Perioperative Registered Nurses: Roles and Standards

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Questions and Answers

In the perioperative setting, what is the MOST important role of the registered nurse in relation to the multidisciplinary team?

  • Enforcing strict adherence to surgical protocols, resolving conflicts and directing team activities.
  • Delegating tasks to all members of the paramedical team to ensure efficiency.
  • Serving as the primary point of contact and coordinator for patient care, integrating the contributions of all team members. (correct)
  • Focusing primarily on medication administration while relying on other team members for patient assessment and communication.

Which of the following BEST describes the sequence of physiological events leading to the conscious perception of pain following tissue injury?

  • Tissue injury, transmission, transduction, perception, pain modulation.
  • Tissue injury, perception, transmission, transduction, pain modulation.
  • Tissue injury, transduction, transmission, perception, pain modulation. (correct)
  • Tissue injury, pain modulation, transduction, transmission, perception.

Which National Safety and Quality Health Service Standard is MOST directly related to ensuring comprehensive and coordinated care during the perioperative period?

  • Comprehensive Care. (correct)
  • Medication Safety.
  • Recognising and Responding to Acute Deterioration.
  • Communicating for Safety.

A patient in the recovery room exhibits increasing restlessness, a falling SpO2, and rising heart rate. What is the MOST appropriate initial nursing intervention?

<p>Increasing the oxygen flow rate and stimulating the patient to take deep breaths. (D)</p> Signup and view all the answers

A patient who has undergone major bowel surgery has a serum sodium level of 128 mEq/L. Which type of intravenous fluid would MOST cautiously address this imbalance?

<p>0.9% sodium chloride. (D)</p> Signup and view all the answers

What mechanism primarily drives fluid movement between the interstitial and intracellular fluid compartments?

<p>Osmotic pressure. (C)</p> Signup and view all the answers

During the perioperative period, which clinical manifestation would indicate a fluid volume deficit?

<p>Increased urine specific gravity and dry mucous membranes. (A)</p> Signup and view all the answers

Which factor is MOST significant in the pathogenesis of breast cancer?

<p>Genetic mutations affecting cell growth and DNA repair. (C)</p> Signup and view all the answers

A patient is scheduled for a sentinel lymph node biopsy. What is the PRIMARY purpose of this procedure in the management of breast cancer?

<p>To determine if the cancer has spread beyond the breast. (B)</p> Signup and view all the answers

What is the underlying pathophysiology of lymphedema following breast cancer treatment?

<p>Blockage or disruption of lymphatic vessels, leading to fluid accumulation. (C)</p> Signup and view all the answers

What is the MAIN importance of critically appraising evidence before implementing changes in nursing practice?

<p>To assess the reliability, validity, and applicability of the research findings. (D)</p> Signup and view all the answers

In quantitative research, what is the PRIMARY rationale for conducting sampling?

<p>To ensure that the study findings are applicable to a larger population. (A)</p> Signup and view all the answers

Which of the following BEST describes the concept of pharmacokinetics?

<p>The study of how drugs are absorbed, distributed, metabolized, and excreted by the body. (C)</p> Signup and view all the answers

A drug that binds to a receptor and prevents the action of an endogenous substance is known as what?

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

When administering medications to treat infections, what is the MOST important nursing consideration related to antimicrobial resistance?

<p>Educating patients to complete the full course of antibiotics, even if they feel better. (D)</p> Signup and view all the answers

Following a mastectomy, a patient reports persistent swelling in their affected arm. What is the MOST likely underlying cause of this chronic condition?

<p>Lymphatic system disruption affecting fluid drainage. (D)</p> Signup and view all the answers

You notice a postoperative patient's wound has separated, with underlying tissues exposed. Which intervention is the MOST appropriate initial nursing action?

<p>Cover the wound with a sterile, saline-moistened dressing, and notify the surgeon. (A)</p> Signup and view all the answers

A patient's blood pressure drops suddenly during surgery. What compensatory mechanism is the body MOST likely to activate initially?

<p>Increased heart rate and vasoconstriction to maintain cardiac output. (B)</p> Signup and view all the answers

Which statement BEST describes the primary role of the scrub nurse during a surgical procedure?

<p>Maintaining a sterile field and assisting the surgeon with instruments. (C)</p> Signup and view all the answers

Following a total hip arthroplasty, a patient reports severe pain that is unrelieved by opioid analgesics. What is the MOST appropriate next step?

<p>Evaluate for potential complications such as compartment syndrome or nerve injury. (D)</p> Signup and view all the answers

A patient develops acute shortness of breath and crackles in the lungs shortly after a large volume crystalloid infusion. What is the MOST likely cause of these findings?

<p>Fluid overload leading to pulmonary edema. (C)</p> Signup and view all the answers

A research study aims to determine the effect of a new pain management protocol on patient satisfaction scores. What research approach is MOST appropriate?

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

Which of the following BEST illustrates the application of evidence-based practice (EBP) in nursing?

<p>Implementing a new catheter insertion technique based on current research findings. (C)</p> Signup and view all the answers

A study's inclusion criteria specify that participants must be over 65 years of age with a diagnosis of type 2 diabetes. What is the PRIMARY purpose of these criteria?

<p>To minimize potential confounding variables and ensure homogeneity. (C)</p> Signup and view all the answers

A patient receiving an immunosuppressant medication develops a fever, cough, and shortness of breath. Which opportunistic infection is MOST likely?

<p>Pneumocystis pneumonia (PCP) (A)</p> Signup and view all the answers

A patient asks why they are receiving an antibiotic prior to surgery. Which response BEST explains the rationale for prophylactic antibiotic administration?

<p>To prevent infection at the surgical site during and after the procedure. (C)</p> Signup and view all the answers

A patient is prescribed an opioid analgesic for chronic pain. What is the MOST important nursing consideration regarding potential adverse effects?

<p>Educating the patient on preventing constipation and respiratory depression. (B)</p> Signup and view all the answers

What is the PRIMARY mechanism of action by which nonsteroidal anti-inflammatory drugs (NSAIDs) relieve pain and inflammation?

<p>Inhibiting the synthesis of prostaglandins by blocking cyclooxygenase (COX) enzymes. (B)</p> Signup and view all the answers

During a preoperative assessment, a patient reports taking St. John's Wort. What is the MOST important consideration for the nurse related to this herbal supplement?

<p>It can interact with certain medications and affect liver metabolism. (D)</p> Signup and view all the answers

A patient receiving chemotherapy develops neutropenia. What is the MOST critical nursing intervention to prevent infection?

<p>Implementing strict hand hygiene and limiting exposure to potential pathogens. (B)</p> Signup and view all the answers

During the perioperative period, what is the MOST appropriate nursing intervention to prevent medication errors?

<p>Performing independent double checks with another qualified healthcare provider. (A)</p> Signup and view all the answers

How would the healthcare clinician use evidence-based practice (EBP) to address a high incidence of surgical site infections (SSIs)?

<p>Systematically review research, evaluate the evidence, and implement evidence-based protocols to reduce SSIs. (B)</p> Signup and view all the answers

After induction of anesthesia, a patient's blood pressure suddenly drops. What is the MOST appropriate FIRST nursing action?

<p>Increase the rate of the intravenous fluids and notify the anesthesiologist. (D)</p> Signup and view all the answers

A patient receiving opioid analgesics postoperatively exhibits signs of respiratory depression. Which medication would the nurse MOST likely administer?

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

A researcher aims to investigate the lived experiences of patients undergoing chemotherapy. Which research approach is MOST suitable?

<p>Phenomenological study (B)</p> Signup and view all the answers

A patient with a history of chronic pain is scheduled for surgery. What is the MOST appropriate approach to pain management?

<p>Consult with the pain management team preoperatively to develop an individualized pain management plan. (D)</p> Signup and view all the answers

What is the PRIMARY reason for monitoring a patient's serum electrolyte levels (e.g., sodium, potassium) during and after major surgery?

<p>To detect and manage potential fluid and electrolyte imbalances. (C)</p> Signup and view all the answers

A patient who underwent a mastectomy reports numbness and tingling in the surgical area. What is the MOST likely cause of this sensation?

<p>Nerve damage during the surgical procedure. (B)</p> Signup and view all the answers

Which action exemplifies the registered nurse's role in coordinating care within the perioperative multidisciplinary team?

<p>Facilitating communication and collaboration among surgeons, anesthesiologists, and other healthcare professionals. (D)</p> Signup and view all the answers

What is the PRIMARY purpose of critically appraising a research article before applying its findings to clinical practice?

<p>To evaluate the study's validity, reliability, and applicability to the specific patient population. (D)</p> Signup and view all the answers

In quantitative research, what differentiates a simple random sample from a stratified random sample?

<p>In stratified sampling, the population is divided into subgroups, and random samples are taken from each subgroup. (B)</p> Signup and view all the answers

What is the PRIMARY difference between a drug agonist and a drug antagonist?

<p>Agonists bind to receptors and activate a response, while antagonists bind to receptors and block a response. (D)</p> Signup and view all the answers

A patient is prescribed an antibiotic, and the nurse provides education on antimicrobial resistance. What statement indicates the patient UNDERSTANDS the teaching?

<p>&quot;I need to take the antibiotic exactly as prescribed, even if I start feeling better.&quot; (C)</p> Signup and view all the answers

A postoperative patient has a nasogastric (NG) tube set to low intermittent suction. Which clinical finding indicates the patient is developing a fluid volume deficit?

<p>Poor skin turgor, dry mucous membranes, and concentrated urine. (D)</p> Signup and view all the answers

What is the PRIMARY reason for administering prophylactic heparin or enoxaparin to a patient following major surgery?

<p>To prevent the formation of deep vein thrombosis (DVT) and pulmonary embolism (PE). (D)</p> Signup and view all the answers

Flashcards

Perioperative Registered Nurse Role

The registered nurse is responsible for patient care during each of the three phases of surgery: Preoperative, Intraoperative, and Postoperative.

Perioperative Team

Involves physicians, surgeons, anesthesiologists, surgical technicians, and other healthcare professionals to help provide optimal patient care.

Pathophysiology of Pain

Tissue injury leads to the release of chemical mediators, activating pain receptors and sending signals to the brain, resulting in the conscious perception of pain.

Multidisciplinary Pain Treatment

Includes medications (opioids, NSAIDs), nerve blocks, physical therapy, psychological support, and alternative therapies.

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Safety Standards

The National Standards mandate protocols for patient identification, communication, medication safety, and preventing healthcare-associated infections.

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Care of Deteriorating Patient

Includes frequent monitoring of vital signs, oxygen saturation, and level of consciousness, as well as prompt intervention per established protocols.

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Nursing Interventions for Deterioration

Interventions include administering oxygen, notifying the healthcare provider, initiating resuscitation measures, and documenting changes.

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Tonicity of Fluids

Fluids are categorized as isotonic, hypotonic, or hypertonic based on their solute concentration compared to plasma.

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Fluid Replacement Therapy

Fluid replacement includes crystalloids (normal saline) and colloids (albumin), used to restore intravascular volume and correct electrolyte imbalances.

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Body Fluid Shifts

Fluids shift between intravascular, interstitial, and intracellular compartments, influenced by hydrostatic and osmotic pressure.

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Fluid Shift Mechanisms

Hydrostatic pressure pushes fluid out of vessels, while osmotic pressure pulls fluid back in, influenced by albumin and electrolytes.

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Fluid Compartments

Include intravascular (blood plasma), interstitial (fluid around cells), and intracellular (fluid inside cells) compartments.

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Effects of Fluid Alterations

Fluid alterations cause edema, dehydration, electrolyte imbalances, and changes in blood pressure and tissue perfusion.

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Fluid Deficit Manifestations

Manifestations include thirst, dry mucous membranes, decreased urine output, tachycardia, hypotension, and altered mental status.

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Evidence-Based Practice (EBP)

Evidence-based practice (EBP) is using the best available research evidence to make clinical decisions.

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Critically Appraising Evidence

The process of critically evaluating research findings to assess their validity, reliability, and applicability to clinical practice.

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Primary Sources

Original research studies or reports, like journal articles where researchers present their own findings.

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Secondary Sources

Summaries or interpretations of primary sources, like textbooks or review articles.

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Scholarly Literature

Articles written by experts, peer-reviewed, and often found in academic journals.

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Quantitative Research

A structured investigation using measurable data to establish facts and relationships.

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Qualitative Research

Explores complex human experiences through words, stories, and detailed descriptions.

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Sampling in Quantitative Research

Selecting a subgroup of the population to represent the whole, to enable inferences about the entire population.

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Selection Criteria

Predetermined characteristics that define who can and cannot participate in a study.

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Data Collection Methods

Methods such as surveys, experiments, and questionnaires used to gather numerical data in research.

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Pharmacokinetics

What the body does to the drug; absorption, distribution, metabolism, and excretion.

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Pharmacodynamics

How the drug affects the body; the biochemical and physiological effects.

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Agonist

A molecule that binds to a receptor and activates it, producing a response.

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Antagonist

A molecule that binds to a receptor and blocks the action of an agonist, preventing a response.

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Therapeutic Effect

The desired and beneficial effect of a drug in treating a medical condition.

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Adverse Effects

Undesired or harmful effects resulting from a medication.

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Breast Cancer Risk Factors

Risk factors include genetics, age, hormonal factors, and lifestyle choices.

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Clinical Manifestations

Clinical findings may include a lump, changes in breast size/shape, skin changes, or nipple discharge.

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Breast Cancer Pathophysiology

Involves genetic mutations leading to uncontrolled cell growth and invasion of surrounding tissues.

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Diagnosing Breast Cancer

Mammography, ultrasound, biopsy, MRI.

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Surgical Breast Cancer Treatments

Lumpectomy, mastectomy, sentinel lymph node biopsy, axillary lymph node dissection.

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Pharmacological Breast Cancer Treatments

Chemotherapy, hormonal therapy, targeted therapy, immunotherapy.

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Lymphedema Pathophysiology

Accumulation of lymph fluid in tissues due to impaired lymphatic drainage commonly after lymph node removal.

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Value of Research in Nursing

The use of research findings to inform and improve nursing and midwifery practice.

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Components of EBP

A step-by-step method to solve problems using research evidence.

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Clinician's Role in EBP

Healthcare clinicians should stay updated on research, apply findings, and participate in research projects.

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EBP and Professional Standards

Professional standards require nurses to use evidence and contribute to research.

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Refining a Research Idea

Based on clinical experience, existing literature, or problem analysis.

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Conducting a Literature Search

Use databases (PubMed, Cochrane) to find relevant articles.

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Types of Quantitative Sampling

Describing main types such as simple random sampling, stratified sampling, convenience sampling used in quantitative research.

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Sampling Selection Criteria

The characteristics that determine eligibility to participate in a research study.

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Study Notes

  • Perioperative registered nurses play a crucial role in patient care during the preoperative, intraoperative, and postoperative phases.
  • Registered nurses are vital members of the perioperative paramedical team.
  • Tissue injury triggers a pathophysiological process, leading to the conscious perception of pain.
  • Multidisciplinary teams use pharmacological and non-pharmacological treatments and interventions to manage acute and chronic pain.
  • National Safety and Quality Health Service Standards are essential during the perioperative period.
  • Registered nurses are responsible for caring for deteriorating perioperative patients.
  • Nursing interventions are required when a patient deteriorates in the recovery room or in the postoperative surgical ward.
  • Tonicity of fluids is important in correcting body fluid imbalances.
  • Different types of fluid replacement therapy exist.
  • Fluids shift around the body.
  • Different mechanisms influence how fluids shift around the body.
  • There are different types of fluid compartments in the body.
  • Fluid alterations can have significant effects on the body.
  • Clinical manifestations of fluid balance deficit can occur in the perioperative period.

Breast Cancer

  • Risk factors exist for the development of breast cancer.
  • Clinical manifestations of breast cancer can vary.
  • Pathogenesis and pathophysiology are important aspects of breast cancer.
  • Procedures are used to diagnose breast cancer.
  • Surgical procedures are used in the management of breast cancer.
  • Pharmacological agents are available to treat breast cancer.
  • Pathogenesis and pathophysiology of lymphedema are important to understand.

Evidence-Based Practice

  • Research and evidence-based practice has value in nursing and midwifery.
  • Evidence-based practice involves using the best available evidence to inform clinical decision-making.
  • Evidence-based practice has key components that need to be identified.
  • Healthcare clinicians have a role to play in evidence-based practice.
  • Evidence-based practice aligns with professional standards.
  • Identifying and refining a research idea, question, or clinical problem is important.
  • Performing a literature search based on topics or specific information is important.
  • Primary and secondary sources should be differentiated.
  • Scholarly and non-scholarly literature should be contrasted.
  • It is important to determine the level of evidence of sources, before implementing changes.
  • Critical appraisal of evidence is vital.
  • Theoretical and philosophical positions underpin different research approaches.
  • Relationships between paradigms, methodologies, methods, and frameworks exist.
  • Qualitative and quantitative research approaches and designs have different features.
  • Sampling is conducted in quantitative research.
  • There are main types of quantitative sampling.
  • Selection criteria are used in quantitative sampling.
  • There are different data collection methods in quantitative research.

Pharmacology

  • Understanding drugs and drug preparations, properties of an ideal drug, pharmacokinetics, pharmacodynamics, variability of drug actions, reactions across a lifespan, and individual differences between drugs is important.
  • Nursing responsibilities are important to understand.
  • Understanding drugs interacting with receptors, the difference between agonists and antagonists, therapeutic effects, common adverse effects and drug interactions, and the psycho-socio-cultural aspect of pharmacotherapeutics is important.
  • Nursing considerations need to be understood.
  • Understanding medications used to treat infections and those that suppress the immune system is important.
  • Understanding the mechanism of action of medications used to treat infections and suppress the immune system is important.
  • Understanding the pharmacokinetics and drug particulars of medications used to treat infections and suppress the immune system is important.
  • Nursing considerations need to be understood.

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