Surgical nursing

Question 1

Your patient tells you she is having postoperative pain and cramping in her right lower leg. You document this, report it to the team, and assess for the presence of DVT by:

a. Massaging the skin and palpating over the tibia and fibula
b. Measuring and documenting calf circumference every shift
c. Taking and recording vital signs four times a day
d. Noting difficulty with ambulation

Answer 1

The correct answer is b. DVT reduces venous return which increases the size of the affected extremity and can be assessed by measuring circumference on a regular basis.

Question 2

Older adults often have reduced vital capacity as a normal physiological change. Which care action would be most important for the postoperative care of an older surgical patient specific to this change?
a. Take and record vital signs every shift
b. Turn, cough, and deep breathe every 4 hours
c. Encourage increased intake of oral fluids
d. Assess bowel sounds daily

Answer 2

The correct answer is b. Reduced vital capacity in older adults increases the risk of respiratory complications including atelectasis and pneumonia. Having the person turn, cough, and deep breathe every 4 hours maintains respiratory function and helps to prevent complications.

Question 3

Whats Diagnostic surgery?

Answer 3

To make or confirm a diagnosis

Breast biopsy, laparoscopy, bronchoscopy, exploratory laparotomy

Question 4

Whats a Ablative surgery?

Answer 4

To remove a diseased body part

Appendicectomy, subtotal thyroidectomy, partial gastrectomy, colon resection, amputation

Question 5

Whats Palliative surgery?

Answer 5

To relieve or reduce intensity of an illness; is not curative

Colostomy, nerve root resection, debridement of necrotic tissue, balloon angioplasties, gastric bypass

Question 6

What assesments are done pre op

Answer 6

• BMI
• Age
• Medical history
• Current medications
• Alcohol or drug intake
• Mouth, dental and airway inspection
• Observation of neck flexibility and head extension.

Question 7

What hx may alter body functions during surgery?

Answer 7

• Obstructive sleep apnoea
• Seizures
• Existing Cardiac conditions
• Existing hepatic conditions
• Existing renal conditions
• Hypertension
• Alcohol abuse
• Smoking
• Allergies
• Medications that can increase bleeding
• Diabetes
• Obesity

Question 8

What are the Routine Post-op Assessments?

Answer 8

• Level of consciousness
• Respiratory status / airway
• SP02
• Temp
• Cardiac status: pulse and blood pressure
• Pain
• Nausea/ vomiting
• Urinary output

Patient only comes back to the ward once medically stable and have a reasonable level of consciousness.
Educate to breathe deeply and cough regularly to help prevent alveolar collapse and move respiratory secretions.

Question 9

What are some POST-OPERATIVE COMPLICATIONS?

Answer 9

• Haemorrhage / Hypovolaemic Shock
• Deep Vein Thrombosis / Pulmonary Embolism

Question 10

What does -Ectomy mean

Answer 10

removing

Question 11

What does ostemy mean

Answer 11

made an opening

Question 12

What does Plasty mean

Answer 12

Plasty: changed the shape of
something

Question 13

What does pexy mean?

Answer 13

Pexy: moved the organ to the right
place

Question 14

What does Laparoscopy mean

Answer 14

performed by making several incisions and using scopes (Camera). Laparoscopy is generally safer, less invasive and has a faster recovery.

Question 15

What are side effects of Anaesthesia

Answer 15

Temporary confusion and memory loss
Dizziness
Difficulty passing urine
Nausea and vomiting
Sore throat – due to intubation

Question 16

Whats the post operative Analgesia Ladder

Answer 16

1. When pain first occurs a non-opioid should be
   provided e.g. paracetamol, NSAIDs, Cox2 inhibitors.
2. If pain persists or increases, a weak opioid as well as a non-opioid should be used e.g. codeine, tramadol.
3. If pain is still present or increasing a strong opioid should be used with or without a non-opioid e.g. morphine, oxycodone, fentanyl.