PeriOperative Continuum of Care Q&A
1 – Which allergy must a nurse be most aware of
if a patient has a history of congestive heart
disease?
Latex
2 – What should the nurse inquire about
regarding anesthesia?
Past troubles with experience or family
members
3 – OR locations are: unrestricted, semirestricted and restricted. Which location are
family members not allowed?
Semi-restricted & Restricted
a. Semi-restricted
a. Which room is support service allowed?
4 – Who are parts of the surgical team?
a. Which team member is responsible for
counting?
b. Which member is responsible for
maintaining the airway & VS
Surgeon, Anesthesia Care Provider (ACP)
Scrub nurse, and Circulating nurse
a. Circulating nurse
b. ACP
c. Scrub nurse
c. Who hands instruments to the surgeon?
5 – Positioning the patient occurs ________ the
anesthesia is given.
AFTER
6 – Time it takes for skin break down?
20 minutes
7 – Important points for ____________ include:
- Maintain proper alignment
- Prevent pressure
- Prevent occlusion of vessels
- Avoid known areas of pain/weakness
Positioning
a. What should the nurse be aware of when
positioning a pt for surgery?
8 – The use of this Universal Protocol
established by the Joint Commission is held in
the holding room or OR to ensure the correct 5
Rights.
9 – In addition to counting, this team member
also:
- Maintains safety (position, procedure,
meds)
a. Properly aligned
Prevent pressure
Prevent vessels occluding
Avoid known areas of pain/weak
TIME OUT (aka Procedural Pause)
-
Maintain modesty (cover pt)
Questions anything that does not seem
‘right’
Circulating nurse
Anesthesia ContinuumDrug-induced level of consciousness
Minimal Sedation
Moderate Sedation &
Analgesia
Deep Sedation &
Analgesia
General Anesthesia
Conscious
Responds to verbal
commands
Depressed
-Responds to verbal or
light stimulation
 between 
*Cannot be easily aroused
Totally unconscious
-No response after any
type of stimulation
Unaffected CV & Resp
-Airway independent
-CV usually maintained
-Impaired ability to
maintain airway
-Required airway
assistance
-Spontaneous ventilation
may be inadequate
-CV may be impaired
-Responds after repeated
or painful stimulation
-May require assistance
-CV usually maintained
Note: Colonoscopy
Need to continuously
monitor VS
Equipment needed:
Debrillator, ambulation
bag & suction
Note: Brain surgery (to
ensure areas still
respond), shoulder or
hip replacements
Note: Skeletal, prolonged
surgeries
Drugs are used to
maintain VS
Aka “Conscious sedation”
10 – Patients w/ conscious sedation undergo
sedation for short-term therapeutic, diagnostic
or surgical procedures at the bedside or OR.
What are possible complications?
Respiratory depression/obstruct.
Hypoxia
Hypotension
11 – Patients in postoperative care must return
to pre-sedation level/score before discharge
under which sedation type?
Minimal or Conscious sedation
12 – What should the nurse not do following
administration of conscious sedation?
Should not leave the pt unattended or
compromised
13 – Below are nursing responsibilities for what
type of sedation?
-
Monitory airway
Monitor & document VS every 5 min
Monitor LOC (level of conscious.)
Position
Monitor for potential complications
Document
Conscious sedation
14 – This anesthesia is performed by the
Anesthesiologist (CRNA) only.
General anesthesia
15 – Loss of somatic & autonomic responses,
and loss of certain reflexes such as coughing and
gag reflex is characterized by this type of
anesthesia.
General
a. What responses/reflexes are lost with
general anesthesia?
a. Somatic & Autonomic responses
Coughing & gag reflexes
16 – Skeletal surgeries or prolonged surgeries
use what type of anesthesia?
General
17 – A pt undergoing General anesthesia
requires constant monitoring of what? (3)
Airway
Circulation (imbalance electrolytes)
Safety (loss of sensation/reflex)
18 – Malignant Hyperthermia is a severe
complication of what?
General anesthesia
a. This rare metabolic disease is
characterized by what S&S?
a. Skeletal rigidity and later high
temperatures
b. Which symptom comes later & needs
monitoring?
b. High temperature
19 – Dantrolene is the Tx for?
Malignant Hyperthermia
20 – Succinylocholine with inhaled anesthesia,
stress, trauma and heat may trigger which
severe complication of general anesthesia?
Malignant hyperthermia
a. Triggers that may cause severe
complications with general anesthesia
include what?
21 – Intracellular Ca+ levels incr resulting in
hypermetabolism in skeletal muscles causing 
rigidity, hyperthermia, hypoexemia etc. in what
condition?
22 –What should the nurse monitor in a pt with
a. Succinylocholine
Stress
Trauma
Heat
Malignant hyperthermia
malignant hyperthermia?
Temp.
23 – This period begins when the patient leaves
the OR and arrives in PACU/recovery room
PostOperative
a. Most important person who
accompanies the pt
24 – Run through of PACU care:
a. Nurse anesthetist
Report from circulating nurse or anesthesia
ABC’s
Teaching
Discharge instructions + report to floor nurse
*care based on body systems
25 – ABC’s
a. How does the nurse assess A?
b. What happens if O2 Sats decr for B?
c. What does the nurse assess for C?
Airway
 Inspect chest rise/fall
 Auscultate (breathing, speech)
Breathing
 Stimulate pt to take deep breaths
Circulation
 Skin color
 BP/pulse
 Temp
 Capillary refill time
 Peripheral pulses
26 – Factors to consider with each body system
during Post Op:
- Respiratory
- Cv
- Nv
Pain
- Integumentary
- Gi
Urinary
Respiratory
 Breathing
Cardiovascular
 Hypertension/hypotension
 Arrhythmias
 Flow
Neurovascular
 Consciousness
 Memory
Pain
 Intermittent does v. PCA
Integumentary
 Surgical, IV sites, drains –infection
 Note how much drainage
 1st dressing changed by surgeon
(usually), unless ordered
Gastrointestinal
 Nausea & vomit are common
 Bowel sounds 
 Diet restrictions
Urinary
 Monitor output
 1st hour usually low urine output
 After 1st hour: 30 mL/hr
 If pt unable to void after 6-8 hours
bladder scan & catheter insertion
27 – How much should the pt be voiding after
the 1st hour of Post Op?
28 – The Post Op patient has 5 drains and an IV
a. What is this patient at risk for?
b. What should the nurse take note relating
to the pt’s drains?
29 – The nurse should be teaching what to a
Post Op. pt?
30 cc/hour
a. Infection
b. The amount of drainage
Pain management
Drain management*
Maintaining normal temp. (blankets)
Check blood sugar more often if diabetic*
Why meds were ordered*
Activity level
Dietary restrictions
Wound care*
Bowel regularity
Report S&S to nurse or MD
Follow-up care
answer all pt questions
30 – What should the patient not be doing after
discharge from the Post Operative care?
Driving
31 – The patient is have a difficult time passing a
bowel. What sort of order should the nurse
request and why?
Stool softener –to prevent straining for a bowel
 sutures may open
32 – The following are complications to what?
- Atelecstasis & risk of Pneumonia
- Risk for constipation, ileus and
abdominal distention
- Urinary retention
- Wound infection
- Wound dehiscence & evisceration
- Wound drains
- Thromboemboli
Post Operative Surgery
33 – This Post Op complication is collapse of
alveoli, resulting in insufficient gas exchange.
a. As a nurse, what is key with this
complication?
b. What are some interventions that may
be helpful for the pt with this
complication?
c. How may the nurse assess for this
complication?
d. Increased temp may be caused by what?
e. A pt with this complication would have
high or low values- HR, Pulse Ox, Temp,
and RR?
Atelecstasis
34 – Lack of peristalsis leads to ________
Ileus
35 – How would the nurse assess the pt for
urinary retention?
Palpate the bladder & bladder scans
36 – The nurse should monitor ____ for wound
infection
WBC
37 – Wound _________ introduce another route for
infection
Drains
38 – This is opening and extruding contents of
the cavity of the wound
Wound dehiscence and evisceration
39 – Pt’s with DVT/thromoboemoboli are at risk
for the thrombosis to break loose and travel to
the lungs, causing?
a. Tx for DVT?
Pulmonary emboli
a. Prevention
b. Incentive spirometry
Early ambulation*
Hug-me pillow
Deep breaths
c. Listen to the pt’s heart
anterior/laterally/posterior, RR, pulse
oximetry, HR, temp. and CBC
d. Pneumonia
e. HR high
RR high
Temp high
Pulse Ox low*
a. “Sequence-compression device” (SCD) &
blood thinners
KEY Medical Terminology
-ectomy
Remove
-ostomy
Create opening
-otomy
Cut into
-plasty
Reconstruct
-orraphy
Repair or suture
-scopy
Look into