RNSG 1341 Module
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. Refer to Table 18-1 in Lewis to finish this
matching exercise.
_____ 1. Aden/o
_____ 2. Pancreat/o
_____ 3. Arthr/o
_____ 4. Cardi/o
_____ 5. Hepat/o
_____ 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
a. heart
b. lung
c. ureter
d. visual examination
e. larynx
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
_____ 23. orrhaphy
_____ 24. oscopy
_____ 25. ostomy
_____ 26. otomy
_____ 27. plasty
_____ 28. pexy
_____ 29. cholecyst/o
_____ 30. herni/o
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 Lewis, indicate the contributing factor(s) and appropriate intervention(s) for
each of the following surgical risks.
Contributing Factor(s)
_______________
Surgical Complication
1. Delayed wound healing or
dehiscence
Nursing Intervention(s)_
_______________________
_______________
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. You may need to
use your drug guide as a reference for this exercise.
Bicitra
Pepcid
Reglan
Versed
Prevacid
Atropine
Morphine
1. Suppresses gastric acid secretion
___________________________________
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.