NUR 28201 Adult Health 1 PNW College of Nursing Skeleton for Peri-operative nursing care Pre-Operative Nursing Care: 1. Why is an emergency surgery considered to have more risks than a planned elective surgery? 2. In your own words, list the 11 goals of the nursing assessment in the pre-op phase. 3. Anxiety before immediately before (i.e. the day of) surgery will impact any teaching. According to the Joint Commission what does the patient have the right to know before their surgery? Why? 4. How does renal insufficiency and hepatic dysfunction impact the medications used for anesthesia? 5. Who may sign a consent for surgery document? What if the patient has questions about the risk of surgery and does not want to sign the consent yet? 6. Below is a list of medication classes. Identify the purpose or action for each of these preoperative medication classes. a. Benzodiazepines b. Anticholinergics c. Opioids d. Antiemetics e. Antibiotics NUR 28201 Adult Health 1 PNW College of Nursing Intra-operative Nursing Care: 7. During surgery, what are the 3 main nursing activities? (see p. 316 Table 18.2) 8. The following 3 questions are based on Table 18.3, p. 318. a. If a sterile item comes in contact with an unsterile item, what do you do? b. If a sterile fabric is moist, it is considered contaminated, why? c. How are the microorganisms on the patient and surgical team confined? 9. The levels of anesthesia are determined by the patient’s sensorium (i.e. LOC) and pain perception. Place the following 5 types of anesthesia in order of those with the least impact or effect on the patient’s LOC and pain, to the anesthesia type with the most or greatest impact on the patient’s LOC or pain perception. ______ regional i.e. spinal or epidural ______ MAC (monitored anesthesia care) ______ general anesthesia ______ local anesthesia ______ moderate sedation (aka conscious sedation) 10. What is the difference between spinal and epidural anesthesia? See diagram in PPT. 11. Define Malignant Hyperthermia and list the 4 early signs. Rise in body temperature is NOT an early sign. What medication is used for treatment of MH? NUR 28201 Adult Health 1 PNW College of Nursing Postoperative Care 12. Initial PACU assessment starts with a. A = b. B = c. C = 13. Define end-tidal CO2. 14. Which sense is first to return in all patients after surgery? 15. List the 7 factors that place a patient at higher risk for post-op respiratory complications. (p. 332). a. b. c. d. e. f. g. 16. Post-op atelectasis is the most common cause of hypoxemia in the post-op patient. In your own words, define postoperative atelectasis. How is it prevented? 17. When using an incentive spirometer (IS), the patient places the mouthpiece into their mouth, _______________ deeply and holds breath for a slow 3 count. As the blue or yellow piece in the IS rises, the patient can look at the markings on the incentive spirometer device to see if they did better than last time. This is motivating or incentivizing. 18. Why is pain management so important for the prevention of blood clots and pneumonia? NUR 28201 Adult Health 1 PNW College of Nursing 19. When should you call the Health Care Provider? Circle the correct response (yes or no). See page 336 in your textbook. a. The patient’s systolic BP is 86 mmHg Yes No b. The patient’s pulse is 132 beats/minute. Yes No c. The pulse pressure has narrowed from 40 to 20. Yes No d. The heart rhythm has changed to irregular. Yes No 20. What is a PCA? 21. What is active warming (p. 340)? 22. Define post-operative ileus. What are the signs and symptoms? (Page 340) 23. Urine output should be 0.5ml/kg/hour. What will you do if your patient returned from surgery 7 hours ago and has not voided yet? 24. Your patient’s surgical dressing from their left total knee replacement this morning is saturated with sanguineous drainage. Should you change the dressing? Why or why not? 25. How is dehiscence different from evisceration? 26. On which post-op day(s) would you see signs and symptoms of an infected surgical wound? What signs and symptoms indicate an infected surgical wound? NUR 28201 Adult Health 1 PNW College of Nursing 27. What will you include in the discharge instructions for your patient who is in the Same Day Surgery department recovering from their right knee arthroscopy this morning?
