Week 6: Perioperative care and pain

Question 1

untreated pain can result in

Answer 1

unnecessary suffering, physical dysfunction,
psychosocial distress, impaired recovery from acute illness and surgery,
immunosuppression, and sleep disturbances.

Question 2

inadequate pain mgmt can be due to

Answer 2

lack of knowledge and skills to adequately assess and treat pain; misconceptions about pain; and inaccurate and inadequate information regarding addiction, tolerance, respiratory depression, and
other adverse effects of opioids.

Question 3

nursing role in pain mgmt

Answer 3

(1) assessing pain and communicating this
information to other health care providers, (2) ensuring the delivery of effective pain
relief measures, (3) evaluating the effectiveness of these interventions, (4) monitoring
ongoing effectiveness of pain management strategies, and (5) providing education to
patients and their families regarding pain management approaches and possible
adverse effects.

Question 4

physiological pain dimension

Answer 4

genetic, anatomical, and

physical determinants of pain.

Question 5

sensory discriminative component of pain

Answer 5

recognition of sensation is painful

Question 6

motivational affective component of pain

Answer 6

emotional response to pain experience

Question 7

behavioural component of pain

Answer 7

observable actions used to express or control pain

Question 8

cognitive evaluative component of pain

Answer 8

beliefs attitudes memories and meaning attritbuted to pain

Question 9

sociocultural dimension of pain

Answer 9

demographics, support systems, social roles, past pain experiences, and culture

Question 10

nociception

Answer 10

physiological process by which information about tissue damage
is communicated to the central nervous system. Nociception involves transduction,
transmission, perception, and modulation.

Question 11

nociceptive pain

Answer 11

caused by damage to

somatic or visceral tissue. Somatic pain may be described as aching or throbbing.

Question 12

neuropathic pain

Answer 12

caused by damage to nerve cells or changes in spinal cord
processing. Difficult to treat, this type of pain is typically described as burning,
shooting, stabbing, or electrical in nature.

Question 13

acute pain

Answer 13

diminishes over time as healing occurs

Question 14

persistent pain

Answer 14

lasts for long period, often defined as past the time when an expected acute pain or acute injury should subside

Question 15

every pain assessment should include

Answer 15

evaluation of the sensory-discriminative

component: pattern, area, intensity, and nature (PAIN) of the pain.

Question 16

equinalgesic dose

Answer 16

dose of one analgesic that is equivalent in pain-

relieving effects compared with another analgesic.

Question 17

pain meds are divided into 3 categories

Answer 17

nonopioids, opioids, and conanalgesics or adjuvent drugs

Question 18

adjuvent analgesic therapies include

Answer 18

antidepressants, anticonvulsants, corticosteroids, and local anaesthetics

Question 19

neuroablative interventions

Answer 19

performed for severe pain that is unresponsive to all other therapies

Question 20

neuroaugmentation

Answer 20

electrical stim of the CNS

Question 21

transcutaneous electrical nerve stimulation

Answer 21

delivery of an electric current through electrodes applied to skin surface over painful region, trigger points, or over a peripheral nerve

Question 22

ambulatory surgery

Answer 22

also called same day surgery, can be conducted in emergency
departments, endoscopy clinics, doctors’ offices, and outpatient surgery units in
hospitals.

Question 23

preoperative teaching involves the following

Answer 23

Three types of information: sensory (what patients will see, hear, smell, and feel
during surgery), process (general information about what will happen), and
procedural (more specific details).
o Different patients, with varying cultures, backgrounds, and experiences, may want
different types of information.
o All teaching should be documented in the patient’s medical record.
o All patients should receive instruction about deep breathing, incentive spirometry,
coughing, and moving postoperatively.

Question 24

informed consent is valid if

Answer 24

it is voluntary, pt has mental capacity to consent, and the pt is properly informed

Question 25

on the day of surgery the nurse is responsible for

Answer 25

o Final preoperative teaching
o Readiness assessment
o Communication of pertinent findings from diagnostic procedures and consults to
appropriate health care providers
o Ensuring that all preoperative preparation orders have been completed
o Ensuring that records and reports are present and complete to accompany the
patient to the OR
o Verifying the presence of a signed operative consent
o Laboratory data
o A history and physical examination report
o Baseline vital signs
o Nurses’ notes complete to that point

Question 26

surgical suite

Answer 26

controlled environment designed to maximize infection
control and provide a seamless flow of patients, personnel, and operative instruments,
equipment, and supplies.

Question 27

unrestricted area

Answer 27

personnel in street clothes can interact with those in scrubs

Question 28

semirestricted area

Answer 28

personnel must wear surgical attire and cover all head and facial hair

Question 29

restricted area

Answer 29

includes the OR, and all areas where sterile supplies are opened, the scrub sink area, and clean core, masks are required

Question 30

in the holding area the nurse

Answer 30

identifies and assesses the patient, gives
preoperative medications, and, in some institutions, initiates intravenous (IV)
infusions before the patient is transferred into the OR or to an anaesthesia block
room. Minor procedures such as inserting intravenous (IV) catheters and arterial
lines, peripheral and spinal nerve blocks, and drug administration may occur here.

Question 31

circulating OR nurse role

Answer 31

The circulating nurse is neither scrubbed, gloved, nor gowned, and
remains in the unsterile field. The perioperative nurse orchestrates the preparation of the OR with other members of the surgical team. The nurse is usually the first member of the surgical team to greet the patient on arrival to the surgical suite and
advocates for the patient throughout the intraoperative experience

Question 32

scrub nurse role

Answer 32

the scrub nurse is often a practical nurse who performs surgical hand
asepsis, is gowned and gloved in sterile attire, and remains in the sterile field assisting
the surgical team by preparing and handling instruments.

Question 33

general anesthesia

Answer 33

loss of sensation with loss of consciousness, skeletal
muscle relaxation, amnesia, analgesia, and elimination of the somatic, autonomic,
and endocrine responses, including coughing, gagging, vomiting, and sympathetic
nervous system responsiveness.

Question 34

local anesthesia

Answer 34

loss of sensation without loss of consciousness. Local
anaesthesia may be induced topically or via infiltration intracutaneously or
subcutaneously.

Question 35

regional anesthesia

Answer 35

loss of sensation to a region of the body without loss
of consciousness when a specific nerve or group of nerves is blocked with the
administration of a local anaesthetic (e.g., spinal, epidural, or peripheral nerve
block).

Question 36

procedural sedation

Answer 36

refers to the technique of
administering IV sedatives or procedural agents with or without analgesics.
Procedural sedation with analgesia results in depressed levels of consciousness
but patients do maintain independent control of their airway and, subsequently,
oxygenation.

Question 37

malignant hyperthermia

Answer 37

a rare metabolic disease characterized

by hyperthermia with rigidity of skeletal muscles that can result in death

Question 38

phase 1 post op care

Answer 38

▪ Care during the immediate postanaesthesia period
▪ Focused on the patient’s basic life-sustaining needs
▪ Constant, vigilant monitoring
▪ Goal: Prepare patient for safe transfer to phase II or inpatient unit

Question 39

phase 2 post op care

Answer 39

▪ Surgery patient is ambulatory
▪ Goal: Prepare patient for transfer to extended-care environment or home
with discharge teaching

Question 40

extended observation post op care

Answer 40

▪ Ongoing care for patients who will be admitted to the unit and those who
require observation or interventions
▪ Goal: Prepare patient for self-care.

Question 41

potential respiratory complications in the PACU

Answer 41

airway obstruction, hypoxemia, and hypoventilation

Question 42

potential cardiovascular complications in PACU

Answer 42

hypotension, hypertension, and dysrhythmias

Question 43

potential neurological complications in PACU

Answer 43

emergence delirium, delayed awakening, and agitation

Question 44

potential GI complications in PACU

Answer 44

post op nausea and vomiting

Question 45

potential urinary complications in PACU

Answer 45

postop oliguria and acute urinary retention