Preoperative Nursing Care
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Questions and Answers

What is a crucial criterion for safely discharging a postoperative patient from recovery?

  • Patient's drainage and bleeding are excessive.
  • Patient has experienced a controlled post-operative pain level.
  • Patient can communicate with family members.
  • Patient has stable vital signs and O2 saturation above 90%. (correct)

    • Which of the following statements about dormant tuberculosis (TB) is true?

  • Dormant TB can progress to active TB many years later. (correct)
  • A positive TB test indicates that the person is infectious.
  • Dormant TB requires immediate aggressive treatment.
  • Dormant TB is always transmissible to others.

    • What is the initial phase of treatment for active tuberculosis (TB)?

  • Aggressive management using a single medication.
  • 4-5 drugs for a duration of 6-9 months.
  • Combination therapy of first and second-line agents for 2 months. (correct)
  • Immediate hospitalization without medication.

    • During active tuberculosis treatment, which precaution must be taken for the patient?

    <p>Airborne precautions including negative air pressure room.</p> Signup and view all the answers

    What nursing management aspect is important when caring for a patient with active TB?

    <p>Assessing the patient for TB symptoms and transmission risk.</p> Signup and view all the answers

    What is the importance of two consecutive negative cultures in the diagnosis of TB?

    <p>It determines the effectiveness of the treatment.</p> Signup and view all the answers

    In terms of patient teaching, which of the following is most crucial for someone diagnosed with active TB?

    <p>Minimizing exposure to contagious individuals.</p> Signup and view all the answers

    Which of the following is a characteristic of a patient with dormant TB?

    <p>Normal chest X-ray and asymptomatic status.</p> Signup and view all the answers

    What is a primary benefit of effective preoperative teaching?

    <p>Improved patient satisfaction</p> Signup and view all the answers

    Which patient information is essential to gather about medications preoperatively?

    <p>Include all medications in original bottles, including supplements</p> Signup and view all the answers

    What does the surgical 'time-out' process ensure?

    <p>Confirmation of patient identity and surgical site</p> Signup and view all the answers

    What should a preoperative nurse ensure about the informed consent?

    <p>The consent should be signed voluntarily without coercion</p> Signup and view all the answers

    Which comorbidity is NOT typically associated with increased surgical risk?

    <p>Regular physical exercise</p> Signup and view all the answers

    Why is it important to document allergy findings for a surgical patient?

    <p>To prevent miscommunication and provide patient safety</p> Signup and view all the answers

    What is a significant sign of malignant hyperthermia to monitor for in patients?

    <p>Muscle rigidity</p> Signup and view all the answers

    What is the role of the circulator nurse in the operating room?

    <p>To distribute supplies and communicate with the surgical team</p> Signup and view all the answers

    What is the recommended action for a patient with a known history of substance abuse undergoing surgery?

    <p>Assess for any potential complications related to substance use</p> Signup and view all the answers

    How should a nurse respond to a patient expressing fear about anesthesia?

    <p>Discuss the anesthesia process and address their concerns</p> Signup and view all the answers

    What should be accomplished prior to transporting a patient to the OR?

    <p>Verify that preoperative checklist is complete</p> Signup and view all the answers

    For the prevention of surgical site infections, when should prophylactic antibiotics be administered?

    <p>Within 30-60 minutes before incision</p> Signup and view all the answers

    Which type of anesthesia is associated with total loss of sensation and consciousness?

    <p>General anesthesia</p> Signup and view all the answers

    Which intervention is NOT appropriate for preventing hypoxemia in postoperative patients?

    <p>Administer opioids without sedation assessment</p> Signup and view all the answers

    What is a common cause of hypotension in postoperative patients?

    <p>Loss of volume</p> Signup and view all the answers

    Which of the following symptoms is associated with hypoventilation?

    <p>Decreased respiratory effort</p> Signup and view all the answers

    What is an important nursing action to manage emergence delirium?

    <p>Provide a quiet, calm environment</p> Signup and view all the answers

    What type of medication management is recommended for effective postoperative pain control?

    <p>Multimodal analgesia approach</p> Signup and view all the answers

    Which statement about postoperative nausea and vomiting (PONV) is true?

    <p>Primarily affects younger females with a history of motion sickness</p> Signup and view all the answers

    What is the priority nursing action for managing postoperative urinary retention?

    <p>Provide privacy and warmth while encouraging micturition</p> Signup and view all the answers

    What is the expected nursing practice for temperature management in postoperative patients?

    <p>Perform frequent temperature checks until normothermic</p> Signup and view all the answers

    Which complication is the most common cause of postoperative fever?

    <p>Surgical site infection (SSI)</p> Signup and view all the answers

    What should be assessed first in patients exhibiting postoperative cognitive dysfunction?

    <p>Potential infection signs</p> Signup and view all the answers

    What factor primarily contributes to the risk of developing SSI?

    <p>Lack of adherence to SCIP guidelines</p> Signup and view all the answers

    Which is NOT a cause of post-operative ileus?

    <p>High fluid intake</p> Signup and view all the answers

    What is an important assessment related to skin integrity in postoperative patients?

    <p>Assess for redness or swelling around the surgical site</p> Signup and view all the answers

    What should be done if a patient has a decreased urine output postoperatively?

    <p>Assess the bladder for distension</p> Signup and view all the answers

    What is the primary goal of treating patients with pulmonary fungal infections?

    <p>Providing supportive care and management of symptoms</p> Signup and view all the answers

    Which medication may cause hepatotoxicity and requires monitoring of liver function tests?

    <p>Isoniazid</p> Signup and view all the answers

    Which of the following symptoms is NOT a cardinal sign of acute exacerbation of COPD?

    <p>Decreased respiratory rate</p> Signup and view all the answers

    What is a potential complication associated with prolonged ischemia in PAD patients?

    <p>Gangrene</p> Signup and view all the answers

    What diagnostic test is commonly used to confirm the diagnosis of bronchiectasis?

    <p>CT scan of the chest</p> Signup and view all the answers

    Which condition is most likely to cause orthopnea and requires the use of accessory muscles for breathing?

    <p>COPD</p> Signup and view all the answers

    How should nutritional therapy be adapted for patients with COPD?

    <p>Provide small meals before breathing therapies</p> Signup and view all the answers

    What is the primary treatment focus for patients with venous insufficiency?

    <p>Improving blood flow back to the heart</p> Signup and view all the answers

    Which type of therapy is essential for patients with a multi-drug resistant strain of tuberculosis?

    <p>Directly observed therapy</p> Signup and view all the answers

    Which technique is NOT considered an airway clearance technique for patients with COPD?

    <p>Pursed-lip breathing</p> Signup and view all the answers

    What vital sign change is significant in the assessment of someone with COPD?

    <p>Oxygen saturation &lt; 88%</p> Signup and view all the answers

    What is the purpose of using antiplatelet therapy in patients with PAD?

    <p>To decrease cardiovascular events and mortality</p> Signup and view all the answers

    Which of the following is a contraindication for using rifampin?

    <p>Concurrent use of hormonal contraceptives</p> Signup and view all the answers

    What is the primary goal for clients with progressive neurological diseases?

    <p>Reduce the risk of complications</p> Signup and view all the answers

    Which medication is primarily used for managing seizures in epilepsy?

    <p>Carbamazepine</p> Signup and view all the answers

    Which dietary factors can trigger headaches?

    <p>Chocolate and cheese</p> Signup and view all the answers

    What is the recommended first course of action for managing a tonic-clonic seizure?

    <p>Loosening clothes and protecting the head</p> Signup and view all the answers

    In patients with Huntington's disease, what calorie intake is often required to maintain weight?

    <p>4000-5000 calories/day</p> Signup and view all the answers

    What is a common characteristic of multiple sclerosis (MS) in terms of disease management?

    <p>Avoiding infections and trauma</p> Signup and view all the answers

    Which of the following is NOT a common precipitating factor for restless leg syndrome?

    <p>Low blood pressure</p> Signup and view all the answers

    What is the first-line treatment for managing acute myasthenic crisis symptoms?

    <p>Anticholinesterase agents</p> Signup and view all the answers

    In patients with Parkinson's disease, what is the primary medication used for treatment?

    <p>Levodopa with carbidopa</p> Signup and view all the answers

    What is an important safety advice for individuals with epilepsy?

    <p>Avoiding dangerous activities like cooking alone</p> Signup and view all the answers

    Which of the following treatments is recommended for chronic headaches?

    <p>Use of analgesics and comfort measures</p> Signup and view all the answers

    Which medication is commonly used as a preventative treatment for migraines?

    <p>Topiramate</p> Signup and view all the answers

    Which condition is characterized by the presence of generalized seizures that may involve only tonic or clonic movements?

    <p>Tonic-clonic epilepsy</p> Signup and view all the answers

    Study Notes

    Preoperative Nursing Care

    • Educating and preparing patients reduces postoperative anxiety, leading to improved outcomes.
    • Effective teaching boosts patient satisfaction and diminishes complications, length of stay (LOS), and recovery time.
    • Initiation of patient education occurs in the surgeon's office and is reinforced on the day of surgery.
    • Prioritize information based on individual patient needs and document teaching efforts to streamline admissions.
    • Essential information categories:
      • Sensory: patient experiences before/after anesthesia.
      • Procedural: details on timing, restrictions, comfort measures, anesthesia, and site markings.
      • Process: information on the admissions, preoperative area, OR, PACU, and family updates.
    • Preoperative nurses clarify testing results, associated risks, and implement coping strategies while maintaining effective communication and documentation.

    Health History and Assessment

    • Collect comprehensive health history to mitigate surgical risks, including past surgeries, menstrual and obstetric history, and family medical history.
    • Medication assessment: obtain all prescription and over-the-counter medications, including herbs that may affect surgery; review timing for administration or withholding doses.
    • Allergies must be documented accurately, with specific attention to severity and possible reactions; include environmental and food allergies.
    • Review of Systems (ROS) includes cardiovascular, respiratory, neurological, gastrointestinal, hepatic, integumentary, musculoskeletal, endocrine, immune system, fluid and electrolyte status, and nutritional concerns.
    • Identify and address potential complications from comorbidities such as obesity, diabetes, and respiratory issues.
    • Effective communication during the perioperative phase is crucial to prevent errors.
    • Nurses advocate for the patient by ensuring they have all necessary information regarding their surgery.
    • Surgical consent must include complete diagnosis disclosure, risks, benefits, and must be voluntarily signed without coercion.
    • Special provisions apply for minors and individuals deemed unable to give consent.

    Preoperative Checklist and Transport

    • Preoperative nurses validate that all orders are followed and checklists are completed before OR transport.
    • Checklist items include verifying consent, ensuring the patient is NPO, confirming presence of test results, skin preparation, and removal of personal items (dentures, jewelry).
    • Administer preoperative medications like benzodiazepines and ensure IV antibiotics are ready.

    Intraoperative and Postoperative Nursing Care

    • Different zones in the surgical environment: unrestricted (public access), semi-restricted (authorized staff), and restricted (sterile area).
    • Emphasis on safety and teamwork through clear communication and structured protocols (e.g., SBAR).
    • Surgical checklists ensure compliance with procedures and protocols (e.g., Universal Protocol).
    • Monitor anesthesia type and patient assessment to communicate potential concerns effectively.

    Complications and Monitoring

    • Postoperative complications include respiratory issues, cardiovascular problems, neurologic changes, and pain management.
    • Key respiratory complications:
      • Airway obstruction or hypoxemia requires patient repositioning and oxygen administration.
      • Hypoventilation may need assessment of the level of sedation before opioid administration.
    • Cardiovascular complications like hypotension and dysrhythmias must be monitored for perfusion adequacy and electrolyte balance.
    • Neurological issues include emergence delirium and postoperative cognitive dysfunction, necessitating thorough neuro assessments.

    Pain and Temperature Management

    • Postoperative pain needs effective assessment and management to prevent complications like atelectasis.
    • Multimodal analgesia should be used for optimal pain control; monitor regularly.
    • Temperature management involves frequent monitoring; hypothermia can arise from exposure or anesthesia, while fever may indicate infection.

    Gastrointestinal and Urinary Concerns

    • Significant postoperative nausea/vomiting rates; management includes hydration and medications.
    • Constipation and postoperative ileus are common, requiring hydration and ambulation to resolve.
    • Urinary retention is commonly seen post-surgery, necessitating prompt assessment and interventions.

    Surgical Site Infection (SSI) Prevention

    • SSIs significantly prolong recovery and increase costs; adherence to safety protocols is essential.
    • Nursing care should incorporate hand hygiene, proper antibiotic administration, and maintaining normothermia for prevention.

    Discharge Criteria

    • Patients must meet specific criteria before being released from the PACU or discharged home; monitoring for stability and recovery is crucial.### Postoperative Patient Discharge
    • Safe discharge criteria: easily arousable, stable vital signs, O2 saturation > 90%, controlled pain and nausea/vomiting.
    • Important assessments include vital signs, sedation scale, presence of drains, pain, and general focused assessment.
    • Communication between nursing units facilitated via SBAR (Situation, Background, Assessment, Recommendation).

    Tuberculosis (TB) Management

    • TB can remain dormant for years, progressing to active disease, characterized by a positive TB test, normal chest X-ray initially, and no symptoms.
    • Active TB is contagious and requires aggressive treatment with a combination of 1st and 2nd line agents over 6-9 months.
    • Nursing care includes risk assessment, planning for adherence to medication, patient education, and airborne precautions.

    Active TB Treatment

    • Multi-drug resistant TB necessitates directly observed therapy (DOT) to ensure compliance.
    • Medications like isoniazid should be monitored for hepatotoxicity, rifampin can stain secretions and interfere with contraception, pyrazinamide may raise uric acid levels, and ethambutol poses eye health risks.

    Pulmonary Fungal Infections

    • Histoplasmosis is caused by inhaling spores and presents like bacterial pneumonia; diagnosed with specific blood tests and chest CT.
    • Treatment involves oxygen, IV amphotericin B, and prolonged oral antifungal therapy.

    Bronchiectasis Diagnosis and Treatment

    • Protocols for diagnosis include CT chest scans, sputum cultures, and pulmonary function tests.
    • Treatment focuses on preventing infections and flare-ups through antibiotics, airway clearance techniques, and vaccinations.

    Dyspnea Management

    • Early assessment of respiratory acidosis and hypoxemia is essential; non-invasive mechanical ventilation may be necessary.
    • Pharmacological options include bronchodilators and corticosteroids, with additional antibiotics if indicated.

    Chronic Obstructive Pulmonary Disease (COPD)

    • Symptoms include progressive dyspnea, chronic cough, and chest heaviness; exacerbations often show increased dyspnea and sputum changes.
    • Management includes oxygen therapy, breathing retraining, and nutritional support to prevent weight loss; pulmonary rehabilitation is beneficial.

    Peripheral Artery Disease (PAD)

    • Symptoms include claudication pain, pallor, diminished pulses, and ulceration; treatment focuses on restoring blood flow.
    • Surgical options include revascularization or conservative management through angioplasty or lifestyle changes.

    Venous Insufficiency

    • Characterized by edema, pain, and skin changes; treatment aims to improve venous return through compression and skin care.
    • Complications can include venous stasis ulcers which require specific wound care and lifestyle adaptations.

    Myasthenia Gravis (MG) and Amyotrophic Lateral Sclerosis (ALS)

    • MG management focuses on ventilation and adjusting medications for peak effectiveness; corticosteroids may be utilized.
    • ALS care emphasizes infection risk reduction and supportive respiratory strategies.

    Seizure Management

    • Tonic-clonic seizures require vigilance for patient safety; caregivers should monitor and document seizure activity.
    • Headache and epilepsy triggers include diet, stress, and structural brain issues; treatment incorporates various medications, including NSAIDs and anticonvulsants.

    Neurological Disorders Management

    • Goals for progressive neurological diseases include safety, function maintenance, and quality of life improvement.
    • Conditions like MS and Parkinson’s require tailored medication strategies to mitigate symptoms and prevent complications; patient and caregiver education is crucial for effective management.

    Restless Leg Syndrome (RLS) and Multiple Sclerosis (MS)

    • RLS is treated by addressing underlying causes and using medications that enhance comfort.
    • MS treatment involves immunomodulators and education on mobility limitations, self-care, and maximizing independence.

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    Description

    This quiz focuses on the essential aspects of preoperative nursing care, emphasizing education and preparation to alleviate client anxiety and improve postoperative outcomes. Learn about the benefits of effective teaching and how information provided before surgery can enhance patient satisfaction and recovery.

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