Perioperative Nursing Management Overview
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Questions and Answers

What is a common sign of decreased cardiac output?

  • Rapid, irregular pulse
  • Weak, thready pulse (correct)
  • Absent pulse
  • Strong, bounding pulse

    • What is the priority nursing intervention for a patient in hypovolemic shock?

  • Elevate the legs
  • Administering oxygen
  • Monitoring vital signs
  • Volume replacement (correct)

    • Which of the following factors can contribute to the development of hypovolemic shock?

  • Widespread vasodilation
  • Increased capillary permeability
  • Heart failure
  • Hemorrhage (correct)

    • What is the recommended position for a client with hypovolemic shock?

    <p>Supine position with legs elevated (C)</p> Signup and view all the answers

    Why is it important to monitor urinary output in a patient with hemorrhage?

    <p>To assess for blood loss (D)</p> Signup and view all the answers

    What is a common complication that elderly patients are at a higher risk of experiencing after surgery?

    <p>All of the above (D)</p> Signup and view all the answers

    Which of the following nursing interventions can help prevent postoperative complications?

    <p>All of the above (D)</p> Signup and view all the answers

    What is the recommended position to open the airway during pharyngeal obstruction?

    <p>Both A and C (A)</p> Signup and view all the answers

    Which of the following is NOT a responsibility of the post-anesthesia care nurse in preventing immediate postoperative complications?

    <p>Performing a pre-operative assessment of the patient's medical history (A)</p> Signup and view all the answers

    Which of the following is a sign of shock/hemorrhage in a postoperative patient?

    <p>Decreased urine output (A)</p> Signup and view all the answers

    Which of the following is a factor that affects wound healing?

    <p>Hypothermia (C)</p> Signup and view all the answers

    Which type of wound healing occurs when a wound is closed by sutures?

    <p>First-intention healing (C)</p> Signup and view all the answers

    What is the appropriate position for a patient undergoing a lumbar puncture?

    <p>Side-lying knee-chest position (A)</p> Signup and view all the answers

    Which of the following is a priority action in postoperative care?

    <p>Verifying the surgical procedure, site, and patient identity (D)</p> Signup and view all the answers

    Why is it important to avoid using family members as translators for patients needing medical interpretation?

    <p>All of the above (D)</p> Signup and view all the answers

    Which of the following is a common postoperative complication?

    <p>Hematoma (C)</p> Signup and view all the answers

    What is the primary goal of surgical asepsis?

    <p>To prevent contamination of sterile wounds (A)</p> Signup and view all the answers

    In which zone of the surgical environment are street clothes permitted?

    <p>The unrestricted zone (D)</p> Signup and view all the answers

    During which stage of general anesthesia might a patient exhibit yelling or crying?

    <p>Stage 2: excitement (C)</p> Signup and view all the answers

    Which of the following is a characteristic of Stage 3 (surgical anesthesia)?

    <p>Small reactive pupils and regular pulse (A)</p> Signup and view all the answers

    What is a significant risk associated with the administration of epidural anesthesia?

    <p>Life-threatening hypotension and respiratory depression (D)</p> Signup and view all the answers

    Why is intravenous anesthesia often preferred for eye surgeries?

    <p>It reduces the risk of post-operative vomiting (C)</p> Signup and view all the answers

    Which type of anesthesia involves multiple small doses of sedative medications and is used for procedures like dislocated shoulder/hip?

    <p>Moderate sedation (A)</p> Signup and view all the answers

    What is a key characteristic of inhalation anesthesia?

    <p>Rapid induction and rapid recovery (A)</p> Signup and view all the answers

    What is the primary reason many institutions ban artificial nails for healthcare providers?

    <p>They are associated with higher bacterial counts. (C)</p> Signup and view all the answers

    Which of the following is an early sign of malignant hyperthermia?

    <p>Tachycardia and muscle rigidity (D)</p> Signup and view all the answers

    Which action is most important when a patient vomits while under anesthesia?

    <p>Turn the patient to their side. (D)</p> Signup and view all the answers

    What action should a nurse take if a patient is experiencing respiratory depression following an epidural anesthetic?

    <p>Monitor closely and prepare for potential intubation. (D)</p> Signup and view all the answers

    In which position should a patient be placed after experiencing a wound dehiscence?

    <p>Low Fowler's position (B)</p> Signup and view all the answers

    When does the preoperative phase of perioperative patient care conclude?

    <p>When the patient is transferred onto the operating room (OR) bed (D)</p> Signup and view all the answers

    What is the primary purpose of instructing a post-operative patient on using an incentive spirometer?

    <p>To remove secretions and promote lung expansion (B)</p> Signup and view all the answers

    Which of the following is NOT a key area to assess during a comprehensive preoperative assessment?

    <p>Patient's socioeconomic background (B)</p> Signup and view all the answers

    What is a critical nursing responsibility when a patient is receiving conscious sedation?

    <p>To ensure the patient is never left alone. (A)</p> Signup and view all the answers

    What is a significant consideration when providing preoperative care to an older adult patient?

    <p>Reduced renal and hepatic function affecting how medications are processed (C)</p> Signup and view all the answers

    When is the best time to obtain informed consent for a non-emergent surgical procedure?

    <p>Prior to the administration of any psychoactive premedication (B)</p> Signup and view all the answers

    What is the antidote for malignant hyperthermia?

    <p>Dantrolene. (D)</p> Signup and view all the answers

    Besides the surgeon, who is responsible for ensuring a valid informed consent before a patient enters surgery?

    <p>The nurse who clarifies information and witnesses the patient’s signature (B)</p> Signup and view all the answers

    During preoperative preparation, what is particularly important for patients with disabilities?

    <p>Providing multiple education formats and allowing extra time for understanding (C)</p> Signup and view all the answers

    Which of these occurs during the intraoperative phase of patient care?

    <p>The patient is transferred onto the operating room bed (A)</p> Signup and view all the answers

    What is a unique consideration regarding preoperative care for patients with obesity?

    <p>They may have respiratory compromise (D)</p> Signup and view all the answers

    What is the primary goal of managing postoperative nausea and vomiting (N/V)?

    <p>To prevent vomiting (D)</p> Signup and view all the answers

    What nursing intervention is crucial for preventing deep vein thrombosis (DVT) in postoperative patients?

    <p>Administering anticoagulants (C)</p> Signup and view all the answers

    Which of the following is a significant indicator of hypoxia in a postoperative patient?

    <p>Pulse oximetry readings (A)</p> Signup and view all the answers

    What is an important aspect of pain management in postoperative care?

    <p>Providing around-the-clock analgesics (A)</p> Signup and view all the answers

    What should be included in patient education prior to discharge to minimize infection risk?

    <p>Signs and symptoms of infection (D)</p> Signup and view all the answers

    Why is it important to turn a postoperative patient onto their side?

    <p>To prevent aspiration from vomitus (D)</p> Signup and view all the answers

    Which of the following actions can help reduce the risk of infection in postoperative patients?

    <p>Improved fluid intake (A)</p> Signup and view all the answers

    What should be reported immediately in the context of perfusion?

    <p>A systolic blood pressure less than 90 (A)</p> Signup and view all the answers

    Study Notes

    Perioperative Nursing Management

    • Perioperative phases include preoperative, intraoperative, and postoperative phases
    • Preoperative phase begins with decision for surgery, ends with transfer to OR bed
    • Intraoperative phase begins with transfer to OR bed, ends with admission to PACU
    • Postoperative phase begins with PACU admission, ends with follow-up in clinic or home

    Preoperative Assessment

    • Comprehensive assessment needed to identify pertinent health and surgical risk factors
    • Includes health history, physical exam, medications, allergies, nutritional and fluid status, dentition, drug/alcohol use, respiratory and cardiovascular status, hepatic/renal function, endocrine/immune function, previous medication use, psychosocial factors, spiritual/cultural beliefs

    Older Adult, Obesity, Disability Considerations

    • Cardiac reserve, renal and hepatic functions are depressed in older adults
    • Gastrointestinal activity and respiratory compromise are likely reduced
    • Obesity increases risk for several complications
    • Disabilities also require specific considerations

    Regulatory Documents Pre-Surgery

    • Written consent required for non-emergency surgeries, witnessed by two people
    • Surgeon explains procedure, benefits, risks, and complications
    • Must sign consent form before receiving pre-meds
    • Consent form accompanies patient to OR

    Immediate Preoperative Preparation & Education

    • Deep breathing exercises, coughing, incentive spirometry (10x/hour)
    • Active body movement, if possible, helps maintain baseline function pre-surgery
    • Early pain management strategies important to maintain mobility
    • Cognitive coping strategies, like guided imagery, music, or distraction, are useful

    Infection Risk and Medication Safety

    • Corticosteroids and alcohol increase infection risk
    • Avoid herbal medications that interfere with blood clotting for 2 weeks prior to surgery
    • Aspirin should not be taken 7-10 days prior to surgery

    Intraoperative Nursing Management - Roles

    • Surgical team members include patients, anesthesiologist/CRNA, surgeon, circulating nurses (managing OR safety), surgical technicians, and registered nurse first assistants/surgical technologists

    Intraoperative Nursing Management - Complications

    • Anesthesia awareness
    • Nausea, vomiting, and anaphylaxis
    • Vital signs monitor and hypothermia

    Reducing Surgical Site Infections

    • Surgical environment with special air filtration, reduced traffic, and clean rooms
    • Staff must be healthy and follow protocols
    • Unrestricted, semirestricted, and restricted zones delineate areas with different attire and activity levels
    • Surgical asepsis to prevent contamination of sterile wounds
    • Environmental controls to maintain clean conditions

    Types of Anesthesia

    • Different anesthesia types have different uses, advantages, disadvantages, and nursing responsibilities.
    • General anesthesia includes 4 stages: induction, excitement, surgical anesthesia, and deep anesthesia.
    • Regional anesthesia, epidural, spinal, and local all have different methods for delivery and impacts

    Intraoperative Nursing Process

    • Optimizing patient outcomes during intraoperative period requires use of the nursing process
    • Key components include reducing anxiety, preventing injury, protecting from injury
    • Prioritize serving as advocate, monitoring, and managing potential complications
    • Considerations related to older adult patients, patients with obesity, and patients with disabilities also essential

    Postoperative Nursing Management

    • Prevention of immediate postoperative complications a major priority for the postanesthesia care unit (PACU) nurse
    • Pre-op assessment and frequent assessments help detect early signs of complications
    • Providing care until the patient recovers from anesthesia and returns to cognitive baseline vital
    • Clear airways, control nausea and vomiting, maintain stable vital signs, vital and frequent patient assessment, review pre-op information, airway checks, assessments, drainage tube monitoring are crucial tasks
    • Assess vital signs, monitor airway response, check drainage tubes, assess pain levels, vital signs on admission to the PACU, and repeated per institution protocol
    • Aspiration is important to prevent with patients turning, keeping airway clear
    • Fluid volume maintenance, bowel prep, and rapid IVs in older adults increase risks

    Postoperative Problems & Management

    • Identify, manage hypotension/tachycardia/tachypnea, shock/hemorrhage, pallor, cool moist skin, rapid respirations, decreasing pulse pressure, low blood pressure, concentrated urine, hypertension, and arrhythmias
    • Post-op complications like VTE/PE, hematoma, and infection all warrant assessments and management.

    Wound Healing, Post-op Phase Recovery, and Nursing Process

    • First and second intention wound healing processes
    • Implement nursing care to enhance recovery in post-op phase including assessment of comfort and environmental comfort
    • Use nursing process in a framework to aid with recovery: assessment, diagnoses, planning and goals, and nursing interventions
    • Identify specific diagnostic tests (e.g., pulmonary function tests, arterial blood gases, venous blood gases)

    Gas Exchange and Ventilation

    • Proper gas exchange, ventilation, and perfusion are necessary in respiration
    • Assess lung function (checking for conditions like hypoxia and CO2 buildup)

    Assessing, Evaluating, Diagnosing Respiratory Dysfunction

    • Comprehensive respiratory assessments are vital—including inspection, palpation, percussion, and auscultation.
    • Evaluate major symptoms (e.g., difficulty breathing, cyanosis) using a patient's health history and physical exam findings
    • Identify diagnostic tests (e.g., pulse oximetry, sputum studies, imaging studies) used for evaluation and treatment

    Additional Notes

    • Trained medical interpreters needed, not family members
    • Surgical procedure, site, and patient identification verification priority
    • Side-lying knee-chest position for lumbar punctures
    • Maintaining NPO (nothing by mouth) status until gag reflex returns.
    • Contrast media contraindicated in iodine, shellfish, seafood allergies, pregnancy, or elevated creatinine.

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    Preoperative Nursing Management PDF

    Description

    This quiz covers the essential phases of perioperative nursing management, including preoperative, intraoperative, and postoperative care. It emphasizes the importance of comprehensive assessments in identifying health and surgical risk factors, particularly in older adults and patients with obesity or disabilities. Test your knowledge on nursing considerations in the perioperative setting.

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