Pre/Post-Op

Question 1

Nursing assessment for pre-op

Answer 1

Psychosocial
Health history
Medications
Allergies
Review of systems

Question 2

Possible nursing diagnoses for pre-op patient

Answer 2

Knowledge deficit
Anxiety/fear
Anticipatory grieving
Coping, ineffective
Family process, interrupted 
Sleep pattern, disturbed

Question 3

Physical examination

Answer 3

JACHO requires all patients admitted to or have a documented physical exam on the chart done by surgeon

Question 4

Common pre-op tests

Answer 4

Urinalysis:renal status, hydration,infection,disease
Chest x-ray:pulmonary disorders, cardiac enlargement
CBC w/dif:anemia, immune stat, infection
Electrolytes:metabolic status,renal function, diuretic effect
ABG,oximetry :pulmonary /metabolic function
PT/PTT:bleeding tendencies

Question 5

Common lab tests

Answer 5

Blood glucose:metabolic status, DM
BUN/creatinine: renal function 
EKG:cardiac disease, electrolyte abnormal 
Pulmonary function study
SGOT/SGPT,albumin: liver function 
Blood type/crossmatch 
Pregnancy

Question 6

Pre-op teaching

Answer 6

Breathing/coughing exercises
Leg/ankle/foot exercise
Turning in bed
OR expectations and post-op expectations

Question 7

Nurse management of pre-op patient

Answer 7

Pre-op teaching
Legal preparation
Day of surgery prep
Pre-op meds

Question 8

Legal consent for surgery

Answer 8

Adequate disclosure of DX, TX, risks/benefits, prognosis
Patient must demonstrate clear understanding of info
Consent must be voluntarily
Nurse role is witness/patient advocate

Question 9

Pre-op fasting requirements

Answer 9

Clear liquids: 2 hr
Breast milk: 4 hr. Infant formula: 6hr
Light meal: 6 hr (toast and clear liquid)
Heavy meal 8 hr (fried/fatty meal)

Question 10

Administration of pre-op meds

Answer 10

Benzodiazepines: versed/Valium/Ativan (anxiety,sedation)
Narcs:Morphine/Demerol/Fentanyl (relieve discomfort)
Gastric acid blockers: Tagamet/Zantac/Pepcid
Antacids:Sodium citrate (increase gastric pH)
Antiemetic: Reglan/Zofran(decrease n/v increase GI emptying
Anticholinergic:Atropine/Scopalamine (decrease oral/resp secretions, prevent bradycardia
Prophylactic antibiotics: (abdominal hip surgery)

Question 11

PACU care focus

Answer 11

1-2 hr focus is on ABC’s
Admission report
Surgical report(open wound, antibiotics, intake/output,position)
Monitoring: continuous EKG, pulse ox, temp,vitals

Question 12

Criteria for discharge from post anesthesia care unit

Answer 12

Awake or at baseline 
stable vital signs 
no excess bleeding or drainage 
no respiratory depression 
02 saturation above 90% on room air

Question 13

Criteria for discharge home for ambulatory patient

Answer 13

Meet P ACU criteria
Able to stand or walk if appropriate
Free dizziness orientated to baseline
Nausea vomiting controlled
Pain control able to urinate
Adult To transport home

Question 14

Movement of hospitalized patients to floor

Answer 14

PACU nurse calls report to floor nurse: type of surgery, unusual events, Orders,condition of patient
(vital signs level of conscious physical assessment I/O,dressings and drains tubes Foley in G

Question 15

Aldrete scoring

Answer 15

Assesses activity respiration circulation consciousness oxygen saturation

Question 16

Floor nurse’s assessment of patient from PACU

Answer 16

Time of arrival
Baseline vitals
Neuro stat/level of conscious 
Skin temp,color,moisture, appearance 
Connect to drains,suction,oxy
Urinary status
Assess wounds
Pain
Bed position for airway, safety, comfort
Check IV
Orient to call light use
Support emotional status
Implement post op orders

Question 17

Nursing diagnoses for alteration in respiratory function

Answer 17

Ineffective airway clearance
Ineffective breathing pattern
Impaired gas exchange

Question 18

Hypoxia

Answer 18

In adequate concentration of oxygen in arterial blood

S/S: restlessness, dyspnea,hypertension tachycardia diaphoresis cyanosis

Question 19

Nursing interventions for hypoxia

Answer 19

Administer oxygen
Eliminate cause
Monitor lung sounds
monitor pulse ox

Question 20

Airway obstruction causes

Answer 20

Blockage of airway by patients tongue
Supine position
Extremely sleepy patient
Laryngospasm
Retained secretions
Laryngeal edema

Question 21

What is a pulmonary embolism

Answer 21

Blood clot from deep veins, fat or tumor particle that travels through the blood stream to the pulmonary arteries

Question 22

Symptoms of pulmonary embolism

Answer 22

Shortness of breath mild to moderate dyspnea
Pleuritic chest pain
diaphoresis
Anxiety, restlessness impending doom
Rapid respirations with possible crackles
Cough possible hemoptysis & cyanosis
Possible low-grade fever

Question 23

Test for pulmonary embolism

Answer 23

D-dimer: blood test that measures substance that is released when a clot breaks up
vq scan: uses radioactive material to see how well air/blood is flowing to all areas of the lungs
ABG’s, pulmonary angiography chest x-ray

Question 24

Interventions for pulmonary embolism

Answer 24

Place in fowler/high  position w/lower extremities dependent
Oxygen per cannula or mask
Heparin IV and Coumadin 
VS and pulse ox q 15 min
Analgesics but avoid resp depression

Question 25

Atelectasis

Answer 25

Incomplete expansion or collapsed lung tissue with inadequate ventilation and retention of secretions SS: fever >100.4F 24-48 hrs post op Dyspnea Diminished breath sounds,crackles, cyanosis Anxiety/restlessness

Question 26

Atelectasis interventions

Answer 26

``` Head of bed elevated Turn cough deep breathe IS Ambulate if allowed IV PO fluids 2500-3000mls/day Activities with rest periods Respiratory therapy Analgesics to facilitate coughing ```

Question 27

Respiratory complication pneumonia

Answer 27

Inflammation infection of lung tissue due to aspiration retained secretions foreign substances microorganisms SS: fever>100F third day post op or later Chills rapid pulse and respirations Chest pain Productive cough,crackles,wheezes, diminished sounds

Question 28

Pneumonia interventions

Answer 28

Antibiotics expectorants analgesics antipyretic Oral care QID Cover mouth with Cough dispose of tissues handwashing Atelectasis int

Question 29

Nursing diagnoses for alterations in cardiovascular function

Answer 29

``` Tissue perfusion ineffective Decreased cardiac output Fluid volume excess Fluid volume deficient activity intolerance ```

Question 30

Deep vein thrombosis

Answer 30

Formation of clot in an inflamed deep vein usually in a lower extremity Risks: pressure behind the knees sluggish bloodflow age greater than 40 their existing HVAC's obesity infection cancer long bone fracture pulmonary embolus thrombophlebitis

Question 31

Symptoms of deep vein thrombosis

Answer 31

Pain or cramping of the calf or thigh Redness or edema Temp elevation over the vein

Question 32

DVT interventions

Answer 32

Administer anticoagulants and analgesics as prescribed Monitor lab values for clotting times Maintain bed rest and keep affected extremity at or above heart level Applied thigh high antiembolism stockings Record bilateral calf or thigh circumference every shift

Question 33

Cardiovascular complication hemorrhage

Answer 33

Blood loss from leakage from a sutured or cauterized vessel excess leakage from a drain or tube or dislodgment of a clot - venous flow is dark red and oozes out quickly - arterial flow is bright red and spurts out with pulsation

Question 34

symptoms of hemorrhage

Answer 34

Observable flow onto a dressing or via a drain Internal hemorrhage hematoma Gradual lowering of BP increasing pulse with respirations unchanged Skin cool and moist Thirst and slight decrease in urine output Decreased capillary refill

Question 35

Hemorrhage interventions

Answer 35

Assess dressings Every hour four times then every four hours DS Q 15 minutes x4, q30x4, then q 4 & prn Report excess bleeding vital sign changes rapid respirations cool clammy skin pallor restlessness altered mental status Monitor H&H platelets INR PT PTT Mark date/ time drainage on dressing Reinforcing moist dressing with sterile gauze Apply pressure to wound with sterile gauze

Question 36

Hypovolemic shock

Answer 36

Report immediately Loss of greater than 1000 and L of blood/plasma Inability to provide sufficient bloodflow to vital organs Signs: systolic BP ADM M HG rapid threads pulse Cyanotic mottled skin Confused agitated to lethargic and comatose Urine output less than 30 ml per hrx2 hr anuria

Question 37

Nursing diagnoses for alterations in urinary function

Answer 37

Urinary elimination impaired | Urinary retention

Question 38

Symptoms of urinary retention

Answer 38

``` Inability to void Restlessness and diaphoresis Lower abdominal pain/distended bladder Hypertension On percussion the bladder sounds like a drum ```

Question 39

Alteration urinary function interventions

Answer 39

Uncatheterized patient should void at least 200 mL within 6 to 8 hours of surgery Place in normal position for voiding Apply warm water to perineum Visualization and relaxation Straight cath if unable to void need Dr. order Order for Foley it needs more than two I/O caths

Question 40

Nursing diagnoses for alterations in G.I. function

Answer 40

Nausea Altered nutrition less than body requirements Ex. constipation failure to pass still within 48 hours of restart of solid diet, paralytic ileus failure of appropriate forward movement of bowel contents

Question 41

Alteration G.I. functions interventions

Answer 41

Assess bowel sounds NPO until gag reflex returns and bowel sounds are present Medicate for nausea Salem sump care Oral care if NPO Frequent ambulation for gas pains on day 2 to 3 post op Right side position to help expel flatus

Question 42

Wound infection assessment

Answer 42

Fever and chills Warm tender painful inflamed incision site Edematous skin at incision tight skin at sutures Elevated white blood cell count

Question 43

Wound infection interventions

Answer 43

Monitored temp Monitor incision for edema bleeding signs of infection approximation of suture line Maintain patency of drains assess drainage amount color consistency Keep drainage tubes away from incision line and maintain asepsis Change dressings/administer antibiotics as prescribed

Question 44

Wound Evisceration interventions

Answer 44

Notify physician Cover the wound with sterile normal saline dressing Place the patient in semi Fowler's position with knees bent to prevent abdominal tension on abdominal suture line Prevent wound infection Splint wound incision when coughing

Question 45

Treatment of malignant hypothermia

Answer 45

Treated with IV Dantrolene(Dantrium) | Can occur during general anesthesia or up 4 hours after surgery

Question 46

Post op discharge teaching

Answer 46

``` Assess readiness to learn Need for home resources Demonstration of self-care Supplies available Follow-up instructions contacts Suture removal, staple removal Steri-Strips ```

Question 47

Postop discharge teaching

Answer 47

Medication instruction Diet fluid activity level restrictions Return to work sex Instructed on signs/symptoms of complications