10 Questions
What is the primary purpose of communication and documentation of preoperative assessment findings?
To ensure continuity of care
What is the recommended treatment for malignant hyperthermia?
Hyperventilate with 100% oxygen and administer dantrolene
What should be included in the informed consent process?
The name of the surgeon, the type of surgery, and the risks involved
Which of the following supplements is known to increase bleeding risk?
Ginkgo biloba
What should be reported to the operative team during the preoperative assessment?
History of cardiac problems and use of cardiac drugs
What is the purpose of assessing the patient's respiratory system?
To identify potential risks for atelectasis and hypoxemia
Why should smokers be encouraged to quit 6 weeks before surgery?
To reduce the risk of postoperative complications
What is the purpose of assessing the patient's genitourinary system?
To assess the patient's renal function
Why should the patient's musculoskeletal system be assessed?
To identify potential risks for positioning and ambulation
What is the purpose of the joint commission's H&P?
To enable ACP to rate the patient for anesthesia administration
Study Notes
Preoperative Assessment
- Communication and documentation of important preoperative assessment findings are essential to the continuity of care.
Malignant Hyperthermia Treatment
- Stop triggering agents
- Hyperventilate with 100% oxygen
- Administer dantrolene (2.5 mg/kg)
- Provide bicarbonate
- Give glucose and insulin
- Use iced IV fluids and cooling blanket
- Monitor fluid output and administer furosemide if necessary
Informed Consent
- Include the patient's name
- Specify the type and reason for surgery
- Identify the surgeon performing the surgery
- Explain how the surgery will benefit the patient
- Discuss anesthesia options
- Obtain consent for anesthesia
- A legally appointed representative may consent for minors, unconscious, or mentally incompetent patients
Supplements and Bleeding Risk
- Gingko biloba, garlic, ginseng, fish oil, and dong quai may increase bleeding risk
Nursing Assessment
Allergies
- Assess for drug and non-drug allergies
- Screen for latex allergy, which may be indicated by banana or kiwi allergy
Cardiovascular Assessment
- Report any cardiac problems to the operative team
- Note the use of cardiac drugs
- Perform a 12-lead EKG and coagulation studies
- Consider prophylactic antibiotics
Respiratory System
- Inquire about recent airway infections, which may lead to procedure cancellation
- Report dyspnea, coughing, or hemoptysis to the operative team
- Note COPD, asthma, or high risk for atelectasis and hypoxemia
- Smokers should quit 6 weeks before the procedure to decrease complications
- Consider sleep apnea, obesity, and airway deformities affecting respiratory function
Genitourinary System
- Perform renal function tests
- Note problems voiding and inform the operative team
- Assess women for the possibility of pregnancy
Hepatic System
- The liver detoxifies many anesthetics and adjunctive drugs
- Hepatic dysfunction may increase the risk of postoperative complications
Integumentary System
- Assess for skin and musculoskeletal problems
- Consider a history of pressure ulcers and provide extra padding during the procedure
- Note body art, tattoos, and piercings
- Assess mobility restrictions that may affect positioning and ambulation
Musculoskeletal System
- Identify joints affected by arthritis
- Note mobility restrictions that may affect positioning and ambulation
- Consider hip replacement, neck injuries, and report problems affecting the neck or lumbar spine to the ACP
Endocrine System
- Patients with diabetes mellitus are at risk for hypo/hyperglycemia
- Cardiovascular alterations, delayed wound healing, and infection may occur
- Fluid and electrolyte status may require additional fluids and electrolytes before surgery if dehydration occurs
Test your knowledge on nursing care in various surgical settings such as the operating room (OR), postanesthesia care unit (PACU), and surgical intensive care unit (SICU). Focus on communication, documentation, preoperative assessments, and important treatments like malignant hyperthermia protocol.
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