MS - Perioperative Care Flashcards
-lysis
Destruction of
E.g., electrolysis
-ectomy
Excision or removal of
E.g., appendectomy
-orrhaphy
Repair or suture of
E.g., herniorraphy
-oscopy
Looking into
E.g., endoscopy
-ostomy
Creation of opening into
E.g., colostomy
-otomy
Cutting into or incision of
E.g., tracheotomy
-plasty
Repair or reconstruction of
E.g., mammoplasty
Three purposes of the preoperative interview
- Obtain the patient’s health information
- Provide and clarify information about the planned surgery, including anesthesia
- Assess the patient’s emotional state and readiness for surgery, including his or her expectations about surgical outcomes
Herbal products and surgery
- Astragalus and ginseng - increase blood pressure before and during surgery
- Garlic, vitamin E, ginkgo, fish oils - can increase bleeding
- Kava and valerian - cause excess sedation
In general, discontinue all herbal supplements 2 to 3 weeks before any surgical procedure
HELPFUL HERBS AND VITAMINS
- Ginger - useful for preventing nausea associated with anesthesia
- Arnica - useful in soft tissue healing
- Multivitamins can be taken until day before surgery. Taking them on day of surgery on empty stomach can contribute to nausea and vomiting after surgery
Interaction of current medications and anasthetics
- Certain antidepressants can potentiate effect of opioids, agents that can be used for anesthesia
- Antihypertensive drugs may predispose patient to shock from combined effect of drug and vasodilator effect of some anesthetic agents
- Insulin or oral hypoglycemic agents may require dose or agent adjustments during perioperative period because of body metabolism, decreased oral intake, stress, and anesthesia
- Antiplatelet drugs (e.g. aspirin, clopidogrel) and NSAIDs inhibit platelet aggregation and may contribute to post-op bleeding
- Long-term anticoagulation therapy have options: (1) continue therapy, (2) withhold therapy for a time before/after surgery, or (3) withhold therapy and start subQ or IV heparin therapy during perioperative period
Which procedures are done for curative purposes (select all that apply)?
a. Gastroscopy
b. Rhinoplasty
c. Tracheotomy
d. Hysterectomy
e. Herniorrhaphy
d, e (hysterectomy, herniorrhaphy)
Gastroscopy is for the purpose of diagnosis. Rhinoplasty is done for a cosmetic improvement. A tracheotomy is palliative.
A patient is scheduled for a hemorrhoidectomy at an ambulatory day-surgery center. An advantage of performing surgery at an ambulatory center is a decreased need for
a. laboratory tests and perioperative medications.
b. preoperative and postoperative teaching by the nurse.
c. psychologic support to alleviate fears of pain and discomfort.
d. preoperative nursing assessment related to possible risks and complications.
a. laboratory tests and perioperative medications
Ambulatory surgery is usually less expensive and more convenient, generally involving fewer laboratory tests, fewer preoperative and postoperative medications, less psychologic stress, and less susceptibility to hospital-acquired infections. However, the nurse is still responsible for assessing, supporting, and teaching the patient who is undergoing surgery, regardless of where the surgery is performed.
A patient who is being admitted to the surgical unit for a hysterectomy paces the floor, repeatedly saying, “I just want this over.” What should the nurse do to promote a positive surgical outcome for the patient?
a. Ask the patient what her specific concerns are about the surgery.
b. Reassure the patient that the surgery will be over soon and she will be fine.
c. Redirect the patient’s attention to the necessary preoperative preparations.
d. Tell the patient she should not be so anxious because she is having a common, safe surgery.
a. Ask the patient what her specific concerns are about the surgery.
Excessive anxiety and stress can affect surgical recovery and the nurse’s role in psychologically preparing the patient for surgery is to assess for potential stressors that could negatively affect surgery. Specific fears should be identified and addressed by the nurse by listening and by explaining planned postoperative care. Falsely reassuring the patient, ignoring her behavior, and telling her not to be anxious are not therapeutic.
Many herbal products that are commonly taken cause surgical problems. Which herbs listed below should the nurse teach the patient to avoid before surgery to prevent an increase in bleeding for the surgical patient (select all that apply)?
a. Garlic
b. Fish oil
c. Valerian
d. Vitamin E
e. Astragalus
f. Ginkgo biloba
a, b, d, f (garlic, fish oil, vitamin E, ginkgo biloba)
Valerian may cause excess sedation. Astragalus may increase blood pressure before and during surgery.
Priority decision: When the nurse asks a preoperative patient about allergies, the patient reports a history of seasonal environmental allergies and allergies to a variety of fruits. What should the nurse do next?
a. Note this information in the patient’s record as hay fever and food allergies.
b. Place an allergy alert wristband that identifies the specific allergies on the patient.
c. Ask the patient to describe the nature and severity of any allergic responses experienced from these agents.
d. Notify the anesthesia care provider (ACP) because the patient may have an increased risk for allergies to anesthetics.
c. Ask the patient to describe the nature and severity of any allergic responses experienced from these agents.
Risk factors for latex allergies include a history of hay fever and allergies to foods such as avocados, kiwi, bananas, potatoes, peaches, and apricots. When a patient identifies such allergies, the patient should be further questioned about exposure to latex and specific reactions to allergens. A history of any allergic responsiveness increases the risk for hypersensitivity reactions to drugs used during anesthesia but the hay fever and fruit allergies are specifically related to latex allergy. After identifying the allergic reaction, the anesthesia care provider (ACP) should be notified, the allergy alert wristband should be applied, and the note in the record will include the allergies and reactions as well as the nursing actions related to the allergies.
During a preoperative review of systems, the patient reveals a history of renal disease. This finding suggests the need for which preoperative diagnostic tests?
a. ECG and chest x-ray
b. Serum glucose and CBC
c. ABGs and coagulation tests
d. BUN, serum creatinine, and electrolytes
d. BUN, serum creatinine, and electrolytes
BUN, serum creatinine, and electrolytes are used to assess renal function and should be evaluated before surgery. Other tests are often evaluated in the presence of diabetes, bleeding tendencies, and respiratory or heart disease.
During a preoperative physical examination, the nurse is alerted to the possibility of compromised respiratory function during or after surgery in a patient with which problem?
a. Obesity
b. Dehydration
c. Enlarged liver
d. Decreased peripheral pulses
a. Obesity
Obesity, as well as spinal, chest, and airway deformities, may compromise respiratory function during and after surgery. Dehydration may require preoperative fluid therapy and an enlarged liver may indicate hepatic dysfunction that will increase perioperative risk related to glucose control, coagulation, and drug interactions. Weak peripheral pulses may reflect circulatory problems that could affect healing.
What type of procedural information should be given to a patient in preparation for ambulatory surgery (select all that apply)?
a. How pain will be controlled
b. Any fluid and food restrictions
c. Characteristics of monitoring equipment
d. What odors and sensations may be experienced
e. Technique and practice of coughing and deep breathing, if appropriate
a, b, e (how pain will be controlled, any fluid and food restrictions, technique and practice of coughing and deep breathing if appropriate)
Procedural information includes what will or should be done for surgical preparation, including what to bring and what to wear to the surgery center, length and type of food and fluid restrictions, physical preparation required, pain control, need for coughing and deep breathing (if appropriate), and procedures done before and during surgery (such as vital signs, IV lines, and how anesthesia is administered). The other options are sensory and process information.
The nurse asks a preoperative patient to sign a surgical consent form as specified by the surgeon and then signs the form after the patient does so. By this action, what is the nurse doing?
a. Witnessing the patient’s signature
b. Obtaining informed consent from the patient for the surgery
c. Verifying that the consent for surgery is truly voluntary and informed
d. Ensuring that the patient is mentally competent to sign the consent form
a. Witnessing the patient’s signature
The health care provider is ultimately responsible for obtaining informed consent. However, the nurse may be responsible for obtaining and witnessing the patient’s signature on the consent form. The nurse may be a patient advocate during the signing of the consent form, verifying that consent is voluntary and that the patient understands the implications of consent, but the primary legal action by the nurse is witnessing the patient’s signature.
When the nurse prepares to administer a preoperative medication to a patient, the patient tells the nurse that she does not really understand what the surgeon plans to do.
a. What action should be taken by the nurse?
b. What criterion of informed consent has not been met in this situation?
a. The nurse should notify the health care provider because the patient needs further explanation of the planned surgery.
b. Sufficient comprehension
A patient scheduled for hip replacement surgery in the early afternoon is NPO but receives and ingests a breakfast tray with clear liquids on the morning of the surgery. What response does the nurse expect when the anesthesia care provider is notified?
a. Surgery will be done as scheduled.
b. Surgery will be rescheduled for the following day.
c. Surgery will be postponed for 8 hours after the fluid intake.
d. A nasogastric tube will be inserted to remove the fluids from the stomach.
a. Surgery will be done as scheduled.
The preoperative fasting recommendations of the American Society of Anesthesiology indicate that clear liquids may be taken up to 2 hours before surgery for healthy patients undergoing elective procedures. There is evidence that longer fasting is not necessary.
What is the rationale for using preoperative checklists on the day of surgery?
a. The patient is correctly identified.
b. All preoperative orders and procedures have been carried out and records are complete.
c. Patients’ families have been informed as to where they can accompany and wait for patients.
d. Preoperative medications are the last procedure before the patient is transported to the operating room.
b. All preoperative orders and procedures have been carried out and records are complete.
Preoperative checklists are a tool to ensure that many preparations and precautions performed before surgery have been completed and documented. Patient identification, instructions to the family, and administration of preoperative medications are often documented on the checklist, which ensures that no details are omitted.
A common reason that a nurse may need extra time when preparing older adults for surgery is their
a. ineffective coping.
b. limited adaptation to stress.
c. diminished vision and hearing.
d. need to include caregivers in activities.
c. diminished vision and hearing
One of the major reasons that older adults need increased time preoperatively is the presence of impaired vision and hearing that slows understanding of preoperative instructions and preparation for surgery. Thought processes and cognitive abilities may also be impaired in some older adults. The older adult’s decreased adaptation to stress because of physiologic changes may increase surgical risks and overwhelming surgery-related losses may result in ineffective coping that is not directly related to time needed for preoperative preparation. The involvement of caregivers in preoperative preparation. The involvement of caregivers in preoperative activities may be appropriate for patients of all ages.