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WorksheetsPostoperative Considerations
Total questions: 25
Worksheet time: 17mins
In preparation for surgery the Bair Hugger is placed on the patient. It is important to keep the patient warm to help: (Select 2 answers)
Decrease the anxiety
Decrease the risk of a surgical site infection (SSI)
Decrease vasodilation
It helps to improve patient outcomes
Which are the risk factors for post extubation laryngeal edema: (Select all that apply)
Patient is younger than 4 years old
Traumatic Intubation or emergence
Patient is having neck surgery
Patient had a recent upper airway infection
Emergency treatment for oversedation with benzodiazepine consists of the following : (select all that apply)
Notify the anesthesia provider, assess respiratory and cardiovascular status
Call a code blue, get RT at the bedside and immediately intubate the patient
Place an airway, use oxygen and ambu-bag the patient and give naloxone per order
Place an airway, use oxygen and ambu-bag the patient and give flumazenil per order
Epidurals and spinal anesthetics are similar because they can both be redosed when the patient has pain
True
False
Regional nerve blocks provide
Limited effects on the cardiovascular system
Sedation so the patient can asleep during surgery
Your patient is complaining of tingling around the mouth while getting a regional block. Your first intervention should be to:
Reassure the patient that this is a normal side effect to regional blocks and not to worry
Leave the bedside to get lipid rescue from the pharmacy
Inform the anesthesia provider to stop doing the block
Call a code blue and arrange to intubate the patient
Malignant hyperthermia is a disorder of the :
Cardiovascular system
Skeletal muscle
Hypothalamus
Renal system
Choose the triggering agents for MH
Succinylcholine
Propofol
Magnesium
Desflorane
Rapid increase in temperature when a patient has MH is an early sign
True
False
The drug Ryanodex (Dantrolene Sodium) is an antidote to MH
True
False
Unintended hypothermia occurs when the core body temperature is:
Below 98.6 F (37.0 C)
Below 99 F (37.2 C)
Below 96.8 F (36.0 C)
Below 97.8 F (36.5 C)
Hypothermia negatively impacts:
Cardiovascular system
Neurological system
Respiratory System
All of the above
When your patient has an orthopedic type surgery is it important to complete a thorough neurovascular assessment?
No, a general assessment can be completed for any type of surgery
Yes, documentation is required when needing to medicate the patient after his surgery
Yes, to establish a baseline vascular assessment for comparison throughout his postoperative period
None of the above
Prior to discharging your patient from the hospital the PACU nurse knows that for all surgeries when spinal anesthesia has been administered, the patient is NOT at risk for postoperative urinary retention
True
False
Your patient arrives on the postoperative unit after a left carotid endarterectomy and no concerns noted with the initial assessment. Several minutes later, you look at your patient and ask her to extend her tongue and you notice that it deviates to the right and so does the trachea. What could this indicate?
No immediate action is needed as her blood pressure is within normal limits
It is an expected finding since her carotid surgery was on the left side
The patient may be bleeding and the surgeon needs to be notified immediately
Since her initial assessment was normal, it is not unusual for changes to occur in the postoperative period
Pertaining to orthopedic or vascular surgeries, vascular assessment is needed preoperatively and postoperatively. When checking the vascular function of an extremity:
Assess the pulse proximal to the surgery site, then compare to the opposite extremity's pulse
Check the pulse proximal to the surgical site at the same time when assessing the opposite pulse
Assess the pulse distal to the surgical site, then compare with the opposite extremity's pulse
Pulses are not necessary to assess unless there is an order to assess
Your patient had an open reduction internal fixation (ORIF) of the left hip. The left lower extremity's pulse is weak, cool to the touch and capillary refill is greater than 4 seconds. The patient c/o pain in the hip area, but states pain is more intense in the left calf. What could be a potential postoperative complication? (Select as many as apply)
Patient could be presenting with a DVT, further assessment is required
Laceration of the ulnar artery
Peripheral type 1 diabetic neuropathy
Compartment syndrome in the extremity
Which type of hemoglobin is present in a patient who has sickle cell anemia
Hemoglobin AA
Hemoglobin AS
Hemoglobin S
Hemoglobin AC
A sickle cell crisis can be precipitated by:
Dehydration
Fluid overload
Stress
Answer A & C
Carl is a 19 year-old with sickle cell disease. He is in the recovery room after a procedure to repair an inguinal hernia. To assess for signs of a sickle cell crisis, the nurse observes Carl for:
Bleeding from the operative site
abdominal pain and/or neurovascular changes in extremities
muscle tremors and decreased level of consciousness
intractable nausea and vomiting
The lab result that should be monitored in the patient post-surgical parathyroidectomy is?
Calcium
Magnesium
H and H
Sodium
Following a thyroidectomy, your patient complains of numbness and tingling in his finger tips and lips. What is most commonly the cause of this:
reaction to anesthesia
nerve damage
low calcium levels
respiratory insufficiency
Your patient arrives in PACU s/p carotid endarterectomy and you are about to get report. He is on a nitroglycerin drip. He has an arterial line and after zeroing and leveling, the first blood pressure is 88/60 mmHg. There is a good wave form. Which of the following action should the nurse initiate FIRST?
Slowly increase the nitroglycerine drip
Apply 100% non rebreather oxygen mask
Find a cuff and compare the readings for accuracy
Turn off the nitroglycerin drip
Your patient had a Right Carotid Endarterectomy this afternoon. After zeroing the arterial line, you see an exaggerated blood pressure waveform that reads 220/80, BP cuff 170/75. What should you do FIRST?
Call the surgeon and ask whether to go by cuff or A-line
Start a nitroglycerin drip Stat
Perform a square wave test on the arterial tracing to evaluate if it is appropriately “damped,” then take manual cuff pressures to compare.
Give the patient a dose of pain meds because he is likely in a lot of pain
Your post-operative right carotid endarterectomy patient has arrived from the O.R. One of the most important assessment considerations is blood pressure monitoring. The reason for this is that:
Blood pressure monitoring has a direct impact on the patency of the graft
Medications to be given are dependent on the results of the blood pressure monitoring only
Arterial line monitoring and cuff pressure should be equal
Blood pressures can be done q 2 hours once patient arrives to PCU
