Preoperative Assessment for Anesthesia

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Questions and Answers

What is the primary purpose of preoperative education?

To inform patients about the risks of anesthesia

To obtain informed consent from patients

To reduce anxiety and fear (correct)

To provide patients with sensory information

What laboratory test is NOT typically completed pre-operatively?

MRI (correct)

Blood glucose level

Urine analysis

Pregnancy test

What is the purpose of assessing the patient's dentures and bridges pre-operatively?

To evaluate the patient's anesthetic risk

To determine the patient's surgical risk

To prevent dislodgement during intubation (correct)

To assess the patient's nutritional status

What type of information do patients wanting process information desire?

General information about the surgical experience Signup and view all the answers

What is the primary goal of informed consent?

To ensure patients understand the risks and benefits of the surgery Signup and view all the answers

What is the purpose of weighing the patient pre-operatively?

To assess the patient's nutritional status Signup and view all the answers

What type of patient information does the nurse gather during the pre-operative assessment?

History of gastro-intestinal disorders and elimination problems Signup and view all the answers

What exercises may be taught to patients pre-operatively?

Leg exercises and foot exercises Signup and view all the answers

What is a necessary condition for a patient to give informed consent?

The patient must have the mental capacity to consent Signup and view all the answers

What is the primary purpose of a preoperative bowel preparation?

To empty the GI system for GI surgeries Signup and view all the answers

Why is nail polish removed before surgery?

Because it may skew the results of the pulse oximeter Signup and view all the answers

What is the purpose of an identification band on a surgical patient?

To identify the patient and prevent mix-ups Signup and view all the answers

Why must a patient void shortly before surgery?

To prevent involuntary elimination under anesthesia Signup and view all the answers

What type of medication is used to reduce anxiety and sedate a patient preoperatively?

Benzodiazepine Signup and view all the answers

What is the primary purpose of a preoperative medication like Gravol or Maxeran?

To reduce postoperative nausea Signup and view all the answers

When is informed consent not required?

In emergency situations Signup and view all the answers

What type of surgical procedure involves the removal of a body organ?

Cholecystectomy Signup and view all the answers

What is the nurse's role when assisting a client with informed consent before an operative procedure?

Asks the client to explain what surgical procedure she or he is having and ensures that the client understands the operation to be performed Signup and view all the answers

What is the primary goal of the physical environment in the surgical suite?

To maximize infection control and provide a seamless flow of patients, personnel, and operative instruments, equipment, and supplies Signup and view all the answers

Which area of the surgical suite provides access to all people in street clothes?

Unrestricted area Signup and view all the answers

What is the purpose of the semi-restricted area in the surgical suite?

To include peripheral support areas, such as work and storage areas for clean and sterile supplies Signup and view all the answers

What type of attire must authorized personnel wear to access semi-restricted areas?

Surgical attire and cover all head and facial hair Signup and view all the answers

Which area of the surgical suite includes the operating rooms and areas where sterile supplies are opened?

Restricted area Signup and view all the answers

What is a critical component of intraoperative care?

All of the above Signup and view all the answers

What is the primary purpose of skin preparation before surgery?

To reduce the number of transient and resident skin microorganisms at and surrounding the surgical incision site Signup and view all the answers

What is the main goal of positioning the patient during surgery?

To prevent pressure on nerves, skin over bony prominences, and eyes Signup and view all the answers

What is the primary difference between general anesthesia and local anesthesia?

General anesthesia affects the entire body, while local anesthesia affects a specific area Signup and view all the answers

What is the purpose of the circulating nurse during surgical preparation?

To prepare the surgical site for surgery Signup and view all the answers

What is regional anesthesia?

A loss of sensation in a region of the body Signup and view all the answers

What is anaphylaxis?

A severe form of allergic reaction Signup and view all the answers

What is the purpose of recognizing individual needs during surgical positioning?

To respect the patient's autonomy and dignity Signup and view all the answers

What is the primary characteristic of procedural sedation?

A mild depression of consciousness with maintenance of airway control Signup and view all the answers

What is the primary symptom of paralytic ileus?

Abdominal distension and tenderness Signup and view all the answers

Why is it essential to monitor bowel sounds in a postoperative patient?

To assess for paralytic ileus Signup and view all the answers

What is the primary goal of management in a patient with paralytic ileus?

To promote peristalsis and restore bowel function Signup and view all the answers

What is the primary indicator of urinary retention in a postoperative patient?

Urinary output less than 30ml/hour Signup and view all the answers

What is the primary purpose of assessing the surgical wound?

To identify signs of surgical site infection Signup and view all the answers

What is a sign of surgical site infection?

Purulent discharge from the wound Signup and view all the answers

Why is it important to not touch the surgical wound dressing for approximately 48 hours after surgery?

To reduce the risk of surgical site infection Signup and view all the answers

What should be assessed during wound assessment?

The drainage amount, type, color, and odor Signup and view all the answers

Study Notes

Gastro-Intestinal-Nutritional System

History of gastro-intestinal disorders or problems with elimination are identified
Food and fluid intake patterns and recent weight loss are determined
Patient's weight is assessed
Presence of dentures and bridges is assessed to prevent dislodging during intubation

Preoperative Laboratory and Diagnostics

Common lab tests completed pre-operatively:
- CBC (Hgb, WBC)
- Renal studies (electrolytes, glucose)
- Liver studies
- Coagulation studies (PTT, INR, aPTT)
- Blood type and screen (in case patient requires blood transfusion)
- Urine analysis and pregnancy test
Preoperative laboratory and diagnostics are obtained to determine surgical and anesthetic risk

Preoperative Education

Empowers patients to make informed health decisions and participate effectively during the surgical experience
Increases patient satisfaction and reduces fear and anxiety
Involves three types of information:
- Sensory: what patients will see, hear, smell, and feel during surgery
- Process: general flow of what is going to happen
- Procedural: specific details of the surgery

Critical that nurses understand ethical and legal tenets of informed consent
Patients have autonomous right to make informed decisions regarding health care
Informed consent must be voluntary, with mental capacity, and properly informed
Required for non-emergency surgery, invasive procedures, and procedures with more than a slight risk of complications

Physical Preparation

Patient is required to shower or bathe before surgery
Dressed in a hospital gown; underclothes may or may not be permitted
Nail polish is removed to prevent skewing pulse oximeter results
Identification band and allergy band are placed on the patient
Valuables are returned to a family member or locked up according to institutional protocol
Jewelry and prostheses are removed to prevent loss or damage

Preoperative Medications

Used for various reasons, including:
- Bowel preparations (e.g., Pico salax)
- Reducing anxiety and sedating the patient (e.g., Ativan)
- Pain control (e.g., Morphine)
- Prophylaxis against infection (e.g., Ancef)
- Reducing post-operative nausea (e.g., Gravol/Maxeran)

Intraoperative Care

Five major components:
- Physical environment
- Surgical team members and roles
- Nursing management and responsibilities
- Anesthesia
- Unexpected clinical events

Physical Environment

Surgical suite is a controlled environment designed to maximize infection control and provide a seamless flow of patients, personnel, and operative instruments, equipment, and supplies
Divided into three areas:
- Unrestricted: provides access to all people in street clothes
- Semi-restricted: includes peripheral support areas for clean and sterile supplies
- Restricted: includes ORs and areas where sterile supplies are opened

Surgical Positioning

Principles for positioning include:
- Ensuring correct skeletal alignment
- Preventing pressure on nerves, skin over bony prominences, and eyes
- Providing for adequate thoracic excursion
- Preventing occlusion of arteries and veins
- Providing modesty in exposure
- Recognizing and respecting individual needs

Anesthesia

Classified into four types:
- General anesthesia: altered physiological state characterized by reversible loss of consciousness, skeletal muscle relaxation, amnesia, and analgesia
- Local anesthesia: loss of sensation without loss of consciousness
- Regional anesthesia: reversible loss of sensation to a region of the body
- Procedural (conscious) sedation: mild depression of consciousness for minor procedures

Exceptional Clinical Events

Anaphylaxis: severe allergic reaction with abdominal distention and tenderness
Paralytic ileus: impairment of intestinal motility postoperatively
Urinary function complications: decreased urinary output, urinary retention, and impaired sphincter control
Alterations in skin and surgical wounds: surgical site infection, indicators include purulent discharge, isolation of organisms, pain, tenderness, local edema, and warmth

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Description

This quiz assesses the steps involved in preoperative assessment for anesthesia, including patient history, physical examination, and laboratory tests. It covers the evaluation of gastro-intestinal disorders, nutritional status, and other factors that may impact anesthesia care.