NURS 166 ~ Ticket to Class SLS Scenario 25 ~ Lucia Hoyas Name: Jesslyn Ba-aya Date: 3/21/22 Lewis, et al: Medical-Surgical Nursing: Assessment and Management of Clinical Problems,10th Edition Chapter 17: Preoperative Care: | pp. 301-314 Chapter 18: Intraoperative Care | pp. 315-329 Chapter 19: Postoperative Care | pp. 349-364 Chapter 25: Assessment of Respiratory System: Arterial Blood Gases | pp. 456-457 Chapter 29: Assessment of Hematologic: Diagnostic Studies pp. 599-604 Chapter 39: Nutritional Problems: Specialized Nutrition Support | pp. 865-870 Chapter 42: Lower Gastrointestinal Problems: Colorectal Cancer | pp. 954-957 Ostomy Surgery | pp. 958-962 Chapter 59: Dementia and Delirium: Delirium | pp. 1414-1417 Before class: Review the scenario, RN to RN report, use clinical worksheet to organize pertinent pateint information, and be ready to participate. Ticket to class Questions: 1. What criteria must be present for a patient to provide informed consent? Who is responsible for providing information to the patient regarding the planned surgical procedures? The surgeon is responsible for providing information about the surgery by giving the diagnosis, the purpose of the treatment, the risks and consequences, the probability of success, alternative treatments, and prognosis if the treatment is not carried out. The nurse must also be present during the signing of the informed consent to represent as a witness that the consent was given out correctly and the patient has understood all the information provided by the surgeon. 2. When planning surgery, what methods should the nurse consider using when providing information? The nurse should plan on giving information verbally and in written form for patients to take home. Information should be given as three categories: sensory, process, and procedural. The nurse should also ensure to not give too much information that leaves the patient confused and overwhelmed and not give too little information that the patient does not understand. Asking the patient to repeat information and encouraging them to ask questions is also important. 3. Prior to surgery, a series of laboratory tests may be ordered. Identify some laboratory tests commonly ordered during the preoperative period. Some laboratory tests that are ordered before surgery are ABGs, Blood glucose, BUN, creatinine, CBC, Electrolytes, hCG, ALT, AST, serum albumin, PT, PTT, INR, platelet count, and pulmonary function studies. Ticket to class multiple choice questions: 1. A patient is planning to undergo surgery. The patient questions the type of anesthesia being used and reports that a friend had positive experiences after having medication that left only the area being operated on numbed. Based on your understanding, what type of anesthesia is the patient likely referring to? A. B. X General anesthesia Local anesthesia C. Epidural anesthesia D. Peripheral nerve block 2. A patient is preparing to undergo conscious sedation for a procedure. Benzodiazepines are used. After administration, the nurse must be aware of which adverse reaction associated with this medication? ** A. Hypertension B. Elevated temperature C. D. X Pruritus Tachycardia 3. The husband of a patient planning to have surgery requests that the hospital staff not discuss potential complications or concerns with his wife to avoid worrying her. How should the nurse respond? ** A. "You have no choice in the matter." B. C. X "I will document these concerns." "We have a responsibility to be honest with your wife." D. "You shouldn't hide things from your wife." 4. A nurse is reviewing the laboratory results of an 18-year-old female patient who had surgery 36 hours ago and who has since experienced repeated episodes of nausea and vomiting. Which finding should be expected? ** A. B. X Hematocrit 49% Hemoglobin 8 g/dL C. WBC 7,500/mm3 D. Partial thromboplastin time 33 seconds 5. A nurse is preparing a care plan for a patient who recently underwent hernia correction surgery. During the assessment, the nurse notes that the patient's pulse oximetry reading is 91%. The patient has been avoiding turning, coughing, and deep breathing. When questioned, the patient reports being unable to cooperate because of his pain level. Which nursing diagnosis is most appropriate for this patient? ** A. Potential complication; atelectasis B. Potential complication; pneumonia C. D. X Ineffective airway clearance Ineffective breathing pattern 6. A student nurse is caring for a patient with a Jackson-Pratt drain. When observing the student provide care for the patient's drain, which action indicates an inadequate understanding of the care needed? *** A. B. X The student employs clean technique to empty the device. The student pins the drain to the patient's gown. C. The student measures the drainage after emptying the device. D. The student compresses the device to restore suction after emptying it. 7. A patient has been diagnosed with refeeding syndrome. When reviewing the patient's assessment data, which manifestation of this syndrome will likely be noted? A. X Confusion, cardiac dysrhythmias, and weakness B. Elevated temperature, tetany, and hyperactivity C. Tachycardia, paralysis, and elevated temperature D. Hyperactive bowel sounds, diarrhea, and tetany 8. A nurse has just completed the stoma assessment of a patient who had surgery 24 hours ago. Which finding indicates the need to contact the surgeon? A. A small amount of red fluid oozing from the stoma B. A moderate amount of edema at the stoma site C. D. X A rose-colored stoma A blanched stoma 9. After completing the stoma assessment of a patient who had a colostomy 2 days earlier, the patient asks how much longer the stoma will appear swollen. Which response by the nurse is indicated? A. "We will need to investigate this swelling as it may signal a problem." B. C. X "Swelling is normal and may last for up to a year." "The stoma will be swollen for the next few weeks." D. "The swelling is permanent." 10. A nurse is collecting data from a patient during the preoperative period. The patient tells the nurse that he is nervous because his mother died as a result of malignant hyperthermia and that he is concerned that he will experience it as well. Which response by the nurse is indicated? A. "There is no need for concern related to this complication." B. C. X "This complication is limited to women of a certain age who undergo surgery." "Have you been tested for susceptibility to this disorder?" D. "Have you ever experienced hypertension?"
