Chapter 42

Care Of The Surgical Patient
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Pre-op information helps with what things?

Lessens Anxiety
Decrease amount of anesthesia needed
Decrease post surgical pain
Decrease corticosteroid production

True or False?
Avoid questions that can be answered yes or no?
Pre-op considerations for Ginger?

Risk of prolonged clotting times
Discontinue beofre surgery
Assessment should include clotting studies
When is pre-op teaching done?
1-2 days before surgery
Pre-op considerations for Valerian Root?

DOn't use with sedatives or anxiolytics
May increase effects of CNS depressants
Following surgery is called?
Pre-op considerations of St. Johns Wart?

DOn't use with psychoactive drugs, MOI's, or Seratonin Reuptake Inhibitors
Discontinue before surgery, possible drug interactions

Which latex allergy?
Cell mediated response to the chemical irritaqnts found in latex products
Type IV
_____ & _____are the prophylactic treatments for latex allergies to pre-op patients?

Glucocorticoid Steroids
Risk factors for latex allergy include ______?
Kiwi, bananas, avacodos, chestnuts, pointsetta plants, history of alergies and asthma

Which latex allergy?
True latex allergy
Occurs after exposure to proteins in latex rubber
IgE mediated systemic reaction that occurs when latex is touched, inhaled, or ingested.
Type I
What are the 3 classifications of latex allergies

Type IV
Type I
When is GoLYTELY contraindicated?
In patients with GI obstruction, gastric retention, bowel perforation, toxic colitis, mega colon
During surgery is called ____?
_____nursing refers to the role of the nurse during the pre-op, intra-op, and post-op phase of surgery.
____ is an amputation or excision of any part of the body or removal of a growth or harmful substance?
Before surgery is called _____?
The 4 primary purposes of the Incentive Spirometer?

Prevent / Treat Atelectasis
Increase lung expansion
Increase Oxygenation
Prevent post-op pneumonia
After removal of a cath post-op a nurse should teach the patient to drink ___oz of fluid per hour while awake?
Collapse of lung tissue is called _____?
Which patients is reflexology contraindicated in?

Heart problems
BP problems
When is a cath removed post-op
1-2 days

True or False?
After general anesthesia the urinary bladder tone is increased?
False - Decreased

Which latex allergy?
Most commonly seen
Actually a non-allergic reaction
Irritant reaction
Pre-op considerations for Feverfew?

Has anticoagulant factors
Assessment should include clotting studies
Discontinue before surgery
A patient should void within ____hr after surgery?
Teaching coughing to post-op patient is contraindicated in which patients? WHY?

Cranial & Spinal-related surgeries
Cataract surgery patients
Increases ICP (intracranial pressure)
_____is a disorder in which the normal flow of fluid through a vessel of the body is slowed or halted. The underlying cause of thrombus formation.
Venous Stasis
How would a wound be covered when open (as in evisceration or dehiscence)?
COver with sterile towel moistened with sterile saline (warm)
Normally dressings are not changed but are reinforced during the first 24hr. To accuratley measure the amount of drainage the nurse would _____?
Circle the drainage markings on the dressing and write time and date on it.
_____is the separation of a surgical incision or rupture of a wound closure.
NI for patients receiving Opioid Analgesics?
MOnitor for Resp depression, N/V, Orthostatic hypotension, pruritis.
_____is a localized area of necrosis. (without adequate blood supply)

True or False?
Surgery *cancels all orders* and must be rewritten?
When a thrombus is dislodged and begins to travel to the heart, lungs, or brain it is called a _____?
If edema, aching, cramping, sensitivity, or pain occurs in the calf (+Homans sign) or leg, the pt. will complain of calf pain on dorsiflexion of the foot, and a _____should be suspected?
_____is a protrusion of an internal organ through a wound or surgical incision, especially in the abdominal wall?
_____is ill health, malnutrition, and wasting as a result of chronic disease?
_______is a core temp of less than 98.6 F & occurs in 60-80% of all post-op pt.'s?
During recovery how often would vitals be taken?
Every 15min
_____is an accumulation of platlets, fibrin, clotting factors, and cellular elements of the blood attached to the anterior wall of a vessel, sometimes including the lumen?

Scrub Nurse or Circulating Nurse?
Performs surgical hand scrub
Dons sterile gown and gloves aspetically
Arranges sterile supplies
Checks instruments for proper function
Counts sponges, needles, and instruments with other nurse
Gowns and gloves surgeon upon entering OR
Assists with surgical draping of pt.
Maintains sterile field
Observes progress of procedure
Hands instruments to DR.
Identifies and handles surgical specimens
Maintains count of sponges, needles, etc..
Before ambulating pt. for the first time....what NI should nurse perform?
Have pt. sit on side of bed (legs dangling) to become accustomed to upright position.
How long would you listen for bowel sounds ____?
One full minute in each quad.
_____is an involuntary contraction of the diaphram followed by rapid closure of the glottis. Results from irritation of the phrenic nerve?
Singultus (hiccups)
Unless the pt. has other problems (decreased renal excretion r/t renal failure, or advanced age) encourage the pt. to drink _____ml of fluid in 24hrs.
What steps would the nurse take when a pt. appears to be going into shock?

Admin O2 or increase rate of delivery
Raise pt.'s legs above level of the heart
Increase rate of IV fluids (unless contraindicated)
Notify anesthesia provider & surgeon
Provide meds ordered
Continue to assess pt. & response to interventions
AKA Singultus

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