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When does the preoperative phase begin?
When pt first visits MD When pt first makes decision to have surgery When pt enters hospital on the day of surgery |
When the pt first decides to have surgery
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When does the intraoperative period begin and end?
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Begins when pt is transferred to operating table and ends when pt enters the Postanesthesia Care Unit (PACU)
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When does the postoperative period begin and end?
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Begins when pt fist reaches PACU and ends when recover is complete
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What is palliative surgery?
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Surgery that reduces the pain or the symptoms of a disease but does not cure it
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What is ablative surgery?
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This is surgery that removes a diseased body part like a tonsilectomy
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What is diagnostic surgery?
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Surgery that confirms or disproves a diagnosis. i.e. a breast biopsy
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If the nurse asseses that the client does not want a procedure performed, what should the nurse do?
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They surgeon is contacted and requested to speak with the client
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Perioperative Care: when providing preoperative care explain to the patient what to expect before, during, and after surgery. Make sure they understand why they are having their surgery, and what their surgery entails. Explain to them what is expected of them, and what they must do afterwards to recover. It may also be helpful to explain the smell, noise, lights, feelings, etc... of the operating room and PACU so that the patient is less anxious and know what to expect going into the surgery.
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Anesthesia:
Anticholinergics (i.e. atropine) are used to reduce oral and pulmonary secretions and prevent laryngospasm Histamine-receptor antihistamines (ranitidine or cimetidine-Tagamet) are used to reduce gastric fluid volume and gastric acidity |
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Can preoperative teaching of things like leg exercises, deep breathing etc, be delegated to a UAP?
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No, however the UAP can reinforce teaching, asssist the client with exercises, and report to the nurse if the client is unable to perform the exercises
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How would you teach a pt with a Rt. abdominal incission or rt sided chest incission to sit up in bed?
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Flex the knees
splint the wound or incission by holding the left arm or hand or a small pillos against the incission Turn to the left while pushing down with the rt foot and grasping a partial side rail on the left side of the bed with the rt hand Come to a sitting position by using the rt arm to press against the mattress and swinging the feet over the edge of the bed |
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How would you teach a client deep breathing exercises?
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Place hands palms down on the border of your rib cage and inhale slowly and evenly through the nose until greatest chest expansion is reached
hold breath for 2-3 s exhale slowly through the mouth after 5 deep breaths tell the client to cough deeply once or twice, if the incision is painful have client splint the incision with hands or a pillow |
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What leg exercises would you teach a client to do?
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Alternate dorsiflexion and plantar flexion (calf pumping)
flex and extend the knees (if clients cannot raise legs off bed encourage isometric exercises) raise and lower legs from bed by flexing the knee of the stable leg and raising the leg of the other leg |
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What are the ASA guidelines for preoperative fasting?
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Clear liquids are allowed for up to 2 hours before elective surgery requiring aneshertic
a light breakfast (i.e. tea and toast) 6 hours before surgery a heavy meal 8 hours before surgery |
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Can jewelry be kept on during surgery, including wedding bands?
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No, all body piercins and jewelry must be removed. Wedding bands may be tapped in place as long as the surgery does not cause swelling.
Other things like dentures, contacts, artificial eyes, wigs etc are removed before surgery, though hearing aids may be kept in and the surgical team is notified |
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What are the three steps JCAHO established to prevent Wrong pt, wrong site, wrong surgery?
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1. pt verification on surgery schedule, admission, and whenever pt is transferred to another care giver
2. marking the site of surgery unambiguously (i.e. and x is consider ambiguous) 3. "time out" before surgery the team makes sure the right pt, procedure, and site are verified |
