Chapter 39 Perioperative Care
What is the old term for OR nurses? - correct answer-Operating room nurse
What was operating room nursing limited to back in the day? - correct answer-Transferring
patients in and out of operating rooms
Handing instruments to surgeons during surgical procedures
Perioperative nursing involves what three types of care for the client? - correct
answer-Preoperative: before surgery
Intraoperative: during surgery
Postoperative: after surgery
What percentage of deaths, or physical or emotional harm can preventable perioperative
errors cause? - correct answer-10%
List six examples of never events. - correct answer-Surgery on the wrong body part
Surgery on the wrong person
Wrong surgery on a patient
Deep vein thrombosis or pulmonary embolism after total knee or hip replacement
Foreign body left in a patient after surgery
Surgical site infections after after certain elective procedures (AORN, Joint Commission,
NQP, and IHI extend that to include ALL infections)
List four ways surgical procedures can be classified. - correct answer-By body system
By purpose
By degree of urgency
By degree of risk
How is body system classification useful in surgery? - correct answer-It determines the
postoperative risk of infections- surgical incisions that enter the gastrointestinal, respiratory,
or genitourinary tract have a higher risk for infection than surgery of other body systems.-
However, if an organ ruptures or surgery is required to to repair a penetrating injury, the risk
of infection is VERY high REGARDLESS of body system
List and describe the 7 different purposes that surgeries are classified. - correct
answer-Ablative surgery: removal of a diseased body part
Diagnostic (exploratory) surgery: confirm or rule out a diagnosis- biopsy
Palliative surgery: to relieve discomfort or other disease symptoms without producing a cure
Reconstructive surgery: performed to restore function- repair of a torn ligament
Cosmetic surgery: to improve appearance- facelift
Transplant surgery: replaces a malfunctioning body part, organ, tissue, or joint
Procurement surgery: similar to transplant surgery, but the organ or tissue is harvested from
someone pronounced brain dead
,List and describe 3 ways degree of urgency in surgeries are classified. List examples of
each. - correct answer-Emergency surgery: requires transport to the OR STAT to preserve
the patient's life or body function
- Internal hemorrhage, ruptured organ, and trauma
Urgent surgery: is scheduled within 24-48 hours to alleviate symptoms, repair a body part, or
restore function
- Removal of a cancerous breast, and internal fixation of a fracture
Elective surgery: surgery is recommended but the condition is not time sensitive
- Repair of a torn ligament, removal of rectal polyps
List and describe 2 ways degree of risk in surgeries are classified. List examples of each. -
correct answer-Major surgery: associated with a high degree of risk- potential for significant
blood loss, prolonged or complicated procedure, surgery involving vital organs, or high risk
for post op complications
- coronary artery bypass graft, nephrectomy, and colon resection
Minor surgery: Often outpatient, involves little risk, and has few complications
- arthroscopy, breast biopsy, inguinal hernia repair, and tonsillectomy
List 7 factors that increase surgical risk. - correct answer-Age
Type of wound
Preexisting conditions
Mental status
Medications
Personal habits
Allergies
How can age increase surgical risk? - correct answer-Infants have a more increased risk for
infection
Toddlers may be anxious about separation from parents
Preschoolers fear needles, pain, or damage to the body
Teens fear disfigurement resulting from scars
Young adults are anxious about cost of surgery
Older adults increased risk because of comorbid conditions- decreased kidney function,
diminished immune function, decreased bone and lean body mass, decreased cardiac
output, decreased cough reflex, increased time for wound healing
How can the type of wound affect surgical risk? - correct answer-Both preexisting and
incision wounds can cause infection
Risk of patient increases with the risk for or presence of infection
How can preexisting conditions affect surgical risk? - correct answer-Underlying acute or
chronic disorders can increase surgical risk
Acute: upper respiratory tract infections
Chronic: cardiovascular diseases, chronic respiratory disorders, coagulation disorders,
diabetes, liver disease, neuro disorders, nutritional disorders, renal disease
How can mental status affect surgical risk? - correct answer-These patients may be unable
to comprehend pre op instructions or give informed consent for surgical procedures
, May also require antipsychotic agents that interact with anesthetics and analgesics
How can medications affect surgical risk? - correct answer-Prescribed and OTC drugs can
pose risk to patients during surgery
Those who take vitamin E are at an increased risk for bleeding
Herbal and alternative meds can cause: increased risk for cardiac dysrhythmias secondary
to potassium loss, interfere with metabolism of anesthetics because of their effects on the
liver, increased potential for bleeding, decreased cerebral blood flow, hypertension, increase
the effects of opioids and sympathetic nervous system stimulants
How can personal habits affect surgical risk? - correct answer-Smoking affects pulmonary
function
Long-term alcohol use contributes to liver disease and increased risk for bleeding
Alcohol and drugs interact with anesthetic agents and medications to create adverse effects
Habitual substance abusers may have a cross-tolerance to anesthetic and analgesic agents,
causing them to need higher than normal doses
How can allergies affect surgical risk? - correct answer-Patients may be allergic to
medications, analgesics, latex, tape, and solutions used in surgery
Reactions range to very unpleasant to life-threatening
How long do medications need to be stopped prior to surgery? - correct answer-24 hours to
7 days but differs depending on the medication
List 10 medications that increase surgical risk - correct answer-Antibiotics
Anticoagulants
Antidysrhythmics
Antihypertensives
Aspirin
Corticosteroids
Diuretics
Opioids
NSAIDS
Tranquilizers
How do antibiotics increase surgical risk - correct answer-May potentiate the action of
anesthetic agents
How do anticoagulants increase surgical risk? - correct answer-Increased risk for bleeding
How do antidysrhythmics increase surgical risk? - correct answer-May impair cardiac
function during anesthesia
How do antihypertensives increase surgical risk? - correct answer-Increase the risk for
hypotension during surgery; may interact with anesthetic agents to cause bradycardia and
impaired circulation
How does aspirin increase surgical risk? - correct answer-Increased risk for bleeding
What is the old term for OR nurses? - correct answer-Operating room nurse
What was operating room nursing limited to back in the day? - correct answer-Transferring
patients in and out of operating rooms
Handing instruments to surgeons during surgical procedures
Perioperative nursing involves what three types of care for the client? - correct
answer-Preoperative: before surgery
Intraoperative: during surgery
Postoperative: after surgery
What percentage of deaths, or physical or emotional harm can preventable perioperative
errors cause? - correct answer-10%
List six examples of never events. - correct answer-Surgery on the wrong body part
Surgery on the wrong person
Wrong surgery on a patient
Deep vein thrombosis or pulmonary embolism after total knee or hip replacement
Foreign body left in a patient after surgery
Surgical site infections after after certain elective procedures (AORN, Joint Commission,
NQP, and IHI extend that to include ALL infections)
List four ways surgical procedures can be classified. - correct answer-By body system
By purpose
By degree of urgency
By degree of risk
How is body system classification useful in surgery? - correct answer-It determines the
postoperative risk of infections- surgical incisions that enter the gastrointestinal, respiratory,
or genitourinary tract have a higher risk for infection than surgery of other body systems.-
However, if an organ ruptures or surgery is required to to repair a penetrating injury, the risk
of infection is VERY high REGARDLESS of body system
List and describe the 7 different purposes that surgeries are classified. - correct
answer-Ablative surgery: removal of a diseased body part
Diagnostic (exploratory) surgery: confirm or rule out a diagnosis- biopsy
Palliative surgery: to relieve discomfort or other disease symptoms without producing a cure
Reconstructive surgery: performed to restore function- repair of a torn ligament
Cosmetic surgery: to improve appearance- facelift
Transplant surgery: replaces a malfunctioning body part, organ, tissue, or joint
Procurement surgery: similar to transplant surgery, but the organ or tissue is harvested from
someone pronounced brain dead
,List and describe 3 ways degree of urgency in surgeries are classified. List examples of
each. - correct answer-Emergency surgery: requires transport to the OR STAT to preserve
the patient's life or body function
- Internal hemorrhage, ruptured organ, and trauma
Urgent surgery: is scheduled within 24-48 hours to alleviate symptoms, repair a body part, or
restore function
- Removal of a cancerous breast, and internal fixation of a fracture
Elective surgery: surgery is recommended but the condition is not time sensitive
- Repair of a torn ligament, removal of rectal polyps
List and describe 2 ways degree of risk in surgeries are classified. List examples of each. -
correct answer-Major surgery: associated with a high degree of risk- potential for significant
blood loss, prolonged or complicated procedure, surgery involving vital organs, or high risk
for post op complications
- coronary artery bypass graft, nephrectomy, and colon resection
Minor surgery: Often outpatient, involves little risk, and has few complications
- arthroscopy, breast biopsy, inguinal hernia repair, and tonsillectomy
List 7 factors that increase surgical risk. - correct answer-Age
Type of wound
Preexisting conditions
Mental status
Medications
Personal habits
Allergies
How can age increase surgical risk? - correct answer-Infants have a more increased risk for
infection
Toddlers may be anxious about separation from parents
Preschoolers fear needles, pain, or damage to the body
Teens fear disfigurement resulting from scars
Young adults are anxious about cost of surgery
Older adults increased risk because of comorbid conditions- decreased kidney function,
diminished immune function, decreased bone and lean body mass, decreased cardiac
output, decreased cough reflex, increased time for wound healing
How can the type of wound affect surgical risk? - correct answer-Both preexisting and
incision wounds can cause infection
Risk of patient increases with the risk for or presence of infection
How can preexisting conditions affect surgical risk? - correct answer-Underlying acute or
chronic disorders can increase surgical risk
Acute: upper respiratory tract infections
Chronic: cardiovascular diseases, chronic respiratory disorders, coagulation disorders,
diabetes, liver disease, neuro disorders, nutritional disorders, renal disease
How can mental status affect surgical risk? - correct answer-These patients may be unable
to comprehend pre op instructions or give informed consent for surgical procedures
, May also require antipsychotic agents that interact with anesthetics and analgesics
How can medications affect surgical risk? - correct answer-Prescribed and OTC drugs can
pose risk to patients during surgery
Those who take vitamin E are at an increased risk for bleeding
Herbal and alternative meds can cause: increased risk for cardiac dysrhythmias secondary
to potassium loss, interfere with metabolism of anesthetics because of their effects on the
liver, increased potential for bleeding, decreased cerebral blood flow, hypertension, increase
the effects of opioids and sympathetic nervous system stimulants
How can personal habits affect surgical risk? - correct answer-Smoking affects pulmonary
function
Long-term alcohol use contributes to liver disease and increased risk for bleeding
Alcohol and drugs interact with anesthetic agents and medications to create adverse effects
Habitual substance abusers may have a cross-tolerance to anesthetic and analgesic agents,
causing them to need higher than normal doses
How can allergies affect surgical risk? - correct answer-Patients may be allergic to
medications, analgesics, latex, tape, and solutions used in surgery
Reactions range to very unpleasant to life-threatening
How long do medications need to be stopped prior to surgery? - correct answer-24 hours to
7 days but differs depending on the medication
List 10 medications that increase surgical risk - correct answer-Antibiotics
Anticoagulants
Antidysrhythmics
Antihypertensives
Aspirin
Corticosteroids
Diuretics
Opioids
NSAIDS
Tranquilizers
How do antibiotics increase surgical risk - correct answer-May potentiate the action of
anesthetic agents
How do anticoagulants increase surgical risk? - correct answer-Increased risk for bleeding
How do antidysrhythmics increase surgical risk? - correct answer-May impair cardiac
function during anesthesia
How do antihypertensives increase surgical risk? - correct answer-Increase the risk for
hypotension during surgery; may interact with anesthetic agents to cause bradycardia and
impaired circulation
How does aspirin increase surgical risk? - correct answer-Increased risk for bleeding
