Nursing 307 Exam 1 Study Guide 1

1. Define Surgery.

Surgery refers to the practice of prescribing medications for the treatment of medical conditions.

Art and science of treating diseases, injuries, and deformities by operation and instrumentation Perioperative nursing IS surgery

Surgery is a branch of alternative medicine that focuses on natural healing methods and remedies.

Surgery is a medical specialty that primarily deals with the diagnosis and treatment of diseases and conditions through non-invasive methods.

Surgery is a medical specialty that involves performing procedures on patients to treat diseases, injuries, or deformities. It typically involves using invasive methods such as incisions and instrumentation. Surgery is a critical component of healthcare and plays a significant role in medical treatment.

Explanation

Surgery is a medical specialty that involves performing procedures on patients to treat diseases, injuries, or deformities. It typically involves using invasive methods such as incisions and instrumentation. Surgery is a critical component of healthcare and plays a significant role in medical treatment.

2. What is the role of the Nurse in the Perioperative Period?

Administrative paperwork handling

Surgical instrument sterilization

Pharmacy medication dispensing

Patient Safety --> always the number one priority of ALL members on the surgical team Patient advocate --> patient is the center of the whole process Educator --> it iis your job to know the patient’s procedure inside and out in order to give them information; validation, clarification, etc.

The role of the Nurse in the Perioperative Period primarily revolves around ensuring patient safety, advocating for the patient, and educating them about their procedure and care.

Explanation

The role of the Nurse in the Perioperative Period primarily revolves around ensuring patient safety, advocating for the patient, and educating them about their procedure and care.

3. What does perioperative mean?

Perioperative is the name of a specialized surgical technique.

The perioperative period is the time period of a patient's surgical procedure. It commonly includes ward admission, anesthesia, surgery, and recovery. Perioperative may refer to the three phases of surgery: preoperative, peroperative, and postoperative, although it is better used for the first and third of these only, that is around the time of the surgery. The goal of perioperative care is to provide better conditions for patients before operation and after operation.

Perioperative is a term used to describe a type of surgical instrument.

Perioperative refers to a type of medication used during surgery.

The correct definition of perioperative refers to the time period surrounding a patient's surgical procedure, encompassing preoperative, peroperative, and postoperative phases to provide optimal care and conditions for the patient.

Explanation

The correct definition of perioperative refers to the time period surrounding a patient's surgical procedure, encompassing preoperative, peroperative, and postoperative phases to provide optimal care and conditions for the patient.

4. What are some influences on current surgical practices?

Limited scope of procedures: Only performed in surgical sites, No involvement of interventional radiology or endoscopy

Avoidance of cost reduction measures: Lengthened stays, Inpatient settings, No focus on reducing complications

Increased use of technology Minimally invasive surgery --> no big incisions if we do not need toRobotics --> allows for SMALL incisionsCost Reduction Measures:Shortened stays-->shorter stays means less risk of infectionAmbulatory settingsSurgical Care Improvement Project (SCIP)Focus: reduce complications that occur from or during surgeryProcedures done outside surgical sitesInterventional radiology Endoscopy labCardiac catheterization labs

Decreased use of technology: Traditional open surgery, Manual procedures

5. What are the three phases of the perioperative period?

Perioperative experience --> begins as soon as the patient realizes they need surgery or decides to have surgery and ends when the patient is recovered and or dischargedPreoperative--> begins with the decision to have the surgery, lasts until the patient is transferred to the ORIntraoperative --> extends from the admission to the OR to transfer to PACUPostoperative --> lasts from admission to PACU to complete recovery from surgeryPACU --> post anesthesia care unitYou CANNOT put a time limit on the whole perioperative experience

Perioperative, Interoperative, Recovery

Preoperative, Anesthesia, Post-recovery

Admission, Surgery, Discharge

The correct answer includes the preoperative phase which begins with the decision to have surgery, the intraoperative phase which extends from the admission to the OR to transfer to PACU, and the postoperative phase which lasts from admission to PACU to complete recovery from surgery.

Explanation

The correct answer includes the preoperative phase which begins with the decision to have surgery, the intraoperative phase which extends from the admission to the OR to transfer to PACU, and the postoperative phase which lasts from admission to PACU to complete recovery from surgery.

6. What does the medical terminology 'Ectomy' typically refer to?

A. Osmosis --> movement of solvent molecules from an area of lower solute concentration to an area of higher solute concentration

B. Metastasis --> the spread of cancer cells from one part of the body to another

C. Ischemia --> inadequate blood supply to an organ or part of the body, typically as a result of obstruction by a thrombus or embolus

Ectomy --> excision or removal of; ex. Lumpectomy or appendecotomy Oscopy --> looking into; ex. Colonoscopy Ostomy--> creating an opening; ex. Colostomy Otomy--> cutting into; ex. Tracheotomy Plasty--> repair or restore; ex. Arthroplasty Lysis --> the destruction of; ex. Lysis of adhesions

The correct answer is 'Ectomy', which refers to the excision or removal of a part of the body. It is commonly used in medical terms such as lumpectomy or appendectomy.

Explanation

The correct answer is 'Ectomy', which refers to the excision or removal of a part of the body. It is commonly used in medical terms such as lumpectomy or appendectomy.

7. What are the different classifications of surgery based on reasons?

Maintenance --> done to enhance one's physical health

Reconstructive --> aimed at correcting congenital defects or abnormalities

Experimental --> performed without concrete medical evidence

Diagnostic/exploratory --> done to make or confirm a diagnosis Curative --> repairs or removes the diseased parts or areas Palliative --> DOES NOT CURE; done to slow the disease or decrease the symptoms Cosmetic --> preserve or improve appearance Preventative --> to stop the onset of a disease before it happens Transplant--> replacement of organs Examples: an appendectomy is a curative procedure whereas a cleft palate surgery would be a cosmetic surgery

Surgical procedures can be classified into different categories based on their intended outcomes and purposes. Each classification serves a specific function in addressing medical conditions and improving patients' overall health.

Explanation

Surgical procedures can be classified into different categories based on their intended outcomes and purposes. Each classification serves a specific function in addressing medical conditions and improving patients' overall health.

8. What factors are considered when determining the settings for surgery?

Elective surgery vs. emergency surgery --> elective surgery is usually scheduled Inpatient (hospital) SDA/AM admission --> same day admission or morning admission Outpatient --> hospitals have centers where this can be done?Ambulatory/same daySPU --> short procedure unitFree standing surgical centersPhysician’s offices Effected by:Complexity of the surgery Potential complications (pain, blood loss)General health status of the patient Outpatient centers --> cheaper, decrease chance of infection, decreased anxietyAnywhere where surgery can be done SAFELY and EFFECTIVELY

Cost of the surgery and insurance coverage.

Location of the hospital or surgical center.

Time of day the surgery takes place and availability of operating rooms.

9. What is the importance of assessing anxiety in a preoperative patient?

Preoperative patients do not typically experience anxiety.

Assessment of anxiety is not necessary in preoperative patients.

Assessment --> ALWAYS FIRST; interview and nursing history Anxiety --> can GREATLY effect decision making skills, coping and cognitive abilities, outcome Surgery is a frightening experience; EXPECT ANXIETY Anxiety has been shown to influence the outcome of a surgery

Anxiety has no impact on decision making skills or surgical outcomes.

Assessing anxiety in preoperative patients is crucial as it can greatly impact their decision making skills, coping abilities, and the overall outcome of the surgery. It is important to expect anxiety in preoperative patients and address it appropriately.

Explanation

Assessing anxiety in preoperative patients is crucial as it can greatly impact their decision making skills, coping abilities, and the overall outcome of the surgery. It is important to expect anxiety in preoperative patients and address it appropriately.

10. Psychological Response Fear of --> the mental effects it can have on the patient.

PainMutilation The unknownDisruption of lifeLoss of controlDeath --> if they have a fear of this, tell the OR team about this; the surgery may be delayed to take care of this issue The small details can improve mood very easily Hope--> giving a patient hope can be their strongest method of coping Explain to the patient how involved we will be, comfort measures, etc. Pain and pain management must be addressed Let the patient know we will protect them

Fatigue

Isolation

Anesthesia

These incorrect answers do not directly address the psychological response of fear in the context of surgery.

Explanation

These incorrect answers do not directly address the psychological response of fear in the context of surgery.

11. What are the typical physiological responses to surgery?

Physical response

Emotional response

Physiological/stress response?Peripheral vasoconstriction--> constriction of the veins at the extremitiesThis is a good thing--> blood goes to the major organs, we need that to happen during surgery Increased blood coagulability --> blood clots; this helps to reduce hemorrhaging TachycardiaHypertensionIncreased gastric acidity Decreased peristalsis--> anesthesia slows this downIncreased blood glucose-->increases your energy and your body will heal betterIncreased metabolic rateAnti-inflammatroy responseAnxiety will trigger the stress responseAll are needed--> they are good unless exaggerated This will cause complications

Psychological response

During surgery, the body usually exhibits a stress response which includes various physiological changes such as peripheral vasoconstriction, increased blood coagulability, tachycardia, hypertension, and others.

Explanation

During surgery, the body usually exhibits a stress response which includes various physiological changes such as peripheral vasoconstriction, increased blood coagulability, tachycardia, hypertension, and others.

12. What is an important consideration for the Perioperative Patient?

Assessmen--> Nursing interview Age factors--> Elderly and the young/newborn are extremely fragile and a higher risk??Immune systems are not developed or are just too old Nurses MUST gather and obtain all information in order to allow the surgery to go as smoothly as possible

The weather outside

The patient's favorite color

The type of surgery

The most important consideration for the Perioperative Patient is to assess them thoroughly, paying attention to age factors and ensuring all necessary information is gathered for a smooth surgery process.

Explanation

The most important consideration for the Perioperative Patient is to assess them thoroughly, paying attention to age factors and ensuring all necessary information is gathered for a smooth surgery process.

13. What important information should be considered when asking about previous surgical experience?

The patient's preferred music genre to listen to during surgery

Types --> ALSO ASK HOW MANY Reaction to anesthesia --> we need to ask this! This can effect coping Family history with anesthesiaExtremely important; ESPECIALLY with malignant hypothermia Unpleasant factors --> we want to avoid this experience

The patient's favorite food after surgery

The patient's favorite color during surgery

When asking about previous surgical experience, it is important to focus on types of surgeries, reactions to anesthesia, family history with anesthesia (especially with malignant hypothermia), and any unpleasant factors to avoid. Questions about favorite color, food, or music genre are not relevant to ensuring a successful surgical experience.

Explanation

When asking about previous surgical experience, it is important to focus on types of surgeries, reactions to anesthesia, family history with anesthesia (especially with malignant hypothermia), and any unpleasant factors to avoid. Questions about favorite color, food, or music genre are not relevant to ensuring a successful surgical experience.

14. What should be included in a patient's medication history before undergoing a medical procedure?

Only prescription medications

WE MUST KNOW ALL MEDSOTC--> over the counter medicationsHerbal preparations -->can interact with anesthetic agentsVitamins Patient should not have aspirin, motrin, or alleive 6-10 days before because it does not help the body clotCorticosteroidsAnticoagulants --> increased risk of bleeding outAntibioticsTranquilizersAntihypertensive/cardiac Diuretics --> water pill, effects electrolytesAntidiabetic agents--> blood sugarETOH --> alcoholRecreational drugsTobacco --> vasoconstriction , big effect on the lungsMarijuana and cocaineCan stay in your system for weeks

Patient's family medical history only

Non-prescription medications only

When gathering a patient's medication history, it is important to include all medications, including over-the-counter medications, herbal preparations, vitamins, and substances such as alcohol, recreational drugs, and tobacco. This comprehensive information helps healthcare providers assess potential risks and interactions during medical procedures.

Explanation

When gathering a patient's medication history, it is important to include all medications, including over-the-counter medications, herbal preparations, vitamins, and substances such as alcohol, recreational drugs, and tobacco. This comprehensive information helps healthcare providers assess potential risks and interactions during medical procedures.

15. What is an important consideration for patients with allergies?

Patients with allergies do not need to inform healthcare providers.

MedicationsEnvironmentalLatex -- HUGE; report right away MUST be flagged so nurse is awareAsk reactions as wellPatients with history of allergic response have increased risk for hypersensitivity to anesthetic agents

Allergy information is not important for patient safety.

Allergies are not relevant in medical settings.

It is crucial for patients to disclose their allergy history to healthcare providers as they may have an increased risk of hypersensitivity to various medications and environmental factors, including anesthetic agents.

Explanation

It is crucial for patients to disclose their allergy history to healthcare providers as they may have an increased risk of hypersensitivity to various medications and environmental factors, including anesthetic agents.

16. What is crucial for post-operative/recovery emotional assessment?

Watching comedy movies

Support systems --> huge for post op/recovery; who will take care of them once home, meds, transportation Knowledge/understanding

Ignoring emotional needs of the patient

Presence of flowers in the hospital room

Support systems play a vital role in the emotional assessment of a patient post-operation. This includes factors such as who will take care of them once home, managing medications, transportation to appointments, and having a solid understanding of the situation.

Explanation

Support systems play a vital role in the emotional assessment of a patient post-operation. This includes factors such as who will take care of them once home, managing medications, transportation to appointments, and having a solid understanding of the situation.

17. What is a key component of physical assessment required by The Joint Commission?

H+P required by The Joint CommissionWe MUST establish a baselineGeneral survey --> height, weight, vital signsHead and neck--> head back, open wide, assess airwayIntegument --> skin looks like after and during surgeryLook for poison ivy, some procedures last a long time Patient can be in same position for hoursYou CANNOT make an incision on impaired skinRespiratory --> lungs, ability to breathe deeply, always listen to lung soundsCardiovascular --> heart rate, pulses, peripheral pulsesEsp. if patient is being operated on their extremityG.I. --> bowel sounds, abdomen soft or hardNeuromuscular --> PERRLA, strength, grasping, bearing weightRenal --> voiding, catheterNutritional status --> proteins (healing)Malnourished body is not in balanced, adaptation will be hardObese patients take longer to heal due to adipose tissueObesity increases your risk of surgical risks, diabetes, complications, increased stress, CVD, and can cause other issues

Only assessing the patient's height and weight is sufficient

Physical assessment is not necessary before surgery

H+P required by The American Medical Association

Physical assessment is a crucial step required by The Joint Commission to establish a baseline for the patient's health and to ensure comprehensive care before, during, and after surgery.

Explanation

Physical assessment is a crucial step required by The Joint Commission to establish a baseline for the patient's health and to ensure comprehensive care before, during, and after surgery.

18. What diagnostic studies are typically done before surgery?

An ECG does not need to be done for patients under the age of 40

MRI is always done before surgery regardless of the type of procedure

A pregnancy test is not necessary for female patients over the age of 50

CBC --> complete blood count; WBC, hemoglobin, hematocrit Electrolytes --> diuretics or cardiac meds PT, PTT, INR --> anticoagulants Bleeding time --> based on meds taken Pregnancy test --> on ANY female child bearing ageThis is ALWAYS done EKG --> done on any cardiac patient or patient on anti-hypertensive meds or anyone 60 and aboveCXRUA --> urinalysisOther studies, x-rays, MRI specific to surgical procedure If you feel a patient needs a certain test done, you can be an advocate for the patient and do it; you do not always need permission Doing them is determined by the surgeon or anesthesiologist since they are expensive Some hospitals may have policies that you must adhere to before the surgery process

Presurgical diagnostic studies include a variety of tests depending on the patient's condition and the type of surgery. While some tests are standard and necessary for most patients, others may be recommended based on individual factors. It is important to follow guidelines and protocols to ensure the best possible care for the patient.

Explanation

Presurgical diagnostic studies include a variety of tests depending on the patient's condition and the type of surgery. While some tests are standard and necessary for most patients, others may be recommended based on individual factors. It is important to follow guidelines and protocols to ensure the best possible care for the patient.

19. What is the Nurse's role in Pre-Surgical Testing?

Ensure tests are explained; educate ALWAYS Ensure test results are recorded in patient record before surgeryResults MUST be in the chart before surgery Ensure abdominal results are reportedYou are responsible for knowledge of what is normal and what is not normal

Perform surgery without consulting with the healthcare team

Avoid informing the patient about test results before surgery

Administer medications to the patient before surgery

The nurse plays a crucial role in ensuring that all necessary pre-surgical tests are explained to the patient and that results are properly recorded and reported. The nurse's responsibility includes educating the patient, confirming test results are in the chart, and knowing the difference between normal and abnormal results.

Explanation

The nurse plays a crucial role in ensuring that all necessary pre-surgical tests are explained to the patient and that results are properly recorded and reported. The nurse's responsibility includes educating the patient, confirming test results are in the chart, and knowing the difference between normal and abnormal results.

20. Ethical/Legal Assessment: What is required before all non-emergency medical procedures can be legally performed?

Insurance verification

Informed consent Adequate disclosure must be provided --> surgeon responsible for thisYou have to tell the patient what procedure is, and where it will be doneANY risks associated who will be in operating room (students, residents)Patient cannot be coerced and can withdraw consent at any time This MUST be done before all non-emergency can be legally performedPatient must VOLUNTARILY sign the consent form in the presence of a witness

Physical examination

Preoperative medications

Before non-emergency medical procedures, informed consent with adequate disclosure is necessary to ensure the patient understands the procedure, risks involved, and who will be present in the operating room. This process is to protect the patient's autonomy and ensure they are fully informed before consent is given.

Explanation

Before non-emergency medical procedures, informed consent with adequate disclosure is necessary to ensure the patient understands the procedure, risks involved, and who will be present in the operating room. This process is to protect the patient's autonomy and ensure they are fully informed before consent is given.

21. What is the nurse's role in informed consent?

Decide on behalf of the patient whether or not to proceed with the treatment

Clarify facts after the physician has provided detailed info to patients and families ?We can assess and clarify AFTER the fact; if the patient still does NOT understand, call back the surgeon to re-clarify Ensure consent form is signed Serve as a witness to the signature, NOT that the patient is informedWe are witnessing the signature, NOT that the patient is informed

Provide detailed medical information to the patient

Perform the surgery

22. What is the purpose of pre-op teaching?

A. To educate patients on how to perform surgery on themselves.

Post op procedures Exercises --> esp. leg exercises; avoid developing blood clots Breathing -> coughing/deep breathingAvoids pneumonia because they clear secretions Surgeon --> provides information on the procedure and the nature of it Anesthesiologist --> to discuss anesthesia with the patient Our job --> CLARIFY

C. To confuse patients about the upcoming procedure.

B. To encourage patients to skip preoperative preparations.

Pre-op teaching aims to educate patients on post-op procedures, exercises, and breathing techniques to ensure a smooth recovery process. The main goal is to provide clear instructions and address any concerns or doubts the patient may have before undergoing surgery.

Explanation

Pre-op teaching aims to educate patients on post-op procedures, exercises, and breathing techniques to ensure a smooth recovery process. The main goal is to provide clear instructions and address any concerns or doubts the patient may have before undergoing surgery.

23. What is an important aspect of physical preparation before surgery?

Tobacco use up until the morning of surgery

Wearing all jewelry and valuables during surgery

Nutrition --> NPO past midnight and written by surgeon or anesthesiologist ?NPO prevents aspiration; no vomiting Tubes, IV, access --> let them know if they will have tubes most patients have to have IV access for fluids and meds Clothing and valuables --> they do have to undress, all jewelry, and other things must be removedHearing aids may stay in Skin preparation --> evaluation of surgical siteDone to reduce microorganisms on the skin cleansing, antimicrobial agents

Drinking a full glass of water before surgery

Physical preparation before surgery typically involves following specific guidelines provided by the surgeon or anesthesiologist to ensure the safety and success of the procedure. This includes instructions regarding nutrition, NPO guidelines, and removal of clothing and valuables, among other things.

Explanation

Physical preparation before surgery typically involves following specific guidelines provided by the surgeon or anesthesiologist to ensure the safety and success of the procedure. This includes instructions regarding nutrition, NPO guidelines, and removal of clothing and valuables, among other things.

24. What is the correct protocol for identifying the correct site before a procedure?

Patient verification pre sedation Consent form Surgeon--> done prior to sedation History and physical Marks the site (or other symbol per hospital protocol)

Wait until after the procedure to mark the site for identification.

Skip obtaining consent form as it is a minor procedure.

Administer sedation immediately without verifying patient information.

It is crucial to follow proper protocol to ensure the correct site is identified for any medical procedure. This includes patient verification, obtaining consent, verifying with the surgeon, conducting a history and physical, and marking the site according to hospital protocol.

Explanation

It is crucial to follow proper protocol to ensure the correct site is identified for any medical procedure. This includes patient verification, obtaining consent, verifying with the surgeon, conducting a history and physical, and marking the site according to hospital protocol.

25. How should a patient be transported to the OR?

Using a bicycle to transport the patient

Having the patient crawl to the OR

Driving the patient in their own car

Bed, stretcher, wheelchair, ambulation --> patient can sometimes walk into the OR Critical documentsPre op checklistConsentsH+P All diagnostic results Communicate to caregiver Hand off of care to OR- SBAR

Patient should be transported to the OR using appropriate medical equipment such as a bed, stretcher, wheelchair, or allowing the patient to ambulate if possible. The incorrect answers are not safe or recommended methods for transporting a patient to the operating room.

Explanation

Patient should be transported to the OR using appropriate medical equipment such as a bed, stretcher, wheelchair, or allowing the patient to ambulate if possible. The incorrect answers are not safe or recommended methods for transporting a patient to the operating room.

26. What are the characteristics of an Operating Room (OR) environment?

A. Only people in street clothes and scrubs are allowed in the OR environment

C. Shoes covers are not required in the semi-restricted area of the OR environment

B. Only people in scrubs are allowed in the OR environment

Non restricted area --> people in street clothes and scrubs can go here Semi restricted area --> only people in scrubs, areas around operating rooms, no street clothes, head covers and shoe covers MUST be worn Restricted area --> OR itself; headcover, shoe covers, scrubs, and mask OR is located where ICU or PACU is nearby ORs are always cold and traffic flow is restricted The whole surgical area is a controlled environment Repels dust, positive air pressure, set up to decrease spread of microorganisms

The Operating Room environment has specific guidelines and restrictions to ensure a controlled and sterile environment for surgical procedures.

Explanation

The Operating Room environment has specific guidelines and restrictions to ensure a controlled and sterile environment for surgical procedures.

27. What are the different nursing roles in a surgical setting?

Respiratory Therapist: specializes in helping patients with breathing problems or cardiopulmonary disorders

Medical Doctor: holds the main responsibility in diagnosing and treating illnesses and diseases

Phlebotomist: responsible for drawing blood from patients for various laboratory tests

Scrub Nurse: sterile, surgical attire, surgical scrub and sinkHands instrumentsAssists surgeonCounts/sterilizes instrumentsMust know all instruments, needs to anticipate Circulating Nurse: is an RN, NOT sterile, does not have sterile down onScrubs, shoecover, headcover, and maskThe patient advocateLooks at name braceletPositioning, comfortCan adjust lights, reach under drapeCounts sponges/instrument Nurse Anesthetist (CRNA)

28. What is included in surgical attire?

All PPE Scrub attireOR capsShoe coversMaskEyewear/googlesJewelry prohibitedSurgical scrub can be done

Casual clothing and sneakers

Formal attire and high heels

Scrubs and a lab coat

Surgical attire includes specific PPE to ensure infection control and safety in the operating room. Scrubs with caps, shoe covers, masks, eyewear/googles are necessary, while jewelry is prohibited. Additionally, proper surgical scrub must be performed prior to entering the sterile field.

Explanation

Surgical attire includes specific PPE to ensure infection control and safety in the operating room. Scrubs with caps, shoe covers, masks, eyewear/googles are necessary, while jewelry is prohibited. Additionally, proper surgical scrub must be performed prior to entering the sterile field.