question

The Preoperative Phase

answer

Begins when the patient and surgeon mutually decide that surgery is necessary and will take place. It ends when the patient is transferred to the operating room or procedural bed

question

The Intraoperative Phase

answer

Begins when the patient is transferred to the OR bed, also called a table, until transfer to the postoperative recovery area

question

The Postoperative Phase

answer

Lasts from admission to the recovery area to complete recovery from surgery and the last follow-up physician visit

question

The Postoperative Phase can be divided into:

answer

Phase one, Phase II, and Phase III,

question

Phase one

answer

Providing patient care from a totally anesthetized state to one requiring less acute nursing interventions

question

Phase II

answer

preparing the patient for self of family care or for care in a phase III extended care environment

question

Phase III

answer

providing ongoing care for patients requiring extended observation or intervention after transfer for discharge from phase one or II

question

How are surgical procedures classified?

answer

According to urgency, risk, and purpose

question

Elective surgery

answer

a procedure that is preplanned and based on the patients choice and availability of scheduling for the patient, surgeon, and facility. this is a non urgent procedure that does not have to be done immediately

question

Emergency surgery

answer

must be done immediately to preserve life, a body part, or function

question

Urgent surgery

answer

must be done within a reasonably short time frame to preserve health, but is not an emergency. Usually done within 24-30 hours

question

Optional surgery

answer

is not critical to survival or function

question

Based on Urgency:

answer

Elective, urgent, and emergency

question

Based on degree of risk:

answer

major which may be elective urgent, or emergency, and minor which is primarily minor

question

Based on purpose:

answer

diagnostic, ablative, palliative, reconstructive, transplantation, and constructive

question

Ablative

answer

to remove a diseased body part Examples: appendectomy, subtotal thyroidectomy, colon resection, and amputation

question

Palliative

answer

to relieve or reduce intensity of an illness; is not curative

question

Reconstructive

answer

to restore function to traumatized or malfunctioning tissue. Examples: scar revision, plastic surgery, skin graft, internal fixation of a fracture

question

Constructive

answer

to restore function in congenital anomalies. Examples: cleft palate repair, closure of atrial-septal defect

question

Anesthesia

answer

a method and technique of making potentially uncomfortable interventions tolerable and safe

question

General, or systemic, anesthesia:

answer

a combination of both I.V. and inhalation anesthetics. the patient is non arousable, not even to painful stimuli. they lose the ability to maintain ventilatory function and require assistance maintaining a patent airway

question

The three phases of general anesthesia:

answer

1. induction 2. maintenance 3. emergence

question

Regional anesthesia:

answer

occurs when an anesthetic agent is injected near a nerve or nerve pathway in or around the operative site. The patient remains awake, but loses sensation in a specific region or area of the body

question

Nerve Blocks:

answer

A type of general anesthesia accomplished by injecting a local anesthetic around a nerve trunk supplying the area of surgery

question

Spinal anesthesia:

answer

A type of general anesthesia. Achieved by injecting a local anesthetic into the subarachnoid space through a lumbar puncture. It is used for surgery of the lower abdomen, perineum, and legs

question

Adverse effects of spinal anesthesia:

answer

hypotension, headache, and urine retention

question

Caudal anesthesia:

answer

A type of general anesthesia. Is the injection of the local anesthetic into the epidural space through the caudal canal in the sacrum. May be used for procedures on the lower extremities or perineum

question

Epidural anesthesia

answer

A type of general anesthesia. involves the injection of the anesthetic through the intervertebral spaces, usually in the lumbar region. It is used for surgeries of the arms, shoulders, thorax, abdomen, pelvis, and legs

question

Topical and Local Anesthesia:

answer

Cocaine in a 4% to 10%, Lidocaine, and Bupivicaine

question

Local Anesthesia

answer

the injection of an anesthetic agent such as Lidocaine, Bupivicaine, or tetracaine to a specific area of the body

question

Moderate sedation/analgesia

answer

used for short term and minimally invasive procedures. The patient retains the ability to keep their airway open and can respond appropriately

question

Pre-admission testing:

answer

is often conducted several days before surgery as part of preoperative laboratory screening and teaching

question

Why are infants at greater risk from surgery?

answer

infants have a lower total blood volume, placing them at a risk for dehydration. The infant also has difficulty maintaining stable body temperature during surgery. Their lower glomerular filtration rate and creatinine clearance can lead to a slower metabolism of drugs.

question

Cardiovascular Diseases that place the patient at risk during surgery

answer

thrombocytopenia, hemophilia, recent myocardial infarction or cardiac surgery, heart failure, and dysrhythmias, increase the risk for hemorrhage and hypovolemic shock, hypotension, venous stasis, thrombophlebitis, and over hydration with IV fluids

question

Respiratory disorders that place the patient at risk during surgery

answer

pneumonia, bronchitis, asthma, emphysema, and COPD, increase the risk for respiratory depression from anesthesia as well as postoperative pneumonia, atelectasis, and alterations in acid-base balance

question

Kidney and Liver diseases:

answer

influence the patients response to anesthesia, affect fluid and electrolyte as well as acid-base balance, alter the metabolism and excretion of drugs, and impair would healing

question

Endocrine diseases:

answer

especially diabetes mellitus, increase the risk for hypoglycemia or acidosis, slow wound healing and present an increased risk for postoperative cardiovascular complications

question

Anticoagulants increase surgical risk by:

answer

may precipitate hemorrhage

question

Diuretics increase surgical risk by:

answer

may cause electrolyte imbalances, with resulting respiratory depression from anesthesia

question

Tranquilizers increase surgical risk by:

answer

may increase the hypotensive effect of anesthetic agents

question

Adrenal steroids increase surgical risk by:

answer

Abrupt withdraw may cause cardiovascular collapse in long-term users

question

antibiotics in the mycin group increase surgical risk by:

answer

when combined with certain muscle relaxants used during surgery, may cause respiratory paralysis

question

Oral antidiabetic medications such as metformin hydrochloride increase surgical risk by:

answer

may react with radiologic (x-ray) iodinized contrast dyes, and cause acute renal failure

question

A patient who is malnourished is at a higher risk for:

answer

alterations in fluid and electrolyte balance, delay in wound healing, and wound infection

question

A patient who is obese is at a higher risk for:

answer

respiratory, cardiovascular, positional injury, DVT, and gastrointestinal problems

question

Patients with a large habitual intake of alcohol:

answer

require larger doses of anesthetic agents and postoperative analgesics, increasing the risk for drug-related complications

question

Patients who smoke are at higher risk for:

answer

respiratory complications, hypoxia, and postoperative pneumonia

question

Usual presurgical screening tests:

answer

chest x-ray, electrocardiography, complete blood count, electrolyte levels, and urinalysis

question

Alternative methods of pain control:

answer

transcutaneous electrical nerve stimulation (TENS), pressure-controlled pain pumps filled with local anesthetics, patient controlled analgesia (PCA), and patient-controlled epidural anesthesia

question

Deep Breathing

answer

Place the patient in semi-Fower's. Ask the patient to hold their breath for 3-5 seconds. Exhale through the mouth with pursed lips. Repeat 3 times. This exercise should be done every 1-2 hours while the patient is awake.

question

If the patients screening test shows a hemoglobin less than ____ and a hematocrit of less than _____ blood component should be given preoperatively

answer

hemoglobin <10 and hematocrit <33%

question

The intra-operative phase of surgery begins:

answer

with the admission of the patient to the surgical area and lasts until the patient is transferred to the PACU

question

The universal protocol has 3 components:

answer

1. preoperative verification process 2. marking the operative site 3. final verification just prior to beginning a procedure

question

The scrub nurse:

answer

is a member of the sterile team who maintains surgical asepsis while draping and handling instruments and supplies

question

The circulating nurse:

answer

identifies and assesses the patient on admission to the operating room, collaborates in safely positioning the patient on the operating bed, assists with monitoring the patient during surgery, provides additional supplies, maintains environmental safety, and counts the number of instruments

question

The RNFA:

answer

actively assists the surgeon by providing exposure of the operative area, hemostasis (blood clotting), and wound closure

question

The APN:

answer

coordinates care activities, collaborates with physicians and nurses in all phases of perioperative and postanesthesia care, research into care of the surgical patient

question

What position is commonly used for minimally invasive surgery of the lower abdomen or pelvis?

answer

Trendelenburg position

question

Trendelenburg position side effects

answer

decreases diaphragmatic movement and respiratory exchange; blood pools in the upper torso, and blood pressure increases; hypotension can result with return to the supine position

question

What position is used for gynecologic, rectal and urologic procedures?

answer

The lithotomy position

question

Risk of lithotomy position?

answer

risk for thrombophlebitis

question

Postanesthesia Rough handling can cause?

answer

severe hypotension or potentially lethal cardiac or respiratory arrest

question

The postoperative phase can be divided into two stages:

answer

1. Immediate care 2. ongoing postoperative care

question

What assessments are made in the PACU?

answer

respiratory status, cardiovascular status, central nervous system status, fluid status, wound status, and general condition

question

Immediate Postoperative assessments

answer

Assessed every 10-15 minutes

question

What is the most common PACU emergency?

answer

respiratory obstruction

question

How is postoperative cardiovascular function assessed?

answer

taking vital signs, monitoring electrocardiogram rate and rhythm, and observing skin color and condition

question

What complications can hypothermia cause?

answer

poor wound healing, hemodynamic stress, cardiac disturbances, coagulopathy, delayed emergence from anesthesia, and shivering and its associated discomfort

question

What is an EARLY symptom of shock?

answer

tachycardia

question

what are other related symptoms of shock?

answer

decreasing blood pressure, cyanosis, a cool skin temperature, and a decrease in urine output

question

Consciousness returns in what order?

answer

1. unconsciousness 2. response to touch and sounds 3. drowsiness 4. awake but not oriented 5. awake and oriented

question

How is postoperative fluid status assessed?

answer

skin turgor, vital signs, urine output, wound drainage, and IV fluid intake

question

What is a wound assessment indicative of hemorrhage and hypovolemic shock?

answer

large amounts of bright red drainage, combined with other abnormal physical status assessments such as: restlessness, pallor, cold moist skin, decreasing blood pressure, and increasing pulse and respiratory rates

question

Assessments to be made in the PACU:

answer

vital signs are to be monitored every 15 minuets until stable, changing every 1-2 hours for the first 24 hours, and every 4 hours thereafter

question

Specific cardiovascular complications include:

answer

hemorrhage, shock, thrombophlebitis, and pulmonary embolus

question

Hemorrhage

answer

an excessive internal or external blood loss, which may lead to hypovolemic shock

question

Common manifestations of hemorrhage include:

answer

restlessness, anxiety, and frank bleeding as well as hypotension; cold, clammy skin; a weak, thready, and rapid pulse; cool, mottled extremities; deep, rapid respirations, decreased urine output; thirst; and apprehension

question

Shock

answer

the body's reaction to acute circulatory failure as the result of an alteration in circulatory control or a loss of intravascular fluid

question

What is the most common type of shock seen in postoperative patients?

answer

hypovolemic shock, which occurs from a decrease in blood volume

question

What is shock position?

answer

placing the client flat with the legs elevated 30-45 degrees

question

Thrombophlebitis

answer

an inflammation of a vein associated with thrombus formation

question

What type of blood clot is most commonly seen in postoperative patients?

answer

Thrombophlebitis from venous stasis is most commonly seen in the legs of postoperative patients

question

What are manifestations of Thrombophlebitis?

answer

pain and cramping in the calf or thigh of the involved extremity, redness and swelling in the affected area, elevated temperature, and in increase in diameter of the involved extremity

question

What are specific postoperative respiratory complications?

answer

pulmonary embolus, pneumonia, and atelectasis

question

Embolus

answer

a blood clot or foreign substance that is dislodged and travels through the blood stream until it lodges in a smaller vessel

question

Manifestations of pulmonary embolus

answer

dyspnea, chest pain, cough, cyanosis, rapid respirations, tachycardia, and anxiety

question

What position would you place a patient in who has an embolus?

answer

semi-Fowler's position instructing the patient to avoid Valsalva's maneuver

question

Pneumonia

answer

inflammation of the alveoli as the result of an infectious process or the presence of foreign material

question

Manifestations of pneumonia

answer

fever, chills, a cough that produces rusty or purulent sputum, crackles, and wheezes, dyspnea, and chest pain

question

What position would you place a client in who has pneumonia?

answer

semi-Fowler's or Fowler's position

question

Atelectasis

answer

incomplete expansion or collapse of alveoli with retained mucus, involving a portion of lung and resulting in poor gas exchange

question

Manifestations of atelectasis

answer

decreased lung sounds over the affected area, dypsnea, cyanosis, crackles, restlessness, and apprehension

question

In what position would you place a client in who has presence of atelectasis?

answer

semi-Fowler's position

question

When can a patient be discharged?

answer

when they are no longer drowsy or dizzy, have stable vital signs, and has voided

question

Sudden withdrawal of which of the following may result in seizures?

answer

Tranquilizers

question

The nurse is aware that which of the following helps to stimulate T-cell response:

answer

Arginine is necessary for collagen synthesis and deposition, increases wound strength, and stimulates T-cell response.

question

Which of the following medications may increases the hypotensive action of anesthesia?

answer

Chlorpromazine; Thorazine

question

To decrease the amount of bacteria in the air, standard OR ventilation provides how many air exchanges per hour?

answer

15 air exchanges per hour, at least 3 of which are fresh air

question

What temperature is the OR kept at?

answer

20-24 degrees Celsius; 68-73 degrees Fahrenheit, and humidity between 30-60%

question

Laminar Airflow Units

answer

provide 400-500 air exchanges per hour. Generally used for joint replacement or organ transplant surgery

question

Muslims and those of Jewish faith cannot use:

answer

porcine-based products; heparin. porcine or bovine

question

Buddhists may choose not to use:

answer

Bovine products

question

How would a patient who has a systemic disease not related to surgery be classified?

answer

P2, P3, or P4

question

P6 refers to:

answer

a patient who is brain dead and is undergoing surgery as an organ donor

question

Brachial Plexus Block:

answer

produces anesthesia of the arm

question

Paravertebral Anesthesia:

answer

produces anesthesia of the nerves supplying the chest, abdominal wall, and extremities

question

Transsacral (caudal) Block:

answer

produces anesthesia of the perineum and, occasionally the lower abdomen

question

Unrestricted Zone:

answer

street clothes are allowed

question

Semirestricted Zone:

answer

attire consists of scrub clothes and caps

question

Restricted Zone:

answer

where scrub clothes, shoe covers, caps and masks are worn

question

During the preoperative assessment, the nurse learns that the client has been taking prednisone. The nurse realizes that the client is at risk for

answer

Prednisone, a corticosteroid, can result in cardiovascular collapse if suddenly discontinued

question

Atracurium

answer

Atracurium is a nondepolarizing muscle relaxant

question

Succinylcholine

answer

Succinylcholine is a depolarizing muscle relaxant

question

Stage One:

answer

Beginning Anesthesia: Unnecessary noises and motions are avoided when anesthesia begins

question

Stage II:

answer

Excitement: Pupils dilate, pulse rate is rapid, and respirations may be irregular

question

Stage III:

answer

Surgical Anesthesia: Respiration's are regular, pulse rate and volume are normal, skin is pink or slightly flushed

question

Stage IV:

answer

Medullary depression: is characterized by shallow respirations, a weak, thready pulse, dilated pupils that do not react to light, and cyanosis

question

Clinical manifestations of a wound infection include:

answer

fever, tachycardia, an elevated white blood cell count, and increased incisional pain

question

During the first 24 hours after surgery, how often will the nurse evaluate the client's vital signs?

answer

The pulse rate, blood pressure, and respiration rate are recorded at least every 15 minutes for the first hour and every 30 minutes for the next 2 hours. Thereafter, they are measured less frequently if they remain stable. The temperature is monitored every 4 hours for the first 24 hours.

Fundamentals Chapter 29 Perioperative Nursing – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards