Surgical Experience Phases and Responsibilities

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Questions and Answers

What are the three phases of the surgical experience?

The three phases of the surgical experience are: preoperative, intraoperative and postoperative.

When does the Preoperative Phase begin and end?

It begins when the decision for surgical intervention is made and ends with the transfer of the patient to the operating room table.

Which of these are reasons surgery may be performed? (Select all that apply)

Palliative (correct)

Diagnostic (correct)

Curative (correct)

Reconstructive or cosmetic (correct)

Reparative (correct)

What are the two most common preoperative psychological problems?

The two most common preoperative psychological problems are anxiety related to the surgical experience and knowledge deficit regarding preoperative procedures and postoperative expectations. Signup and view all the answers

For patients with cardiovascular disease, sudden changes of position should be encouraged.

False (B) Signup and view all the answers

What is the rationale for obtaining a medication history from each patient preoperatively?

It is obtained to identify potential interactions or effects of medications on the patient’s perioperative course. Signup and view all the answers

What are the two primary reasons why informed consent is necessary before surgery?

Informed consent protects the patient against unsanctioned surgery and protects the surgeon against claims of an unauthorized operation. Signup and view all the answers

What are the three things that deep breathing and coughing exercises promote?

Deep breathing and coughing exercises promote lung ventilation, blood oxygenation and mobilize secretions. Signup and view all the answers

What are the two reasons why incision line splinting is used?

The incision line is splinted to minimize pressure and to control pain. Signup and view all the answers

What are the roles of the surgical team? (Select all that apply)

The anesthesiologist (A), The surgical technician (B), The surgeon (C), The intraoperative nurses (D), The patient (E) Signup and view all the answers

The anesthesiologist's role is limited to administering anesthesia during surgery.

False (B) Signup and view all the answers

The circulating nurse is responsible for which of these tasks? (Select all that apply)

Safe functioning of equipment (A), Providing supplies to the scrub nurse (B), Ensuring cleanliness, proper temperature, humidity, and lighting of the OR (C), Checking medical records for completeness (D), Verifying consent (E) Signup and view all the answers

What are the two classes that anesthetics are divided into?

The two classes that anesthetics are divided into are general anesthesia and regional anesthesia. Signup and view all the answers

Which of these are potential intraoperative complications? (Select all that apply)

Hypoxia (A), Nausea and Vomiting (C), Malignant Hyperthermia (D), Hypothermia (E) Signup and view all the answers

What is the rationale for the use of antiemetics preoperatively or intraoperatively?

The use of antiemetics is intended to counter act possible aspiration. Signup and view all the answers

What are the four causes of hypoxia during surgery?

Hypoxia during surgery can be caused by inadequate ventilation, occlusion of the airway, respiratory depression caused by anesthetic agents, or aspiration of respiratory tract secretion or vomitus. Signup and view all the answers

What are the seven causes of hypothermia during surgery?

The seven potential causes of hypothermia are: low temperature of the OR, infusion of cold fluids, inhalation of cold gases, open body wounds or cavities, advanced age, vasodilator medications, and intentional induced hypothermia to reduce metabolic rate. Signup and view all the answers

What are the steps in managing hypothermia during surgery?

The goal is to bring the patient's temperature back to normal, which can be achieved by adjusting the temperature of the OR, warming IV and irrigating fluids, replacing wet gowns and drapes, and monitoring core temperature. Signup and view all the answers

What are the characteristics of someone susceptible to malignant hyperthermia?

People susceptible to malignant hyperthermia often exhibit: bulky, strong muscles, a history of muscle cramps, muscle weakness, unexplained temperature elevation, unexplained death of a family member during surgery, and a febrile response. Signup and view all the answers

Which of these are clinical manifestations of malignant hyperthermia?

Oliguria (A), Decreased cardiac output (B), Tachycardia (C), Ventricular dysrhythmia (D), Hypotension (E), Increased Body Temperature (F), Rigidity (G) Signup and view all the answers

What are the goals of treatment for malignant hyperthermia?

The goals of treatment for malignant hyperthermia are to decrease metabolism, reverse metabolic and respiratory acidosis, correct dysrhythmia, decrease body temperature, provide O2 and nutrition to tissue, and correct electrolytes imbalance. Signup and view all the answers

Why should the scrub nurse count sponges, needles and instruments before and after surgery?

The scrub nurse counts sponges, needles, and instruments before and after surgery to ensure patient well being. Signup and view all the answers

Why should antiemetics be administered to a patient preoperatively or intraoperatively?

Antiemetics are administered to counter act possible aspiration. Signup and view all the answers

What are the two major differences between epidural anesthesia and spinal anesthesia?

Epidural anesthesia is injected into the epidural space that surrounds the dura mater of the spinal cord while spinal anesthesia involves the introduction of medication directly into the subarachnoid space of the spinal cord. Signup and view all the answers

What are the steps for managing a patient with a hypothermic condition in the OR?

What assessment points should be monitored in the early postoperative period?

The assessment points that should be monitored in the early postoperative period include Respiratory, Circulatory, Neurologic, Surgical site, Comfort, Psychological, Safety, Equipment. Signup and view all the answers

List the vital signs that should be reported to the physician immediately?

Vital signs that should be reported to the physician immediately include a temperature above 37.7°C or below 36.1°C, respiration over 30 or under 16 C/M, and a falling systolic blood pressure under 90 mmHg. Signup and view all the answers

Which 5 nursing diagnoses can apply to a postoperative patient? (Select all that apply)

Impaired physical mobility (A), Self-care deficit (B), Risk for infection (C), Risk for fluid volume deficit (D), Anxiety (E), Pain (F), Risk for ineffective airway clearance (G), Risk for altered nutrition (H), Risk for ineffective management of therapeutic regimen (I), Altered bowel elimination (J), Altered urinary elimination (K), Risk for altered body temperature (L), Impaired skin integrity (M), Risk for injury (N) Signup and view all the answers

How is the nutritional status of a postoperative patient maintained?

The nutritional status is managed by providing liquids, then transitioning to soft foods, and eventually solid food as tolerated. A nasogastric tube may be used for 24-48 hours post-gastrointestinal surgery, and parenteral or enteral feedings can be given if oral intake is not tolerated. Signup and view all the answers

Why should vasoactive medications not be stopped abruptly?

Vasoactive medications should not be stopped abruptly because it can cause severe hemodynamic instability, which can perpetuate a shock state. Signup and view all the answers

What is the rationale for prescribing Zantac or a proton pump inhibitor for a patient in a shock state?

Proton pump inhibitors, such as Zantac, are prescribed to guard against stress ulcers. Stress ulcers can develop due to a compromised blood supply. Signup and view all the answers

Why is enteral or parental nutrition support prescribed for a patient with shock?

Enteral or parental nutrition support is essential to address the metabolic requirements that are often dramatically increased in shock. Signup and view all the answers

What are the steps involved in the management of shock?

Management of shock includes non-invasive interventions such as controlling bleeding, modifying the trendelenburg position, using cardiac monitoring, and maintaining airway and breathing, as well as invasive interventions such as IV fluids, blood products, and medication. Signup and view all the answers

What are the different components of the management of shock?

Management of shock involves addressing fluid replacement, vasoactive medication, nutritional support, and oxygen administration. Signup and view all the answers

What are the common early postoperative complications?

Common early postoperative complications include: abdominal distention, atelectasis, hypostatic pneumonia, hypoxia, shock, urinary retention, and wound hemorrhage. Signup and view all the answers

What is the typical duration of occurrence for each of these early postoperative complications?

Abdominal Distention and Atelectasis typically manifest within the 48 hours following surgery. Hypostatic Pneumonia and Hypoxia usually occur within the same timeframe as the previous conditions. Shock typically sets in immediately following surgery, whereas urinary retention is commonly observed 6-8 hours after surgery. Wound hemorrhage may occur within the first 48 hours. Signup and view all the answers

Study Notes

Perioperative Nursing Management: Preoperative Phase

Perioperative nursing encompasses the entire surgical experience, including preoperative, intraoperative, and postoperative phases.
The preoperative phase starts when the decision for surgery is made and ends with transfer to the operating room.
Learning objectives include defining perioperative terms, identifying reasons for surgery, classifying surgery by urgency, performing a comprehensive preoperative assessment to identify surgical risk factors, and understanding informed consent.
Teaching plans are designed to promote postoperative recovery and prevent complications.
Preoperative nursing measures decrease infection risk and other postoperative complications.
Immediate preoperative preparation involves patient attire, hair management, and removal of valuables/dentures.
Surgical indications include diagnostic, curative, reparative, reconstructive/cosmetic, and palliative.
Emergency surgery requires immediate intervention, potentially life-threatening.
Urgent surgery necessitates prompt attention within 24-30 hours.
Required surgery is needed within a few weeks to months.
Elective surgery is scheduled without immediate threat.
Optional surgery is based on patient preference.
Preoperative assessment includes psychosocial, general physical, nutritional, and other factors.
Psychosocial assessment focuses on anxieties and knowledge deficits related to surgery.
General physical assessment involves history taking, diagnostic tests, and physical examination.
Nutritional assessment involves measuring height/weight, skin folds, etc., and correcting nutrient deficiencies.
Chemical substance use includes managing intoxication cases.
Respiratory status assessment includes smoking cessation, treatment of infections, and blood gas analysis for patients with pulmonary problems.
Cardiovascular conditions warrant avoiding sudden position changes and prolonged immobilization.
Liver and kidney function tests are assessed preoperatively due to their role in medication removal.
Identifying previous allergies and any immuno-suppression drug use is necessary.
Endocrine function monitoring is critical for patients with diabetes and those taking corticosteroids.
Preoperative medication history is essential to understand the possible effects and drug interactions.

Voluntary and informed consent is crucial before surgery.
Consent protects the patient from unauthorized surgery and the surgeon from claims of unauthorized procedures.

Preoperative Patient Education

Deep breathing and coughing exercises promote lung ventilation and blood oxygenation.
Splinting the incision line minimizes pressure and controls pain.
Leg and foot exercises are crucial for maintaining mobility.
Turning to the side, getting out of bed, and pain control using preanesthetic medications are emphasized.
Anticipating pain relief and using prophylactic antibiotics are important considerations in the preoperative period.

General Preoperative Nursing Interventions

Seven primary national patient safety goals should inform perioperative care protocols.
Ensuring accurate patient identification, efficient communication, safe medication and infusion pump use, and reducing infections is stressed.
Patient records, including informed consent, laboratory reports, and nursing records, are essential.
Food and water intake is withheld 8-10 hours before surgery to prevent aspiration.
Intestinal preparation (cleansing enemas/laxatives) facilitates visualization and prevents contamination.
Preoperative skin preparation involves warm baths, using povidone-iodine soap, and using electric clippers for hair removal.
Immediate preoperative interventions involve dressing, hair covering, and removal of dentures and jewelry.
Valuables are safely stored per hospital policy.
Patients (excluding those with urologic disorders) should void before surgery.
Indwelling catheters are connected to closed drainage systems when necessary.
Preanesthetic medications are given 15-20 minutes before transport to the operating room, including maintaining side rails in a safe position and keeping a quiet/calm environment.

Expected Patient Outcomes

Expected outcomes include relief of anxiety, decreased fear, understanding of the surgical intervention, and absence of preoperative complications.

Intraoperative Phase

The surgical team consists of the patient, anesthesiologist, surgeon, intraoperative nurses, and surgical technician.
Anaesthesiologist's role includes patient pre-op assessment, anesthetic agent administration/monitoring, and maintaining vital signs.
Intraoperative nurses coordinate personnel, prioritize patient safety, perform scrub nurse and circulation nurse duties, and maintain surgical standards.
Circulating nurses verify consent, check medical records, ensure OR cleanliness, supervise equipment function, and verify supplies.
Scrub nurses use aseptic techniques to perform surgical hand scrubs. Surgical gowns are donned aseptically, special equipment/sterile tables are prepared, and equipment is counted.
Anaesthesia is a state of narcosis, analgesia, relaxation, and reflex loss produced by pharmacologic agents.
General anesthesia blocks awareness centers to produce unconsciousness and loss of sensation, using inhaled volatile liquids(e.g., Fluothane) or intravenous agents. Administration methods and advantages/disadvantage differences between the two methods are outlined.
Regional anesthesia, which includes epidural, spinal, and local conduction blocks delivers blockage from specific nerves. Advantages and Disadvantages of the methods, including complications associated with epidural and spinal anesthesia, and various types of local applications are covered.
Potential complications during surgery include nausea, vomiting, hypoxia, hypothermia, and malignant hyperthermia.

Postoperative Phase

Postoperative assessment prioritizes respiratory and circulatory status and neurological response, surgical site observation for bleeding, comfort level (pain, nausea), psychological factors (patient's questions); safety, and equipment functioning.
Monitoring of vital signs, including temperature for initial 24 hours, is important.
Respiratory, circulatory, neurological, comfort, psychological, safety, and equipment functioning must be monitored.
Nursing interventions focus on promoting lung expansion with deep breathing, coughing, and splinting, promoting comfort with opioids, antiemetics, pain relief measures, reducing causes other than the surgery, relieving abdominal distension and hiccups , managing body temperature, and avoiding injuries and complications.
Nutritional status focuses on providing fluids (water, fruit juices) and appropriate soft/solid food as tolerated.
Urine output is monitored, with interventions to aid normal voiding as necessary.
Early ambulation and bed exercises help restore mobility.
Maintaining anxiety levels and psychological well-being is prioritised.
Patient education is an important element; and at discharge, the patient & significant others are coached on management strategies.
Complications (early and later) for postoperative patients are described, including abdominal distention, atelectasis, and hypostatic pneumonia, hypoxia, shock, urinary retention, wound hemorrhage, thrombophlebitis, wound infections, wound dehiscence, and wound evisceration.
Management of shock is described involving non-invasive (e.g., pressure/modified Trendelenburg) and invasive methods (e.g., fluids/medications) including ongoing assessments for treatment adjustments.
Outcomes include absence of complications.

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Description

This quiz explores the phases of the surgical experience, focusing on preoperative, intraoperative, and postoperative considerations. Participants will answer questions about surgical procedures, roles in the surgical team, and patient management. It's designed for those studying or working in the healthcare field, particularly in surgical settings.