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Questions and Answers
What is a nursing diagnosis related to surgical procedures?
Deep-breathing and coughing exercises are promoted at least every 2 hours to prevent pneumonia.
True
What type of intervention is used to promote wound healing?
Managing surgical drains
Patients should report any signs of infection such as redness, marked swelling, and __________.
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Which of the following interventions is important for promoting bowel function after surgery?
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Match the following terms with their definitions:
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What should be monitored frequently to avoid complications after surgery?
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Anticoagulants are not necessary after surgery to prevent venous thromboembolism.
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Signs of wound infection may include increased pulse rate and __________.
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What are the three phases of perioperative patient care?
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What is the purpose of obtaining informed consent?
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Which of the following are types of surgical classifications? (Select all that apply)
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What should be included in the preoperative assessment?
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Informed consent must be obtained for all surgical procedures.
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What is the primary responsibility of the circulating nurse during surgery?
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Match the following roles with their primary responsibilities in the surgical team:
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What is the significance of the informed consent form in surgery?
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The preoperative phase lasts from when the decision for surgery is made to when the patient is transferred to the ______.
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Which of the following interventions help in reducing preoperative anxiety? (Select all that apply)
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What are some common postoperative problems nurses should be aware of?
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What is the purpose of surgical asepsis?
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Which of these is a phase in the Post Anesthesia Care Unit (PACU)?
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Artificial fingernails are permitted in the operating room.
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What should be done immediately before a surgical procedure regarding hair removal?
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The restricted zone of the operating room allows street clothes.
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What is the main risk of anesthesia awareness?
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Patients under general anesthesia are not arousable, not even to __________ stimuli.
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Which of the following is a method of administering regional anesthesia?
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Hypothermia in patients can be caused by cold fluids and open wounds.
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What is an essential element in maintaining cardiovascular stability postoperatively?
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What is the primary procedure to address hypopharyngeal obstruction?
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What are common postoperative complications that should be monitored?
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The __________ must be reviewed for correct informed surgical consent prior to surgery.
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Study Notes
Perioperative Patient Care Phases
- Perioperative care involves three phases: preoperative, intraoperative, and postoperative.
- Preoperative phase lasts from the surgical decision to patient transfer to the operating room.
- Intraoperative phase starts upon admission to the operating room and ends with admission to the post-anesthesia care unit.
- Postoperative phase continues until follow-up evaluations are completed.
Advances in Surgical Techniques
- Minimally invasive surgeries use laparoscopy for smaller incisions.
- Robotic surgeries improve precision, range of motion, and provide 3D visual feedback.
- Such techniques often reduce hospital stay duration and enhance patient comfort.
Surgical Classifications
- Diagnostic: procedures like biopsies.
- Curative: such as tumor excisions.
- Reparative: involved in wound repairs.
- Reconstructive/Cosmetic: includes procedures like mammoplasty.
- Palliative: aimed at relieving symptoms, e.g. tumor debulking.
- Rehabilitative: like total joint replacements to alleviate pain.
Informed Consent
- Informed consent is required before non-emergent surgery, ensuring patients understand the risk, benefits, and alternatives.
- Necessary for invasive procedures, sedation, and treatments posing significant risk.
- Consent must be obtained when the patient is fully capable of understanding, not under medication influence.
- Respect for personal rights is crucial; coercion in offering consent is unacceptable.
Comprehensive Preoperative Assessment
- Assess risk factors, health history, and physical examinations including vital signs.
- Evaluate for allergies, particularly to latex and anesthesia.
- Monitor nutritional status, hydration, and drug/alcohol use.
- Conduct psychological evaluations to assess readiness for surgery and understand support systems.
- Special considerations apply for geriatric, disabled, and ambulatory surgery patients.
Preoperative Nursing Interventions
- Educate patients on breathing exercises using incentive spirometry to promote lung function.
- Encourage mobility to prevent complications such as venous stasis.
- Manage pain effectively using PCA (patient-controlled analgesia) methods.
- Utilize cognitive coping strategies for anxiety reduction, such as guided imagery and music therapy.
- Prepare the bowel for surgery using cleansing enemas if necessary.
Patient Safety Measures
- Adhere to National Patient Safety Goals: accurately identify patients, ensure safe medication use, prevent infections, and avoid surgical errors.
- Maintain fasting protocols pre-surgery to prevent aspiration risks.
Intraoperative Nursing Management
- Surgical team consists of the patient, surgeon, anesthesiologist, nurses, and technologists.
- Circulating nurse manages operating room conditions and ensures patient safety, while the scrub nurse prepares sterile instruments.
- Anesthesiologists oversee patient anesthesia and monitor vital signs during surgery.
Surgical Environment Safety
- Operating Room (OR) is divided into unrestricted, semi-restricted, and restricted zones to maintain sterility.
- Headgear must cover hair, and artificial nails are prohibited to minimize infection risk.
Principles of Surgical Asepsis
- Ensures contamination free surgical wounds by sterilizing all surgical supplies and maintaining strict hygiene standards.
- Surgical personnel wear sterile gowns and gloves and must maintain sterility throughout the procedure.### Sterile Drapes and Sterile Field Management
- Sterile drapes create a sterile field; the top surface of a draped table is considered sterile.
- Items should be placed onto a sterile field in a way that maintains sterility and integrity.
- Surgical team movements must adhere to sterile to sterile and unsterile to unsterile principles.
- Maintain at least a 1-foot distance from the sterile field to prevent contamination.
- Any breach in sterile barriers, such as tears or access to unsterile surfaces, renders the area unsterile.
- Constant monitoring is essential; any items of uncertain sterility should be treated as unsterile.
- Sterile fields are prepared as close to the procedure time as possible.
Types of Anesthesia and Sedation
- General anesthesia involves narcosis and complete loss of consciousness; patients cannot maintain their own airway.
- Stages of general anesthesia:
- Stage I: Beginning anesthesia with warmth and dizziness.
- Stage II: Excitement with involuntary movements.
- Stage III: Surgical anesthesia with a stable unconscious state.
- Stage IV: Medullary depression due to excessive anesthesia, requiring immediate intervention.
- Regional anesthesia involves injections around nerves, allowing the patient to remain awake.
- Epidural anesthesia targets the epidural space for pain relief; advantages include reduced headache risk.
- Spinal anesthesia affects lower extremities and may lead to headaches.
- Local conduction blocks target specific areas (e.g., brachial plexus block for the arm).
- Moderate sedation is used for short procedures; patients remain responsive with patent airways.
Potential Intraoperative Complications
- Anesthesia awareness can occur; vigilance is necessary.
- Nausea and vomiting must be managed appropriately.
- Risks include anaphylaxis, hypoxia due to inadequate ventilation, and hypothermia from environmental factors.
- Malignant hyperthermia, a rare condition, causes severe physiological reactions and requires immediate attention.
Nursing Process in Intraoperative and Postoperative Care
- Assess physiological, psychosocial, and ethical concerns before and after surgery.
- Key nursing diagnoses include anxiety related to surgical procedures and risks related to latex exposure and positioning.
- Interventions include reducing anxiety through communication and comfort measures.
Positioning and Patient Safety
- Positioning varies based on surgical needs:
- Dorsal recumbent for abdominal surgeries.
- Trendelenburg for lower abdomen procedures.
- Lithotomy for perineal surgeries.
- Verify documentation, patient identity, and procedure details before surgery for accuracy and safety.
Postoperative Care and PACU Management
- The postoperative period lasts from OR exit until follow-up.
- PACU phases:
- Phase I: Intensive care for immediate recovery.
- Phase II: Preparation for self-care.
- Phase III: Discharge readiness.
- Admitting procedures include careful monitoring of vital signs, consciousness, and managing tubes and drains.
Maintenance of Airway and Cardiovascular Stability
- Ensure ventilation and monitor for respiratory complications.
- Manage changes in cardiovascular health post-surgery to detect shock or hypotension.
- Administer fluids and blood products if necessary to maintain hemodynamic stability.
Pain Management and Nausea Control
- Implement opioid analgesics and PCA to enhance pain control and facilitate recovery.
- Monitor and manage postoperative nausea with appropriate antiemetic medications.
Readiness for Discharge from PACU
- Discharge criteria include stable vital signs, adequate orientation, pulmonary function, urine output, and controlled pain and nausea.
Immediate Postoperative Interventions
- Assess respiratory function and provide oxygen if needed.
- Monitor vital signs and surgical site drainage.
- Ensure patient comfort and safety by managing pain and mobility post-surgery.
- Reinforce the importance of breathing exercises to prevent complications.
Wound Healing Mechanisms
- First-intention healing involves minimal tissue loss and quick recovery.
- Second-intention healing occurs in infected wounds with granulation tissue formation.
- Third-intention healing pertains to deep wounds that require delayed suturing.
- Proper care of surgical drains enhances healing and prevents complications.### Wound Drainage Management
- Purpose of wound drains: Allow escape of fluids that could promote bacterial growth.
- Types of wound drains include: Penrose, Hemovac, and Jackson-Pratt.
- Output from wound systems is meticulously recorded and assessed for changes.
- Increased fresh blood on the dressing should be reported immediately; evaluating drainage is routine.
- Wounds may require heavy irrigation before closure; open drains may be included in dressings.
Dressing Change Procedures
- Dressings assure wound healing, absorb drainage, provide immobilization, and protect against contamination.
- Dressing changes are performed by nurses, ensuring patient awareness and privacy throughout.
- Hand hygiene is crucial—perform before and after dressing change with disposable gloves.
- Soiled dressings must be placed in designated biomedical waste containers.
- If adhesive sensitivity exists, hypoallergenic tapes are recommended.
- Patient education on home care and dressing changes is essential.
Temperature Management Post-Surgery
- Monitor body temperature; low readings reported to the provider.
- Maintain a comfortable room temperature; treatment measures include oxygen, hydration, and nutrition.
- Older adults are at greater risk for hypothermia, particularly post-operation.
Gastrointestinal Function and Nutrition
- Nasogastric tubes may be required; monitor for postoperative hiccups from phrenic nerve irritation.
- Clear liquids are typically first tolerated post-surgery; address abdominal distention caused by gas.
- Constipation can stem from decreased mobility and medications; strategies include early ambulation, diet, and stool softeners.
- Chewing gum may help restore bowel function and prevent ileus.
Bladder Function Assessment
- Bladder distention and voiding urges assessed post-arrival and continuously monitored.
- Patients should void within 8 hours post-surgery; measures to encourage voiding include warm water and perineal heat.
- If unable to void, ultrasound bladder scans are conducted; intermittent catheterization may be employed until spontaneous voiding occurs.
- Safety measures include three-side rail positioning and ensuring call bells are within reach.
Wound Care Instructions
- Until sutures are removed, keep the wound clean and dry; avoid removing dressings unless necessary.
- Report signs of infection like redness, swelling, or fever immediately.
- Apply a cold pack for discomfort, but avoid aspirin without consultation due to bleeding risks.
- Post-surgical swelling is common; elevation aids in reducing it.
Post-Suture Removal Care
- After sutures are removed, the wound may still be tender; post-operative care continues for several weeks.
- Ensure cleanliness of the suture line and avoid vigorous rubbing.
- Any persistent redness or pain after 8 weeks necessitates healthcare provider consultation.
Managing Potential Complications
- Venous Thromboembolism: Use anticoagulants for prevention and monitor for DVT symptoms such as swelling and calf pain. Early ambulation is critical.
- Hematomas: Small clots usually require no intervention; large clots may necessitate surgical removal.
- Infection: Signs include temperature elevation, wound tenderness, and discharge. Treatment involves wound management and antimicrobial therapy.
- Wound Dehiscence and Evisceration: Watch for disruption or protrusion of wound contents. Keep the patient in a low Fowler’s position and cover protruding tissues with saline-moistened sterile dressings while notifying the surgeon immediately.
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Description
This quiz covers the crucial aspects of perioperative patient care, focusing on the phases of care, comprehensive assessments, and informed consent in surgical settings. It also addresses preoperative nursing measures and interdisciplinary approaches essential for successful surgical outcomes. Perfect for nursing students preparing for clinical practice in surgery.
