question

consists of 3 phases that begin & end at a particular point in the sequence of events in the surgical experience

answer

perioperative

question

phase begins when the decision to proceed with surgical intervention is made & ends with transfer of the patient onto the OR table

answer

preoperative

question

phase begins when the patient is transferred onto OR table and ends with admission to the PACU.

answer

intraoperative

question

phase begins with the admission of the patient to the PACU & ends with a follow-up evaluation in the clinical setting or home. Nursing responsibilities include role as scrub nurse, circulating nurse, or registered nurse first assistant (RNFA)

answer

postoperative

question

initial preop assessment, verify compltion of preop diagnostic testing, verify understanding, discuss & reviews advanced-directive document, begin discharge planning

answer

preadmission testing

question

assessment; teach appropriate needs to patient ; involve family in interview

answer

preoperative

question

planning that involves assessing pt's postop care needs/transportation

answer

discharge

question

when does discharge planning begin?

answer

admission

question

surgery without delay; immediate attention; life threatening possibly

answer

emergent

question

surgery within 24-30 hours

answer

urgent

question

surgery within a few weeks / months

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required

question

failure to have this type of surgery wont be catastrophic

answer

elective

question

surgery that allows personal preference

answer

optional

question

consent that must be freely given; atleast 18 yrs old; in writing

answer

informed

question

document signed by pt and physician including all info & risks that pt must sign freely giving consent that they understand these risks; document must be signed at moment by both pt and dr

answer

informed consent

question

informed consent must be signed ____ any meds are given preoperatively!

answer

before

question

the nurse may do what 3 things involving informed consent

answer

witness consent clarify notify physician of pt concerns

question

individual who is not autonomous ; cannot give/withhold consent

answer

incompetent patient

question

individual who cant give/withhold consent due to cognitively impaired, mentally ill, or neurologically incapacitated

answer

incompetent patient

question

assessment including nutrition, dentition, drug use, resp status, etc

answer

preoperative

question

___ can increase risk. severity of complications associated with surgery

answer

obesity

question

___ ___ are more susceptible to infection & an increase in wound dehiscence.

answer

fatty tissues

question

any nutritional deficiency; should be corrected before surgery to provide adequate protein for tissue repair

answer

malnutrition

question

adequate ___ is needed for tissue repair

answer

protein

question

adequate __ ___ are needed for increased wound strenght & collagen deposit

answer

amino acids

question

___ & ___ are primary source of energy for wound healing

answer

carbs fats

question

chronic alcoholics have ____

answer

malnutrition

question

alcohol withdrawal syndrome can occur 48-72 hours after surgery

answer

delirium tremens

question

patients are urged to stop smoking __ to __ weeks before surgery

answer

4 8

question

these clots occur most often in calfs

answer

DVT

question

prevents atelectasis; used 10 times per hour when awake

answer

incentive spirometer

question

cognitive coping strategies provide ____ support

answer

psychosocial

question

goal is to decrease bacteria without injuring the skin

answer

skin prep

question

meds such as ASA or blood thinners need to be stopped ___ to ___ days before surgery

answer

7 10

question

many ___ meds affect coagulation

answer

herbal

question

herbal meds are to be stopped __ to ___ weeks before surgery

answer

2 3

question

dont discontinue this suddenly ; affects immune system

answer

steroids

question

these cause respiratory depression

answer

diuretics

question

these cause hypotension

answer

antipsychotics

question

this med can change effect of surgery

answer

insulin

question

these can increase bleeding potential during surgery

answer

anticoagulants

question

these meds can decrease seizure threshold

answer

anti seizure

question

these 2 can increase bleeding potential

answer

aspirin nsaids

question

these meds are indicated for good control through surgery

answer

cardiac

question

which med classification must be assessed during the preop period b/c it can cause an electrolyte imbalance during surgery?

answer

diuretics

question

___ can cause cardiovascular collapse if discontinued suddenly

answer

corticosteroids

question

___ may increase the hypotensive action of anesthetics

answer

phenothiazines

question

t/f : Pressure to reduce hospital stays & contain costs has resulted in patients undergoing preoperative preparation before admission to the hospital.

answer

true

question

t/f : It is the nurse's responsibility to provide appropriate information concerning surgery & obtain written consent.

answer

false

question

t/f: The goal of a patient with diabetes mellitus is to maintain the blood glucose level at or below 300 mg/dL.

answer

false

question

t/f: Herbal medications should be discontinued 2 to 3 weeks prior to surgery because they can interfere with clotting & may have potential interactions with other medications.

answer

true

question

t/f: The elderly patient may have greater risks during the perioperative period because of having less physiologic reserve than the younger patient.

answer

true

question

Peri-operative nursing addresses the nursing roles relevant to the three phases of the surgical experience, which are preoperative, __________________, and postoperative.

answer

intraoperative

question

The ______________________phase of the surgical experience begins with admission to the PACU.

answer

postoperative

question

_______________________is a common over-the-counter medication that inhibits platelet aggregation and must be stopped 7 to 10 days before surgery.

answer

aspirin

question

Like age, ___________________ increases the risk and complications associated with surgery.

answer

obesity

question

The goal of preoperative skin preparation is to decrease ______________without injury to the skin.

answer

bacteria counts

question

includes circulating nurse, scrub nurse, surgeon. anesthesiologist, nurse for pt advocate

answer

surgical team

question

not involved in touching pt; not sterile; make phone calls/paperwork

answer

circulating nurse

question

sterile; handles sterile equipment in OR

answer

scrub nurse

question

speaks for pt when they cant make decisions for themself

answer

nurse advocate

question

t/f: the circulating nurse is responsible for monitoring the surgical team

answer

true

question

free of bacteria; prevent bacteria and infection in pt.

answer

surgical asepsis

question

zone; surgical environment involving reception and holding area

answer

unrestricted

question

zone; surgical environment involving scrubs

answer

semi restricted

question

zone; surgical environment involving scrubs, masks, OR core area

answer

restricted

question

gowns are sterile in ____. from __ to level of sterile field ; sleeves from __ inches above elbow to cuff

answer

front chest 2

question

only __ layer of drape is sterile

answer

top

question

the environment in the OR has __ bacteria

answer

airborne

question

most ORs have special vents; ___ air exchanges per hour with __ fresh air exchanges

answer

15 3

question

at least ___ distance from sterile field must be maintained

answer

1 foot

question

includes gases and volatile liquids

answer

inhalation

question

includes tranquilizers, opioids, neuroleptanalgesics, dissociative agents, barbiturates and nonbarbiturates

answer

intravenous

question

includes spinal, nerve blocks, nondepolarizing agents, depolarizing agents

answer

regional

question

"caine" agents (lidocaine)

answer

local

question

most common gas

answer

nitrous oxide

question

inhaled anesthesia administered with oxygen & usually __ ___

answer

nitrous oxide

question

monitor ____ suppression with pentothal

answer

respiratory

question

area supplied by the nerves is anesthetized

answer

regional

question

spinal anesthesia usually introduced into ____ space at lumbar level L4-L5 (anesthesia of lower levels)

answer

subarachnoid

question

___ anesthesia into tissues at the planned incision site; often combined with a local regional block

answer

local

question

stage include stage 1-4

answer

general anesthesia

question

stage; beginning sedation/relaxation

answer

1

question

stage; excitement/delirium

answer

2

question

stage; surgical anesthesia

answer

3

question

stage; danger

answer

4

question

goal for general anesthesia is to keep pt in stage ___

answer

3

question

stage; noise is exaggerated; noise must be kept to a minimum

answer

1

question

stage; pt may be laughing, crying, or struggling ; important to administer anesthesia smoothly and quickly ; pt may need restraints

answer

2

question

stage; surgical anesthesia is reached by continued administration of anesthetic vapor or gas; stage may be maintained for hours

answer

3

question

stage; medullary depression ; too much anesthesia administered; stimulants are occasionally developed and anesthesia is DC

answer

4

question

severe allergic reaction to an irritating substance

answer

anaphylactic shock

question

can be life threatening during surgery ; genetic

answer

malignant hyperthermia

question

can be complicated during surgery because when pt bleeds u want them to clot, but clotting too much can be life threatening

answer

dic

question

condition in which everything speeds up

answer

hypermetabolic

question

earliest signs of malignant hyperthermia

answer

tachycardia

question

late sign that develops rapidly during malignant hyperthermia; 1-2 degrees C every five minutes

answer

temperature

question

malignant hyperthermia manifests about __ to __ minutes after anesthesia, but can also occur during first 24h after surgery

answer

10 20

question

t/f: With the elderly, mortality is higher with emergency surgery than elective surgery.

answer

true

question

t/f: Double-gloving is routine in all types of surgery.

answer

false

question

t/f: Medullary depression, the fourth stage of anesthesia, is a necessary and vital stage during complicated surgeries.

answer

false

question

t/f: Most materials in contact with surgical wound or used within the sterile field must be sterile.

answer

false

question

t/f: Safety is one of the most critical concerns during the intraoperative period.

answer

true

question

Care provided by the ________________________nurse includes assisting with patient positioning, preparing the patient's skin for surgery, managing surgical specimens, and documenting intra-operative events.

answer

circulating

question

The ____________________ stage of general anesthesia is characterized by struggling, shouting, laughing, or crying & can often be avoided if anesthetic is administered smoothly & quickly.

answer

excitement

question

_________________anesthesia is the preferred method of choice in any surgical procedure in which it can be used.

answer

local

question

Identifying patients at risk for ______________________ hyperthermia is imperative and can reduce its occurrence.

answer

malignant

question

The usual position for surgery is called the _______________.

answer

dorsal recumbent

question

area where nurse provides care until pt recovers from effects of anesthesia

answer

pacu

question

baseline assessment for unit ; airway, respiratory and cardiovascular function, skin color, level of consciousness, ability to respond to commands

answer

pacu

question

in pacu, reassess pt status and VS every ____ minutes

answer

15

question

this is what phase? frequent VS, assess airway, assess pain

answer

postoperative

question

post op: VS every ___ minutes for first hour; every ___ mnutes next 2 hours ; monitor temp at least every __ hours for first 24 hours postop

answer

15 30 4

question

do not remove oral airway until evidence of __ __ returns

answer

gag reflex

question

The primary nursing goal in the immediate postoperative period is maintenance of pulmonary function and prevention of ___ and ___

answer

hypoxemia hypercapnia

question

assess motor response, verbal, and eye response

answer

glasgow coma scale

question

GCS; no opening of eyes

answer

1

question

GCS; opening eye to pain

answer

2

question

GCS; opening eye to command

answer

3

question

GCS; open eyes spontaneously *best score

answer

4

question

GCS; no verbal responsee

answer

1

question

GCS; incomprehensible verbal response

answer

2

question

GCS; inappropriate words

answer

3

question

GCS; confused verbal response

answer

4

question

GCS; oriented verbal respones * best

answer

5

question

GCS; no motor response

answer

1

question

GCS; enxtension to pain

answer

2

question

GCS: flexion to pain

answer

3

question

GCS; withdrawal from pain

answer

4

question

GCS; localizing pain

answer

5

question

GCS; obeys command for motor response *best

answer

6

question

E3 V3 M5 = GCS 11

answer

combined score

question

GCS; ___ or > mild or no brain injury

answer

13

question

GCS; __ to ___ moderate injury

answer

9 12

question

GCS; < ___ severe brain injury

answer

8

question

pale

answer

pallor

question

pallor, cool moist skin, rapid respirations, cyanosis, rapid weak thready pulse, decreasing pulse pressure, low BP, concentrated urin

answer

hypovolemic shock

question

The most important nursing intervention when vomiting occurs postoperatively is to turn the patient's head to prevent ___ of vomitus into the lungs.

answer

aspiration

question

wound ; drain into a container - jackson-pratt or hemovac

answer

closed

question

wound; drain into a dressing - penrose

answer

open

question

intention ; Granulation tissue not visible; scar formation is minimal. Postoperatively many wounds are covered with a dry sterile dressing or a tissue adhesive is used. (Dermabond)

answer

first

question

intention ; Granulations occurs in infected wounds in which edges are not approximated. Often drainage tubes are inserted. Healing is complete when skin cells grow over granulated tissue. This wound usually has a sterile wet to dry dressing.

answer

second

question

intention ; Used for deep wounds that either have not been sutured early or break down and are resutured later. Brings together two opposing granulation surfaces; leaves a deep scar. These wounds are packed with moist sterile gauze and are covered with a dry sterile dressing.

answer

third

question

enhances collagen deposition 1.5 to 2g/kg/day

answer

protein

question

these enhance collagen synthesis

answer

amino acids

question

sources of energy needed for cell function

answer

carb fats

question

allows capillary formation and collagen formation

answer

vitamin c

question

vitamin ___ and __ acid help metabolism and cell proliferation

answer

b folic

question

vitamin __ helps tissue synthesis and wound healing

answer

a

question

vitamin __ helps blood clot

answer

k

question

this helps cell formation/blood loss

answer

iron

question

this helps protein synthesis and wound healing

answer

zinc

question

Which of the following occurs during the inflammatory stage of wound healing?

answer

blood clot forms

question

when a wound opens

answer

dehiscence

question

when something (organ) comes out of wound

answer

evisceration

question

t/f: The postoperative period may extend as long as several months.

answer

true

question

t/f: Shock is one of the most serious postoperative complications.

answer

true

question

t/f: Postoperative confusion & delirium affect as many 51% of patients who smoke

answer

false

question

t/f: Wound evisceration, the protruding of wound contents, may occur gradually or suddenly.

answer

true

question

t/f: Assessment of respiratory status in the hospitalized postoperative patient is imperative because pulmonary complications are the most frequent problem encountered by the surgical patient.

answer

true

question

In the PACU, the patient's vital signs and physical status, are assessed at least every _____minutes

answer

15 minutes

question

_____________obstruction occurs when the lower jaw & tongue fall backward & air passages are obstructed

answer

hypopharyngeal

question

The primary cardiovascular complications seen in the PACU include: hypotension, shock, _____________, hypertension, & dysrhythmias.

answer

hemorrhage

question

______is monitored every 4 hours for the first 24 hours on all hospitalized postoperative patients.

answer

temperature

question

n patients with an abdominal or thoracic incision, the nurse teaches the patient how to ___________ the incision while coughing.

answer

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