Module 9

Question 1

Why is pre-op education and discharge planning important?

Answer 1

Pre-op: improves patient compliance and outcomes, improves patient satisfaction.

D/C planning: improves patient outcomes, reduces length of stay and reduces incidence of readmission.

Question 2

When is the consent form signed?

Answer 2

Before the procedure, after consultation with the surgeon and anaesthetist, and once patient understanding has been ensured.

Question 3

Define the following surgical procedures and identify specific pre-operative preparation for each.

Colonoscopy

Answer 3

Endoscopic examination of the large bowel and distal part of the small bowel with a camera.

Standard care + bowel prep. Pre-med may or may not be ordered.

Question 4

Define the following surgical procedures and identify specific pre-operative preparation for each.

Total Hip Replacement

Answer 4

Diseased or damaged portion of the neck of the femur is replaced with metal or ceramic components.

Standard care + education, analgesia plan, physio plan and DVT prophylaxis.

Question 5

Define the following surgical procedures and identify specific pre-operative preparation for each.

Appendicectomy

Answer 5

Surgery to remove the appendix. Usually emergency - infection risk.

Standard care + open or lap?, hair clipping, ultrasound/CT scan, DVT prophylaxis, antibiotic prophylaxis.

Question 6

Define the following surgical procedures and identify specific pre-operative preparation for each.

Gastrectomy

Answer 6

Removal of part or all of the stomach.

Standard care + education, analgesia plan, physio plan, DVT prophylaxis, nutrition plan (tube vs TPN), nutritional supplements, bowel care plan, social work/psychology

Question 7

Define the following surgical procedures and identify specific pre-operative preparation for each.

Arthroscopy

Answer 7

Examination of inside of a joint (knee, elbow) using a special illuminating instrument inserted through a small incision. An arthroscope can diagnose or treat conditions such as torn cartilage, torn ligaments or arthritis.

Standard care + education, analgesia plan, physio plan.

Question 8

Define the following surgical procedures and identify specific pre-operative preparation for each.

Mastectomy

Answer 8

Removal of the great - unilaterally or bilaterally.

Standard care + education, analgesia plan, DVT prophylaxis, physio plan, social work/psychology, breast nurse referral, wound management plan.

Question 9

Define the following surgical procedures and identify specific pre-operative preparation for each.

Rhinoplasty

Answer 9

Repair or reshaping of the nose for cosmetic reasons or to correct a structural defect.

May require mupiricin ointment to clear MRSA.
Standard care + expectations and understanding of the procedure.

Question 10

Define the following surgical procedures and identify specific pre-operative preparation for each.

Salpingectomy

Answer 10

Removal of one or both of the fallopian tubes.

Standard care + social work/psychology, expectations and understanding of procedure.

Question 11

Define the following surgical procedures and identify specific pre-operative preparation for each.

Laparotomy

Answer 11

Surgical incision into the abdomen. Commonly performed to examine abdominal organs and aid diagnosis.

Standard care + education, DVT prophylaxis, analgesia plan.

Question 12

Complete the following grid of pre-operative and post-operative medications.

Metoclopramide

Answer 12

Drug:
Metoclopramide: antiemetic, prokinetic.

Action:
Dopamine antagonist.

Side effects:
akathisia
drowsiness
dizziness
headache
extra-pyramidal side effects

Question 13

Complete the following grid of pre-operative and post-operative medications.

Temazapam

Answer 13

Drug:
Temazapam: Given as pre-med relaxant.

Action:
Benzodiazepines potentiate the inhibitory effects of GABA throughout the CNS, resulting in anxiolytic, sedative, hypnotic, muscle relaxant and anti-epileptic effects.

Side effects:
drowsiness
over sedation
lightheadedness
memory loss
hyper salivation
ataxia
slurred speech
dependence
effects on vision (blurriness, impaired tracking)
hiccups
hypotension
arrhythmias 
respiratory arrest

Question 14

Complete the following grid of pre-operative and post-operative medications.

Midazolam

Answer 14

Drug:
Midazolam: sedative during procedure; low dose used as antiemetic.

Actions:
Benzodiazepines potentiate the inhibitory effects of GABA throughout the CNS, resulting in anxiolytic, sedative, hypnotic, muscle relaxant and anti-epileptic effects.

Side effects:
drowsiness
over sedation
lightheadedness
memory loss
hyper salivation
ataxia
slurred speech
dependence
effects on vision (blurriness, impaired tracking)
hiccups
hypotension
arrhythmias
respiratory arrest

Question 15

Complete the following grid of pre-operative and post-operative medications.

Ondansetron

Answer 15

Drug: Ondansetron - treatment of N&V associated with cancer chemotherapy, post-op and radiotherapy.

Actions: CNS & PNS 5HT3 receptor blockade

Side effects:
constipation
headache
dizziness
transient rise in hepatic aminotransferases

Question 16

Complete the following grid of pre-operative and post-operative medications.

Oxycodone

Answer 16

Drug: Oxycodone.

Actions:
Opioid analgesics mimic endogenous opioids by activating opioid receptor in the CNS and PNS to produce analgesia, respiratory depression, sedation and constipation.
They reduce transmission of the pain impulse by acting pre and post synaptically in the spinal cord, and by modulating the descending inhibitory pathways from the brain. Cough suppression occurs in the medullary centre of the brain.

Side effects:
N&V
dyspepsia
drowsiness
dizziness
headache
orthostatic hypotension
itch
dry mouth
mitosis
urinary retention
constipation

Question 17

Complete the following grid of pre-operative and post-operative medications.

Clexane

Answer 17

Drug: Clexane

Actions:
Inactivate clotting factors IIa (thrombin) and Xa by binding to antithrombin III.
Prevention of VTE in surgical patients and in medical patients bedridden due to acute illness.
Treatment of venous thrombosis.
Prevention of extracorporeal thrombosis during haemodialysis.
Treatment of acute STEMI, non-STEMI and unstable angina.

Side effects:
bleeding
brusing and pain at injection site
hyperkalaemia
mild reversible thrombocytopenia
skin necrosis (usually at injection site)
osteoporosis and alopecia with long-term use
allergic reactions including urticaria and anaphylaxis

Question 18

What is the purpose of giving a pre-med?

Answer 18

To reduce anxiety

Question 19

Why are TED/anti-embolic stockings used?

Answer 19

Long, tight-fitting ‘socks’ that keep mild graduated pressure on the legs.
Proper size and fit is important in order for stockings to be effective.
They help the blood to constantly move in the leg providing good circulation, therefore preventing DVT.

Question 20

Why is it important to assess vital signs pre-operatively?

Answer 20

To provide a baseline to compare to postoperatively. May indicate preoperative issues which may delay administration of operative procedure.

Question 21

What is the reason for fasting patients before a surgical procedure?

Answer 21

Reduce risk of aspiration.

Question 22

When should a written consent be obtained?

Answer 22

Surgical, medical, radiology, oncology and endoscopy treatments/procedures requiring general, regional or local anaesthesia or IV sedation.

Invasive procedures or treatments where there are known significant risks or complications (e.g. blood transfusions)

Sterilisation of a minor and application of ECT.

Administration of medication with known high-risk complications or new, unusual medications that may have risks.

Drugs administered under the Special Access Scheme.

Participation in clinical trials and medical research.

Question 23

Why should the consent be signed before giving a pre-med?

Answer 23

Patient needs to be cognitively competent to sign a consent form, pre-medication diminishes as most produce some level of sedation and alteration in cognitive processes.

Question 24

Why is it important for patients to cease taking aspirin and NSAIDs (according to the doctor’s advice) for up to 2 weeks before any surgery?

Answer 24

Reduce risk of haemorrhage.

Question 25

What are your priorities on receiving a postoperative patient to the ward and why?

Answer 25

Assess:
Breathing and administer supplemental oxygen
Vital signs
LOC
Pain and administer analgesia
N&V and administer antiemetics
IV site/s 
Drainage tubes
Urine output

In addition:
Position patient to enhance comfort and in an appropriate and safe position for the type of surgery they have had. Reassure patient and family.
Give patient call bell.
Follow specific policy and post-op instructions set by surgeon and health organisation.

Question 26

What are some of the complications that may occur in your patient post-operatively?

Answer 26

Infection
Venous thromboembolism (DVT, PE)
Pneumonia
ventilation--perfusion mismatch
Hypoventilation (e.g. from opioid medication)
Haemorrhaging
Atelectasis
Pain
N&V
Oliguria
Post-operative pyrexia (common in THR)
Pressure sores
Constipation
Delirium

Question 27

How would you as a nurse detect these complications?

Answer 27

Frequent monitoring of vital signs, drains, IVs and other invasive devices, observation of signs exhibited by patient such as shivering, grimacing, guarding, GCS, wound assessment and pain assessment.