Preoperative Care Assignment
Learning Objective for Pre, Intra & Post-Operative:
1. Differentiate the common settings of surgery, surgery departments and attire.
surgery
2. Apply knowledge of the purpose and components of a preoperative nursing assessment.
3. Analyze the components and purpose of informed consent for surgery.
4. Differentiate the purposed and type of common preoperative, intraoperative, and postoperative
medications.
5. Apply basic principles of aseptic technique & importance of safety used in the operating room.
I. Prepare a chart that describes the three phases of perioperative patient care.
Preoperative Phase: period of time from when the decision for surgical intervention is made to when the
patient is transferred to the operating room table
Intraoperative phase: period of time that begins with the transfer of the patient to the operating room
area and continues until the patient is admitted to the postanesthesia care unit
Postoperative phase: period of time that begins with the admission of the patient to the postanesthesia
care unit and ends after follow-up evaluation in the clinical setting or home
II. Define the following concepts.
a. Ambulatory surgery: Includes outpatient, same-day, or short-stay surgery that does not require
an overnight hospital stay.
b. Atelectasis: Collapse of the alveoli, lung
c. Bronchospasm: When the muscles that line bronchi (airways of the lungs) tighten.
d. Cephalad diffusion: Toward the head ( or anterior extremity), a direction that in humans
corresponds to superior.
e. Cubital: An area of transition between the anatomical arm and the forearm.
f. Dehiscence: Partial or complete separation of wound edges.
g. Electrocautery: A procedure that uses heat from an electric current to destroy abnormal tissue,
such as a tumor or other lesion.
h. Fasciculation: Flickering contractions visible for a moment within the belly of the affected
muscle.
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i. Hemostasis: the body has a fibrinolytic mechanism that eventually dissolves clots (thrombi) formed
within blood vessels. The balance between these two systems—clot (thrombus) formation and clot
dissolution.
j. Hypercoagulation: A condition that causes blood to clot more easily than normal.
k. Hypoxia: Inadequate supply of oxygen to the cell.
l. Intraoperatively: Period of time that begins with transfers of the patient to the operating room
area and continues until the patient is admitted to the postanesthesia care unit.
m. Laryngospasm: A transient and reversible spasm of the vocal cords that temporarily makes it
difficult to speak or breathe.
n. Perioperative: Period of time before surgery.
o. Postoperative: Period of time that begins with the admission of the patient to the postanesthesia
care unit and ends after follow-up evaluation in the clinical setting or home.
p. Preoperative: Period of time from when the decision for surgical intervention is made to when
the patient is transferred to the operating room table.
q. Prophylactically: Guarding against or preventing the spread or occurrence of disease or
infection
r. Surgical Care Improvement Project: Improving the quality and safety of surgical care by
reducing post-operative complications.
s. Time-out protocol: The surgical team’s short pause, just before the incision, to confirm that
they are about to perform the correct procedure on the correct body part of the correct patient.
III. Instructions: Define the medical terms and fill out the correct correspondences to the statements.
1. Pre-operative- Period of time that constitutes the surgical experience: includes the
preoperative, intraoperative, and postoperative phases of nursing care.
_____________________________________________________________
2. Surgical Settings: consists of; the Patient, Circulating nurse, Scrub nurse, Surgeon, Registered
nurse first assistant, and the Anesthesiologist, anesthetist
3. Elective surgery: The patient should have surgery. Failure to have surgery is not catastrophic.
vs
Non-elective/ Emergency: The patient requires immediate attention; the disorder may be lifethreatening. Without delay.
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4. For inpatient surgery, patients who are going to be admitted to the hospital are usually
admitted on the day of surgery ( same- day admission) or ambulatory ( outpatient).
Provide 4 examples of these:
a. __acute gallbladder infections
b. __kidney or ureteral stones
c. __hernia repairs
d. __cataract surgeries
5. Communication and documentation of important preoperative assessment is the role of
__preoperative nurse_, which are essential to the continuity of care. List four major functions
that are essential to this role.
a. _Administering pre-anesthetic medication
b. _Maintaining a preoperative record
c. _Transporting the patient to a presurgical area
d. _Attending to family needs
6. List six things that are discussed and gathered during the patient interview:
a. _health history and family health history
b. _physical examination is performed, vitals noted
c. _baseline is established
d. _allergies
f. _comorbid conditions
g. _genetic consideration, activity, and function levels.
7. What are the overall goals of the nursing assessment during the preoperative period
a. preventing surgical complications, to assess the patient's medical status and ability to tolerate
anesthesia for the planned procedure
b. surgical site infections reduce the risks of anesthesia and surgery and prepare the patient for
the procedure.
8. Key goals of the nursing assessment goals include:
a. _health history
b. _physical examination
c. _list of medications taken routinely
d. _history of surgical
e. _history of allergies
f. _anesthetic histories
g. _overall health status
h. _the patient’s level of experience
______________________________________________________________
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9. Nursing Assessment: Psychosocial assessment
Excessive stress response can be magnified and affect recovery. Even for a procedure considered
minor, surgery is a stressful event.
i. Describe psychological and physiological reactions during a surgical procedure and anesthesia
that may elicit the stress response.
a. ___prior surgical experience
b. ___lack of control
c. ___fear of the unknown
d. ___fear of death
ii. Anxiety can rise from:
a. __a threat to the patient’s role in life
b. __a permanent incapacity or body integrity
10. Describe what is included in the nursing assessment of the patient’s past health history
a. __Obtain a thorough assessment of personal and family history for three generations, inquiring
about prior problems with surgery or anesthesia with specific attention to complications, such as
fever, rigidity, dark urine, and unexpected reactions
b. __Inquire about any history of musculoskeletal complaints, history of heat intolerance, fevers
of unknown origin, or unusual drug reactions.
c. _ Assess for family history of any sudden or unexplained death, especially during participation
in athletic events
d. __ Assess whether any family members have been diagnosed with King– Denborough
syndrome, as this is a form of congenital myopathy that places the patient at risk for malignant
hyperthermia.
11. Describe what is included in the nursing assessment of the patient’s current medication
related to the surgical procedure.
a. _use of prescription medications
b. _OTC medications (especially aspirin)
c. _herbal agents
d. _the frequency with which medications are used
e. _nurse must clearly communicate this information to the anesthesiologist or CRNA
12. Nursing assessment includes the review of allergies ( drug and non-drug). Why is this part of
the assessment important and what is included in this assessment?
a. __to prevent allergic reactions, and surgical complications. Herbal and other supplements are
included.
13. What are the risk factors associated with latex allergy.
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a. __patient allergy to kiwi
b. __patient allergy to avocado
c. __patient allergy to banana
d. __patient cannot blow up balloons
14. Nursing Assessment Exam
i. The joint commission ( JACHO) requires _name____&___date of birth___ to be in the chart
on every client.
ii. Indicate relevant findings that should be shared with the perioperative team.
a. _consent forms are completed & signed
b. _x-rays, lab results and EKG are on the chart
c. _patient allergies
d. _verify the availability of an implant if needed, and the availability of blood
iii. What laboratory tests should be performed for the following patients:
a. patient taking antiplatelet medication _TEG and ROTEM
b. Patient on diuretic therapy_ Monitor electrolytes (especially potassium), blood glucose, BUN,
and serum uric acid levels
c. patient of child bearing age_ Alpha-fetoprotein (AFP) test or multiple marker test.
Amniocentesis.
Chorionic villus sampling.
Cell-free fetal DNA testing.
Percutaneous umbilical blood sampling (withdrawing a small sample of the fetal blood from the
umbilical cord)
Ultrasound scan
d. Patient on dysthymic medications_
Complete blood count (CBC) with a sedimentation rate
Thyroid function tests
Homocysteine and methylmalonic acid levels
e. Diabetic patient
A1C Test. The A1C test measures your average blood sugar level over the past 2 or 3 months.
Fasting Blood Sugar Test.
Glucose Tolerance Test.
Random Blood Sugar Test.
Glucose Screening Test.
Glucose Tolerance Test
15. Describe 5 topics that are necessary during the preoperative teaching:
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a. _Deep Breathing, Coughing, and Incentive Spirometry
b. _Mobility and Active Body Movement
c. _Pain Management
d. _Cognitive Coping Strategies
e. _ Education for Patients Undergoing Ambulatory Surgery
16. Legal preparation: Mention 4 required forms that must be signed and included in the patient
chart.
a. __voluntary consent: Valid consent must be freely given, without coercion. Patient must be at
least 18 years of age (unless an emancipated minor), a physician must obtain consent, and a
professional staff member must witness the patient’s signature.
b. __incompetent patient:_ Legal definition: an individual who is not autonomous and cannot
give or withhold consent (e.g., individuals who are cognitively impaired, mentally ill, or
neurologically incapacitated).
c. __informed subject: Informed consent should be in writing.
d. __patient able to comprehend: If the patient is non-English speaking, it is necessary to provide
consent (written and verbal) in a language that is understandable to the client. A trained medical
interpreter may be consulted. Alternative formats of communication (e.g., Braille, large print,
sign interpreter) may be needed if the patient has a disability that affects vision or hearing.
Questions must be answered to facilitate comprehension if the material is confusing.
17.What should be included in the informed consent?
a. _Explanation of procedure and its risks
b. _Description of benefits and alternatives
c. _An offer to answer questions about the procedure
d. _Instructions that the patient may withdraw consent
e. _A statement informing the patient if the protocol differs from customary procedure
i. Who is responsible for obtaining the consent? __The Physician or surgeon; the nurse may
__ask the patient to sign the consent form and verify the signature
ii. Legally appointed representative of a family may consent if patient is:
a. _cognitively impaired
b. _mentally ill
c. _ neurologically incapacitated
18. What is included in the nursing management on the day of the surgical preparation?
a. _assessing the patient's physical
b. _reducing patient anxiety, fear
c. _ social states
d. _ preparing the patient for surgery
e. _ implementing nursing interventions
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f. __maintaining patient safety
g. _managing nutrition, fluids
h. _preparing patient’s skin
19. What is the purpose during nursing management to have the patient void before surgery &
before medication is administered?
a. _to prevent falls
b. _to prevent injuries
20. Indicate common classes of preoperative medication used during surgery and their indicated
uses.
a. __anesthesia: the use of medicines to prevent pain during the surgery and other procedures.
b. _ paralytics: powerful muscle relaxants used to prevent muscle movement during surgical
procedures
c. _ benzodiazepines: produce sleepiness or drowsiness and relieve anxiety before surgery or
certain procedures
d. _antibiotics: to prevent infections at the surgical site
e. _analgesics: to relieve pain and inflammation
f. _anticoagulants: to reduce the risk of blood clots following surgery
g. _ antiemetics: to prevent them from being sick after general anesthesia.
h._stool softeners: to maximize pain relief and minimize the use of opioids, as well as their side
effects
21. Transportation to the Operating Room ( OR)
Via stretcher or wheelchair & communication “ handoff”- Define what each letter in SBAR
stands for and the information that will be handed off.
S Situation ; What is going on with the patient?
B Background; What is the clinical background or context?
A Assessment; What do I think the problem is?
R Recommendation or Request; What would I do to correct it?
22. A 68-year-old male scheduled for a hernia repair at an ambulatory surgical center that he will
not have enough care at home and asks if he can stay in the hospital aft the surgery . The best
response by the nurse is
a. “ Who is available to help you at home after the surgery? “
b. “ I’m sure you will be able to manage at home after surgery. It is a simple procedure.”
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c. “We will teach you everything you need to know to be able to care for yourself after surgery.”
d. “ Your health insurance will pay for inpatient care only if complications develop during
surgery.”
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