Perioperative Care: Preoperative 1 Of 3 (Nac1)

Front 1

(def)

the art and science of treating diseases, injuries, and deformities by operation and instrumentation

Back 1

surgery

Front 2

(def)

determination of the presence and/or extent of pathology

Back 2

diagnosis

Front 3

(def)

alleviation of symptoms without cure

Back 3

palliation

Front 4

Removing a mole before it becomes malignant or removal of the colon in a patient with familial polyposis to prevent cancer are examples of what?

Back 4

prevention

Front 5

(def)

surgical examination to determine the nature or extent of a disease

Back 5

exploration

Front 6

Suffix meaning excision or removal?

Back 6

-ectomy

Front 7

Suffix meaning destruction of?

Back 7

-lysis

Front 8

Suffix meaning repair or suture of?

Back 8

-orrhaphy

Front 9

Suffix meaning looking into?

Back 9

- oscopy

Front 10

Suffix meaning creation of opening into?

Back 10

- ostomy

Front 11

Suffix meaning cutting into or incision of?

Back 11

-otomy

Front 12

Suffix meaning repair or reconstruction of?

Back 12

-plasty

Front 13

(def)

surgery that it performed on the same day of admission and does not require an overnight stay at the hospital

Back 13

ambulatory surgery

Front 14

Many ambulatory surgeries involve the use of _________ techniques.

Back 14

endoscopic

Front 15

If a surgery is classified as urgent, it must be done within ___ - ___ hours.

Back 15

24-30

Front 16

What are the 4 primary purposes of the preoperative interview?

Back 16

1. obtain health information
2. determine the patient's expectations about surgery and anesthesia
3. provide and clarify information
4. assess the patient's emotional state and readiness for surgery

Front 17

What is the overall goal of the preoperative assessment?

Back 17

- to gather data in order to identify risk factors and plan care to ensure patient safety throughout the surgical experience

Front 18

What is the purpose of determining the psychological status of the patient during the preoperative nursing assessment?

Back 18

- to reinforce the use of coping strategies during the surgical experience

Front 19

What is the purpose of determining physiological status of the patient during the preoperative nursing assessment?

Back 19

- to look for factors that are directly or indirectly related to the surgical procedure that may contribute to operative risk factors

Front 20

What is the purpose of obtaining baseline data during the preoperative nursing assessment?

Back 20

- for comparison in the intraoperative and postoperative period

Front 21

When does the nurse identify and document the surgical site/side on which the surgical procedure will be performed?

Back 21

during the preoperative assessment

Front 22

What medications should be identified and documented during the preoperative assessment? What is the purpose of this?

Back 22

- prescription, OTC, and herbs
- to identify if they may affect the surgical outcome

Front 23

What must the nurse do re: lab and diagnostic tests during the preoperative assessment?

Back 23

- confirm that they are documented in the patient's record
- confirm that they are communicated to the appropriate personnel

Front 24

At what point should the nurse identify any cultural or ethical factors that may affect the surgical experience?

Back 24

during the preoperative assessment

Front 25

Who is required to obtain informed consent from the patient?

Back 25

The MD is responsible for receiving informed consent

Front 26

Does the nurse have any responsibilities regarding informed consent?

Back 26

- determine if the patient has adequate information to make an informed decision
- ensure that the form is signed and witnessed

Front 27

The psychologic and physiologic reactions to a surgical procedure and anesthesia elicit what response from the patient?

Back 27

the stress response which enables the body to prepare to meet the demands in the perioperative period

Front 28

What might happen if the patient's stressors/response to stressors are excessive?

Back 28

the stress response can be magnified and recovery can be affected

Front 29

Why is it important that the nurse be aware of a patient's perceived and actual stressors?

Back 29

b/c it allows the nurse to provide support and the needed information during the preoperative period so that the stress will not become distress

Front 30

What are the 3 most common psychological factors that a nurse will address when dealing with perioperative patients?

Back 30

- anxiety
- fear
- hope

Front 31

While a mild amount of anxiety is expected when facing surgery, patients with an extremely high level of stress will have diminished abilities with what 3 things?

Back 31

- cognitive function
- decision making
- coping abilities

Front 32

What can the nurse do to help a patient who is experiencing anxiety due to a lack of knowledge, unrealistic expectations, or fear regarding the procedure?

Back 32

- provide information about what can be expected
- inform the surgeon if the patient needs additional information or if his/her anxiety seems extreme

Front 33

Cultural and religious issues may often conflict with surgical interventions. In particular, the nurse and surgical staff should specifically inquire about what?

Back 33

the patient's views on blood transfusions

Front 34

How should a nurse deal with a patient who is experiencing a strong fear of death?

Back 34

- talk with the patient re: these feelings
- if the fear of death is overwhelmingly strong, the nurse should inform the physician. The physician may opt to delay the surgery b/c the stress may alter the surgical outcome

Front 35

A patient confides that he has a great fear of pain related to an upcoming surgery. What are some things the nurse can do to help this patient?

Back 35

Fear of pain and discomfort related to surgery is universal.
- If the fear appears extreme, the nurse should notify the anesthesia care provider (ACP) so that appropriate medications can be given
- encourage the patient to communicate with the ACP about his concerns
- reassure the patient that drugs are available for both anesthesia and analgesia during surgery
- encourage patient to ask for pain medication IF pain is present after surgery
- notify the patient that the medications given during surgery cause temporary memory loss

Front 36

What are 5 common fears that patients have regarding surgery?

Back 36

1. Fear of Death
2. Fear of Pain and Discomfort
3. Fear of Mutilation or Alteration in Body Image
4. Fear of Anesthesia
5. Fear of disruption of Life functioning

Front 37

What should the nurse do if the patient confides a fear of anesthesia preoperatively?

Back 37

- inform the ACP so that he or she can talk further with the patient
- reassure the patient that both the nurse and ACP will be present at all times during surgery

Front 38

A nurse is assessing a patient who confides that she is having extreme fear and anxiety about the financial strain her surgery and sickness has put on her family. What types of consultations may help this patient?

Back 38

- social worker
- spiritual or cultural advisor
- psychologist
- hospital financial advisors
- **family members can prove valuable in assisting and resolving patient fears

Front 39

Although many psychologic factors related to surgery seem to be negative, hope stands out as a positive attribute. What is the nurse's role when a patient has great hope regarding a surgery?

Back 39

- assess and support the presence of hope and anticipation of the positive results the patient is expecting

Front 40

What specific information should be obtained from the patient regarding past health history? (5)

Back 40

- past hospitalizations
- previous surgeries
- reproductive functioning
- possible inherited conditions
- adverse reactions/problems with anesthesia

Front 41

Why is it important to assess reproductive functioning when obtaining health history?

Back 41

- b/c if the patient states that she might be pregnant, exposure to anesthesia during the first trimester can be avoided

Front 42

A nurse is obtaining a health history on a 14 year old female with her parents in the room. When the nurse asks about the date of her last menstrual period, the girl states she cannot remember. When asked if there is any possibility of pregnancy, the girl becomes anxious and nervous, however states that there is no chance she is pregnant. What should the nurse do?

Back 42

- the nurse can wait until the parents are no longer in the room and revisit the questions

(have the MD order a pregnancy test?)

Front 43

What is malignant hyperthermia?

Back 43

a genetic condition that causes severe reactions, including death, when a person is placed under anesthesia

Front 44

What are 4 things that should be documented when obtaining medication information from the patient?

Back 44

- current medication use
- herbal or dietary supplements
- recreational drug use
- and abuse/addictions, including alcohol

Front 45

Antihypertensive drugs may predispose a patient to _______ due to the combined effect of the drug and the vasodilation effect of some anesthesias.

Back 45

shock

Front 46

True/false:

Insulin and some hypoglycemic agents may require dose adjustments during the perioperative phase.

Back 46

True- increased metabolism, decreased caloric intake, stress and anesthesia all contribute to this

Front 47

What is the difference between drug intolerance and drug allergies?

Back 47

drug intolerance= side effects that are uncomfortable or unpleasant but not life threatening
drug allergy= anaphylactic reaction

Front 48

What is placed on the patient to notify the surgical staff of any drug intolerances or allergies?

Back 48

an allergy wristband is put on the patient the day of surgery

Front 49

In addition to drug allergies, the nurse should inquire about allergies to what additional 4 things?

Back 49

- food
- chemicals
- pollen
- latex

Front 50

During the preoperative review of systems, CV function is evaluated to confirm what?

Back 50

- the presence of any preexisting disease or existing problems so that CV functioning can be monitored during and after surgery

Front 51

What information needs to be listed if a patient is (or has been) under the care of a cardiologist?

Back 51

- type of condition
- treatment/medications for the condition
- level of maintenance and functioning
- cardiologist's information

Front 52

During the preoperative review of systems, the nurse discovers that a patient has had a recent MI. What impact does this have on surgical plans?

Back 52

a cardiologist needs to be consulted before surgery

Front 53

The patient's heart will be monitored continuously during surgery, and possibly after. The vital signs that are used as a baseline for this monitoring are obtained when?

Back 53

during the preoperative assessment

Front 54

A patient who receives digitalis therapy will have what specific lab drawn preoperatively?

Back 54

serum potassium levels

Front 55

A patient with a history of HTN may receive what type of drug during surgery to assist in maintaining BP?

Back 55

a vasoactive drug (likely titrated to maintain optimal BP)

Front 56

What type of drug may be given to a patient who has a history of congenital, rheumatic, or valvular heart disease? why?

Back 56

- antibiotic prophylaxis may be given before surgery to decrease the risk of bacterial endocarditis

Front 57

A patient with an upper respiratory infection is at a higher risk of what complications r/t surgery? (4)

Back 57

- bronchospasm
- laryngospasm
- decreased O2 saturation
- problems with respiratory secretions

Front 58

True/False:

A patient with an upper respiratory infection may have an elective surgery postponed until the infection has cleared.

Back 58

True

Front 59

What type of respiratory issues should be documented by the nurse, as well as reported to the ACP and surgeon?

Back 59

- history of dyspnea
- coughing
- hemoptysis
- asthma/COPD

Front 60

A patient tells the preoperative nurse that he has a history of asthma. What type of information should the nurse inquire about specific to this disorder?

Back 60

- used of inhaled or oral corticosteroids and bronchodilators
- frequency of attacks
- triggers

Front 61

A 65 year old female has a history of COPD. The nurse understands that this patient is at a higher risk for postoperative pulmonary complications. List 2 examples of these complications.

Back 61

- hypoxemia
- atelectasis

Front 62

A patient who smokes should be encouraged to stop at least ___ weeks preoperatively.

Back 62

6

Front 63

When assessing the respiratory system preoperatively, what type of physical conditions should be noted and reported? (2)

Back 63

- obesity
- spinal, chest, or airway disorders

Front 64

The nurse is assessing a patient's respiratory system, and documents a history of asthma and smoking. The patient also reports a history of SOB and coughing. What 2 tests does the nurse anticipate the doctor will order preoperatively.

Back 64

- baseline pulmonary function test
- ABGs

Front 65

Preoperative evaluation of neurologic functioning includes assessing what 3 things?

Back 65

- ability to respond to questions
- ability to follow commands
- ability to maintain orderly thought patterns

Front 66

The patient's ability to pay attention, concentrate, and respond appropriately must be documented in the preoperative phase to establish what?

Back 66

- a baseline for postoperative comparison

Front 67

The nurse is conducting a preoperative neurological assessment on an 85 year old male. Upon assessment, the nurse notes that the patient is having difficulty understanding/responding to the questions that are being asked. What is the nurse's next action?

Back 67

Ensure that the patient's hearing and vision are intact.

Front 68

During a neurological assessment, the nurse detects deficits in cognitive functioning. After further review, it is noted that this deficit cannot be corrected. What is the nurse's next action?

Back 68

- ensure that a guardian or person with durable power of attorney for health care be involved to assist the patient and provide informed consent for surgery

Front 69

The older adult may have intact mental abilities, but be more prone to adverse reactions to additional stressors. What are examples of these stressors? (5)

Back 69

- the surgical procedure itself
- dehydration
- hypothermia
- anesthesia
- adjunctive medications

Front 70

Older patients undergoing surgery are at a greater risk of the development of _______ _______, a condition that may be falsely labeled as senility or dementia.

Back 70

postoperative delirium

Front 71

What are examples of diseases/disorders that the nurse should inquire about when doing a preoperative neurological assessment?

Back 71

- strokes
- TIAs
- spinal cord injuries
- myasthenia gravis
- Parkinson's disease
- multiple sclerosis

(important to document any treatments as well)

Front 72

What are 3 examples of kidney related diseases/disorders that should be relayed to the nurse during the preoperative assessment?

Back 72

- glomerulonephritis
- chronic kidney disease
- repeated UTIs

Front 73

What are 4 problems associated with Renal dysfunction?

Back 73

- F&E imbalances
- Coagulopathies
- increased risk of infection
- impaired would healing

Front 74

How does a decrease in renal function affect a patient's response to drugs?

Back 74

the patient may have an altered response to the drug and unpredictable drug elimination

Front 75

The nurse is completing a urinary system assessment on a preoperative patient. The nurse anticipates that what 2 common renal function tests will be ordered and recorded before surgery?

Back 75

- serum creatinine
- BUN

Front 76

List 5 functions of the liver.

Back 76

1. glucose homeostasis
2. fat metabolism
3. protein synthesis
4. drug and hormone metabolism
5. bilirubin formation and excretion

Front 77

The patient with hepatic dysfunction may have a perioperative risk for what 2 things?

Back 77

- clotting abnormalities
- adverse responses to medications

Front 78

The nurse should consider the presence of liver disease if there is a history of what 3 things?

Back 78

1. jaundice
2. hepatitis
3. alcohol abuse

Front 79

During the preoperative assessment, the skin should be observed for what? (4)

Back 79

- rashes
- boils
- ulcers
- other dermatologic conditions

(pay special attention to the area where the incision will be made)

Front 80

A patient with a history of pressure ulcers may require what special adaptation to surgery?

Back 80

extra padding

Front 81

What types of musculoskeletal and mobility problems should be noted?

Back 81

- arthritis (all affected joints)
- chronic pain
- spinal problems

Front 82

True/False:

Frequently, post-operative pain is due to chronic musculoskeletal pain and positioning during surgery, rather than acute pain of the surgical procedure.

Back 82

True

Front 83

The nurse is doing a preoperative assessment on a 58 year old female with diabetes mellitus. The nurse knows that this patient is especially at risk for what complications? (6)

Back 83

1. adverse effects of anesthesia and surgery
2. hypo/hyperglycemia
3. ketosis
4. cardiovascular alterations
5. delayed wound healing
6. infection

Front 84

The nurse is assessing a perioperative patient with diabetes mellitus. The nurse anticipates that what test will be ordered on the morning of the surgery?

Back 84

Serum glucose test (to determine baseline levels)

Front 85

True/False:

A patient with diabetes mellitus should not take their usual dose of insulin or oral hypoglycemic agent on the day of surgery.

Back 85

False- this is determined by the surgeon or ACP. The dose could be allowed, withheld, or even adjusted based on the patient's current status and history.

Front 86

A patient with diabetes mellitus will be undergoing surgery. How is this person's glucose levels managed during/after surgery?

Back 86

levels are drawn periodically and managed with regular insulin

Front 87

Either hyperthyroidism or hypothyroidism can place the patient at surgical risk because of alterations in what?

Back 87

metabolic rate

Front 88

What are 2 special considerations re: surgery for the patient with Addison's disease?

Back 88

1. Addisonian crisis or shock can occur if the patient abruptly stops taking replacement corticosteroids
2. additional IV corticosteroids may be required due to the stress of surgery

Front 89

What information regarding the immune system must be documented during the preoperative assessment? (3)

Back 89

- history of a compromised immune system
- any diseases/disorders related to the immune system
- any immunosuppressive drugs that the patient is taking

Front 90

The nurse is performing a preoperative assessment on a 34 year old woman who is scheduled for a tubal ligation. The patient informs the nurse that she has just been diagnosed with and begun treatment for an upper respiratory infection. What impact does this information have on the impending surgery?

Back 90

Since this is an elective surgery, it will likely be canceled and rescheduled once the infection has cleared.

Front 91

An impairment in the immune system can lead to what 2 problems related to surgery?

Back 91

- delayed wound healing
- increased risk for postoperative infections

Front 92

What are 3 examples of conditions that increase the risk for fluid and electrolyte imbalances?

Back 92

- vomiting
- diarrhea
- difficulty swallowing

Front 93

Although F&E history is important for all patients, it is especially critical for the older adult. Why?

Back 93

- b/c the reduced adaptive capacity of the older adult leaves a narrow margin of safety between overhydration and underhydration in the older adult

Front 94

The nurse is performing a preoperative assessment on a 68 year old male with a history of renal disease. The patient is on a daily diuretic. What test regarding Fluid and Electrolyte status does the nurse anticipate the doctor will order?

Back 94

Serum electrolyte level

Front 95

What modifications to surgery and special considerations should be made for a patient who is obese? (4)

Back 95

- larger operating bed
- longer instruments
- predisposure to wound dehiscence, wound infection, and incisional herniation postoperatively
- slower to recover from anesthesia b/c the medication is stored by adipose tissue

Front 96

Nutritional deficiencies of proteins and vitamins A, C, and B complex present what problem?

Back 96

wound healing b/c these are essential substances

Front 97

The nurse is assessing a 58 year old female preoperatively who is scheduled for a surgery that is estimated to take 8-10 hours. The client is 5'6" tall and weighs 110 lbs. All tests indicate that the patient is in good health despite being underweight. The nurse notifies the perioperative team that what additional measure should be taken during surgery?

Back 97

additional padding on the operating bed to prevent the development of pressure ulcers

Front 98

True/False:

Caffeinated beverages are not given to a postoperative patient.

Back 98

False- certain patients (those who intake high levels of caffeine) are often given caffeinated beverages to prevent withdrawal headaches

Front 99

The physical examination and findings from the patient's history will enable the ACP to assign the patient what?

Back 99

a physical status rating for anesthesia administration

Front 100

What Anesthesia Physical Class rating?

A normal healthy person

Back 100

P1

Front 101

What Anesthesia Physical Class rating?

A patient with mild systemic disease

Back 101

P2

Front 102

What Anesthesia Physical Class rating?

A patient with severe systemic disease

Back 102

P3

Front 103

What Anesthesia Physical Class rating?

a patient with severe systemic disease that is a constant threat to life

Back 103

P4

Front 104

What Anesthesia Physical Class rating?

a moribund patient who is not expected to survive without surgery

Back 104

P5

Front 105

What Anesthesia Physical Class rating?

a declared brain-dead patient whose organs are being removed for donor purposes

Back 105

P6

Front 106

What lab test does the nurse anticipate will be ordered for a patient on an aspirin therapy regimen?

Back 106

a coagulation profile

Front 107

What lab test does the nurse anticipate will be ordered for a patient on Lasix?

Back 107

a potassium level

Front 108

What test might be ordered preoperatively for a patient taking medications for dysrhythmias?

Back 108

ECG

Front 109

A common preoperative test used to assess renal status, hydration, UTI?

Back 109

urinalysis

Front 110

A common preoperative test used to assess for pulmonary disorders and cardiac enlargement?

Back 110

Chest X-ray

Front 111

A common preoperative test used to assess for anemia, immune status, and infection?

Back 111

Blood studies (RBC, Hb, Hct, WBC, WBC differential)

Front 112

A common preoperative test used to assess metabolic status, renal function, and diuretic side effects?

Back 112

electrolytes

Front 113

A common preoperative test used to assess for pulmonary and metabolic function?

Back 113

ABGs and oximetry

Front 114

A common preoperative test used to assess for bleeding tendencies?

Back 114

PT, PTT, INR, platelet count

Front 115

A common preoperative test used to assess metabolic status and diabetes mellitus?

Back 115

blood glucose

Front 116

A common preoperative test used to assess renal function?

Back 116

BUN and creatinine

Front 117

A common preoperative test used to assess nutritional status?

Back 117

serum albumin

Front 118

A common preoperative test used to assess cardiac disease and electrolyte abnormalities?

Back 118

ECG

Front 119

A common preoperative test used to assess pulmonary status?

Back 119

pulmonary function studies

Front 120

A common preoperative test used to assess liver function?

Back 120

liver function tests

Front 121

A common preoperative test used to prepare blood for availability in the event a replacement is needed?

Back 121

type and crossmatch

Front 122

A common preoperative test used to assess for pregnancy?

Back 122

hCG

Front 123

Generally, preoperative teaching concerns what 3 types of information?

Back 123

- sensory
- process
- procedural

Front 124

With sensory information, patients want to know what type of information?

Back 124

what they will see, hear, smell and feel during the surgery

Front 125

With process information, patients want to know what type of information?

Back 125

the general flow of what is going to happen

Front 126

With procedural information, patients want to know what type of information?

Back 126

specific, detailed information regarding their surgery, including procedures and protocols

Front 127

True/False:

All teaching should be documented in the patient's medical record.

Back 127

True

Front 128

When giving a patient general surgery information, it is important that ALL patients receive information about what 3 postoperative techniques?

Back 128

- deep breathing
- coughing
- moving

**teach how and the rationale behind each, encourage practice prior to surgery**

Front 129

What is the current evidence-based practice on patients having fluids prior to surgery? Does this apply to all patients / all institutions?

Back 129

- Clear liquids up to 2 hours before surgery have shown no increase in implications for patients not at risk for regurgitation/aspiration

- each agency continues it's own protocol on NPO prior to surgery

- NPO orders should be individualized for each patient

Front 130

What 3 conditions must be met for informed consent to be valid?

Back 130

1. adequate disclosure (diagnosis, options, purpose of treatment, risks and consequences)
2. patient must understand and comprehend the information being provided
3. consent must be voluntary

Front 131

True/False:

In an emergency situation, if the patient is unable to give consent and the next of kin cannot be reached, the physician may institute treatment without written consent.

Back 131

True

Front 132

Benzodiazepines and barbiturates are given preoperatively for what purpose?

Back 132

for their sedative and amnesic properties

Front 133

Anticholinergics are given preoperatively for what purpose?

Back 133

to reduce secretions

Front 134

Opiods may be given preoperatively for what purpose?

Back 134

to decrease intraoperative anesthetic requirements

Front 135

Antiemetics may be given preoperatively for what purpose?

Back 135

to decrease nausea and vomiting

Front 136

The nurse is caring for a 68 year old male with a history of valvular heart disease. The nurse anticipates that the physician will order what additional medication preoperatively due to this patient's history? Why?

Back 136

antibiotics- used to prevent the development of infective endocarditis

Front 137

Unless otherwise stated, PO medications are given ____ to ____ minutes before arrival to the OR.

Back 137

60-90

Front 138

Unless otherwise stated, SQ and IM injections are given ____ to ____ minutes before arrival to the OR.

Back 138

30-60

Front 139

What information should the nurse be aware of regarding the older adult and surgery? (5)

Back 139

- Generally, the older the patient, the greater the risks of postoperative complications
- Sensory deficits (be alert to vision and/or hearing problems)
- Family support
- Multiple doctors and/or agencies to coordinate care
- Perceived or actual loss because of the surgical procedure

Front 140

What information should the nurse be aware of regarding cultural/ethnic differences and surgery? (3)

Back 140

- cultural attitudes towards pain, family, roles
- family inclusion in decision making
- interpreter may be needed