Study Guide – Module # 5 Nursing Care of the Individual with Preoperative Health Care
Needs
“Classification of Surgical Procedures.”
Fill in the blanks using the appropriate classification from the list below.
Diagnostic
Palliative
Ablative
Reconstructive
Constructive
Emergency
1. _______________ Life saving surgery that must be performed immediately.
2. _______________ Procedure determination of the presence and/or extent of
pathology.
3. _______________ Surgery done to remove a diseased tissue, organ, or extremity.
4. _______________ Surgery performed to correct a congenital anomaly by
building tissue that was absent at birth.
5. _______________ Rebuilding a tissue or organ that was present at birth but has
been damaged.
6. _______________ Surgery performed to alleviate symptoms without a cure.
Knowledge of terminology promotes an understanding of the type of surgical
procedure that will be performed. Use the “TERMINOLOGY LIST – Surgical
Procedures” handout in your syllabus as a reference and match the following
combining forms and suffixes with their meaning.
_____ 1. Aden/o
_____ 2. Pancreat/o
_____ 3. Arthr/o
_____ 4. Cardi/o
_____ 5. Hepat/o
a. heart
b. lung
c. ureter
d. visual examination
e. larynx
_____ 6. Gastr/o
_____ 7. Hyster/o
_____ 8. Salping/o
_____ 9. Oophor/o
_____ 10. Prostat/o
_____ 11. Orchid/o
_____ 12. Pharyng/o
_____ 13. Laryng/o
_____ 14. Trache/o
_____ 15. Pulmon/o or Pneum/o
_____ 16. Nephr/o
_____ 17. Ureter/o
_____ 18. Cyst/o
_____ 19. Urethr/o
_____ 20. ectomy
_____ 21. lysis
_____ 22. centesis
_____ 23. orrhaphy
_____ 24. oscopy
_____ 25. ostomy
_____ 26. otomy
_____ 27. plasty
_____ 28. pexy
_____ 29. cholecyst/o
_____ 30. herni/o
f. testicle
g. kidney
h. trachea
i. suture into place
j. surgical repair
k. pharynx
l. bladder
m. urethra
n. surgical removal, excision
o. gland
p. pancreas
q. prostate gland
r. ovary
s. stomach
t. liver
u. puncture to aspirate
v. joint
w. uterus
x. fallopian tube
y. incision, cutting into
z. making an artificial
opening
a2. setting free, relief of
b2 abnormal protrusion
c2. suturing, repairing
d2. gallbladder
Based on your review of the common surgery related suffixes, prefixes, and word
roots provided, write a simple definition of the following surgical procedures.
1. Hysteropexy –
2. Gastroscopy –
3. Nephrostomy –
4. Arthroplasty –
5. Prostatectomy –
6. Tracheotomy –
7. Herniorrhaphy –
8. Cholecystectomy -
9. Lysis of adhesions 10. Thoracentesis -
Place a check mark beside each item that correctly addresses the statement
provided.
1. Items that describe Outpatient Surgery:
_____ a. Site where most minor surgical procedures are performed
_____ b. Ability to return home the day of the procedure reduces stress for
many patients
_____ c. Procedures performed cause less disruption of family and work
schedules
_____ d. The most common complication resulting from surgery at these
locations is infection
_____ e. There is more time for assessments and patient teaching because
the procedures are less complex
2. Items that describe Inpatient Surgery:
_____ a. The site where more complex surgeries are performed
_____ b. Procedures performed here are more expensive due to the need
for complex equipment and supplies, staff trained to perform
more complex skills and varied tasks, and extended stay in the
facility
_____ c. Prolonged stay decreases the patient’s risk for complications
such as infection
_____ d. Procedures performed here are more likely to be classified as
major, urgent or emergency in nature
_____ e. Patients having surgery here are more likely to need IV therapy,
blood transfusions, physical and respiratory therapy, referral for
assistance with home care, or detailed postoperative teaching
3. Items necessary for informed consent for a surgical procedure:
_____ a. Have a family member or friend witness the patient’s signing of
the consent form even if this occurs after the patient has been
transported to surgery.
_____ b. The patient may sign the form anytime prior to the performance
of the procedure.
_____ c. If the patient is a minor, is unconscious, or is mentally
incompetent to sign the permit, the written permission may be
given by a legally appointed representative or responsible family
member.
_____ d. For consent to be informed, the patient must have been informed
and must understand the nature of the surgery, the qualifications
of the surgeon, the risks of the procedure, the chances for
success, alternate methods available for treatment of the
problem, as well as the right to refuse or withdraw consent at
anytime.
_____ e. There is no circumstance in which a physician can perform
surgery without the signature of the patient or next of kin.
4. Responsibilities of the nurse related to obtaining informed consent:
_____ a. Describing the steps of the procedure that the surgeon will
perform, the exact organs that will be removed or endangered as
a result of the procedure, and the potential complications.
_____ b. Obtaining the patient’s signature and the signature of the person
actually seeing the patient sign the form..
_____ c. Signing as a witness to the patient’s signature if no family
member is available.
_____ d. Clarifying simple issues of misunderstanding that the patient or
family may have prior to the signing of the consent form.
_____ e. Encouraging the patient to not sign the form if there are many or
major misunderstandings about the procedure, risks, benefits,
and expected outcomes of the surgery or anesthesia.
_____ f. Notifying the surgeon and/or anesthesiologist about major
concerns expressed by the patient or family members so that
additional teaching and clarification can be completed prior to
signing the form.
5. Current beliefs about preoperative fasting provided by the American Society of
Anesthesiologists in regard to healthy patients preparing for elective surgery:
_____ a. all patients must be NPO after midnight prior to any surgical
procedure.
_____ b. clear liquids and appropriate oral medications may be taken 2
hours prior to surgery.
_____ c. tea and toast may be taken 6 hours prior to surgery and a heavier
meal 8 hours prior to surgery.
_____ d. aspiration is no longer considered a risk associated with general
anesthesia.
6. The preoperative cardiovascular nursing assessment must include:
_____ a. history of known cardiovascular disorders
_____ b. assessment of vital signs, heart sounds, and pulses
_____ c. assessment for edema and JVD
_____ d. identification of prescription and non-prescription preparations
that impact cardiovascular function and risk for bleeding.
_____ e. review of the diagnostic test findings
7. Prior to surgery, the routine respiratory data collection should include:
_____ a. assessment for signs and symptoms of infection and history of
previous serious and chronic respiratory illnesses.
_____ b. use of prescription and non-prescription medications as well
tobacco products.
_____ c. assessment of rate and character of respirations
_____ d. assessment of breath sounds, shape of the chest, and use of
accessory muscles.
_____ e. review of the available diagnostic test findings addressing
respiratory function.
_____ f. collection of sputum to test exposure to TB and other pathogens.
8. The preoperative assessment of the integumentary system and nutritional status
includes:
_____ a. assessment of skin and mucosa for lesions, color, moisture,
hydration, temperature, and makeup that would hinder
assessment of circulation.
_____ b. assessment of boney pressure points for redness and ulcers.
_____ c. completion of skin scrub and shaving of the surgical site by the
patient prior to admission.
_____ d. assessment of oral cavity for dentures, loose teeth, and infection.
_____ e. presence of gag and swallow reflexes
_____ f. NPO status and time that last food and liquids were consumed.
_____ g. intake of own medications and dietary supplements in the last 3
weeks as well as the AM of surgery.
_____ h. patient’s recall of his/her height and weight.
9. The preoperative neurological and muscular assessments should include:
_____ a. orientation to person, place and time.
_____ b. checking for indications of confusion, disorderly thinking, and
inability to follow simple two part commands.
_____ c. assessment for abuse of alcohol and other substances.
_____ d. history of hearing and/or visual impairment.
_____ e. determination of muscle strength and joint function
_____ f. determination of ability to ambulate, ambulatory aids, gait,
balance, and usual activity level.
_____ g. determination of the patient’s ability to drive himself/herself
home after the procedure or hospital stay.
10. Each patient’s preoperative bowel and bladder preparation includes:
_____ a. assessment of ability to void and history of urinary track
infections.
_____ b. checking usual bowel patterns including date and type of last
bowel movement.
_____ c. abdominal assessment for shape, lesions, presence and character
of bowel sounds in each quadrant, and palpation for firmness and
discomfort.
_____ d. administration of antibiotics such as neomycin for several days
prior to surgery.
_____ e. administration of enemas until clear the night prior to surgery.
_____ f. administration of a bowel prep drink such as Go-Lytely the night
prior to surgery.
_____ g. insertion of a Foley catheter for all patients having general
anesthesia.
11. Preoperative teaching relating to pain management:
_____ a. should be avoided because it frightens the patient and increases
the pain / anxiety cycle.
_____ b. informs the patient that the nurses will administer doses of pain
medication based on his pulse rate and blood pressure.
_____ c. stresses the need for early medication before the pain becomes
too severe.
_____ d. emphasizes that the patient should not be expected to experience
pain greater than 3 on the 0 to 10 rating scale.
_____ e. includes the fact that the patient will be expected to rate and
describe his pain each time vital signs are measured, each time
he requests a pain medication, and after each intervention to
relieve his pain.
_____ f. informs the patient not to worry about addiction until pain control
is achieved and the wound is healed.
12. Teaching preoperative exercises will help the surgical patient by:
_____ a. allowing time to learn them prior to administration of pain
medications and discomfort that focuses the patient’s attention
away from learning.
_____ b. providing a means by which the patient can participate in the
prevention of complications.
_____ c. increasing his strength, joint function, and weight reduction.
_____ d. decreasing the need to assess for a positive Homan’s sign.
Write the name(s) of the common preoperative diagnostic test(s) on the line next to
the purpose for performance.
RBC, H & H
Blood Sugar
BUN, Creatinine
Pregnancy
WBC
Platelets
Serum Electrolytes
ECG
Chest X-ray
PT/INR & PTT
AST/ALT
Type & Crossmatch ABG’s & Pulse ox.
Cholinesterase Urinalysis
1. _______________ determines the patient’s ability to combat infection.
2. _______________ measures the patient’s ability to transport oxygenate to the
tissues.
3. _______________ determines the patient’s ability to metabolize drugs
administered to paralyze muscles thus his ability to regain
movement and respiratory function after surgery.
4. _______________ indicates the level of kidney function.
5. _______________ indicates effectiveness of respiratory function.
6. _______________ indicates the need for insulin & predicts wound healing
problems.
7. _______________ helps to identify risk for cardiac malfunction which would
make the patient more likely to experience complications such
as shock or cardiac arrest.
8. _______________ indicates the liver’s ability to metabolize many medications
given during the surgical procedure.
9. _______________ indicates the patient’s risk for hemorrhage.
10. _______________ helps to identify if certain procedures can be performed or if
certain medications can be safely administered in order to
protect an unborn child.
11. _______________ prepares blood or blood products that may be needed to
replace loss prior to, during, or after surgery.
Match the following NANDA Stems with the assessment data, related to statements,
and interventions provided. Hint – some items may have more than one answer.
A.
B.
C.
D.
E.
Knowledge deficit
Anxiety &/or fear
Anticipatory grieving
Coping, ineffective
Family process, interrupted
PERSON Data
_____ 1. Shy, 15 year old female, first admission to a hospital and first surgical
experience, in bed fully dressed in her street clothes with covers pulled up to her
chin, parent shouting at the patient stating that her behavior is ridiculous
_____ 2. History of chronic lung disease, smoked 2 packs a day for the last 44 years,
joking about already missing his cigarettes, respirations increased from 22 at
rest to 30 / minute when assisted to the bathroom to void, wheezing with course
crackles noted on auscultation, unable to effectively deep breathing and cough
_____ 3. Tense facial expression, eyes red with tears evident when speaks about the need
to be separated from her 3 year old daughter and 7 month old son, verbalizes
concern about care that will be provided at her in-laws home
_____ 4. States, “I feel like I will no longer be considered attractive by my spouse after
this surgery is performed. This will be a very hard thing to face in our home.”
_____ 5. “When I had my last surgery in 1953, I wasn’t allowed to get out of bed for
about 6 days. Why isn’t rest needed anymore? How can a wound heal if I have
to exercise and walk around. Won’t the wound open up?”
Related to statements
_____ 1. related to lack of previous experience with a specific procedure
_____ 2. related to serious concern about the outcome of the procedure
_____ 3. related to concerns about family finances S/T cost of hospitalization and need
for a prolonged recovery period
_____ 4. related to embarrassment and reluctance to frankly discuss concerns with
significant other
Typical nursing interventions
_____ 1. Use active listening and open ended statements to promote the patient’s ability
to verbalize concerns
_____ 2. Use simple or common terminology when stating the rational for tasks being
performed and information being presented
_____ 3. Offer to help the patient call a trusted friend or offer to call social services
or the Hospital Chaplin for the patient
_____ 4. Sitting at the bedside, demonstrate the postoperative exercises and have the
patient perform a return demonstration
_____ 5. Provide basic information about community services available to patients
having the scheduled procedure
_____ 6. Assess what the patient knows or understands about the scheduled procedure
and the information to be taught
_____ 7. Ask the client how he/she has managed difficult experiences in the past and
identify what has been most helpful
_____ 8. Inform the patient that you will explain each procedure again when it is time to
perform it
_____ 9. Acknowledge and value the patient’s feelings and if appropriate, ask the patient,
“What do you hope for?”
_____ 10. Communicate concern but avoid giving ‘false hope.’
Using Lemone, Table 7-2 and your class notes as a guide, indicate the contributing
factor(s) and appropriate intervention(s) for each of the following surgical risks.
Contributing Factor(s)
Surgical Complication
Nursing Intervention(s)_
_______________
1. Delayed wound healing or
dehiscence
_______________________
_______________
2. Hemorrhage
________________________
_______________
3. Shock
________________________
_______________
4. Atelectasis and pneumonia ________________________
_______________
5. Infection
________________________
_______________
6. Formation of clots and emboli
________________________
Identify the preoperative drug described by the following actions.
Bicitra
Pepcid
Morphine
Reglan
Versed
1. Suppresses gastric acid secretion
Prevacid
Atropine
___________________________________
2. Reduces gastric acid volume and ______________________________________
concentration
3. Promotes gastric emptying ___________________________________________
4. Decreases vomiting and aspiration _____________________________________
by drying the mouth and respiratory tract
5. Decreases anxiety but causes respiratory _______________________________
depression and hypotension
6. Causes both sedation and extrapyramidal _____________________________
or involuntary movements and changes in
muscle tone
7. Increases the pH and reduces the volume ______________________________
of gastric fluid in patients with GERD
8. Induces amnesia, drowsiness and lack of ______________________________
coordination
Indicate whether the following statements are true or false.
_____ 1. Use of herbal “dietary supplements” is increasingly common in the United
States and patients who use them often do not think of them as medicines to be
reported prior to surgery.
_____ 2. Patients may not be aware that herbal “dietary supplements” can cause serious
complications during or after surgery.
_____ 3. Herbal preparations are primarily used by preoperative patients from cultural
groups that have recently entered the United States.
_____ 4. It is best to administer the preoperative medication prior to describing the
surgical risks and prior to asking the patient to sign the permit for surgery.
_____ 5. Ambulating a preoperative patient to the bathroom after the administration of a
narcotic or sedative may result in falls due to postural hypotension.
_____ 6. The most common preoperative medications in current use include the IM
administration of Morphine or Demerol.
_____ 7. All preoperative patients are taught that they will have to cough and deep
breathe every 2 hours while awake.
_____ 8. Calf pumping and quadriceps setting are exercises that are considered essential
for the prevention of blood clots in the lower extremities.
_____ 9. Obtaining the patient’s baseline vital sign range helps the nurse to better
evaluate his response to the multiple stressors experienced in the surgical and
postoperative periods.
_____ 10. Patients allergic to shellfish are at high risk for allergy to iodine based
cleansers used for surgical scrub skin preparation.
** Additional Interesting Surgery Related Information **
Interesting web sites:
National Center for Alternative and Complementary Medicine and others.
http://nccam.nih.gov/health
Natural Medicines Comprehensive Database
http://www.naturaldatabase.com
Facts and Comparisons, Review of Natural Products
http://www.factsandcomparisons.com
FDA Center for Food Safety and Applied Nutrition
http://www.cfsan.fda.gov/-dms
According to Zoler, it is estimated that about 22 to 32% of people in the United
States preparing to undergo surgery use some type of herbal medication. It is also
estimated that more than 70% of patients preparing to undergo surgery fail to
disclose this use.
According to Heyneman, the increased use of herbal preparations can be related to
the high cost of traditional western medicine, the accessibility of these products,
increased exposure to a variety of cultures, and the desire to control ones health
care. It is increasingly common for white people, those suffering from chronic
diseases, people of higher socioeconomic and educational status, and women to use
alternative medical therapy.
Generally speaking, these herbal preparations fall under the category of “dietary
supplements” and under the Dietary Supplement and Health Education Act
(DSHEA) of 1994. As such, they are exempt from the rigorous safety and efficacy
testing required by the FDA of all prescription and over-the-counter drug products.
The manufacturers alone are responsible for quality control, yet the burden of proof
regarding safety issues lies with the FDA. Serious concerns have been raised
regarding quality and standardization of herbal products. Although many are safe,
Heyneman reports that the March 1999, Consumer Reports article “Herbal Rx-the
promises and pitfalls” documents 2,621 adverse events including 101 deaths that
have been reported to the FDA over a 5-year period.
The American Society of Anesthesiologists offers no official guidelines regarding the
use of herbs preoperatively but has prepared educational materials which
encourage patients to discontinue their use at least 2 to 3 weeks prior to surgery. If
this is not possible other authors, Ang-Lee et al recommend that the discontinuation
time be 5 X the half-life of the particular herb.
Potential Risk Factors due to Preoperative use of Herbal Preparations
Please note that these and many other herbs are also known by a variety of common
names.
Some herbs that can increase the risk for bleeding or hemorrhage alone or in
combination with prescribed medications:
Goldenseal
Fenugreek
Ginkgo biloba
Danshen
Ginseng
Pau d’arco
Ginger
Horse chestnut
Dong quai
Feverfew
Garlic
Saw malmetto
Salvia Papain
Angelica root
Arnica flower
Anise
Celery
Camomile
Lovage root
Parsley
Passionflower herb
Guassia
Red clover
Rue
Turmeric
Clove
Onion
Bromlain
Willow bark
Poplar
Meadowsweet
*Regular ingestion of garlic-containing foods is not believed to pose a risk. While doses
of 4 cloves daily over a prolonged period has caused serious problems.
*Taking coenzyme Q10, green tea, and Oriental ginseng may antagonize the effect of
warfarin.
Some herbs that can increase the risk for infection:
Echinacea
Some herbs that increase risk by causing prolonged or deeper sedation:
Valerian
*Discontinue valerian with caution in long term users as a benzodiazepine-like
withdrawal may occur.
St. John’s Wort
Kava (Kava kava or Piper methysticum)
Hawthorn
Sarsaparilla
Some herbs that increase surgical risk by alteration of vital signs:
Lower blood pressure- Garlic, Yerba mate (Paraguay tea), St. John’s Wort, Ginseng
Elevated blood pressure- Goldenseal, Ginseng, Ephedra or Ma Huang, licorice, Yerba
mata (Paraguay tea), Black cohosh, guarana (caffeine)
Elevate pulse – Ginseng, Ephedra or Ma Huang,
Some herbs that put vital organ function at risk:
Liver function – Kava, Echinacea – risk for hepatotoxicity
Heart failure &/or cardiac arrest – in high doses licorice, Aconite (monkshood, friar’s
cap, helmet flower or wolfsbane), Ephedra or Ma Huang
Some herbs that are associated with increased risk for allergic reaction:
Echinacea
Some herbs that lower blood sugar, elevate it, or interact with antidiabetic agents:
Ginseng
Garlic
Ephedra (ma-huang)
Some Common Herbs and Their Use
Preop D/C Times if Known
Echinacea – boosts immunity with short term use,
D/C as far in advance as
stimulates immune system and should be avoided
by patients who need preoperative
immunosuppression. When used for more than 8
weeks it may cause immunosuppression which can
lead to impaired wound healing and risk for infection
Used to prevent the common cold, sunburn, yeast
and bacterial infections, migraines
possible
Ephedra – weight loss and energy booster often
combined with guarana (caffeine)
Relief of nasal congestion, edema, headache
D/C 24 hrs. preop
Garlic – Hypertension, hyperlipidemia,
antibacterial, prevention of cancer and
atherosclerosis, diabetes, allergies, arthritis
D/C 7 days preop
Gingko – boosts memory, antioxidant, aids in
antidepressant-induced sexual dysfunction,
dizziness, cerebrovascular insufficiency
D/C at least 36 hrs. preop
Ginseng – Helps manage stress, diabetes,
Facilitates learning and memory, stimulant,
Diuretic, weak immunity, physical and mental
Exhaustion, fatigue
D/C at least 7 day preop
Kava – Anxiety, stress, insomnia,
restlessness
D/C at least 24 hrs. preop
St. John’s Wort – Helps with depression,
Anxiety, menopausal symptoms, and
viral and bacterial infections
D/C at least 5 days preop
Valerian – Insomnia, sleep disorders, anxiety,
migraines
Taper dose weeks preop
D/C by 7 days preop
Saw palmetto – Benign prostatic hyperplasia,
diuretic, sedative, anti-inflammatory, aphrodisiac
Guarana (caffeine) – used to increase energy level
D/C at 24 hours preop
Licorice – allergies, arthritis, asthma, constipation,
poor appetite, Peptic ulcers, esophagitis, gastritis,
hepatitis, inflammatory conditions, poor adrenal
function
D/C 24 hours preop
Aloe – used internally for intestinal inflammation
and ulcers, aid to stimulating bile secretion
Ginger – nausea, motion sickness, indigestion,
inflammation
Green tea – prevention of cancer and heart disease,
hypercholesterolemia, diarrhea
Sarsaparilla – anti-inflammatory, antiseptic,
syphilis, skin diseases, rheumatism, necrosis,
mercury poisoning
Red clover – antispasmodic, expectorant, sedative,
Psoriasis, eczema, amenorrhea
Passionflower – antifungal, hypertension,
anti-inflammatory
Horse chestnut – diuretic, genitourinary astringent,
Anti-hemorrhagic, Bell’s Palsy, healing broken bones
Feverfew – migraines, cluster headaches, fever,
psoriasis, inflammation
Angelica – heartburn, indigestion, gas, colic, poor
circulation to the extremities, bronchitis, poor appetite
Black Cohosh – menopause: hot flashes, nervous conditions
dysmenorrheal: cramps, pain, inflammation
This herb related information is summarized from the following resources:
1. Heyneman, Catherine A. “Preoperative considerations: which herbal products
should be discontinued before surgery? – Pharmacology” Critical Care Nurse.
April 2003. Located at http://www.looksmart.com and
http://www.findarticles.com This article provides a comprehensive listing of high
quality websites and other references for additional information.
2. “Herbal remedies pose surgery risk.” Health. July 10, 2001 BBC News. Located
at http://news.bbc.co.uk/1/hi/health/1431599.stm
3. Zoler, Mitchel L. “Eight herbal medications pose potential dangers in surgical
patients – Discontinuation Before Surgery Needed” OB/GYN News. April 1,
2003. Located at http://www.looksmart.com/ and http://www.findarticles.com/
4. Mosby’s 2004 Nursing Drug Reference. Mosby, Inc. 2004, pp.1106 – 1112.