Exam 3: Care of Surgical Client

Question 1

What are the three phases of surgery?

Answer 1

Pre-Operative
Intra-Operative
Post-Operative

Question 2

List the three primary types of surgery from least urgent to most urgent

Answer 2

Elective Surgery
Urgent Surgery
Emergency Surgery

Question 3

What data needs to be collected in the Preoperative phase of surgery?

Answer 3

1) Complete Health Hx
2) Medications
3) Informed Consent
4) Education

Question 4

When taking a complete health hx, what are important key points to gather from the pt?

Answer 4

Hx of surgieries and anesthesia (and how the pt reacted to anesthesia)
Advance Directives (Living Will, MPOA, Pt. Code Status, Blood Transfusions)
OSA Risks
Allergies and reactions
Comorbidities (These might affect healing)
Substance use by pt.

Question 5

When gathering pt. medications what info should you prioritize obtaining from the pt?

Answer 5

All medications (prescribed, OTC, herbal/vitamin supp.), Why the pt. takes said medications.

Question 6

What are nursing considerations when it comes to medications and surgical procedures?

Answer 6

The nurse should consider what medications can/should be taken prior to procedure, as well as what medications should be help prior to the procedure!

Question 7

What are the three primary components of informed consent from a pt?

Answer 7

Consent for the procedure
Consent for use of anesthesia
and Consent for Blood

Question 8

When should you provide Education to a surgical pt?

Answer 8

Always provide pt. education BEFORE the surgical procedure!

Question 9

What are key points to educate a pt. on PRIOR to surgery?

Answer 9

Time and length of the procedure (when should the pt arrive to facility, expected time of hospitilization,ect)
NPO status ( When should the pt stop eating and drinking and why is this necessary?)
Any preps ordered by the provider (Bowel preps, washing of the surgical site, ect)
And Post op expectations.

Question 10

What are post op expectations? (SLIDE 12)

Question 11

What is SCIP and what is it’s purpose?

Answer 11

SCIP= Surgical Care Improvement Plan

Which is often used as a guideline to streamline pt care and prevent post op infection!

Question 12

REVIST SLIDE 15 and 16!

Question 13

What are the 3 most common complications/risks with General Anesthesia?

Answer 13

1) Respiratory Depression
2) N/V
3) Alterations in thermoregulation.

Question 14

What are the three phases of General Anesthesia monitoring?

Answer 14

1) Induction
2) matinence
3) Emergence

Question 15

What is the difference between General Anesthesia and Regional Anesthesia?

Answer 15

General Anesthesia ideally provides an overall CNS sedativie effect and renders the pt. unconcisous.

Regional Anesthesia is applied only to the area in question and the pt. is concious during the procedure.

Question 16

What are influencing factors that dictate the use of GA from RA?

Answer 16

Length of surgery
Physical state of pt.

Question 17

What are some of the advantages of Regional Anesthetics over General Anasthetics?

Answer 17

Some advantages to RA are that they are noted for;
Reduced rates of post surgical pain
Reduced rates of bowel dysfunction
Reduced length of hospitilization
RA may also be used with other anesthesia

Question 18

What is the difference between an Epidural Anesthetic and a Spinal Anesthetic?

Answer 18

Epidural Anesthetic is injected into the epidural space via lumbar puncture.
Spinal Anesthetic is injected into the subarchonoid space where CSF is present.

Question 19

What are common side effects of an Epidural?

Answer 19

Hypotension, headache, and urinary retention

Question 20

What are side effects of a Spinal Anesthetic?

Answer 20

Hypotension, headache, or more severe spinal headache.

Question 21

What is Moderate Sedation and what procedures does it typically accompany?

Answer 21

Moderate Sedation= Concious Sedation
Which is typically seen in Endoscopy lab, Cath lab, and interventional radiology

Question 22

What are the two most common Moderate Sedatives?

Answer 22

Propofol
Midazolam

Question 23

With a Concious sedation will the pt. be able to remember the procedure?

Answer 23

NO! While the pt. may be able to respond to simple commands, they typically will not remember the procedure.

Question 24

Where is the pt transferred after post op if a procedure requires anesthesia?

Answer 24

PACU

Question 25

What must be IMMEDIATELY assessed once the pt. is transferred to the PACU?

Answer 25

Vitals- Q 15x 4, Q 30x2, then hourly while remaining in PACU
Alertness of pt once awake
Airway safety
Pain control
CNS/Neuro checks
Peripheral Vascular checks
Fluids
Wounds and drains

Question 26

What occurs with IV meds once pt nears discharge? What are the side effects of this transistion?

Answer 26

Pt. meds will transistion from IV meds to PO
with common side effects including hypotension, constipation, and 02 sat

Question 27

What should be monitored with I& post op?

Answer 27

IV fluids and antibiotics
Drains
Amount of urine along with times voided

*W/O Foley a pt has 6-8 hours post op to void!