Unit 1: Perioperative Care

Question 1

What information from a patient’s health history could be risk factors for complications?

Answer 1

Smoking, alcohol, heart disease, respiratory disease, kidney disease, age, malnutrition, obesity, and previous reactions to anesthsia (malignant HTN).

Question 2

When does d/c planning begin?

Answer 2

Begins at admission, provider will write in progress notes expected date of discharge. Does the patient have family to help or should they go to rehab, home with homehealth.

Question 3

What preop instructions are important to review with the patient before surgery?

Answer 3

NPO status, skin prep, what meds needed the morning of surgery
-Insulin, BP meds, did the pt stop taking NSAIDs weeks before surgery or stop anticoagulants.

Question 4

Discuss consent.

Answer 4

MD explains procedure, nurse witness, 2 nurses witness, 2 nurses witness if blind, speaks another language, phone consnet, or cannot write and sign with an x.

Question 5

What post op complications will we try to prevent?

Answer 5

Hemorrhage- assess VS, dressing for drainge, drains.
DVT- SCDs, TED hose, ambulation, enoxaprian injections, ROM exercises.
Fluid Volume Excess/ Deficit- Monitor I/Os, vs for changes reflecting fluid status, kidney functions.
Pneumonia- IS, TCDB q 2 hours, fluids, ambulation.
Constipation- fluids, fiber, ambulation.
Paralytic ileus- listen to BS, passing gas? look for increased distention, vomit, no BS. Put down NG tube, make NPO.
dehiscence/ evisceration – look for increased drainage, risk factor
– diabetic, obesity, steroids, malnutrition.
infection – proper dressing changes, assess for odor, purulent drainage, redness, swelling, pain, fever, increased WBC.

-impaired skin integrity: turn, reposition, assess bony prominences, nutrition

Question 6

What preop drugs can be given?

Answer 6

PPI – reduce stomach acid.
Midazolam – for anxiety.
Morphine – pain.
Anticholinergics – dry up secretions.
Antibiotic – given 1 hour before surgery.

Don’t allow patient to get out of bed after these meds, safety to prevent falls.

Question 7

List in order the assessments you would make as the PACU nurse.

Answer 7

-ABC
-Pain
-Surgical area
-I/Os, drains
-LOC
-GI

Question 8

Your patient is 5 days post op. They are complaining of a lot of drainage from their incision site. What could be the problem? What do you do?

Answer 8

Dehiscence – cover and call MD

Question 9

What considerations do we need to think about when an elderly patient is recovering from surgery?

Answer 9

More confusion, longer to recover from anesthesia – airway problems.

Question 10

FYI INFORMATION:
When answering NCLEX questions about priorities, especially which patient to see first, think of this acronym:

Answer 10

S - stable / unstable
P - potential / real
E – expected / unexpected
C – chronic / acute