NSG 3105 Week 2: Peri-operative nursing, Pain Questions
With Complete Solutions
4 different surgical settings Correct Answer Emergency;
Unexpected, urgent
Elective; Planned
Inpatient; same-day admission
Ambulatory; same-day surgery, usually under 2hrs, under 3-4hrs
in PACU/PARR
Acute pain Correct Answer post-op pain, labour pains,
trauma, angina. Should diminish as healing occurs. Usually a
sign of an issue, adaptive.
Airway assessment immediately post-op Correct Answer
Patency, oral or nasal, laryngeal mask airway, endotracheal tube
with ventilator settings
Alectasis: what is it and who may be at higher risk? Correct
Answer Alveolar collapse, mucous plugs forms if not breathing
effectively after surgery
May result from bronchial obstruction from retained secretions
or decreased respiratory excursion
Most common (with pneumonia) after abdominal and thoracic
surgery
Risk: Men who grow tall really fast during puberty at risk of
atelectasis: lungs/muscle/thoracic cavity may not have grown
with height at the same rate
,American society of anesthesiologists classifications Correct
Answer ASA I: normal healthy patient. Nonsmoking, minimal
alcohol use
ASA II: mild systemic disease, without functional limitations.
Smoker, social drinker, pregnant, obese, controlled HTN, mild
ling disease
ASA III: Severe systemic disease: substantial functional limits,
severe disease. Poorly controlled HTN, COPD, morbid obesity,
hepatitis (active), alcohol dependence, pacemaker, reduced
Ejection Fraction, ESRD (undergoing dialysis),
MI/CVA/TIA/CAD(stents) in last 3 months
ASA IV: Severe disease, constant threat to life: Recent
MI/TIA/CVA, ongoing cardiac ischemia, valve dysfunction,
severely reduced EF, shock, sepsis, ESRD without dialysis
ASA V: Moribound patient, not expected to survive without
operation. Ruptured aneurysm, massive trauma, severe
intracranial bleed, multi-organ dysfunction
ASA VI: Declared Brain-dead patient
Analgesic ladder: mild pain Correct Answer 1-3/10, aspirin,
salicylates, NSAIDs, acetaminophen. Used for ceiling effect
(higher dose doesn't impact efficacy), no tolerance or
dependence, available OTC.
Analgesic Ladder: mild to moderate pain Correct Answer 4-
6/10, May be opioids. There are 3 receptors, OP1 (delta) OP2
(kappa) and OP3 (Mu)
At this stage opioids are often given in combination with non-
opioids, like Codeine + acetaminophen.
,Analgesic ladder: Moderate to severe pain Correct Answer 4-
10/10, often Mu (OP3) receptor agonists. These are potent, no
analgesic ceiling, and are given via many different routes.
Antidepressants for adjuvant analgesic therapy Correct Answer
tricyclic, at doses lower than that used for depression. Higher
levels of HT and NE in synaptic cleft inhibit nociceptive signals.
Antiseizure medication for adjuvant analgesic therapy Correct
Answer stabilize membrane of neurons to prevent transmission.
Used in neuropathic pain and headaches
Barriers to pain management Correct Answer Tolerance:
chronic exposure to drugs, higher doses needed for the same
effects
Dependence: expected physiological response, manifested by a
withdrawal syndrome when drug is stopped
Misuse: use in high doses or inappropriate situations.
Breathing assessment and interventions immediately post-op
Correct Answer Resp vitals, Auscultated sounds, SpO2,
monitoring as indicated, supp. O2
Encouraging coughing and deep breaths prevent alveolar
collapse and encourage secretions (3-4 deep breaths per 5-10
mins). Deflated alveoli = collapse of lung segment = atelectasis.
Coughing mobilizes secretions.
Cardiovascular indications to contact anesthesia post-op
Correct Answer systolic <90 mm Hg or >160 mm Hg.
pulse <60 or >120 beats per minute.
, pulse pressure narrows (diff btw syst and diast). Too wide is
sign of death, narrow = cardiac compromise
Greater than 20 mmHg of pre-op
Cardiovascular pre-op assessment Correct Answer identify
acute or chronic problems (angina, hypertension, heart failure,
recent MI, renal diasease, or diabetes)
identify any drugs or herbal supplements that may effect
coagulation
identify pts with prosthetic heart valves, pacemakers or
defibrillators
assess pt for edema noting location & severity
inspect neck for distention
obtain bilateral baseline for BP
assess pulses for rate, rhythm, & quality
Chronic Pain Correct Answer persistent beyond normal
healing, usually over 3 months. Hard to track objectively as the
nervous system changes. Rarely adaptive.
Circulating nurse Correct Answer not scrubbed, gowned or
gloved, remains in unsterile field, documents pertinent nursing
information and care completed
Circulation post-op considerations Correct Answer ECG for
rate and rhythm, BP, Temperature, Cap refill, skin colour, dry,
temp, apical and peripheral pulses
Fluid imbalances contributed to changes in CV status (cardiac
output), overload and retention may occur if IV given too fast,
age, or existing cardiac/renal issues.
With Complete Solutions
4 different surgical settings Correct Answer Emergency;
Unexpected, urgent
Elective; Planned
Inpatient; same-day admission
Ambulatory; same-day surgery, usually under 2hrs, under 3-4hrs
in PACU/PARR
Acute pain Correct Answer post-op pain, labour pains,
trauma, angina. Should diminish as healing occurs. Usually a
sign of an issue, adaptive.
Airway assessment immediately post-op Correct Answer
Patency, oral or nasal, laryngeal mask airway, endotracheal tube
with ventilator settings
Alectasis: what is it and who may be at higher risk? Correct
Answer Alveolar collapse, mucous plugs forms if not breathing
effectively after surgery
May result from bronchial obstruction from retained secretions
or decreased respiratory excursion
Most common (with pneumonia) after abdominal and thoracic
surgery
Risk: Men who grow tall really fast during puberty at risk of
atelectasis: lungs/muscle/thoracic cavity may not have grown
with height at the same rate
,American society of anesthesiologists classifications Correct
Answer ASA I: normal healthy patient. Nonsmoking, minimal
alcohol use
ASA II: mild systemic disease, without functional limitations.
Smoker, social drinker, pregnant, obese, controlled HTN, mild
ling disease
ASA III: Severe systemic disease: substantial functional limits,
severe disease. Poorly controlled HTN, COPD, morbid obesity,
hepatitis (active), alcohol dependence, pacemaker, reduced
Ejection Fraction, ESRD (undergoing dialysis),
MI/CVA/TIA/CAD(stents) in last 3 months
ASA IV: Severe disease, constant threat to life: Recent
MI/TIA/CVA, ongoing cardiac ischemia, valve dysfunction,
severely reduced EF, shock, sepsis, ESRD without dialysis
ASA V: Moribound patient, not expected to survive without
operation. Ruptured aneurysm, massive trauma, severe
intracranial bleed, multi-organ dysfunction
ASA VI: Declared Brain-dead patient
Analgesic ladder: mild pain Correct Answer 1-3/10, aspirin,
salicylates, NSAIDs, acetaminophen. Used for ceiling effect
(higher dose doesn't impact efficacy), no tolerance or
dependence, available OTC.
Analgesic Ladder: mild to moderate pain Correct Answer 4-
6/10, May be opioids. There are 3 receptors, OP1 (delta) OP2
(kappa) and OP3 (Mu)
At this stage opioids are often given in combination with non-
opioids, like Codeine + acetaminophen.
,Analgesic ladder: Moderate to severe pain Correct Answer 4-
10/10, often Mu (OP3) receptor agonists. These are potent, no
analgesic ceiling, and are given via many different routes.
Antidepressants for adjuvant analgesic therapy Correct Answer
tricyclic, at doses lower than that used for depression. Higher
levels of HT and NE in synaptic cleft inhibit nociceptive signals.
Antiseizure medication for adjuvant analgesic therapy Correct
Answer stabilize membrane of neurons to prevent transmission.
Used in neuropathic pain and headaches
Barriers to pain management Correct Answer Tolerance:
chronic exposure to drugs, higher doses needed for the same
effects
Dependence: expected physiological response, manifested by a
withdrawal syndrome when drug is stopped
Misuse: use in high doses or inappropriate situations.
Breathing assessment and interventions immediately post-op
Correct Answer Resp vitals, Auscultated sounds, SpO2,
monitoring as indicated, supp. O2
Encouraging coughing and deep breaths prevent alveolar
collapse and encourage secretions (3-4 deep breaths per 5-10
mins). Deflated alveoli = collapse of lung segment = atelectasis.
Coughing mobilizes secretions.
Cardiovascular indications to contact anesthesia post-op
Correct Answer systolic <90 mm Hg or >160 mm Hg.
pulse <60 or >120 beats per minute.
, pulse pressure narrows (diff btw syst and diast). Too wide is
sign of death, narrow = cardiac compromise
Greater than 20 mmHg of pre-op
Cardiovascular pre-op assessment Correct Answer identify
acute or chronic problems (angina, hypertension, heart failure,
recent MI, renal diasease, or diabetes)
identify any drugs or herbal supplements that may effect
coagulation
identify pts with prosthetic heart valves, pacemakers or
defibrillators
assess pt for edema noting location & severity
inspect neck for distention
obtain bilateral baseline for BP
assess pulses for rate, rhythm, & quality
Chronic Pain Correct Answer persistent beyond normal
healing, usually over 3 months. Hard to track objectively as the
nervous system changes. Rarely adaptive.
Circulating nurse Correct Answer not scrubbed, gowned or
gloved, remains in unsterile field, documents pertinent nursing
information and care completed
Circulation post-op considerations Correct Answer ECG for
rate and rhythm, BP, Temperature, Cap refill, skin colour, dry,
temp, apical and peripheral pulses
Fluid imbalances contributed to changes in CV status (cardiac
output), overload and retention may occur if IV given too fast,
age, or existing cardiac/renal issues.
