MED SURG: QUIZ #2
CHAPTER 17: PREOPERATIVE NURSING
 Elective Procedures – Those that are scheduled in advance for a nonacute condition. Performing a procedure
electively is always preferred because the patient will be in better health than he or she would be during an acute
illness, and advance planning allows optimum physiological and psychological preparation of the patient.
o NI: The nurse should ensure that the consent form has been signed
 Holding Area – A place where patients await surgery. It is increasingly common for preoperative medications to be
given in the holding area of the surgical suite immediately prior to the operation
o NI: The nurse should give the patient preoperative medication at this area.
 Perioperative – This term encompasses the entire surgical experience: preoperative, intraoperative, and
postoperative
o NI: The nurse should prepare the patient for surgery
o NI: the nurse should assist and observe the patient during the operation
o NI: The nurse should prevent and treat postoperative complications
o NI: The nurse should prepare the patient for discharge
o NI: The nurse should verify the appropriate data has been obtained. Assess the patient for readiness both
physically and emotionally. Reinforce teaching as needed.
 Same-Day Admission – The patient reports from home directly to the reception area of the operating room, is
becoming standard procedure for many surgeries, including complex cardiac procedures.
o NI: The registered nurse must complete the initial assessment when the patient comes in for procedure.
o NI: The nurse should verify the patient’s identification.
o NI: Review patient’s medical record and preoperative checklist
o NI: The nurse should ensure that the consent form has been signed
o NI: The nurse should verify that all documentation, preoperative procedures, and orders completed.
 Cosmetic Surgery – Performed for the primary purpose of improving physical appearance. Examples include
liposuction, rhinoplasty, and breast augmentation**
 Curative Procedures – Done for the purpose of effecting a cure; for example, the successful treatment of a disease or
condition (includes cholecystectomy, hernia repair, and open reduction of a fracture. **
 Diagnostic Procedures – Performed for the purpose of making or confirming a medical diagnosis. These procedures
frequently require the removal of tissue or cells for analysis. Diagnostic surgeries include procedures such as breast
biopsy, arthroscopy, and diagnostic laparotomy. **
 Emergent (Emergency) Surgery – A procedure that must be performed immediately to prevent serious consequences
**
 Exploratory Surgery – The surgeon examines or explores the tissues and structures in order to decide what further
procedures or treatments need to be done**
 Palliative Procedures – Done for the purpose of alleviating symptoms caused by disease or a condition. Palliative
surgery does not effect a cure, but it frequently improves the patient’s quality of life. **
 Reconstructive Surgery – Done for the purpose of rebuilding tissues or body structures to achieve a more normal
function and appearance (ex. skin grafting and breast reconstruction following mastectomy) **
 Urgent Procedures – Performed for conditions that require prompt attention, within the next 48 hours, but that are
not currently life threatening (ex. appendectomy performed for acute appendicitis) **
**Nursing Interventions:
o NI: Review patient’s medical record and preoperative checklist
o NI: The nurse should ensure that the consent form has been signed
o NI: The nurse should verify that all documentation, preoperative procedures, and orders completed.
CHAPTER 18: INTRAOPERATIVE NURSING
 Bier Block – A specific type of peripheral nerve block that is administered intravenously, but certain techniques are
used to trap the anesthetic in the local area. Bier blocks may be used for surgeries on an extremity, usually the arm.
o NI: After the surgery, the tourniquet is intermittently deflated so that the lidocaine enters the patient’s
general circulation slowly, preventing a toxic reaction to the anesthetic.
 Circulating Nurse – Observes the surgical team from a broad perspective and assists the team to create and maintain
a safe, comfortable environment for surgery. The circulating nurse communicates patient care needs to each member
of the surgical team, facilitating a united effort while being the patient’s advocate.
MED SURG: QUIZ #2
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o NI: The nurse is dedicated to ensuring that the patient’s rights and wishes are respected and carried out
Conscious Sedation – Benzodiazepines are used in combination with other drugs to produce conscious sedation or as
adjuncts to regional anesthesia to produce sedation and muscle relaxation.
o IV delivery of sedative, hypnotic, and opioid drugs reduces the level of consciousness but allows the client to
maintain a patent airway and to respond to verbal commands.
o NI: The nurse should assess the airway, level of consciousness, oxygen saturation, electrocardiographic
status, and vital signs monitored every 15-30 min.
o NI: Prior to giving meds, the nurse should assess the patient’s HR and BP because benzodiazepines can bring
the BP and HR even lower. Hold if BP is <90/60 and/or if HR is less than <60 and/or if RR <10
Epidural Anesthesia – The injection of a local anesthetic into the epidural space. The epidural space is located
adjacent to the dura mater and contains fat, tissue, and blood vessels.
o NI: When headache develops, the nurse should treat them with hydration and analgesics.
o NI: The nurse should place the patient on bed rest with the HOB maintained at less than 30 degrees to reduce
CSF leak
General Anesthesia – Induced state of partial or total loss of sensation, occurring with or without loss of
consciousness. Used to block nerve impulse transmission, suppress reflexes, promote muscle relaxation, and, in some
instances, achieve a controlled level of unconsciousness
o NI: If the patient is experiencing malignant hyperthermia, the nurse should treat the patient with dantrolene.
o NI: The nurse should be monitoring the patient’s respiratory rate and depth frequently because anesthesia
can cause respiratory depression and/or hypoventilation.
Intraoperative – Patient teaching for the intraoperative patient is usually done in a preadmission testing clinic or on
the day before the surgery in a patient general surgical unit.
o NI: Verify patient’s identification.
o NI: Review patient’s medical record and preoperative checklist
o NI: The nurse should ensure that the consent form has been signed
o NI: The nurse should verify that all documentation, preoperative procedures, and orders completed.
o NI: The nurse should conduct the preanesthetic assessment
Intrathecal Anesthesia – The injection of a local anesthetic into the subarachnoid space and directly into the CSF. The
anesthetic blocks nerve fibers at the level for the spinal cord.
o NI: The nurse should comfort/assist the patient in maintaining a sitting position or in a side lying position with
the head and knees flexed.
o NI: The nurse should be monitoring the patient’s respiratory rate and depth frequently because anesthesia
can cause respiratory depression.
Malignant Hyperthermia (MH) – Involves a sudden fast increase in body temperature and metabolism rate along with
severe muscle contractions, is a rare but life-threatening complication of anesthesia. (Pg. 444)
o NI: If the patient is experiencing MH, the nurse should administer Dantrolene
Peripheral Nerve Block – The injection of a focal anesthetic into or around a nerve plexus to produce anesthesia of a
selected area. The major advantage of a nerve block is that anesthesia is confined to the area of the surgery and does
not have a systemic effect.
o NI: The nurse should educate the patient that even though the area is numb, they are still at risk for
inadvertently injuring the area
Regional Anesthesia – A general classification of anesthesia that includes spinal and epidural anesthesia, peripheral
nerve blocks, Bier blocks, and local anesthesia.
o NI: To reduce pain, the nurse can recommend to the doctor to order opioid analgesics. Opioid analgesics may
be administered to reduce the pain associated with the insertion of needles and the administration of
numbing agents.
o NI: The nurse should be monitoring the patient’s respiratory rate and depth frequently because anesthesia
can cause respiratory depression.
Scrub Nurse – Works directly with the surgeon within the sterile field (the area closely surrounding the OR table),
passing instruments, sponges, and other items needed during the surgical procedure
o NI: The nurse must keep all objects that are to be used sterile.
Spinal Anesthesia – The injection of a local anesthetic into the subarachnoid space and directly into the CSF. The
anesthetic blocks nerve fibers at the level for the spinal cord.
MED SURG: QUIZ #2
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NI: The nurse should comfort/assist the patient in maintaining a sitting position or in a side lying position with
the head and knees flexed.
Surgical Conscience – “An inner commitment to strictly adhere to aseptic practice, to report any break in asepsis
technique, and to correct any violation whether or not anyone else is present or observes the violation. A surgical
conscience mandates a commitment to aseptic practice at all times”
o NI: The nurse should make sure that surgical attire, scrubbing, gowning, and gloving are all done and
maintained aseptically.
CHAPTER 19: POSTOPERATIVE NURSING
 Airway obstruction – Occurs most often because medications used in anesthesia cuase the muscles to relax
o NI: The nurse should position the patient on their side to prevent airway obstruction
o NI: The nurse should assess for signs of an obstructed airway including snoring, stridor, retraction of
intercostal muscles, and a fall in the O2 saturation levels.
 Atelectasis – Refers to the collapse of alveoli and the surrounding airways. When alveoli collapse, lung volume is
reduced and mucus accumulates causing localized airway obstructions form mucous plugs.
o NI: The nurse should assess the patient’s RR and depth, listen to lung sounds, assess O2 saturation, and check
for fever
o NI: For signs of atelectasis, the nurse should provide lung expansion therapies, encourage forced coughing,
ambulate 3X per day, administer pain med, turn, cough and deep breath, relaxation techniques, maintain NG
tube, and titrate oxygen.
 Dehiscence – Opening of the incision
o NI: the nurse should teach the patient how to perform splinting prevent dehiscence or opening of the incision
if it is in the abdomen.
 Diuresis – Increased excretion of urine to decrease the amount of fluids in the third space.
o NI: The nurse should assess/monitor the patient’s intake and output and encourages the patient to drink
fluids to maintain fluid electrolyte balance.
 Fast-Tracking - Describes a situation in which the patient is transferred from the operating room to PACU phase II
bypassing PACU phase II, bypassing PACU phase I
o NI: Complete system assessment immediately on arrival at PACU
 Graduated Compression Stockings (GCSs) – Elastic stockings that apply varying degrees of pressure on the lower leg,
with the greatest exertion of pressure eat the ankle and the lowest pressure at the thigh (or knee in shorter
stockings). GCSs increase venous return and velocity, thereby reducing venous wall distention and venous stasis
o NI: Along with GCSs, the nurse should encourage the patient to ambulate to increase venous return and
prevent DVT.
o NI: GCSs may be used in conjunction with antithrombotic drug therapy, or they may be used as an alternative
to it in patients who should not receive any type of anticoagulant
 Hematuria – Blood in the urine
o NI: If the patient has blood in the urine, the nurse should report to the doctor.
o NI: The nurse should obtain cultures and labs of urine and report to the doctor.
 Hemostasis – Stopping bleeding
o NI: The nurse should not remove the surgical dressing. However, the nurse should mark an area of drainage
(circle it in pen) on the dressing, monitors it for enlargement, and reports any finding to the surgeon
 Hypothermia – Defined as a core body temperature of less than 36˚C (98.6˚) or a condition, regardless of body
temperature, in which a person experiences shivering, peripheral vasoconstriction.
o NI: The nurse should give forced air warming systems, warmed IV solution infusion, Use of warm/humidified
oxygen
o NI: the nurse should administer meperidine (Demerol)
 Hypoxemia – Insufficient oxygen content in the blood
o NI: The nurse should monitor the patient’s O2 saturation (should be over 90%) frequently until patient is
stable.
 Ileus – A hypoactive bowel with delay in peristalsis
o NI: The nurse should palpate the patient’s abdomen for hardness and firmness
o NI: The nurse should auscultate for hypoactive or absent bowel sounds
MED SURG: QUIZ #2
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NI: If the patient complains of pain, hiccups, no stool, flatus, nausea, and vomiting, then the nurse should
auscultate and palpate the patient’s abdomen for any signs of ileus.
Intermittent Pneumatic Compression Devices (IPCs) – Helps to decrease the risk of DVT. They work by applying
intermittent compression of the calf muscle, thereby increasing venous return.
o NI: If the patient is at risk of DVT (ex. bedrest), the nurse should apply IPC to the patient.
o NI: PCDs should not be used on patients who are immobilized for 72 hours or more without prophylaxis. If a
clot has formed, the device could dislodge it.
Ischemia – Restriction of blood flow to the coronary arteries
o NI: The nurse should decrease anxiety of the patient by using techniques such as relaxation, reassurance,
calm, quiet, restful environment, etc. to decrease the risk for myocardial ischemia.
Laryngospasms – Occurs when the muscles of the larynx contract forcefully, causing a closure or partial closure of the
airway.
o NI: The nurse should suction secretion, administer oxygen, administer an aerosolized epinephrine solution.
Mydriasis – Pupil dilation
o NI: If the nurse is administering the medication Scopolamine, the nurse should assess for side effects such as
mydriasis (pupil dilation)
Normothermia – Normal body temperature
o NI: The nurse should assess the patient’s temperature every 30 minutes until discharge. The patient must
achieve a minimum core body temperature of 36˚C (98.6˚) prior to PACU discharge.
Piloerection – Elevation of hairs on the body to conserve heat, known as “goose bumps”
Postanesthesia Care Unit (PACU) – Where the patient recovers from the effects of anesthesia. Located close to the
operating room. It is designed to care for patients as they stabilize and recover from surgery and anesthesia
o NI: The nurse should complete system assessment immediately on arrival at PACU
Postoperative Nausea and Vomiting (PONV) – A significant problem that can be more debilitating than the surgical
procedure.
o NI: The nurse should administer antiemetic agents (beginning during preoperative and intraoperative period)
o NI: The nurse should hydrate well with IV fluids
o NI: the nurse should change position slowly, position of patient choice
o NI: The nurse should use cool washcloths, provide frequent mouth care, give ice chips.
Sanguineous – Blood in the drainage
o NI: The nurse should monitor the drainage for any significant increase and notify the surgeon of any increase
or unexpected changes in the type of drainage.
Serosanguineous – Blood and serum in the drainage
o NI: The nurse should monitor the drainage for any significant increase and notify the surgeon of any increase
or unexpected changes in the type of drainage.
Surveillance – The systematic and continuous assessment of the patient
o NI: The nurse should monitor the patient’s psychological reactions to surgery and anesthesia, providing
reassurance and comfort
Third Spacing – Fluids that accumulate in the third space of tissues
o NI: The nurse should administer a hypertonic solution to pull out fluid from the interstitial space and into the
vasculature.
o NI: The nurse should administer diuretics to decrease the amount fluid in the third space.