Perioperative Nursing Care Part 1 Exam Practice

• Perioperative nursing's primary goal is to provide patient-centered, evidence-based care before, during, and after surgery.
• Surgical procedures are classified as elective, urgent, emergent, diagnostic, palliative, and preventive.
• The surgeon is responsible for obtaining informed consent, and the nurse ensures the patient signs before any sedatives.
• Anticoagulants like warfarin elevate the risk of intraoperative and postoperative bleeding, and may need to be held prior to surgery at the provider's discretion.
• Patients need to be NPO before surgery to reduce the risk of aspiration during anesthesia.

Preoperative Assessment

• History of hypertension
• Allergies to latex
• Previous surgical infection are findings that may increase surgical risks.
• Hypertension increases cardiac risk.
• Latex allergy affects intraoperative management
• Prior infections increase postoperative infection risk.

Postoperative Atelectasis Prevention

• Incentive spirometry
• Early ambulation
• Deep breathing exercises expand the lungs and prevent alveolar collapse

Increased Risk of Latex Allergy

• Nurses working in the OR for 10 years
• Patients with a banana allergies
• Patients with asthma
• Patients with long-term exposure to latex, fruit allergies, and asthma increase the risk of developing a latex allergy.
• One should immediately report if the patient took warfarin the night before, as warfarin increases bleeding risk and must be discontinued per the surgeon's orders.
• Patients should not remove a dressing without medical advice.

Key Components of Informed Consent

• Procedure’s risks and benefits
• Alternative treatment options
• Ability to withdraw consent at any time
• Preoperative care includes consent verification, medication administration, and patient education.
• Clopidogrel is an antiplatelet medication that escalates the risk of bleeding during and after surgery.
• Address the patient's concerns and provide reassurance as this is crucial for psychological preparation.
• Patients with COPD are at higher risk for respiratory complications postoperatively.

Patients Should Follow NPO Guidelines

• To prevent aspiration
• Key preoperative assessments include medication history, previous surgical history and current vital signs, since these factors affect surgical risk and management.
• Sequential compression devices (SCDs), ambulation, and anticoagulants will help prevent postoperative venous thromboembolism (VTE), promoting circulation and preventing clot formation.
• Patients with a latex allergy are at risk for cross-reactions with bananas, kiwi and chestnuts, as these foods contain proteins similar to latex.
• Age, obesity, and clotting disorders increase surgical risks, therefore: a 78-year-old patient with diabetes, a 45-year-old patient with obesity and a 60-year-old with a history of deep vein thrombosis are at a higher risk for complications during surgery.
• The nurse must confirm that informed consent is obtained before sedation.
• Early ambulation is key in preventing pnuemonia.
• Deep breathing and coughing prevent atelectasis and pneumonia.
• Early movement helps stimulate bladder function.

Factors That Impair Wound Healing

• Poor hand hygiene
• Diabetes
• Obesity
• Smoking increase the risk of postoperative infection..
• Measures to reduce nausea and improve gastrointestinal function would include administering antiemetics as ordered, encouraging deep breathing, and gradually advancing diet as tolerated
• Hypovolemia can be identified and monitored by checking vital signs, inspecting surgical dressings, monitoring urine output, and evaluating skin color.
• Nursing responsibilities in perioperative care play a key role in preoperative, intraoperative, and postoperative patient care, by ensuring informed consent is signed, administering preoperative medications, monitoring for postoperative complications, and educating the patient about recovery.
• NPO status must be maintained to prevent aspiration during anesthesia, therefore if a patient reports drinking water an hour before surgery, the nurse should report immediately to the surgical provider.
• Patients with a history of MI are at higher risk for cardiac complications postoperatively and should be monitored closely.
• Nail polish must be removed for accurate oxygen saturation monitoring.
• Teaching about pain control, lung expansion, mobility, and antibiotics helps prevent complications.
• Early ambulation prevents respiratory, circulatory, and gastrointestinal complications from occuring.
• Older adults, obese patients, and those with chronic illnesses or smoking history have delayed healing and increased complication risk.
• Surgery cannot proceed without signed informed consent; if it is not signed, intervention is immediately required.
• Patients have the right to withdraw consent, the surgeon must be informed immediately.
• A bladder scan determines urinary retention before interventions like catheterization.

Increased Bleeding Risk Before Preceeding With Surgery:

• Patient took aspirin this morning
• Patient has an elevated INR level
• Patient reports drinking herbal tea daily
• Maintaining warmth prevents hypothermia, which can delay recovery.
• Pain control includes medication, repositioning, breathing exercises, and monitoring for side effects.