The surgical client

Question 1

What assessment should the nurse complete for preoperative patients?

Answer 1

*Head to toe assessment
*Reviews health history
*Reviews labs & diagnostics
*Identifies risk factors
*Older adult considerations

Question 2

What are the steps for the head to toe assessment for a surgical client?

Answer 2

Vital signs
General appearance
Pain
Neurological system
Head & neck
Integumentary
Lungs & thorax
Cardiovascular
Gastrointestinal
Nutritional
Psycho/social
Cultural considerations
Religious/spiritual
Expectations

Question 3

What information should the nurse gather from the patients health history records prior to surgery?

Answer 3

Medical & surgical history
*Cardiac and pulmonary diseases
*Surgical complications
*Family complications during surgery
*Malignant hyperthermia
*Health habits
*Allergies
*Current medications
*Social history
-Spiritual and cultural beliefs

Question 4

Malignant hyperthermia

Answer 4

-SEVERE reaction to medications from anesthesia agents
-Causes a hypermetabolic state
-Life threatening emergency

Question 5

What are the signs and symptoms of Malignant hyperthermia?

Answer 5

-tachycardia
-hyperthermia
-muscle rigidity
-acidosis
-hypercarbia
- glycolysis
-hypoxemia

Question 6

What treatment for Malignant hyperthermia

Answer 6

dantrolene

Question 7

What potential interactions do NSAIDs and anticoagullants have during surgery ?

Answer 7

Both Increases risk for bleeding

Question 8

What potential interactions do anticonvulsants (seizure med) have during surgery ?

Answer 8

-Can alter the metabolism of anesthesia

Question 9

What potential interactions do diuretics have during surgery ?

Answer 9

-risk for electrolyte imbalances
-nurse must monitor electrolytes pre and post surgery

Question 10

What potential interactions do antihypertensive have during surgery ?

Answer 10

-Monitor BP and inform medical staff

Question 11

What potential interactions do insulin have during surgery ?

Answer 11

-Glucose levels can rise during surgery
-Insulin may needed post op

Question 12

Labs and diagnostic test potentially needed for surgery include..

Answer 12

-Complete blood count (CBC)
-Complete metabolic panel (CMP)/Basic metabolic panel (BMP)
-Fasting blood glucose/hemoglobin A1C
-Coagulation studies
-Blood type and screen/type and cross
-Urinalysis
-Electrocardiogram (ECG)
-Stress testing
-Chest X-ray
-Pulmonary function tests
-Sleep study

Question 13

What are complications & risk factors that can interfere with surgery?

Answer 13

Cardiac & pulmonary diseases
-Chronic obstructive pulmonary disease (COPD)
-Obstructive sleep apnea (OSA)
-Asthma
-Coronary artery disease (CAD)
-Congestive heart failure (CHF)

-Pregnancy
-Diabetes
-Liver disease
-Kidney disease
-Obesity and malnutrition
-Age
-Older adults
-Tobacco and alcohol

Question 14

Informed consent (signed)

Answer 14

permission given by the client (or their legal representative) to provide care or perform a surgical procedure

Question 15

What is the nurses responsibility during a informed consent?

Answer 15

-Verify and witness that the appropriate person signed the consent
-Ensure they have enough information to make the decision

Question 16

Elements of informed consent include…

Answer 16

Full disclosure
-Explanation of procedure
-Who will be performing the procedure
-Risks vs benefits
-Consequences of refusal & alternative treatments
-Rights to refuse treatment and withdraw consent

Terms the client can understand
-The client needs to understand need for procedure and risks
-Use lay person terms

Voluntary
-No coercion (do not pursude client to do anything)
-Mentally competent
-Not sedated
-Not a minor

Question 17

Emergency consent only happens when…

Answer 17

-When client cannot give permission and family/guardian is not available
-Two providers must document the necessity for the surgery beforehand
-Post operation consent is later obtained

Question 18

What are the goal for client teaching?

Answer 18

-Prepare for surgery and recovery
-Reduce anxiety
Encourage client to provide self-care post operatively
-Provide support to client’s family
-Promote active participation from the client
-Teaching begins when decision to have surgery begins

Question 19

What general information should you teach the client prior to surgery?

Answer 19

-When to arrive
-Where to go
-What to bring
-Visitor policy
-How long they are expected to stay
-NPO status
-Skin preparation
-Medications
-Tobacco & alcohol use

Question 20

What are post op expectations that should be met for the client after surgery?

Answer 20

-What to expect immediately following surgery
-Pain management plan
-Pulmonary hygiene post op
-Post op activity/exercises

Question 21

Prehabilitation goal is to provide ..

Answer 21

surgery interventions to improve the client’s health and fitness to reduce post op complications, decrease length of stay, and enhance recovery

Involves:
-Medication optimization
-Physical activity
-Nutrition plan
-Strategies to reduce anxiety
-General health promotion

Question 22

Fasting prior to surgery for specific diets

Answer 22

Clears: 2 hours or more
Light meals: 6 hours
Meat and fried food: 8 hours

Most agencies: NPO midnight

Question 23

Preoperative checklist includes…

Answer 23

-Ensure all informed consents are completed
-Documentation
-Vital signs
-Hygiene
-Removal of jewelry, prosthetics, dentures, partials, hearing aids, valuables, etc
-Urinary prep
-Anti embolism devices
-Pre-op meds
-Educational needs
-IV in place

Question 24

Intraoperative nursing

Answer 24

-Involves the nurses care from the moment the surgical procedure takes places until the completion of surgery

Question 25

Nursing responsibilities intraoperative

Answer 25

-Make sure pre operative check list is complete
-Make sure informed consent is signed
-Promote safety and privacy for the client
-Ensure that the Time Out is performed and participate in it
-Position the client
-Ensure the count is accurately completed

Question 26

Time out (Joint commission standard)

Answer 26

-Entire operating room team does a final verification of the right client, procedure, and site
-If possible include the client in the time out
-Introduce all team members to promote active communication

Question 27

Anesthesia: Local & adverse effects

Answer 27

-Used to numb a small area in the body
-Prevents conduction of pain impulses
-No central effects

Adverse Effects:
-Hives
-Itching
-Rash
-Acute or severe anaphylactic

EX: breast biopsy, sutures, broken bone

Question 28

Anesthesia: regional & adverse effects

Answer 28

-Loss of sensory and/or motor function of a specific portion of the body
-No central effects

Adverse Effects:
-Spinal and epidural= rapid hypotension and respiratory paralysis
-Spinal=spinal headache
- hematoma
- Abscess (puss filled pimple)

Question 29

Anesthesia: General & adverse effects

Answer 29

-Loss of all sensations, consciousness, and reflexes
-Given by : IV, inhaled gases, and muscle relaxants

Adverse effects :
-Hypoxia
-Respiratory and/or cardiac dysfunction,
- Hypotension and hypertension
-F&E imbalances
-Residual muscle paralysis
- Neurological problems,
-Malignant hyperthermia

Question 30

Anesthesia: moderate sedation and Adverse effects

Answer 30

-Decreased/impaired level of consciousness

Adverse effects:
-Depends on the medication given
-Drowsiness
-Hypotension
-Headache
-Nausea
-Vomiting
-Respiratory depression
-Bradycardia
-Pruritus (itching)

Question 31

Common client positioning include ..

Answer 31

Postition goal = client safety

-Supine
-Trendelenburg
-Reverse Trendelenburg
-Fowler’s
-Prone
-Jackknife
-Lateral
-Lithotomy

Question 32

PACU care for post operative clients

Answer 32

-Continue to assess and monitor the responses to surgery and anesthesia
-Resolve any problems that arise quickly when noticed
-Evaluate outcomes of interventions
-Ongoing assessments
-Evaluation of meeting criteria to be discharged
-Make sure patients is being discharge to appropriate location or unit

Question 33

inpatient unit : Post operative care

Answer 33

-Complete full assessment
-Complete assessment with PACU nurse still there
-Encourage the use of IS
nurse still there
-Frequent TCDB
-Reposition q2h
-Ambulate early
-Follow diet order
-Pain management
-Collect I&O
-SCDs
-Mark drainage, assess drains and incision

Question 34

What are some home discharge requirements that must be fulfilled?

Answer 34

-Client awake and alert
-VS at baseline
-Tolerating PO liquids
-Pain relief with PO medications and/or nonpharmacological methods
-Client is stable and can walk steadily
-Client able to void
-No s/s of bleeding
-Skin is intact and surgical dressing
-No complications present from surgery
-No further inpatient testing required
-Client understands the education provided and plan of care

Question 35

Computerized pump with a syringe of pain medication connected to an IV line that the client can self-administer based on their level of pain is called ______________________

Answer 35

Patient controlled Anesthesia Pump (PCA)

Question 36

What assessments should you do for respiratory post op?

Answer 36

-Lung sounds
-Respiratory rate
-Breathing pattern
-Oxygen level

Question 37

What assessments should you do for Cardiovascular post op?

Answer 37

-S/S of electrolyte imbalance,
- VS
-Pulses
-S/S of DVT and bleeding

Question 38

What assessments should you do for Neurological post op?

Answer 38

-LOC
-Mental status
-S/S of oversedation
-S/S of post op delirium

Question 39

What assessments should you do for Pain management post op?

Answer 39

-Pain assessment using appropriate scale

Question 40

What assessments should you do for Integumentary post op?

Answer 40

-Dressing,
-incision
-S/S surgical Infection
-Drainage
-Drains in place

Question 41

What assessments and interventions should you do for Gastrointestinal post op?

Answer 41

Assess:
-Presence of nausea and vomiting
-Bowel sounds and bowel movement

Intervention:
-Ambulate, bowel meds PRN

Question 42

What assessments should you do for Renal post op?

Answer 42

Assess:
-Urine I&O’s
-Mucous membranes
-Tenting
-Edema
-Distended bladder
-Catheter
-Catheter care

Question 43

Post op assessment: Epidural

Answer 43

-Respiratory
-VS
-Pain
-Degree of motor and sensory block
-N&V
-Urine output
-Presence of headache
-Epidural site

Question 44

Post op assessment: Spinal

Answer 44

-Assess for presence of headache
-Ensure client lays flat initially to avoid HA
-VS
-Respiratory
-Movement and sensation

Question 45

Post op assessment: Regional

Answer 45

-Location specific
-Pain
-Movement and sensation
-VS

Question 46

Wound care and diet for healing

Answer 46

-Assess wound and document every shift
-Provider changes first one 24 hours after surgery
-When changing dressing teach the client how to do it as well
-Use proper hand hygiene
-Mark drainage to keep track
-May reinforce

Diet:
-Rich in protein, vitamins A, C, and Zinc

Question 47

What are potential post operative complications?

Answer 47

-Deep vein thrombosis (DVT)
-Pulmonary embolism (PE)
-Atelectasis
-Delirium
-Evisceration
-ileus
-Falls
-Aspiration
-Surgical site infection
-Dehiscence
-Post operative nausea nad vomiting
(Fluid imbalances)
-Hypovolemia
-Hypervolemia

Question 48

What is aspiration and ways to prevent it ?

Answer 48

-When food/liquid is inhaled into lungs
-Very high-risk during surgery
-Dysphagia increases this risk
-Ensure they fast pre-op

Post op:
- sitting up for meals
-stay up for at least an hour after
-small bites
-eat/drink slow
- avoid talking/watching TV while eating

Question 49

Fall risk preventions

Answer 49

-Many occur at home
-Move slowly
-Yellow wristband
-Assess home for risks
-Install handrails in bathroom
-Nonskid shoes
-Education regarding medications

Question 50

what are causes of impaired cognition after post op and interventions?

Answer 50

-Post op delirium
-Prolong hospital stay
-Increased risk of death
- Administration of anticholinergics
-Often occurs when clients feel disoriented for a brief period of time after surgery

Interventions:
-Monitor mental status
-Oxygenation status
-Mobilize early
-Monitor F&E balance