NCM 112: Perioperative Nursing Management

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Questions and Answers

Which phase of the perioperative period involves preparing the client for surgery?

Intra-operative Phase

Recovery Phase

Post-operative Phase

Pre-operative Phase (correct)

What is an essential component of preoperative teaching?

Medication administration during surgery

Anesthesia administration

Pain assessment and management (correct)

Nutritional assessment post-surgery

What is a potential complication that nurses must anticipate during the postanesthetic phase?

Nausea and vomiting (correct)

Blood pressure fluctuations

Infection at surgical site

Excessive bleeding

Which nursing responsibility is crucial in planning perioperative nursing care?

Conducting a thorough preoperative assessment Signup and view all the answers

Which type of intervention is important for preventing postoperative complications?

Encouraging mobilization and leg exercises Signup and view all the answers

What is one of the primary goals during the planning phase of nursing in the operating room?

Maintain the client’s safety Signup and view all the answers

What role does the scrub nurse or technician play in the operating room?

Maintains sterility and assists the surgeon directly Signup and view all the answers

In which position should a patient undergoing abdominal surgery typically be placed?

Supine Signup and view all the answers

What is NOT a focus of nursing care during the postoperative phase?

Performing complex surgical procedures Signup and view all the answers

Which of the following is assessed by the circulating nurse during the implementing phase?

Safety and aseptic practice Signup and view all the answers

What action is performed during the surgical skin preparation process?

Preparing the surgical site with an antimicrobial agent Signup and view all the answers

Which nursing diagnosis is concerned with potential injury due to positioning during surgery?

Risk for perioperative-positioning injury Signup and view all the answers

Where do patients recover after undergoing surgery before being discharged?

Post Anesthesia Care Unit (PACU) Signup and view all the answers

What is the primary focus during the admission of a patient to the PACU?

Reviewing essential information regarding the patient's surgery and anesthesia Signup and view all the answers

How often should vital signs be monitored during the first hour in the PACU?

Every 15 minutes Signup and view all the answers

What should the nurse ensure regarding the airway when admitting a patient to the PACU?

The airway is patent and stable Signup and view all the answers

What is an important consideration during transportation to the PACU?

Maintaining airway and preventing strain on the incision site Signup and view all the answers

Which function is NOT a priority during nursing management in the PACU?

Managing the patient's financial records Signup and view all the answers

What action should the anesthesiologist take when transferring a patient to the PACU?

Attach monitoring equipment and stay until stable Signup and view all the answers

What is the role of the nurse in assessing the patient in the PACU?

To perform and document a baseline assessment of vital functions Signup and view all the answers

When might a patient be discharged directly from the PACU?

If their recovery warrants it, within 4 to 6 hours Signup and view all the answers

What is assessed to determine a patient's readiness for discharge from the PACU?

Pain levels and vital signs stability Signup and view all the answers

What is an important aspect of monitoring during a patient's stay in the PACU?

Observing for signs of nausea and vomiting Signup and view all the answers

What is the primary goal of preoperative nursing care?

To prepare the patient mentally and physically for surgery Signup and view all the answers

Which of the following is a responsibility of the surgeon during the informed consent process?

To obtain the consent from the patient Signup and view all the answers

What aspect is NOT included in the physical assessment for preoperative nursing care?

Patient's favorite food Signup and view all the answers

Which of the following is a preoperative teaching responsibility of the nurse?

Explaining what to expect during the postoperative period Signup and view all the answers

Which medication is commonly administered for preoperative anxiety reduction?

Anxiolytics like Diazepam Signup and view all the answers

Which phase of general anesthesia involves the patient becoming unconscious?

Induction Signup and view all the answers

What is a primary intervention for a patient experiencing hypotension in the PACU?

Replacement of circulating volume Signup and view all the answers

What is a key characteristic of regional anesthesia?

Maintains the patient's ability to respond to commands Signup and view all the answers

Which medication is commonly prescribed to manage post-operative nausea and vomiting in the PACU?

Ondansetron Signup and view all the answers

What measure is important for patient safety in the intraoperative phase?

Performing surgical counts for instruments Signup and view all the answers

What symptom may indicate hypovolemic shock in a patient?

Rapid, weak pulse Signup and view all the answers

Which of the following is essential to confirm on the day of surgery?

Patient and procedure identification Signup and view all the answers

What action should be taken if vomiting occurs in a patient recovering in the PACU?

Turn the patient to their side Signup and view all the answers

A nurse preparing a patient for surgery must ensure which of the following prior to anesthesia administration?

The patient has empty stomach if given NPO Signup and view all the answers

What indicates a patient is ready for discharge from the PACU?

Stable blood pressure Signup and view all the answers

In order to maintain a patent airway, which condition must be checked?

Hypopharyngeal obstruction Signup and view all the answers

What role does the circulating nurse fulfill in the operating room?

To assist the anesthesiologist and position the patient Signup and view all the answers

What is the primary complication related to anesthesia that must be monitored in PACU?

Hypoxemia Signup and view all the answers

What is a primary concern that may complicate general anesthesia?

Increased risk in patients with cardiovascular or respiratory disease Signup and view all the answers

What is the appropriate position for a patient suspected of hemorrhage and experiencing shock?

Flat on back with legs elevated Signup and view all the answers

In what scenario is monitored anesthesia care (MAC) typically indicated?

In situations requiring a greater depth of sedation than moderate Signup and view all the answers

What is a sign of cardiovascular instability in the PACU?

Cyanosis of the skin Signup and view all the answers

Which complementary care intervention is used to reduce anxiety before surgery?

Utilizing music therapy Signup and view all the answers

What should be monitored to prevent hypercapnia in the PACU?

Respiratory rate and depth Signup and view all the answers

What is a common side effect of anesthesia that may require monitoring in the PACU?

Drowsiness and confusion Signup and view all the answers

What is indicated by a low Aldrete score?

Potential complications present Signup and view all the answers

What is recommended if a patient exhibits decreased oxygen saturation scores?

Administering supplemental oxygen Signup and view all the answers

Which part of the patient's skin condition should be assessed for indications of shock?

Moisture and temperature Signup and view all the answers

Study Notes

Management of Clients Having Surgery: Perioperative Nursing

Phases of the Perioperative Period: Pre-operative, intra-operative, and post-operative phases.
Learning Objectives: Understanding preoperative assessment, nursing diagnoses, planning care, patient education, anesthesia types, and postoperative interventions.

Pre-operative Nursing Care

Goal: Prepare the patient mentally and physically for surgery.
Preanesthesia Preparation: Involves preadmission testing, health history, and physical assessment.
Physical Assessment Elements: Includes evaluation of allergies, medications, mental status, prior surgeries, smoking, alcohol use, and cultural considerations.
Preoperative Diagnostic Tests: Identify abnormalities that may require treatment before surgery.
Day of Surgery Protocol: Confirm patient and procedure identification, ensure informed consent, administer medications as needed.

Importance: Understanding the nature, risks, alternatives, and outcomes of surgery.
Process: Surgeon is responsible; the nurse serves as a witness; no sedation prior to consent.

Medication Administration

Purpose: Induce sedation, reduce anxiety and discomfort, and prevent postoperative complications through antibiotic prophylaxis.

Complementary Care Interventions

Techniques: Music therapy, massage, aromatherapy, and relaxation techniques can minimize anxiety and enhance comfort.

Preoperative Teaching

Information: Explain procedures and expectations to alleviate anxiety.
Skills Training: Involves teaching moving, deep breathing, coughing, and splinting techniques.

Physical Preparation

Considerations: Nutrition (NPO status), elimination, hygiene, and managing valuables and prostheses pre-surgery.

Intraoperative Phase

Primary Goal: Maintain client safety and provide effective monitoring.
Roles in the Surgical Team: Includes surgeon, anesthesiologist, scrub nurse, and circulating nurse.

Types of Anesthesia

General Anesthesia: Induces unconsciousness; involves IV and inhalation agents; risks include complications with respiratory and cardiovascular systems.
Regional Anesthesia: Loss of sensation in a targeted area; patient remains conscious; includes nerve blocks and epidurals.
Moderate/Conscious Sedation: Allows patient to maintain airway; requires informed consent; potential adverse effects include hypotension and drowsiness.

Principles of Sterility

Operating Room Protocols: Ensure all objects in sterile fields are maintained sterile; strict surgical attire is mandated.

Postoperative Phase

Focus of Care in PACU: Address physiologic equilibrium, pain relief, complication prevention, and self-care education.
Monitoring in PACU: Continuous assessment of airway, cardiovascular function, and level of consciousness; vital signs checked frequently.

Phases of Post Anesthesia Care

Phase I: Immediate recovery with intensive nursing care; vital signs monitored closely.
Phase II: Patient preparation for self-care or transfer to extended care.
Phase 3: Focus on discharge readiness.

Nursing Management in PACU

Postoperative Assessment: Evaluate airway, respiratory function, and skin condition; check for drainage and hemorrhage.
Documentation: Maintain accurate records of assessments, medication administration, and surgical site observations.

Goals of Nursing Care

Ensure safety, promote recovery, maintain homeostasis, and provide effective pain management throughout the surgical experience.### Maintaining a Patent Airway
Prevent hypoxemia (reduced oxygen) and hypercapnia (excess carbon dioxide) through supplemental oxygen.
Assess respiratory rate, depth, ease of respirations, oxygen saturation, and breath sounds regularly.
Monitor for hypopharyngeal obstruction caused by relaxed pharyngeal muscles post-anesthesia, indicated by:
- Choking
- Noisy and irregular respirations
- Decreased oxygen saturation levels
- Cyanosis
Elevate the head of the bed to reduce the risk of aspiration, unless contraindicated.
In case of vomiting, turn the patient to the side for safety and use an emesis basin for collection.
Suction mucus or vomitus with caution, especially post-tonsillectomy, to prevent bleeding.

Maintaining Cardiovascular Stability

Assess patient's mental status, vital signs, cardiac rhythm, skin temperature, moisture, and urine output.
Key complications include hypotension, shock, hemorrhage, hypertension, and dysrhythmias.

Hypotension

Can arise from blood loss, hypoventilation, position changes, or medication side effects.
Blood loss exceeding 500 mL, especially rapidly, may require replacement.
Monitor for significant blood and plasma loss leading to compromised circulating volume.

Shock

Typically results from hypovolemia and decreased intravascular volume.
Timely IV fluids and blood products are critical for management.
Common indicators of hypovolemic shock:
- Pallor and cool, moist skin
- Rapid breathing and cyanosis of mucous membranes
- Rapid, weak pulse and narrowing pulse pressure
- Concentrated urine output

Hemorrhage

May occur immediately postoperatively or several days after surgery.
Signs include hypotension, rapid pulse, disorientation, restlessness, oliguria, and pale skin.
Initial measures: transfusion of blood products and inspection of the surgical site for bleeding.
If bleeding is evident, apply sterile gauze/pressure dressing and elevate the site.

Hypertension & Dysrhythmias

Commonly experienced postoperatively due to sympathetic nervous system stimulation from pain, hypoxia, stress, or bladder distention.
Associated with electrolyte imbalance and altered respiratory function.

Relieving Pain & Anxiety

PACU nurse monitors physiologic status and manages pain through opioid analgesics for immediate relief.
Family visitations may be allowed to lower both patient and family anxiety.

Controlling Nausea & Vomiting

Nausea and vomiting are common in PACU; interventions should start at the first sign of nausea.
Position the patient fully on one side for effective drainage and to prevent aspiration.
Common medications include metoclopramide and ondansetron.

Determining Readiness for Discharge from the PACU

Patients remain in PACU until fully recovered from anesthesia, indicated by:
- Stable blood pressure
- Adequate respiratory function
- Satisfactory oxygen saturation compared to baseline.
The Aldrete score is utilized as an evaluation guide for readiness to transfer, with a score of 8 to 10 typically required for discharge.

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Description

This lesson module covers the nursing care for clients facing surgery, including the pre-operative, intra-operative, and post-operative phases. It addresses key concepts related to oxygenation, fluid and electrolytes, infections, inflammatory responses, and cellular aberrations. Enhance your nursing knowledge and prepare for effective client management in surgical settings.