exam prep

Question 1

Surgical settings

Answer 1

GP practices and specialist clinics Minor surgical procedures e.g. removal of small skin cancers, biopsies.

Hospitals - general public; private; day surgery; specialist

Primary health care services - pharmacies, optometrists, dentists

Question 2

Preoperative risk factors

Answer 2

Age
Nutritional status
Medical/surgical history
Medications
Lifestyle choices
Environmental
Procedural

Question 3

Older adult - considerations

Answer 3

Metabolism
Integument
Respiratory
Cardiovascular
Gastrointestinal
Liver and kidneys
Cognitive
Social

Question 4

Pre-operative patient preparation to reduce risk

Answer 4

• Pre-operative preparation – MDT approach
• Assessment by nurse/surgeon/anaesthetist/allied heath e.g. pharmacist, physiotherapist etc.
• Begin discharge planning (transfer of care)– assess patient needs & wants
• Verify understanding of pre-operative orders
• Assess nutrition status,
• Provide patient education to child and family to minimise complications

Question 5

Risks with obesity

Answer 5

Anaesthetic risk

Slower recovery from anaesthetic

Question 6

Risks with obesity - Anaesthetic risk

Answer 6

sleep apnoea, difficulty with intubation

Question 7

Risks with obesity - Slower recovery from anaesthetic

Answer 7

Adipose tissue stores inhalation gases, some drugs ↓mobility

May require higher dosage of medications

Question 8

Nurse’s role - intra-operative

Answer 8

Different roles in the operating theatre e.g. anaesthetic nurse, instrument/scrub nurse, circulation/scout

Patient safety in positioning, specimen collection, surgical counts, maintaining sterile field, assist surgeon/anaesthetist or other staff as required; organize and pass equipment

Question 9

Nurse’s role post-operative

Answer 9

Continuously assess patient ABCDE• Primary assessment - airway, breathing, circulation, disability, exposure

FGH
Secondary assessment - fluids/full set of vital signs, glucose/give comfort; head to toe assessment

Question 10

Electrolytes - sodium

Answer 10

nerve transmission, muscle contraction, maintains normal concentration of ECF

Question 11

Electrolytes - chloride

Answer 11

acid/base balance, nerve transmission

Question 12

Electrolytes - potassium

Answer 12

nerve transmission, muscle contraction, normal heart rhythms, concentration of ICF

Question 13

Electrolytes - calcium

Answer 13

nerve transmission, muscle contraction, strong bones & teeth, blood clotting, enzyme reactions

Question 14

Electrolytes - magnesium

Answer 14

enzyme reactions; cardiac & respiratory function

Question 15

Risk of fluid & electrolyte imbalance

Answer 15

due to release of hormones from surgical stress e.g. ADH & aldosterone, IV fluid administration, fluid shifts, transfusion, parenteral nutrition

Question 16

Risk of fluid & electrolyte imbalance - assess

Answer 16

Nausea, vomiting, diarrhoea, renal function, intake, output, serum electrolytes, medications (e.g. diuretics)

Question 17

Risk of fluid & electrolyte imbalance - potential complications

Answer 17

Electrolyte imbalances Ca2+, Mg2+, Na+, K+ E.g.•

Hyponatraemia Na+<135mmol/L due to release of antidiuretic hormone which retains H2O in the circulation & dilutes Na+

Hypokalaemia K+<3.5mmol/L due to release of aldosterone which retains Na+& excretes K+

Hypovolaemia/hypervolaemia(low or excess fluid volume)

Question 18

Nervous system - Potential post-operative complications

Answer 18

Confusion, chronic pain

Question 19

Musculoskeletal system - Potential post-operative complications

Answer 19

Loss of mobility and strength

Question 20

Endocrine System - Potential post-operative complications

Answer 20

Hormone imbalance such as loss of control with diabetes

Question 21

Psychosocial - Potential post-operative complications

Answer 21

Anxiety, depression, altered body image

Question 22

Respiratory system - complications - why?

Answer 22

Anaesthetics ↓respiratory function

Question 23

Respiratory system - complications

Answer 23

↑ secretions & bronchoconstriction & inability to exchange gases

Atelectasis due to incomplete expansion of the alveoli

Laryngospasm – uncontrolled spasm/ constriction of the laryngeal vocal cords due to anaesthetic gas or ET tube

Question 24

Nervous system - complications - why?

Answer 24

Anaesthetics → altered level of consciousness

Question 25

Nervous system - complications

Answer 25

Post-operative emergence delirium → agitation, confusion, restlessness, disorientation

Question 26

Urinary system - complications - why?

Answer 26

Anaesthetics can alter urinary function

Question 27

Urinary system - complications

Answer 27

Post-operative urinary retention

Fluid/electrolyte imbalance

Acute renal failure due to dehydration

Question 28

Integumentary system - complications - why?

Answer 28

Anaesthetics ↓ability to maintain homeostasis & body temperature & can ↑nausea

Question 29

Integumentary system - complications

Answer 29

Nerve injuries due to inappropriate positioning

Hypothermia →cardiac arrhythmias

Question 30

Endocrine system - complications - why?

Answer 30

Surgery/anaesthetics are a stress on the body & negative nitrogen balance. Anaesthetics suppress the immune system and pain effects the endocrine system

Question 31

Endocrine system - complications

Answer 31

Unable to cope with stress due to lack of cortisol response from adrenals and/or ↓N levels

Fluid/electrolyte imbalances due to release of ADH & aldosterone from surgical stress response

Question 32

Medication risk - complications - why?

Answer 32

Anaesthetics can cause ↑levels of some drugs in the body due to ↓blood flow to the liver. Some drugs can interact with some anaesthetic agents

Question 33

Medication risk - complications

Answer 33

Anticoagulants, antiplatelets, NSAIDs ↑bleeding

Patient goes into shock from hypotension