Preoperative
A patient comes in for a day procedure with elevated BP and a fever which is the best response for the nurse:
1. Ask patient if they took their BP meds this morning
2. Administer an antipyretic to decrease the temperature and proceed with intake
3.Notify the surgeon of the patients status
ANSWER: 3
More than likely we would be postponing the procedure
What is a temperature indicative of?
Why would we not want to proceed
Which member of the surgical team is responsible for these duties:
Verifies the consent is signed
Documents care, interventions, meds and events
Monitors urine and blood loss throughout the procedure
What is circulating nurse
Box 4.4 Major Functions of the Circulating Nurse
• Coordinates care, oversees the environment, and cares for the patient in the operating room (OR)
• Greets the patient and performs patient assessment
• Verifies that consent is signed and accurate and that surgical site is correctly marked
• Checks medical record and preoperative forms for completeness
• Sets up the OR; adjusts lights, stools, and discard buckets; and ensures that supplies and diagnostic support are available
• Gathers, counts, and checks all equipment and supplies that are anticipated to be used, ensuring its safe function
• Opens sterile supplies for the scrub nurse
• Provides needed padding and warming or cooling devices for the operating table
• Assists with the transfer of the patient to the operating table and positions the patient
• Places the electrocautery ground pad on the patient if electrocautery is to be used
• Assists the anesthesia provider
• May prep the patient’s skin before sterile draping occurs
• May insert a Foley catheter
• Initiates the procedural time-out
• Handles labeling and disposition of specimens
• Coordinates activities with radiology and pathology departments
• Monitors urine and blood loss during surgery and reports findings to the surgeon
• Supplies, monitors, and documents the infusion of ordered fluids
• Observes for breaks in sterile technique and announces them to the team
• Monitors traffic and noise within the OR
• Communicates information on the surgery’s progress to family during long procedures
• Documents care, events, interventions, drugs, fluids, and findings
• Assists the scrub person with final count of sponges, sharps, and instruments
• Helps transfer the patient to the gurney and accompanies the patient to the recovery area, providing a report of the surgery and patient condition to the recovery nurse in collaboration with the anesthesia provider
• Verifies that the count of equipment is the same after surgery as before
The patient stays on the PACU until all of these are present EXCEPT:
1. Vital Signs stable
2.Patient able to follow commands
3. Patient able to tolerate ice chips
3.
Food and drink will be introduced when bowel sounds are present.
Patient required to have stable VS and able to follow commands before transferring to medsurg floor
What is the priority nursing assessment for a patient who is about to receive an opioid analgesic for pain 7/10
1. BP 145/79
2. Pulse 102
3. Respirations 10
NSWER: 3
Opioids can cause respiratory depression, they are to be held for patients whose respirations are less than 10/min
Hypotension and bradycardia are also common with opioid use.
Taylor Swift has 3 cats.. name one of them
Olivia
Meredith
Benjamin Button
True or False
Once a patient has signed consent, they are required to proceed with the procedure
False
Patients have the right to revoke consent at any time, If a patient tells you they have decided against the surgery, you should let the charge nurse and surgeon know
Which of the following is NOT a function of the scrub nurse
1. Remaining sterile throughout procedure
2. Counts sponges and and instruments before and after procedure
3. Updating the family on patient's status throughout procedure
ANSWER 3:
Box 4.3 PG 77 Major Functions of the Scrub Nurse or Technician
• Gathers all equipment for the procedure
• Prepares all sterile supplies and instruments using sterile technique
• Gowns and gloves surgeons on entry into operating room
• Assists with sterile draping of the patient
• Maintains sterility within the sterile field during surgery
• Hands instruments and supplies to the operating team during surgery, anticipating what is needed
• Maintains a neat instrument table
• Labels and handles surgical specimens correctly
• Maintains an accurate count of sponges, sharps, and instruments on the sterile field; verifies counts with the circulating nurse before and after surgery
• Monitors for breaks in sterile technique and points them out
• Cleans up after the surgery is over
What is the priority intervention for the nurse to recommend for a client who is constipated post procedure?
Early ambulation
Encourage increasing fluids, enemas and laxatives can be given as well. HOWEVER our first line of action is always least invasive.
Name the 7 points in a pain assessment.
1. Location
2. Characteristics/ describe your pain
3. Quantity/ pain scale
4. Pattern/how long have you had this pain
5. Associated factors/ any other symptoms related to pain n/v, referred pain
6. Alleviating factors/ does anything make it better
7. Aggravating factors/ does anything make it worse
What is the PRIORITY assessment before initiating any nursing intervention or skill
Verify patient: Name and DOB compared to chart or MAR and bracelet
Which patient would be most appropriate to sign consent
1. An 87 yr old female with a UTI who is exhibiting confusion.
2. A 33 yr old male who broke his leg playing soccer and who just took a hydrocodone for pain 8/10.
3.A 63 year old male with a history of anxiety.
ANSWER:3
The patient must be mentally competent and give consent freely.
The 87 year old woman is experiencing confusion, she may not be able to understand what she is signing
the 33 year old male just recieved pain medication, this can affect mentation. It is also important to note that we wouldn't have a patient sign consent after being given preop meds.
Who is responsible for pointing out a break in sterile technique during a surgical procedure
ANY MEMEBER OF THE OR TEAM THAT NOTICES IT
The med surg nurse receiving a patient from the PACU should do all to prepare the patients room EXCEPT.
1. Get fresh linens and pillows for patient
2. Get a fresh water pitcher and cups for the bedside table.
3. Retrieve all additional equipment needed, and place in patients room.
2. Patient NPO until BS resumed
Which patient would NOT be appropriate for a PCA pump for severe pain.
1. Hospice patient at end of life conversing with family with severe pain from a cancer tumor
2. Paraplegic patient with severe nerve pain from a motor vehicle accident
3. 33 year old male with a traumatic brain injury who is difficult to arouse and does not respond to commands
3. Difficult to arouse and unable to follow commands insinuates the patient would have a difficult time being alert enough to use PCA
True or False
An LVN/LPN can initiate a preoperative education plan for a patient who will be undergoing surgery next met
ANSWER: False
Remember the RN must initiate any education plan. AS an LVN/RN you are able to REINFORCE education as needed.
Which 2 populations are most at risk for complications of surgery
The very old due to decline in function of body systems
The very young due to immature body systems
True or False
An LVN/LPN can work on the surgery team as a scrub nurse.
TRUE
Typically the circulating nurse MUST be an RN die to the extensive assessment required
Name 3 hallmark signs of hemorrhagic bleeding for a post op patient.
1. Decreasing BP
2. Increasing Pulse
3. Pale skin (pallor)
4. Restlessness
** remember this are true for any hemorrhagic shock
True or false
Over-the-counter pain medications such as tylenol or advil can be administered in the hospital without an order
FALSE
A procedure performed to relieve symptoms, but does not cure it is called_____________
Palliative
Which of the following would be considered an elective procedure
1. Eye injury
2.Hernia repair
3. Kidney stone removal
ANSWER: 2
Elective is defined as planned for correction of a nonacute problem
Urgent defined as requiring prompt intervention/ may be life-threatening if treatment delayed 24-48 hrs
Emergent is defined as requiring immediate intervention to prevent life-threatening consequences
During "time out", the correct patient, correct procedure, and correct implants (if applicable) are verified before the procedure.
What else MUST be verified before the procedure.
ANSWER: SITE
Safety Alert
Time-Out
Before surgery begins, while all members of the team are present, a “time-out” occurs during which a final verification of the correct patient, procedure, site, and implants (if applicable) is performed. Any questions or concerns must be resolved before the procedure begins.
PG 78 SAFETY ALERT
How often are VS assessed for the first hour a patient is in the PACU
Every 15 min
Policy in place per facility
Which Classification of medication is NOT used to treat pain:
1. Anticonvulsants
2.Antiemetics
3.Immunosuppresents
2. Antiemetics
What is Ms. McKenzie's favorite Taylor Swift album?
REPUTATIONNNNNNNNN!