Peri-operative (Pre-operative and Post-operative) Flashcards
PACU/Recovery Room purpose
ongoing evaluation and stabilization of patients
anticipate, prevent and manage complications after surgery
hand off report
two way verbal interaction
report between two health care professionals is required to communicate the patient’s condition and needs
Assessments in PACU
history
initial assessment- LOC and awareness, Respiratory assessment, temp, pulse, resp, BP, O2 sat, examine surgical site for bleeding and drainage
discharge from PACU
determined by health care team
criteria for discharge: stable VS, normal temp, no overt bleeding, return of swallow and gag reflux, ability to take liquids, adequate UO
places people can be discharged to
hospital unit- ICU, telemetry, med surg
home
respiratory complications of surgery
atelectasis
pneumonia
PE
laryngeal edema
ventilator dependence
pulmonary edema
cardiovascular complications of surgery
HTN
hypotension
hypovolemic shock
dysrhythmias
VTE (venous thromboembolism)
DVT
heart failure
General complications of surgery
sepsis
anemia
anaphylaxis
pressure ulcer
wound infection
wound dehiscence
wound evisceration
skin rashes or contact allergies
gastrointestional complications of surgery
paralytic ileus
gastrointestinal ulcers and bleeding
neuromuscular complications of surgery
hypothermia
hyperthermia
nerve damage/paralysis
joint contractures
kidney/urinary complications from surgery
UTI
acute urinary retention
electrolyte imbalance
AKI
stone formation
focused assessment after discharge from PACU
airway
breathing
mental status
surgical incision site
vital signs
IV fluids
tubes (foley, NG monitor output)
pain assessment and management
common reactions after surgery
postoperative n/v
decreased or no peristalsis for up to 24 hours
paralytic ileus
constipation
Labs for after surgery
electrolytes
CBC
ABGs
Urinanalysis
Creatinine
Priority patient problems after surgery
potential for hypoxemia
potential for wound infection and delayed healing
acute pain
interventions to prevent hypoxemia
airway maintenance
monitor O2 sat/pulse ox
positioning
oxygen therapy
breathing exercises
movement/mobility
preventions for wound infection and delayed healing
dressing changes
asses wound for infection
assess drains
drug therapy
wound complications
dehiscence- partial or complete separation
evisceration- total separation of all wound layers and protrusion of internal organs
managing pain
drug therapy
relaxation
distraction
massage
positioning
patient teachings on discharge
prevention of infection
care and assessment of surgical wound
management of drains and catheters
nutrition therapy
pain management
drug therapy
peri-operative
combination of pre op, intra op and post op
pre-operative
begins when the patient is scheduled for surgery and ends at the time of transfer to the surgical site
post-operative
starts with completion of surgery and transfer of the patient to a specialized area of monitoring such as the PACU and may continue after discharge from the hospital until all activity restrictions have been lifted
primary roles of the nurse
educator, patient advocate, and promoter of health
1st priority ALWAYS
patient safety
categories of surgical risk
urgency: elective, urgent, emergent
degree of risk: minor, major
extent: simple, radical, minimally invasive
factors that increase risk for surgical complications
65 or older
medications
medical history
prior surgical experiences
family history
type of procedure planned
specific considerations for older adults
greater incidence of chronic illness
greater incidence of malnutrition
more allergies
greater incidence of impaired self care
inadequate support systems
decrease ability to withstand the stress of surgery and anesthesia
age related changes with cardiovascular, musculoskeletal, neurologic, renal/kidney, skin and respiratory systems
preoperative assessments
complete set of VS
focus on problem areas identified in patients history
s/s of infection
increased PT and INR
abnormal electrolytes
HCG test
psychosocial exam
lab test: UA, CBC, H/H, Clotting study, electrolyte, BUN, creatinine, ABGs
Imaging
ECG
informed consent
implies that the patient has sufficient information to understand:
nature and reason for surgery
who will be preforming surgery and other ppl present
all available options and risks
risk associated with procedure and potential outcomes
nurse’s responsibility in informed consent
that the consent form is signed, and you serve as a witness to the signature, not to the fact that patient is informed
nursing interventions
Teaching about identification and prevention of cardiovascular complications
Antiembolism stockings
Pneumatic compression devices
Leg exercises and early ambulation to promote venous return
Minimize anxiety
Assess the patient’s knowledge
Allow ample time for questions
Encourage communication, incorporating family or supportive persons
Promote rest
Provide opportunity for distraction
Plans for pain management
Determining the existence and nature of the patient’s advance directives
Implementing dietary restrictions (NPO)
(This will be determined by surgeon and anesthesiologist)
Administering regularly scheduled drugs
Ensuring intestinal preparation
Performing skin preparation
Preparing the patient for tubes, drains, and vascular access
Teaching about postoperative interventions to prevent respiratory complications
Deep diaphragmatic and expansion breathing
Incentive spirometry
Coughing and splinting
Turning and positioning
preoperative chart review
ensure all documentation, preoperative procedures, order are complete
check consent forms
preoperative patient preparation
Hospital gown
Antiembolism stockings or pneumatic compression devices, if ordered
Give valuables to a family member or lock them in a safe place
ID band in place, bracelet indicating allergies, bracelet indicating type and screen was completed
Remove dentures (some facilities allow them in the OR)
Remove all prosthetic devices, hairpins, and clips
Remove hearing aids (some facilities allow them in the OR)
Per hospital policy, remove nail polish, artificial nails
Have the patient empty their bladder
After drug administration that can affect cognition or judgment, raise siderails, ensure call system is within easy reach of the patient, and the bed is in low position
Answer questions and offer reassurance as needed
preoperative drugs
Sedatives
Hypnotics
Anxiolytics
Opioid analgesics
Anticholinergic agents
Antibiotics
Specific – purpose drug
May be given “on call” or after the patient is
transferred to the preoperative area
Because of an unexpected emergency case, a patient
scheduled for colon surgery at 8 AM has been rescheduled
for 11 AM. What is the nurse’s best action related to
preoperative prophylactic antibiotic administration according
to the Surgical Care Improvement Project (SCIP)
guidelines?
1. Administer the preoperative antibiotic at 7 AM as originally
prescribed
2. Administer the antibiotic at the same time as the other
prescribed preoperative drugs
3. Adjust the antibiotic administration time to be within 1 hour
before the surgical incision
4. Hold the preoperative antibiotic until the patient is actually in
the operating room and has been anesthetized
3
A 75-year old patient is having an exploratory
laparotomy tomorrow. The wife tells the nurse that at
night the patient gets up and walks around his room.
What priority action does the nurse take after hearing
this information?
1. Notifies the provider
2. Develops a plan to keep the patient safe
3. Obtains an order for sleep medication
4. Tells the patient not to get out of bed at night
2
The nurse is preparing the patient for surgery. Which
common laboratory tests does the nurse anticipate to be
ordered? (Select all that apply)
1. Total cholesterol
2. Urinalysis
3. Electrolyte levels
4. Uric acid
5. Clotting studies
6. Serum creatinine
2,3,5,6
The nurse has given the ordered preoperative
medications to the patient. What actions must the
nurse take after administering these drugs?
(Select all that apply)
1. Raise the side rails
2. Place the call light within the patient’s reach
3. Ask the patient to sign the consent form
4. Instruct the patient not to get out of bed
5. Place the bed in its lowest position
1,2,4,5
The nurse is monitoring a patient who is receiving
moderation sedation. An expected outcome for conscious
sedation is:
1. Blocked multiple peripheral nerves in a specific region
2. Decreased motor function in the targeted limb
3. Decreased level of consciousness, yet able to respond
to verbal commands
4. CNS depression, resulting in analgesia and amnesia,
with loss of muscle tone and reflexes
3
Which medical condition increases a patient’s risk
for surgical wound infection?
1. Anxiety
2. Hiatal hernia
3. Diabetes mellitus
4. Amnesia
3
The patient in the OR holding area tells the nurse that his
surgery is for the right foot. The patient’s chart states that
the surgery is for his left foot. What is the nurse’s best
action?
1. Do nothing because the patient is confused after
receiving premedications
2. Make a note about this in the nursing notes of the
patient’s chart
3. Call the nurse anesthetist to check whether the chart or
patient is correct
4. Notify the surgeon immediately before the patient goes
into the OR about this discrepancy
4
The nurse is about to give the prescribed pain
medication to a patient 30 minutes before a
scheduled dressing change. The patient states that
the drug makes him feel sick and he would rather
“tough it out.” What is the nurse’s best first
response?
1. “Tell me more about the sick feeling.”
2. “That’s fine. You have the right to refuse any drug.”
3. “Your surgeon would not have prescribed the drug if
it wasn’t needed.”
4. “Remember that the pain of the dressing change
would be worse than feeling sick.”
1
The nurse is assessing a postoperative patient’s
gastrointestinal system. What is the best indicator
that peristaltic activity has resumed?
1. Presence of bowel sounds
2. Patient states he is hungry
3. Passing of flatus or stool
4. Presence of abdominal cramping
3
What is the priority nursing assessment when a
patient is admitted to the PACU?
1. Level of consciousness
2. Airway and gas exchange
3. Dressing and incision status
4. Vital signs and body temperature
2
A patient who is 2 days postoperative for abdominal
surgery states, “I coughed and heard something pop.”
The nurse’s immediate assessment reveals an opened
incision with a portion of large intestine protruding.
Which statements apply to this clinical situation?
(Select all that apply)
1. Dehiscence has occurred
2. This is an emergency situation
3. The wound must be kept moist with normal saline-
soaked sterile dressings
4. This is an urgent situation
5. Evisceration has occurred
2,3,5
Which are interventions for the medical-surgical nurse
to use in preventing hypoxemia for the postoperative
patient? (Select all that apply)
1. Monitor the patient’s oxygen saturation
2. Position the patient supine
3. Encourage the patient to cough and breathe
deeply
4. Get the patient up ambulating as soon as possible
5. Instruct the patient to rest as much as possible
1,3,4
- You know that nursing care in PACU is
multifaceted and involves: (select all that apply)
A. Monitoring the patient’s physiological status
B. Intervening to ensure uneventful recovery from
anesthesia and surgery
C. Providing a safe environment for the patient
experiencing limitations in physical, mental, and
emotional function
D. Preventing or promptly treating complications in
the immediate post-anesthesia period
E. Upholding the patient’s rights to dignity, privacy,
and confidentiality
F. Utilizing high tech equipment so health care
costs will be justified
ABCDE
The nurse anesthetist gives you Mr. Potter’s
record, and prepares to give you a verbal report.
You know that her verbal report should include:
(Select all that apply)
A. Mr. Potter’s height and weight
B. The name of the surgical procedure Mr. Potter
had
C. Mr. Potter’s relevant health history
D. Anesthetic agents and other drugs that were
administered to Mr. Potter
E. Mr. Potter’s estimated blood loss during surgery
F. Mr. Potter’s religious preference
G.Mr. Potter’s fluid status and IV therapy
ABCDEG
In providing care for Mr. Potter, your first
step is to:
A. Assess your patient
B. Analyze patient data
C. Plan care
D. Intervene
E. Evaluate care
A
In PACU, many assessments and
interventions are done simultaneously.
However, the most critical, high-priority
assessment to be done with Mr. Potter is his:
A. Operative site
B. Skin integrity
C. Pulse
D. Airway
E. Blood Pressure
D
Which TWO assessments are your next
priorities?
A. Operative site
B. Skin color
C. Skin integrity
D. Pulse
E. Blood pressure
F. Orientation
DE
Since Mr. Potter is a smoker, he has
increased risk associated with surgery and
anesthesia. You are aware that smoking can
be responsible for which of the following in
the immediate postoperative period? (Select
all that apply)
A. Dehydration
B. Difficulty in clearing secretions
C. Cardiac dysrhythmias
D. Increased drowsiness
BC
Why is it important to measure arterial
oxygen saturation (SpO2) levels in
PACU?
A. Levels indicate how much oxygen is
available for use by tissues
B. Levels reflect the effectiveness of
intraoperative sedation
C. Levels reflect the ability to absorb
medications from the bloodstream
D. Levels reflect how much oxygen has
been used by tissues
A
Given Mr. Potter’s SpO2 of 97%, what
intervention is indicated?
A. Continue to monitor SpO2
B. Increase oxygen to 100%
C. Increase liter flow to 15 liters per minute
D. Remove Mr. Potter from the ventilator
A
You know that Mr. Potter’s shivering is a
physiological effort to do which of the
following?
A. Avoid seizure
B. Generate heat
C. Reset the body’s internal ‘thermostat’ setting
D. Eliminate heat
B
You recognize that a number of conditions
may be responsible for Mr. Potter’s low body
temperature. These include which of the
following? (Select all that apply)
A. Surgical wound infection
B. The anesthetics Mr. Potter received
C. The environmental temperature in the OR
D. Mr. Potter’s preoperative skin prep
E. The common use of cooled irrigation
solutions during surgery
BCD
Ice packs have been ordered for
application to Mr. Potter’s scrotum. As you
apply an ice pack, he asks the reason why.
You correctly advise Mr. Potter that the ice
pack will:
A. Promote healing at the operative site
B. Prevent inflammation and swelling of the
scrotum
C. Encourage blood flow to the surgical site
D. Help to prevent postoperative wound
infection
B
The opiate antagonist ____________
should be readily available in PACU should
reversal of respiratory depression be
necessary.
A. atropine sulfate
B. naloxone hydrochloride
C. protamine sulfate
D. aminophylline
B
You palpate Mr. Potter’s lower abdomen
and notes suprapubic distention. This is
most likely a result of:
A. Bleeding
B. A distended urinary bladder
C. Tension in abdominal muscles
D. Inflammation secondary to surgical
manipulation
B
You assist Mr. Potter to a sitting position
on the side of the PACU bed and allows
him to dangle his feet for ten minutes. This
will help prevent _____________ when Mr.
Potter stands.
A. Orthostatic hypotension
B. Orthostatic hypertension
C. Orthostatic paresis
D. Orthostatic paralysis
A
Before discharge, Mr. Potter is given
instructions regarding the need to: (Select
all that apply)
A. Report an elevated temperature
B. Monitor and protect his operative site
C. Avoid strenuous activity
D. Have a glass of wine at bedtime
E. Continue deep breathing exercises
F. Let someone else drive him home
G. Continue ice packs at home
ABCEFG
The nurse anesthetist reports that your patient is Mr. Potter, a 69-year-old man, who had a right inguinal hernia repair under general anesthesia. Mr. Potter smokes 1 1/2 packs of cigarettes per day and has a history of chronic bronchitis. He received no preoperative medication. During surgery, Mr. Potter received 900 mL of Lactated Ringer’s intravenously. Estimated blood loss was 20 mL. A variety of general anesthetics were administered. Mr. Potter remains intubated with a 7.5 oral endotracheal (ET) tube because he is not fully awake. Continued intubation in PACU will allow for maintenance of a patent airway until Mr. Potter is in a more alert state and can breathe and expectorate secretions on his own.
Mr. potter report… useful for practice questions
