C H A P T E R
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved. 69
70 Chapter 19 Nursing Management: Intraoperative Care
8. At the end of the surgical procedure, the perioperative nurse evaluates the patient’s response to the nursing care delivered during the perioperative period. What reflects a positive outcome related to the patient’s physical status?
a. The patient’s right to privacy is maintained.
b. The patient’s care is consistent with the perioperative plan of care.
c. The patient receives consistent and comparable care regardless of the setting.
d. The patient’s respiratory function is consistent with or improved from baseline levels established preoperatively.
9. Which short-acting barbiturates are most commonly used for induction of general anesthesia (select all that apply)?
a. Nitrous oxide b. Propofol (Diprivan) c. Isoflurane (Florane)
d. Thiopental sodium (Pentothal) e. Sodium methohexital (Brevital)
10. Because of the rapid elimination of volatile liquids used for general anesthesia, what should the nurse anticipate the patient will need early in the anesthesia recovery period?
a. Warm blankets b. Analgesic medication
c. Observation for respiratory depression d. Airway protection in anticipation of vomiting
11. What is the primary advantage of the use of midazolam (Versed) as an adjunct to general anesthesia?
a. Amnestic effect b. Analgesic effect c. Prolonged action d. Antiemetic effect
12. Identify the rationale for the use of each of the following drugs during surgery and one nursing implication indicated in the care of the patient immediately postoperatively related to the drug.
Drug Use Nursing Implication
Ketamine (Ketalar) Fentanyl (Sublimaze) Desflurane (Suprane) Succinylcholine (Anectine)
13. Monitored anesthesia care (MAC) is being considered for a patient undergoing a cervical dilation and endometrial biopsy in the health care clinic. The patient asks the nurse, “What is this MAC?” The nurse’s response is based on the knowledge that MAC
a. can be administered only by anesthesiologists or nurse anesthetists.
b. should never be used outside of the OR because of the risk of serious complications.
c. is so safe that it can be administered by nurses with direction from health care providers.
d. provides maximum flexibility to match the sedation level with the patient and procedure needs.
14. Match the methods of local anesthetic administration with their descriptions.
_______ a. Injection of agent into subarachnoid space _______ b. Injection of anesthetic agent directly into tissues _______ c. Injection of a specific nerve with an anesthetic agent _______ d. Injection of anesthetic agent into space around the vertebrae
_______ e. Injection of agent into veins of extremity after limb is exsanguinated
1. Nerve block 2. IV nerve block 3. Spinal block 4. Epidural block 5. Local infiltration
Chapter 19 Nursing Management: Intraoperative Care 71 15. The patient will be placed under moderate sedation to allow realignment of a fracture in the emergency department.
When the family asks about this anesthesia, what should the nurse tell them?
a. Includes inhalation agents b. Induces high levels of sedation c. Frequently used for traumatic injuries
d. Patients remain responsive and breathe without assistance
16. What condition should the nurse anticipate that might occur during epidural and spinal anesthesia?
a. Spinal headache
b. Hypotension and bradycardia c. Loss of consciousness and seizures d. Downward extension of nerve block
17. A preoperative patient reveals that an uncle died during surgery because of a fever and cardiac arrest. Knowing the patient is at risk for malignant hyperthermia, the perioperative nurse alerts the surgical team. What is likely to happen next?
a. The surgery will have to be cancelled.
b. Specific precautions can be taken to safely anesthetize the patient.
c. Dantrolene (Dantrium) must be given to prevent hyperthermia during surgery.
d. The patient should be placed on a cooling blanket during the surgical procedure.
CASE STUDY
Intraoperative Patient Patient Profile
T.M., a 76-year-old retired police officer, is admitted to the OR for an inguinal hernia repair. He has a history of severe chronic obstructive pulmonary disease (COPD) and heart failure. Therefore, the anesthesia care provider (ACP) has decided to administer spinal anesthesia. The circulating nurse has verified the baseline data (vital signs, height, weight, age; allergies; level of consciousness; NPO status; and comfort level). A signed informed consent is on the chart. T.M. has no allergies.
Discussion Questions
Using a separate sheet of paper, answer the following questions:
1. Priority Decision: What are the priority nursing actions that should be taken when T.M. arrives in the OR?
2. What specific precautions should be taken when positioning T.M. for surgery?
3. What complications of spinal anesthesia should T.M. be monitored for during surgery?
4. T.M. is 76 years old. What gerontologic considerations should be taken?
5. Priority Decision: Based on the data presented, what are the priority nursing diagnoses?
C H A P T E R
1. What does progression of patients through various phases of care in a postanesthesia care unit (PACU) primarily depend on?
a. Condition of patient c. Preference of surgeon
b. Type of anesthesia used d. Type of surgical procedure 2. Priority Decision: Upon admission of a patient to the PACU, the nurse’s priority assessment is
a. vital signs. c. respiratory adequacy.
b. surgical site. d. level of consciousness.
3. How is the initial information given to the PACU nurses about the surgical patient?
a. A copy of the written operative report b. A verbal report from the circulating nurse
c. A verbal report from the anesthesia care provider (ACP) d. An explanation of the surgical procedure from the surgeon
4. To prevent agitation during the patient’s recovery from anesthesia, when should the nurse begin orientation explanations?
a. When the patient is awake
b. When the patient first arrives in the PACU c. When the patient becomes agitated or frightened
d. When the patient can be aroused and recognizes where he or she is
5. What is included in the routine assessment of the patient’s cardiovascular function on admission to the PACU?
a. Monitoring arterial blood gases c. Determining fluid and electrolyte status b. Electrocardiographic (ECG) monitoring d. Direct arterial blood pressure monitoring
6. With what are the postoperative respiratory complications of atelectasis and aspiration of gastric contents associated?
a. Hypoxemia c. Hypoventilation
b. Hypercapnia d. Airway obstruction
7. To prevent airway obstruction in the postoperative patient who is unconscious or semiconscious, what will the nurse do?
a. Encourage deep breathing c. Administer oxygen per mask
b. Elevate the head of the bed d. Position the patient in a side-lying position
8. Priority Decision: To promote effective coughing, deep breathing, and ambulation in the postoperative patient, what is most important for the nurse to do?
a. Teach the patient controlled breathing b. Explain the rationale for these activities c. Provide adequate and regular pain medication d. Use an incentive spirometer to motivate the patient
9. While assessing a patient in the PACU, the nurse finds that the patient’s blood pressure is below the preoperative baseline. The nurse determines that the patient has residual vasodilating effects of anesthesia when what is assessed?
a. A urinary output >30 mL/hr c. A normal pulse with warm, dry, pink skin b. An oxygen saturation of 88% d. A narrowing pulse pressure with normal pulse