N106 Perioperative Nursing

Question 1

What are the two classifications of surgery?

Answer 1

Major : Extensive reconstruction of or altercation in body parts. (ie. Coronary artery bypass, gastric resection)
Minor: Minimal altercation in body parts (ie. cataracts, tooth extraction)

Question 2

What are the three levels of urgency regarding surgery?

Answer 2

Elective - Not medically necessary. Patient’s choice. (ie. Plastic Surgery)
Urgent - Necessary for patient’s health (ie. excision of tumor, gallstones)
Emergency - Must be done immediately to save life or preserve function (ie. control of hemmorrhage)

Question 3

What type of surgery restores function lost or reduced as a result of congenital anomalies? (ie. repair of cleft palate, closure of atrial-septal defect in heart)

Answer 3

Constructive Surgery

Question 4

What type of surgery involves the excision or removal of a diseased body part or removal of a growth or harmful substance? (ie, amputation, cholecystectomy, removal of appendix)

Answer 4

Abalation Surgery

Question 5

What type of surgery is done to confirm a diagnosis? (ie. exploratory laparotomy, breast mass biopsy)

Answer 5

Diagnostic Surgery

Question 6

What type of surgery replaces malfunctioning organs or structures? (ie. kidney, cornea, joints)

Answer 6

Transplant Surgery

Question 7

What type of surgery restores function or appearance to traumatized or malfunctioning tissue? (ie. internal fixation of fractures, car revusion, breast reconstruction)

Answer 7

Reconstructive Surgery

Question 8

What type of surgery relieves or reduces intensity of disease symptoms? (ie. colostomy, debridement of necrotic tissue)

Answer 8

Palliative Surgery

Question 9

Name the three stages of perioperative nursing

Answer 9

Preoperative - before surgery
Intraoperative - during surgery
Postoperative - after surgery

Question 10

What three factors can influence patient post-surgical outcomes?

Answer 10

Age: older patients have slower recovery than younger patients.
Physical Condition: patients with coexisting health problems have slower recovery than healthy patients.
Nutritional Factors: Malnurished and obese patients have slower recovery than patients with healthier diets.

Question 11

What preoperative preparation is done to the surgical site to reduce the risk of surgical site infection?

Answer 11

An antiseptic shower or antiseptic wipe and prep of the surgical site with Chlorhexidine.

Question 12

What can effective preoperative teaching reduce?

Answer 12

1. anxiety
2. the amount of anesthesia needed
3. postsurgical pain
4. corticosteroid production

Question 13

Ideally, in what time frame should preoperative teaching take place?

Answer 13

1-2 days before surgery

Question 14

What nursing interventions are done to prevent a thrombus?

Answer 14

• Early ambulation (6hrs post surgery, then every 1-2 hrs)
• Antiembolism stockings (TEDS)
• Sequential Compression Devices
• Leg exercises (flexion and extension, dorsiflexion, plantar flexion and pedal pushes)

Question 15

What are the duties of a circulating nurse?

Answer 15

• Prepares equipment and supplies
• Arranges supplies-sterile and non sterile
• Sends for patient
• Visits with patient preoperatively: verifies informed consent signed. identifies patient and answers questions, pre-op patient education
• Performs patient assessment
• Checks medical record
• Assists in transfer of patient
• Positions patient on operating table
• Scrubs the patient post anesthesia
• Maintains and documents counts of sponges, sharps and instruments throughout the procedure
• Provides supplies to scrub nurse as needed
• Observes sterile field closely and updates counts as items are used and/or added to sterile field
• Cares for surgical specimens
• Documents operative record and nurse’s notes
• Recounts sponges, sharps and instruments when closure of wound begins
• Transfers patient to the stretcher for transport to recovery area
• Accompanies patient to the recovery room and provides a report.

Question 16

What are the duties of a scrub nurse/tech?

Answer 16

• Is surgically scrubbed and dons sterile gown and gloves aseptically.
• Arranges sterile supplies and instruments
• Checks instruments for proper functioning.
• Counts sponges, sharps and instruments with circulating nurse
• Gowns and gloves surgeons as they enter operating room
• Assists with surgical draping of patient
• Maintains neat and orderly sterile field
• Corrects breaks in aseptic technique
• Observes progress of surgical procedure
• Hands surgeon instruments, sponges, and necessary supplies during procedure
• Identifies and handles surgical specimens correctly
• Maintains count of sponges, sharps and instruments so none will be misplaced or lost.

Question 17

When are the four times that sponges are counted during surgery?

Answer 17

1. Before the procedure to establish a baseline
2. Before closure of a cavity within a cavity
3. Before wound closure begins
4. At skin closure or end of procedure

Question 18

What are the guidelines for marking the surgical site?

Answer 18

• The surgeon or designee marks at or near the incision site, no other marks.
• The mark should be positioned to be visible after patient preping.
• The method of marking and type of marking should be organization wide (per policy)
• Patient should be involved in marking (Mark while patient is awake and alert)
• Final verification of the site mark should take place during the “Time Out”

Question 19

What are the components of a “Time Out”?

Answer 19

• It should be conducted in the OR/procedure room before procedure/incision
• It should involve the entire operative team
• Use active communication, and be briefly documented per policy
• Confirm correct patient identity
• Confirm correct side and site
• Confirm premedication antibiotics
• Agreement on the procedure to be done confirmed by all.

Question 20

What information must be included in a patient hand off to the PACU/ICU?

Answer 20

• Name of patient
• Name of surgeon
• Type of anesthesia
• Procedure performed
• Fluids given
• Antibiotics given
• Blood loss
• Local infiltrated into the wound
• Equipment, tubes, drains, wound vacs, etc.

Question 21

What is the priority for immediate observation and assessment by the PACU nurse?

Answer 21

1. AIRWAY
2. LOC
3. Circulation
4. Process through all systems

Question 22

What is the purpose of the Alderte Score and what is assessed?

Answer 22

Purpose: Identifies when patients are ready for discharge from PACU. Score must be 8-10 before discharge.
Evaluated when patient first comes to PACU then again every 30min-1hr after arrival.
Assesses Respiration, O2 Sat, Consciousness, Circulation & Activity.

Question 23

Term for thin, watery, exudate composing the serum portion of the blood.

Answer 23

Serous

Question 24

Term for wound complication that involves separation of a surgical wound; when sutures pull loose

Answer 24

Dehiscence

Question 25

Term for wound complication resulting in protrusion of an internal organ through a wound or surgical incision.

Answer 25

Evisceration

Question 26

What is the normal expectation for post-operative urinary function?

Answer 26

Assess every 2 hours for distention
Patient should have urine output w/in 8 hrs post-op
Output of at least 30 mL per hour

Question 27

When should postoperative ambulation occur and what are the benefits of early ambulation?

Answer 27

*Patient should be out of bed 6-8 hours post-op

Benefits: Increases circulation, rate and depth of breathing, urination, metabolism, peristalsis

Question 28

What is the post-op timeframe for bowel activity to return?

Answer 28

3-4 days

Question 29

What is the definition of singultus?

Answer 29

Hiccup; an involuntary contraction of the diaphragm followed by rapid closure of the glottis; irritation of the phrenic nerve
Causes could be abdominal distention or internal bleeding.

Question 30

What is the term for a genetic disorder characterized by sustained skeletal muscle contractions leading to hyperthermia?
What cooling measures are done to prevent death in patients who develop this syndrome?

Answer 30

Malignant hyperthermia
Cooling Measures:
Cover patient in ice
IV given cold - dantrolene, succinylcholine

Question 31

What post-op complication involves the collapse of the alveoli?
When does this generally occur?
What are signs/symptoms?
What is the treatment for this?
What interventions can help to prevent this?

Answer 31

Atelectasis
In the first 48 hours post-op
Signs/Symptoms: tachypnea, tachycardia, decreased breath sounds, crackles, decreased PaO2, decreased SaO2
Treatment: Deep breathing, incentive spirometer, nebulizer treatment (bronchodialators)
Prevention: Pre-op education and practice of TCDB, early post-op ambulation, medicate to reduce pain and splinting.

Question 32

What post-op complication is defined as the migration of a thrombus from a deep vein to the pulmonary arterial system?
What is the common onset timeframe?
What are the signs/symptoms?
What is the treatment for this?
What interventions can help to prevent this?

Answer 32

Pulmonary Embolism
Commonly occurs between the 7th-10th day post-op.
Signs/Symptoms: sharp, stabbing pain with breathing, SOB, tachycardia, restlessness
Treatment: oxygen, anticoagulants, hydration, analgesia for pain and anxiety
Prevention: Early ROM and ambulation post-op, DVT prophylaxis

Question 33

What post-op complication is defined as the paralysis of intestinal peristalsis?
What is the potential onset timeframt?
What are the signs/symptoms?
What is the treatment for this?
What interventions can help to prevent this?

Answer 33

Paralytic Ileus
Onset: First 3-4 days post-op
Signs/Symptoms: No bowel sounds, abdominal distention, anorexia, nausea
Treatments: Treat cause (electrolyte imbalance, pneumonia, decreased cardiac output)
NG Tube, monitor for intestinal obstruction.