the patient safely and comfortably.
What is the responsibility of the circulating nurse regarding patient positioning?
Preventing positioning injuries
The circulating nurse monitors the patient to avoid complications.
Why are surgical patients at risk for pressure ulcers?
They often spend multiple hours in the same position
The risk is compounded by anesthetic agents that decrease tissue perfusion.
What is one measure to protect a patient from positioning injuries during surgery?
Padding bony prominences
This helps to distribute pressure and minimize skin breakdown.
True or False: The surgical team does not assist with patient positioning.
False
The surgical team often assists with positioning to ensure patient safety.
Fill in the blank: To prevent shearing, ______ the patient into position.
lift
Sliding the patient can increase the risk of skin injury.
What should be factored into the decision about how to position a patient with preexisting injuries?
Information about their injuries or discomfort
This ensures that the positioning does not exacerbate the patient’s condition.
What is the primary responsibility of the circulating nurse before a surgical procedure?
Conduct a final verification process to confirm the correct patient, procedure, and site
This is in accordance with The Joint Commission guidelines from 2020.
What is one of the key responsibilities of the circulating nurse during surgery?
Assist the scrub nurse to prepare and maintain the sterile field
What does the circulating nurse gather for use during surgery?
Surgical supplies and equipment
How does the circulating nurse assist with additional supplies needed during surgery?
Obtains and opens them onto the sterile field
What types of supplies might the circulating nurse provide during surgery?
- Dressings
- Surgical equipment
- Medications
- Irrigating solutions
- Sutures
What does I&O stand for in the context of intraoperative monitoring?
Intake and output
Who monitors the fluid infused, urine output, drainage, and blood loss during surgery?
The circulating nurse, together with the anesthetist
What is the role of the circulating nurse regarding specimens during surgery?
Handles specimens and sends them to the laboratory or pathology for evaluation
What may the surgeon obtain that requires analysis during the operative procedure?
A tissue sample
What does the circulator do with the specimen after it is received?
Coordinates with the pathologist to review the sample and reports the pathology findings to the surgeon
What is the purpose of performing sponge, sharps, and instrument counts during surgery?
To ensure that no instruments, sponges, or sharps are left inside the client
A retained sponge can lead to infection and additional surgeries.
Who is responsible for counting the supplies added to the sterile field?
The circulating nurse and the scrub nurse
They perform a repeat count at the end of the surgery.
What can make sponges difficult to see in the body cavity during surgery?
Once soaked in blood, sponges can blend in with the body cavity
This is particularly concerning during major surgeries, such as heart surgery.
What technology is being used to prevent retained sponges?
Barcode scanning and radiofrequency identification technology
These systems alert the surgical team if a sponge is left behind.
What should be documented on the surgical record?
The care provided and the client’s response to care
This is usually done on a graphic or checklist form.
Fill in the blank: A retained sponge can lead to _______.
infection and additional surgeries
True or False: The surgical team relies solely on manual counting of sponges and instruments.
False
Agencies are now using advanced technologies such as barcode scanning and RFID.
What is the significance of performing a repeat count at the end of surgery?
To ensure no instruments, sponges, or sharps are left inside the client
What marks the beginning and end of the postoperative phase?
Begins when the client enters the PACU and ends when the client has healed from the surgical procedure
What are the two parts of the postoperative phase?
- Recovery from anesthesia
- Recovery from surgery
What is the first postoperative phase commonly known as?
Postanesthesia phase or immediate postoperative phase
When does the immediate postoperative phase begin?
When the patient is transferred from the operating table to a bed or gurney for transport to the PACU
What risks are patients at during the immediate postoperative phase?
High risk for respiratory and cardiovascular compromise
Who accompanies the patient during transport to the PACU?
The anesthetist and the circulating nurse
What is the role of the anesthetist and circulating nurse during transport?
Attend to any needs during transport and give a comprehensive report to the PACU nurse
What is the PACU and its typical characteristics?
Located near the operating room, typically an open unit allowing easy observation of patients
What type of education and experience do PACU nurses have?
Specialized education and experience in caring for postoperative clients, commonly with critical care experience
What does the PACU nurse receive from the anesthesia provider and circulating nurse?
A comprehensive report
What information is included in the report from the surgical suite? (List at least 5 items)
- Procedure performed
- Type of anesthesia
- Medications administered in the surgical suite
- Duration of the procedure and anesthesia
- Postoperative vital signs
Fill in the blank: The PACU nurse monitors _______ values.
Pulse oximetry
What types of complications may be noted in the report from the surgical suite?
Surgical complications
What information regarding fluid balance is included in the report?
Fluid I&O, including urine, stool, gastric losses
What preoperative status details are included in the report? (List at least 3)
- Mobility status
- Skin integrity
- Sensory perception abilities
What existing medical devices might be noted in the report?
- Presence of tubes
- Drains
- Catheters
- Existing IV lines
What is included in the report concerning postoperative care?
Postoperative prescriptions
What is the goal of the second phase of postoperative care?
To facilitate healing and prevent postoperative complications
This phase begins when the patient is discharged from the PACU.
When is a patient transported to the surgical unit after surgery?
After recovery from anesthesia is evident and the patient is stable
This ensures the patient’s safety and readiness for further care.
What does the PACU nurse perform upon initial assessment of the surgical patient?
A quick, focused initial assessment in the presence of the anesthesia provider and circulating nurse
This assessment is crucial for determining the patient’s immediate postoperative status.
How often does the PACU nurse assess the patient after the initial assessment?
Every 5 to 15 minutes
This regular assessment helps monitor the patient’s recovery progress.
What is the only postoperative intervention from NIC’s Perioperative Care category?
Postanesthesia Care
This encompasses assessments and measures for patient safety.
What essential element must be determined by the PACU nurse regarding the patient’s recovery?
That the patient has recovered from the effects of anesthesia
This includes the ability to maintain their airway.
Fill in the blank: The PACU nurse assesses the patient every _______ minutes.
5 to 15
True or False: The PACU nurse can transfer the patient to the surgical unit without confirming recovery from anesthesia.
False
The nurse must confirm the patient’s recovery before transfer.
What is a common airway management tool used in the PACU?
Artificial airway or endotracheal tube
These tools help maintain the patient’s airway until they recover from anesthesia.
What does the NIC intervention ‘Postanesthesia Care’ include?
Assessments and measures such as providing for safety and administering oxygen
This intervention is crucial for patient recovery in the PACU.
What is the recommended position for an unconscious client to maintain an open airway?
On their side
This positioning helps decrease the likelihood of aspirating mucus or saliva.
What is one benefit of elevating the superior arm on a pillow for an unconscious client?
Good chest expansion
This allows the patient to breathe deeply and expand the lungs.
What organization identified the essential elements of assessment in the PACU?
AORN
AORN stands for the Association of periOperative Registered Nurses.
List three vital signs to assess in the PACU.
- Blood Pressure
- Respiratory Rate
- Temperature
What type of blood pressure measurement can be used in the PACU?
Cuff or arterial
Both methods provide important information about the patient’s hemodynamic status.
What should be assessed regarding respiratory adequacy in the PACU?
- Respiratory competence
- Breath sounds
- Skin color and condition
What is the significance of recording temperature measurement type in the PACU?
It provides context for the patient’s temperature status
Examples include skin, tympanic, or oral measurements.
What is considered when assessing oxygen saturation in the PACU?
Pulse oximeter reading
This assessment helps determine the patient’s respiratory function.
What aspects of peripheral circulation should be evaluated postoperatively?
- Peripheral pulses
- Sensation at extremities
What neurological status indicators should be assessed in the PACU?
- Pupil response
- Intracranial pressure (if indicated)
What components are included in assessing mental status in the PACU?
- Level of consciousness
- Alertness
- Lucidity
- Orientation
What should be checked regarding IV therapy in the PACU?
- Patency
- Location of sites
- Rates of solution(s) and/or blood products infusing
What should be assessed in terms of allergies and sensitivities in the PACU?
Document any known allergies or sensitivities
This information is crucial for safe patient care.
What aspects of pain should be assessed in the PACU?
Pain level and management needs
Pain assessment is critical for postoperative care.
What motor abilities should be evaluated in the PACU?
Return of sensory and motor control in affected areas
This is particularly relevant for areas affected by local or regional anesthetics.
What should be assessed regarding skin integrity in the PACU?
Condition of the skin and any surgical incisions
This is important for preventing infection and promoting healing.
What is included in the assessment of temperature regulation in the PACU?
Monitoring for hypothermia or hyperthermia
Temperature regulation is critical in postoperative patients.
What should be inspected at the surgical incision site in the PACU?
Condition of suture line(s) if visible
This helps assess healing and detect any complications.
What should be monitored for nausea and vomiting in the PACU?
Presence and severity of symptoms
This is important for patient comfort and safety.
What components are included in assessing fluid and electrolyte balance in the PACU?
- Input and output
- Electrolyte levels
What safety needs should be addressed in the PACU?
Ensure siderails are raised
This is to prevent falls and ensure patient safety.
What two pressures might be monitored in the PACU?
- Central venous pressure
- Pulmonary wedge pressure
What should be assessed regarding the airway in the PACU?
- Patency
- Presence of artificial airway
- Mechanical ventilator settings
What should be assessed about dressings in the PACU?
Condition of dressing(s)
This includes checking for signs of infection or bleeding.
What drainage aspects should be monitored in the PACU?
- Type
- Patency
- Amount and type of drainage from dressings, tubes, and catheters
What is the first evidence of recovery from anesthesia related to airway?
The patient is able to maintain a patent airway independently and to deep-breathe, cough, and expectorate secretions.
What level of consciousness indicates recovery from anesthesia?
The patient is conscious and easily reoriented, often drifting off to sleep between arousals.
What are the vital signs criteria for recovery from anesthesia?
Vital signs are stable and within an acceptable range, though BP may differ from preoperative measures.
What factors may affect blood pressure readings post-anesthesia?
Anxiety, pain, and not administering routine BP medications due to NPO status.
What mobility and sensation indicators suggest recovery from anesthesia?
The patient is able to move all extremities that they could move preoperatively.
What does fluid balance (I&O) indicate in recovery from anesthesia?
The patient is urinating at least 30 mL/hr and is in relative fluid balance.
What should be considered when calculating fluid balance?
- Blood loss
- Urine output
- Gastric drainage
- Emesis
What are the criteria for dressings and drains during recovery from anesthesia?
Dressings are dry and intact, or wound drainage is appropriate for the procedure.
What signs indicate a patient is ready to be transferred to the surgical unit?
The patient should have no overt signs of excessive blood or fluid loss.
What is the initial postoperative assessment compared to?
Identical to the assessment performed by the PACU nurse
What changes occur in the frequency of assessment after surgery?
Frequency can be less than in the PACU
What is the standard assessment frequency upon arrival to the nursing unit?
On arrival to the nursing unit
What is the assessment frequency for the first hour postoperatively?
Every 15 minutes for the first hour
What is the assessment frequency for the next 2 hours after the first hour?
Every 30 minutes for the next 2 hours
What is the assessment frequency for the next 4 hours after the first 2 hours?
Every hour for the next 4 hours
What is the assessment frequency after the initial 4 hours?
Then every 4 hours
Fill in the blank: The PACU nurse assesses the patient every _______ minutes.
5 to 15
True or False: Agency protocols for postoperative assessments are uniform and do not vary.
False
What should be done if the patient’s condition changes?
Increase the frequency of assessment
What is Aspiration Pneumonia?
Airway inflammation caused by inhaling gastric secretions (especially hydrochloric acid from the stomach) due to absent gag reflex secondary to anesthesia
Aspiration pneumonia is a serious postoperative complication that can arise from inadequate airway protection during anesthesia.
What are the clinical signs of Aspiration Pneumonia?
- Cough
- Fever
- Elevated white blood cell (WBC) count
- Decreased or absent breath sounds
- Decreased oxygen saturation (SaO2)
- Tachypnea
- Dyspnea
- Blood-tinged sputum
These signs indicate the presence of inflammation and infection in the lungs.
What is the preoperative intervention for preventing Aspiration Pneumonia?
Institute NPO (nothing by mouth) as ordered prior to surgery
This intervention helps reduce the risk of gastric contents being present in the stomach during anesthesia.
What should be done postoperatively to prevent Aspiration Pneumonia?
Continue NPO until intestinal motility returns; carefully monitor sedated patient and place in side-lying position
Monitoring and positioning are critical to prevent aspiration of secretions.
What is atelectasis?
Collapse of alveoli due to hypoventilation, airways blocked by mucous plugs, opioid analgesics, immobility
Atelectasis can lead to decreased gas exchange and respiratory complications.
List three clinical signs of atelectasis.
- Decreased or absent breath sounds
- Noisy respirations
- Decreased O2 saturation (SaO2)
Other signs may include chest asymmetry and sternal retractions.
True or False: Fever is a clinical sign of atelectasis.
True
Fever can indicate infection or inflammation associated with atelectasis.
What should be monitored to prevent and detect atelectasis early?
- Clinical signs
- Rate, rhythm, depth, and effort of respirations
- Ability to cough effectively
Monitoring these factors helps identify potential respiratory issues.
Fill in the blank: The use of _______ can help encourage deep breathing and prevent atelectasis.
[incentive spirometry]
Incentive spirometry encourages patients to take deep breaths, which can help expand collapsed alveoli.
What interventions should be taken if crackles and rhonchi are heard?
Suction, as needed
Suctioning can clear secretions that may be contributing to airway blockage.
What are some signs of respiratory distress in a patient with atelectasis?
- Increased restlessness
- Anxiety
- Tachypnea
- Dyspnea
- Tachycardia
- Diaphoresis
- Pleural pain
These signs indicate that the patient may be struggling to breathe and requires immediate attention.
What action should be taken after suctioning the patient?
Auscultate lung sounds to determine effectiveness
This helps ensure that the airway is clear and that normal breath sounds are restored.
True or False: Encouraging ambulation is an intervention for preventing atelectasis.
True
Mobility helps promote lung expansion and clear secretions.
What is pneumonia?
Inflammation of the alveoli due to infection with bacteria or viruses, toxins, or irritants.
What are common causes of pneumonia?
Hypoventilation secondary to anesthesia and opioid analgesics, poor cough effort due to aging, pain, or weakness.
List the clinical signs of pneumonia.
- Productive cough with blood-tinged or purulent sputum
- Fever
- Elevated WBC
- Decreased or absent breath sounds
- Decreased SaO2
- Chest pain
- Tachypnea
- Dyspnea
What interventions can be taken for the prevention and early detection of pneumonia?
- Monitor for clinical signs
- Encourage deep breathing
- Assist with coughing
- Promote moving in bed
- Encourage ambulation
- Use of incentive spirometry
True or False: Pneumonia can be caused by irritants.
True
Fill in the blank: Pneumonia is caused by _______ secondary to anesthesia and opioid analgesics.
[hypoventilation]
What is a common symptom of pneumonia related to breathing?
Decreased or absent breath sounds
What is the significance of elevated WBC in pneumonia?
It indicates an infection or inflammatory response.
What role does incentive spirometry play in pneumonia management?
It helps encourage deep breathing to improve lung function.
What is a Pulmonary Embolus?
A clot that occludes blood flow to a portion of the lungs
Usually results from clot formation in the lower extremities, which breaks loose and migrates to the lungs.
What are the potential causes of a Pulmonary Embolus?
Clot formation in lower extremities, venous injuries, hypercoagulable state, preexisting circulatory disorders
These factors contribute to the risk of developing a pulmonary embolus.
What are the clinical signs of a Pulmonary Embolus?
Sudden onset of dyspnea, shortness of breath, chest pain, hypotension, tachycardia, decreased SaO2, cyanosis
These symptoms can vary in severity and may require immediate medical attention.
Fill in the blank: The sudden onset of _______ is a clinical sign of a Pulmonary Embolus.
dyspnea
What interventions can be taken for the prevention of Pulmonary Embolus?
Encourage leg exercises, ambulation, antiembolism stockings, sequential compression devices, hydration
These interventions aim to prevent thrombophlebitis and improve circulation.
What should be done if thrombophlebitis occurs?
Position and immobilize the limb; do not massage calves
Proper management is crucial to avoid further complications.
True or False: Massaging the calves is recommended if thrombophlebitis occurs.
False
What is Thrombophlebitis?
Blood clot and inflammation of a vein or artery, usually in the legs
Results from increased coagulability and venous stasis due to immobility during and after surgery.
What are the clinical signs of Superficial Thrombophlebitis?
Vein is red, hard, and hot to touch
Indicates localized inflammation.
What are the clinical signs of Deep Thrombophlebitis?
Limb is pale and edematous; aching, cramping in limb; Homans sign (pain in calf when foot is dorsiflexed)
Homans sign is a classic indicator of deep vein thrombosis.
What does an Embolus refer to?
Movement of a thrombus or foreign body from its original location
Can lead to serious complications based on its location.
What are potential outcomes of embolus movement in the arterial system?
Cerebrovascular accident (CVA), myocardial infarction (MI), or loss of circulation to an area
These outcomes are critical and require immediate medical attention.
What is a common result of embolus movement in the venous system?
Pulmonary embolus
This condition can be life-threatening.
What should be monitored for in the prevention and early detection of emboli?
Clinical signs
Early detection is crucial for effective intervention.
What are interventions for preventing thrombophlebitis?
Monitor for clinical signs; position and immobilize the limb; do not massage calves
Massaging calves can dislodge a thrombus and lead to embolism.
True or False: Thrombophlebitis can occur due to immobility during and after surgery.
True
Immobility increases the risk of venous stasis and coagulability.
What is hemorrhage?
Bleeding that may be internal or external
Caused by slipped ligature, uncontrolled bleeder, or infection.
What are clinical signs of external hemorrhage?
Dressings saturated with bright red blood; increased output in drains or chest tubes.
What are clinical signs of internal hemorrhage?
Increased pain, increasing abdominal girth, ecchymosis or swelling around incision, tachycardia, hypotension.
What interventions can be taken for prevention and early detection of hemorrhage?
Frequently monitor vital signs, dressings, and wound drainage.
What is hypovolemia?
Decreased blood volume
May be due to blood loss during and after surgery; dehydration; or excess loss through vomiting, diarrhea, or drains.
What are clinical signs of hypovolemia?
Hypotension, tachycardia, decreased urine output, fatigue, thirst, dehydration.
What interventions can be taken for prevention and early detection of hypovolemia?
Monitor vital signs and I&O; insert urinary catheter if appropriate; monitor skin color, temperature, and moistness; identify possible causes of changes in vital signs.
What should be administered as prescribed for hypovolemia?
IV therapy, blood, or blood products.
Fill in the blank: Hypovolemia may be caused by _______.
[blood loss during and after surgery; dehydration; excess loss through vomiting, diarrhea, or drains]
What is nausea and vomiting related to?
Pain, anxiety, anesthesia, medications, or oral intake before peristalsis returns
What are the clinical signs of nausea and vomiting?
Vomiting, retching, stated nausea
What is the first intervention for preventing nausea and vomiting?
Maintain NPO until return of bowel sounds
How should the diet be advanced after nausea and vomiting?
Advance diet slowly
What is abdominal distention also known as?
Tympanites
What causes abdominal distention?
Excess gas within the intestines; slow return of peristalsis or handling of intestines during surgery
What are the clinical signs of abdominal distention?
Abdominal discomfort, bloating, hypoactive or absent bowel sounds
What intervention can help prevent abdominal distention?
Encourage and assist to move in bed and ambulate
What should be maintained until the return of bowel sounds in abdominal distention?
NPO
What should be avoided when drinking to prevent abdominal distention?
Drinking with a straw
What temperature should fluids be provided at for abdominal distention?
Room temperature
What is constipation?
A decrease in the frequency of bowel movements, resulting in the passage of hard stool
Usually related to use of opioids, immobility, inadequate fluid intake, or low-fiber diet.
What are clinical signs of constipation?
Abdominal discomfort, bloating, hypoactive or absent bowel sounds
These signs indicate potential issues with bowel function.
What interventions can prevent and detect constipation?
Encourage and assist the patient to:
* Move in bed
* Ambulate
* Increase fluid intake
* Increase fiber intake after bowel sounds return
These actions help support bowel function and reduce risks.
What is ileus?
Loss of the forward flow of intestinal contents due to decreased peristalsis
Causes include anesthesia, handling of the intestines during surgery, electrolyte imbalances, infection, or ischemic bowel.
What are clinical signs of ileus?
Abdominal pain, distention, absent bowel sounds, vomiting
These signs suggest a disruption in normal intestinal activity.
What interventions can prevent and detect ileus?
Observe for symptoms; notify the surgeon
There are few independent preventive measures for ileus.
What is renal failure?
Decreased or absent urine output due to hypovolemia, shock, or toxic reaction to medications
Renal failure can lead to serious complications and requires prompt medical intervention.
What are the clinical signs of renal failure?
Urine output less than 30 mL/hr; rising blood urea nitrogen (BUN) and creatinine levels
These signs indicate a decline in kidney function and may necessitate further evaluation.
What are the interventions for prevention and early detection of renal failure?
Carefully monitor I&O and laboratory values
Monitoring is crucial for identifying changes in renal function early.
What is urinary retention?
Accumulation of urine in the bladder
This condition can lead to discomfort and complications if not addressed.
What may cause urinary retention?
Poor muscle tone due to anesthesia, anticholinergic medications, handling of tissues during surgery, or inflammation in the pelvic region
Understanding the causes can help in prevention and management.
What are the clinical signs of urinary retention?
Bladder distention, suprapubic pain, diminished urine output or output less than fluid intake, inability to void or small, frequent voidings, hypertension, restlessness
These signs can help healthcare providers identify urinary retention early.
What are the interventions for prevention and early detection of urinary retention?
Monitor for clinical signs, provide privacy and adequate time to urinate, catheterize if needed
Prompt intervention can alleviate discomfort and prevent complications.
What is a urinary tract infection (UTI)?
Infection in the urinary tract related to catheterization, stagnant urine in the bladder, or instrumentation of the urinary tract
UTIs are common and can lead to more serious infections if untreated.
What are the clinical signs of a urinary tract infection?
Urinary frequency, suprapubic discomfort, burning on urination, cloudy urine
Recognizing these signs early can lead to prompt treatment.
What are the interventions for prevention and early detection of urinary tract infections?
Monitor for clinical signs, monitor I&O, use aseptic technique with catheterization and perineal care, provide adequate IV and oral fluids
These practices help minimize the risk of infection.
What is dehiscence in surgical terms?
Separation of one or more layers of the wound due to poor nutritional status, obesity, strain on suture line, inadequate closure of muscles, or wound infection
Dehiscence can lead to complications if not addressed promptly.
What are the clinical signs of dehiscence?
A pop or tearing sensation, especially with sudden straining, and an immediate increase in serosanguinous drainage
Sudden straining can occur from coughing, vomiting, or changing positions in bed.
List the interventions for prevention and early detection of dehiscence.
- Provide adequate nutrition
- Use binders to support the incision
- Have client avoid strain
- Monitor for infection
These interventions are crucial to minimize the risk of complications.
What is evisceration in surgical terms?
Protrusion of organs or tissues through the separated incision
Evisceration is often a result of dehiscence.
What are the clinical signs of evisceration?
Visible protrusion of organs through the incision
This is a serious condition that requires immediate medical attention.
True or False: The interventions for prevention and early detection of evisceration are different from those for dehiscence.
False
The interventions for evisceration are the same as those for dehiscence.
What is wound infection?
Inflammation or drainage from a wound due to growth of microorganisms secondary to inadequate aseptic technique or pathogens already present in surgical area.
List the clinical signs of wound infection.
- Localized swelling
- Redness
- Heat
- Pain
- Fever greater than 38°C (100.4°F)
- Foul-smelling drainage
- Change in the color of the drainage
What is an effective intervention for preventing wound infection in the preoperative period?
Effective skin prep
What should be done according to guidelines in the intraoperative period to prevent infection?
Surgical scrub
What should be monitored for early detection of wound infection?
Systemic and localized signs and symptoms of infection
What specific areas should be inspected to check for signs of infection?
- Incision and drain areas for redness and extreme warmth
- Surgical dressings for drainage and odor
Which vital sign is especially important to monitor for signs of infection?
Temperature
What technique should be maintained during surgical dressing changes?
Aseptic nontouch technique
What is recommended for wound cleansing up to 48 hours post-operation?
Sterile saline
What should be limited to help prevent wound infection?
The number of visitors, as appropriate
What action should be taken as needed for wound infection?
Obtain cultures
What should be encouraged to support recovery from wound infection?
Sufficient nutritional and fluid intake
What should clients be taught regarding wound infection?
Signs of infection
What is the key point regarding potential nursing diagnoses?
Write potential nursing diagnoses only if a patient has a higher risk for the problem than the average surgical patient.
What nursing diagnosis might be used for patients with a history of peripheral arterial disease?
Peripheral Tissue Perfusion Alteration Risk.
What nursing diagnosis is appropriate for patients who have lost a large amount of blood in surgery?
Fluid Volume Deficit Risk.
Identify a nursing diagnosis for patients with weak accessory muscles for breathing.
Breathing Pattern Impairment Risk.
What nursing diagnosis applies to patients with compromised immune status?
Infection Risk.
When should an actual nursing diagnosis be used?
Whenever a problem becomes actual instead of merely potential.
What is a common postoperative nursing diagnosis related to recovery time?
Surgical Recovery Delay.
What is a common postoperative nursing diagnosis that nearly every surgical patient experiences?
Acute Pain.
What are independent nursing interventions to relieve pain postoperatively?
Teaching the patient to splint the incision.
What usually needs to be administered for adequate pain relief in the early post-op period?
Analgesics, which require a medical prescription.
What nursing diagnosis is typically unnecessary for postoperative patients?
Knowledge Deficit diagnosis.
What is the nursing diagnosis related to postoperative patients experiencing pain and stressors of surgery?
Activity Intolerance
This diagnosis is associated with limitations in physical activity due to pain and the effects of surgery.
List three NOC outcomes for postoperative patients with activity intolerance.
- Activity Tolerance
- Energy Conservation
- Psychomotor Energy
These outcomes aim to assess the patient’s ability to engage in activities without undue fatigue.
What are the goals related to vital signs in postoperative patients with activity intolerance?
- O2 saturation not compromised with activity
- Heart rate not compromised with activity
- Respiratory rate not compromised with activity
- Systolic and diastolic BP not compromised with activity
These goals are essential to ensure the patient’s safety during physical activity.
What should be ensured regarding the ease of breathing for postoperative patients during activity?
Ease of breathing with activity not compromised
This goal is critical to monitor the patient’s respiratory status during physical exertion.
What is one goal related to the patient’s ability to perform daily activities?
Ease of performing activities of daily living not compromised
This goal focuses on maintaining the patient’s independence and functional abilities.
Fill in the blank: The patient should be able to __________ with physical activity not compromised.
speak
This indicates that the patient’s respiratory function and energy levels are adequate.
What is an indicator that energy restoration is successful after rest?
Energy restored after rest, not compromised
This indicates effective recovery and readiness for activity.
What are two nursing interventions related to activity for postoperative patients?
- Activity Therapy
- Energy Management
These interventions aim to enhance the patient’s physical activity levels while managing energy expenditure.
What should nurses assist patients with to promote activity?
- Choosing appropriate activities
- Focusing on strengths
- Identifying activity preferences
This approach encourages patient engagement and motivation in their recovery process.
What is a recommended technique to reduce competition for oxygen supply during activities?
Arrange physical activities to avoid activity immediately after meals
This helps ensure that the body has adequate oxygen for both digestion and physical exertion.
What should be avoided during scheduled rest periods for postoperative patients?
Care activities
This is to ensure that patients have uninterrupted time to recover and rest.
What is one way to assist patients who are unable to transfer or walk?
Assist to sit on side of bed (‘dangle’)
This technique can help improve circulation and prepare the patient for standing or walking.
What should nurses monitor during activity for postoperative patients?
Location and nature of pain
Monitoring pain helps assess the patient’s tolerance to activity and guide further interventions.
What teaching should be provided to prevent fatigue in postoperative patients?
Activity organization and time management techniques
This empowers patients to manage their energy levels effectively.
What is the nursing diagnosis related to postoperative patients experiencing pain and stressors of surgery?
Activity Intolerance
This diagnosis is associated with limitations in physical activity due to pain and the effects of surgery.
List three NOC outcomes for postoperative patients with activity intolerance.
- Activity Tolerance
- Energy Conservation
- Psychomotor Energy
These outcomes aim to assess the patient’s ability to engage in activities without undue fatigue.
What are the goals related to vital signs in postoperative patients with activity intolerance?
- O2 saturation not compromised with activity
- Heart rate not compromised with activity
- Respiratory rate not compromised with activity
- Systolic and diastolic BP not compromised with activity
These goals are essential to ensure the patient’s safety during physical activity.
What should be ensured regarding the ease of breathing for postoperative patients during activity?
Ease of breathing with activity not compromised
This goal is critical to monitor the patient’s respiratory status during physical exertion.
What is one goal related to the patient’s ability to perform daily activities?
Ease of performing activities of daily living not compromised
This goal focuses on maintaining the patient’s independence and functional abilities.
Fill in the blank: The patient should be able to __________ with physical activity not compromised.
speak
This indicates that the patient’s respiratory function and energy levels are adequate.
What is an indicator that energy restoration is successful after rest?
Energy restored after rest, not compromised
This indicates effective recovery and readiness for activity.
What are two nursing interventions related to activity for postoperative patients?
- Activity Therapy
- Energy Management
These interventions aim to enhance the patient’s physical activity levels while managing energy expenditure.
What should nurses assist patients with to promote activity?
- Choosing appropriate activities
- Focusing on strengths
- Identifying activity preferences
This approach encourages patient engagement and motivation in their recovery process.
What is a recommended technique to reduce competition for oxygen supply during activities?
Arrange physical activities to avoid activity immediately after meals
This helps ensure that the body has adequate oxygen for both digestion and physical exertion.
What should be avoided during scheduled rest periods for postoperative patients?
Care activities
This is to ensure that patients have uninterrupted time to recover and rest.
What is one way to assist patients who are unable to transfer or walk?
Assist to sit on side of bed (‘dangle’)
This technique can help improve circulation and prepare the patient for standing or walking.
What should nurses monitor during activity for postoperative patients?
Location and nature of pain
Monitoring pain helps assess the patient’s tolerance to activity and guide further interventions.
What teaching should be provided to prevent fatigue in postoperative patients?
Activity organization and time management techniques
This empowers patients to manage their energy levels effectively.
What are the causes of pain that should be provided to clients?
Causes of the pain, duration of pain, anticipated discomforts from procedures
Example: Teach the client to splint incision when ambulating.
What is the optimal method for pain relief?
Provide optimal pain relief with analgesics as appropriate.
What does PCA stand for in pain management?
Patient-Controlled Analgesia
When should interventions be implemented to manage pain?
Before pain becomes severe.
What should be done before a client engages in activity to manage pain?
Medicate before activity to increase participation.
What are some nonpharmacological pain relief measures?
Visualization, progressive muscle relaxation.
What approach should be utilized for effective pain management?
Multidisciplinary approach.
What is the nursing diagnosis related to anxiety?
Anxiety r/t change in health status, hospital environment.
What are the NOC outcomes for anxiety?
Anxiety Level, Anxiety Self-Control.
What are the NOC goals for managing anxiety?
- Consistently uses effective coping strategies
- Often seeks information to reduce anxiety
- Consistently uses relaxation techniques to reduce anxiety
- Often maintains concentration
- Verbalizes that anxiety is mild
- Minimal restlessness, hand wringing, muscle tension, facial tension, difficulty concentrating.
What is a key NIC intervention for anxiety reduction?
Anxiety Reduction.
What nursing activities can help reduce anxiety?
- Use calm, reassuring approach
- Observe for verbal and nonverbal signs of anxiety
- Explain all procedures and activities
- Provide information concerning diagnosis, treatment, prognosis
- Administer back rub or neck rub as appropriate
- Listen attentively
- Create trusting atmosphere
- Assist the client to identify stressful situations.
What are signs of minimal anxiety response?
Minimal changes in vital signs; no dilated pupils, sweating, or dizziness.
What should be encouraged to help clients recognize anxiety?
Assist the client to recognize that they are anxious.
What should clients be encouraged to verbalize regarding their surgical procedure?
Feelings, perceptions, and fears related to the surgical procedure.
What role do family visits play in anxiety management?
Encourage family visits if these ease the client’s stress.
What should clients be instructed in to help manage anxiety?
Use of relaxation techniques.
What is the nursing diagnosis related to nausea?
Nausea r/t manipulation of gastrointestinal tract, decreased peristalsis secondary to anesthesia
‘r/t’ stands for ‘related to’.
What are the NOC outcomes for nausea management?
- Nausea & Vomiting Control
- Nausea & Vomiting: Disruptive Effects
- Nausea & Vomiting Severity
- Nutritional Status: Food & Fluid Intake
NOC stands for Nursing Outcomes Classification.
What is one goal for NOC related to nausea?
No nausea, or intensity only mild
This goal aims to minimize the impact of nausea on the patient’s quality of life.
What should patients recognize as part of nausea management goals?
- Recognizes onset of nausea
- Recognizes precipitating stimuli
Understanding triggers can help patients avoid or mitigate nausea.
What are the NIC interventions for nausea management?
- Nausea Management
- Medication Management
NIC stands for Nursing Interventions Classification.
What information should be provided to patients regarding nausea and vomiting?
- Cause of nausea and vomiting
- Expected duration of symptoms
Providing information helps patients understand their condition better.
What should be explained about antiemetic treatment?
- Goals
- Effects
- Possible side effects
Understanding antiemetics helps in managing expectations and adherence to treatment.
What is the limited role of administering parenteral fluids?
To prevent dehydration and to administer supplemental electrolytes (e.g., potassium)
Parenteral fluids are used when oral intake is not possible.
Fill in the blank: Clients should be encouraged to monitor their own nausea experience using a _______.
symptom diary
A symptom diary helps track patterns and triggers related to nausea.
What strategies should clients learn for nausea management?
Strategies for managing own nausea
Empowering clients with self-management strategies is crucial for effective care.
What should be included in a complete assessment for nausea?
- Frequency
- Duration
- Severity
- Precipitating factors
A thorough assessment helps in understanding the patient’s condition and planning care.
What is a common observation related to food and fluid intake in patients experiencing nausea?
Only mild decrease in food and fluid intake
Indicates that while the patient may not be consuming as much, they are not severely affected.
What weight change is typically reported in patients experiencing nausea?
No weight loss
Suggests that the patient is maintaining their weight despite nausea.
What bothersome issues may patients report concerning antiemetic treatment?
Reports bothersome side effects from antiemetics
Side effects can impact compliance and effectiveness.
What is a common report regarding the effectiveness of antiemetic treatment?
Reports failure of antiemetic treatment
Indicates that the medications are not providing the desired relief.
What should be observed for in patients experiencing nausea?
Nonverbal cues of discomfort
Important for understanding the patient’s experience beyond verbal communication.
What past experiences should be evaluated in patients with nausea?
Past experiences with nausea
Helps in tailoring treatment strategies based on individual history.
What types of techniques should be discussed if anxiety is suspected in patients with nausea?
Relaxation and distraction techniques
Techniques like guided imagery, self-hypnosis, biofeedback, and music therapy may be beneficial.
What should be encouraged for oral hygiene in patients experiencing nausea?
Frequent oral hygiene unless it stimulates nausea
Maintaining oral health can be important, but care must be taken to avoid triggering nausea.
What types of food are recommended for patients experiencing nausea?
Cold, clear, odorless foods
These are often more tolerable for patients with nausea.
What dietary advice is given regarding the composition of meals for those with nausea?
High-carbohydrate and low-fat foods; small, frequent meals
This helps reduce the likelihood of nausea and promotes easier digestion.
What beverage is suggested for patients experiencing nausea, and how should it be consumed?
Drink cola, but not too cold; suck on an ice cube, sorbet, or a piece of frozen fruit
These can be soothing and may help with nausea.
How long should a patient sit in an upright position after eating?
30 to 45 minutes
This position can aid in digestion and reduce the risk of nausea.
What environmental factors should be controlled in the room of a patient experiencing nausea?
Odors and unpleasant visual stimuli
Minimizing these factors can help create a more comfortable environment.
What type of medications should be administered for nausea?
Antiemetic medications
These are specifically designed to alleviate nausea and vomiting.
When should a referral to a dietician be considered for a patient experiencing nausea?
As needed
A dietician can provide specialized dietary advice to manage nausea effectively.
What is the nursing diagnosis related to constipation?
Constipation r/t decreased activity, decreased food or fluid intake, decreased peristalsis secondary to anesthesia, pain medication
What is the NOC outcome for a patient with constipation?
Bowel Elimination
What are the NOC goals for bowel elimination?
- Elimination pattern not compromised
- Reports ease of stool passage not compromised
- Bowel sounds not compromised
- Muscle tone to evacuate stool not compromised
- Passes soft, formed stool in amount appropriate for diet
- No pain with passage of stool
What is one non-goal related to constipation management?
Bloating not present
What are the NIC interventions for constipation?
- Bowel Management
- Constipation/Impaction Management
What nursing activities should be performed for a patient with constipation?
- Monitor for signs and symptoms of constipation
- Note date of last bowel movement
- Monitor bowel sounds
- Monitor frequency, consistency, shape, volume, and color of bowel movements
- Teach the client about specific foods that assist promotion of bowel regularity
- Insert a rectal suppository, enema, or irrigation, as needed
- Evaluate medication profile for GI side effects (e.g., narcotic analgesics)
- Give warm liquids after meals
- Instruct the client in foods high in fiber
What is the nursing diagnosis discussed in the text?
Urinary Retention
Related to anesthesia, preoperative medications (anticholinergics), pain, fear, unfamiliar surroundings, and client’s position.
What is the NOC outcome related to Urinary Retention?
Urinary Elimination
List the NOC goals for managing Urinary Retention.
- Empties bladder completely
- Fluid intake not compromised
- No hesitancy with urination
What are the NIC interventions for Urinary Retention?
- Urinary Retention Care
- Urinary Catheterization
What nursing activities are involved in managing Urinary Retention?
Perform comprehensive urinary assessment
This includes fluid intake, urinary output, voiding pattern, cognitive function, and preexisting urinary problems.
What is the subjective feeling of an empty bladder referred to?
Reports subjective feeling of empty bladder
This refers to the patient’s perception, which may not always correlate with actual bladder volume.
What should be provided to ensure privacy during elimination?
Provide privacy for elimination
This is essential for patient comfort and dignity during the process.
How long should a client be allowed to empty their bladder?
At least 10 minutes
This allows sufficient time for the client to relax and void.
What technique can be used to estimate the degree of bladder distention?
Use percussion and palpation
These techniques help assess bladder fullness non-invasively.
What nursing diagnosis is appropriate when a patient requires more days to recover than the anticipated length of stay for surgery?
Delayed Surgical Recovery
This diagnosis encompasses various postoperative issues and does not require separate diagnoses for related symptoms unless indicated.
Name one NOC outcome related to post-procedure recovery.
Wound Healing: Primary Intention
This indicates the expected healing process following surgical intervention.
What are some NIC interventions for managing postoperative patients?
Embolus Precautions, Exercise Therapy: Ambulation, Incision Site Care
These interventions are crucial for preventing complications and promoting recovery.
What nursing activity involves monitoring for postoperative complications?
Monitor for postoperative complications
This includes assessing for signs of infection, bleeding, or delayed healing.
What is a potential nursing diagnosis related to pain following surgery?
Activity Intolerance r/t pain
This diagnosis indicates the patient may struggle with usual activities due to pain levels.
What is an appropriate dietary recommendation to support recovery?
Encourage increased intake of protein, iron, and vitamin C
These nutrients are vital for healing and recovery post-surgery.
What should be monitored to ensure postoperative readiness for discharge?
No postoperative complications
This includes assessing for bleeding, infection, or delayed wound healing.
Fill in the blank: The nursing diagnosis ‘Anxiety’ may relate to a change in _______.
health status
This reflects the patient’s emotional response to their surgical experience.
True or False: Nausea can occur due to manipulation of the gastrointestinal tract during surgery.
True
This is a common postoperative symptom due to anesthesia and surgical intervention.
What should be taught to clients regarding incision care?
Teach the client and family how to care for the incision
Proper education on incision care is essential for preventing infection and promoting healing.
What is one goal of pain management postoperatively?
Facilitate pain relief
This can be achieved through various pharmacological and non-pharmacological measures.
What is a sign of adequate postoperative recovery related to blood pressure?
Systolic BP within 20 mm Hg of baseline
Monitoring blood pressure is crucial to assess the patient’s stability post-surgery.
What is one expected outcome for ambulation post-surgery?
Ambulation tolerance in normal range
This indicates the patient is recovering physically and can resume movement comfortably.
What is a common cause of constipation postoperatively?
Decreased activity, decreased food or fluid intake, decreased peristalsis secondary to anesthesia, pain medication
Constipation can develop due to a combination of factors that affect gastrointestinal function.
What are some factors contributing to urinary retention after surgery?
Anesthesia, preoperative medications (anticholinergics), pain, fear, unfamiliar surroundings, client’s position
Urinary retention can be influenced by both physical and psychological factors surrounding the surgical experience.
What is the significance of planning outcomes in postoperative care?
A comprehensive plan of care includes NOC standardized outcomes and individualized goals
Effective planning helps ensure that patients receive tailored care that addresses their specific recovery needs.
How has the postoperative period changed due to shortened hospital stays?
The postoperative period now extends well past the patient’s discharge from the hospital
This change emphasizes the need for ongoing care and monitoring after leaving the hospital.
Who often continues to follow the patient at home after surgery?
A home health nurse
Home health nurses provide support to facilitate a smoother transition through the postoperative process.
What are some examples of NOC standardized outcomes for the postoperative period?
- Activity Tolerance
- Ambulation
- Anxiety Level
- Blood Loss Severity
- Bowel Elimination
- Circulation Status
- Energy Conservation
- Hydration
- Nausea and Vomiting Severity
- Pain Control; Pain Level
- Post-Procedure Recovery
- Urinary Elimination
- Wound Healing: Primary Intention
These outcomes help in assessing patient recovery and setting specific goals.
Fill in the blank: A comprehensive plan of care for postoperative patients includes _______ standardized outcomes.
[NOC]
NOC stands for Nursing Outcomes Classification, which provides a framework for measuring patient outcomes.
True or False: The postoperative period is only relevant while the patient is in the hospital.
False
The postoperative period is an ongoing process that extends beyond hospital discharge.
What is the primary focus of most postoperative interventions?
Prevention and early detection of potential complications
Collaborative problems are addressed through these interventions.
What should specific nursing activities be designed to address?
Identified nursing diagnoses
This includes pain management and routine postoperative teaching.
What is the primary goal of postoperative pain management?
Minimize the dose of medications while providing adequate pain management
This approach helps to lessen side effects.
Why is it important to consider individual factors in pain control?
Because no one drug is likely to work for every person with pain
Factors include medical condition, age, fear, surgical procedure, and response to care.
What approach should be used to formulate a pain relief plan for complicated patients?
An interprofessional team approach
This is essential for patients with medical comorbidities.
What are some benefits of adequate pain management?
Early mobilization, shorter hospital stay, reduced hospital costs, increased patient satisfaction
These benefits highlight the importance of effective pain control.
What routes of analgesics are usually administered postoperatively?
IV, epidural medications, oral opioids, nonopioid analgesics
This progression typically occurs in the immediate postoperative period.
What is the preferred method of administering opioids postoperatively?
Oral opioids should be given preference to IV opioids
Intramuscular injections can cause additional pain and have unreliable absorption.
What should be administered around-the-clock in addition to pain control measures?
NSAIDs if not contraindicated
This helps to maintain effective pain control.
What challenges exist in providing pain control for older adults?
Concerns about impaired cognition, medical comorbidities, drug interactions, and appropriate dosing
These factors often lead to older adults being undermedicated.
What side effects of analgesics should be monitored?
Respiratory depression, hypotension, allergic reaction
Monitoring is crucial to prevent complications.
What symptoms did women report improved after receiving acupuncture post-surgery?
Pain, nausea, anxiety, and increased ability to cope with symptoms
Acupuncture may serve as a nonpharmacologic intervention for symptom management in women undergoing breast cancer surgery.
What is the purpose of a single-use pain relief pump?
Administers a continuous, regulated flow of local anesthetic through a catheter directly into the surgical site
It reduces the need for opioids and associated complications.
How long can a single-use pain relief pump remain in place?
Up to 5 days, depending on the amount of anesthetic included
The pump is filled with 65 to 750 mL of medication.
Why is postoperative teaching important?
Most patients must perform quite a bit of self-care
Teaching reinforces preoperative content and aids in patient recovery.
What should be considered before attempting to teach a postoperative patient?
Ensure the patient is comfortable but alert
Avoid teaching when the patient is in pain, needs to void, or is drowsy from opioids.
What is the purpose of incentive spirometry?
Facilitates deep breathing, increases lung volume, and promotes coughing to clear mucus
It is prescribed for patients at high risk for atelectasis and pneumonia.
What should be included in preoperative teaching if a patient will use an incentive spirometer postoperatively?
Explain its use to the patient
This helps prepare the patient for postoperative care.
Fill in the blank: A single-use pain relief pump can be carried in a _______.
small bag
True or False: Acupuncture is a pharmacologic intervention for symptom management.
False
Acupuncture is a nonpharmacologic intervention.
What should be monitored when using incentive spirometry?
The patient’s progress using a gauge
All incentive spirometer devices include a gauge for this purpose.
What are the key postoperative treatment regimen topics?
Dressing changes, exercises, self-management, expected results, prescribed diet, prescribed activity, signs of complications, return visits, lifestyle changes, community resources
Each of these topics is crucial for patient recovery and understanding after surgery.
Why are antiembolism stockings used in postoperative care?
To promote peripheral circulation and prevent thrombophlebitis
They are particularly important as more than half of hospitalized patients are at risk for venous thromboembolism.
What should patients do to manage their postoperative treatment regimen?
Follow prescribed activities, dietary recommendations, and self-management strategies
This includes understanding how to recognize signs of complications.
What are the signs and symptoms of complications that require notification to a healthcare provider?
Signs of complications vary; patients should be educated on specific symptoms relevant to their surgery
Examples might include excessive bleeding, signs of infection, or severe pain.
What lifestyle changes may be needed after surgery?
Changes based on surgical type and personal health needs
This could include diet modifications, activity level adjustments, or smoking cessation.
True or False: Antiembolism stockings can replace the need for physical activity in postoperative patients.
False
Antiembolism stockings are an adjunct to, not a substitute for, patient activity.
What community resource was mentioned for postoperative patients?
Reach for Recovery
This resource may provide additional support and information for recovery.
Fill in the blank: More than half of hospitalized patients are at risk for _______.
venous thromboembolism
Surgical patients are at higher risk than medical patients.
What are the components of the prescribed diet for postoperative patients?
Nutritional guidelines tailored to individual needs
Patients should learn how to select foods appropriate for their recovery.
What is the rationale for postoperative exercises?
To promote recovery and prevent complications
Exercises help improve circulation and reduce the risk of thromboembolism.
What is the role of anticoagulant medications in postoperative care?
To prevent venous thromboembolism
These medications are often prescribed to surgical patients to minimize the risk of blood clots.
What is the purpose of an incentive spirometer?
To enable patients to monitor the depth of their breathing
Patients with abdominal or chest incisions may require pain medication to use the incentive spirometer.
What position should a patient be in when using an incentive spirometer?
Upright position in the bed or chair
What are the steps a patient should follow to use an incentive spirometer?
- Breathe out normally
- Place the mouthpiece in the mouth and create a seal with the lips
- Breathe in slowly and deeply through the mouthpiece
- Hold the breath for a slow count of three
- Remove the mouthpiece and exhale
- Rest for a few seconds
- Repeat 10 times every hour while awake
- Cough after each set of 10 deep breaths
How should a patient support an incision while coughing?
By holding a pillow firmly against it
What are Sequential Compression Devices (SCDs) used for?
To prevent thrombophlebitis in high-risk patients
Describe the function of Sequential Compression Devices (SCDs).
They apply sequential pressure to the chambers of a plastic sleeve wrapped around the legs, promoting venous return to the heart
What is the process of pressure application in SCDs?
Starting at the ankle, chambers inflate and deflate sequentially
What type of patients are at high risk for abdominal distention?
Patients having certain surgeries, such as those for bowel obstruction
What complications can abdominal distention cause?
Pain, increased postoperative respiratory problems, strain on suture lines, and interference with wound closure
What type of tube may be placed for gastric or intestinal decompression?
Nasogastric (NG) or nasointestinal tube
What may be performed if prolonged intestinal decompression is anticipated?
Gastrostomy
What is the purpose of decompression tubes?
To collect excess fluid and gas from the stomach or intestines
What are the conditions for suction to be continued with decompression tubes?
Until peristalsis resumes, bowel sounds are audible, and the patient is passing flatus
What does NPO stand for in a medical context?
Nothing by mouth
What is the connection between NG tubes and gastrointestinal suction?
NG tubes are used for gastric decompression and are typically connected to intermittent or continuous suction
