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The nurse knows that elderly patients are at higher risk for complications and adverse outcomes during the intraoperative period. What is the best rationale for this phenomenon?
- A. The elderly patient has a more angular bone structure than a younger person.
- B. The elderly patient has reduced ability to adjust rapidly to emotional and physical stress.
- C. The elderly patient has impaired thermoregulatory mechanisms, which increase susceptibility to hyperthermia.
- D. The elderly patient has an impaired ability to decrease his or her metabolic rate.
Correct Answer: B
Rationale: Factors that affect the elderly surgical patient in the intraoperative period include the following: impaired ability to increase metabolic rate and impaired thermoregulatory mechanisms increase susceptibility to hypothermia. Bone loss (25% in women, 12% in men) necessitates careful manipulation and positioning during surgery. Reduced ability to adjust rapidly to emotional and physical stress influences surgical outcomes and requires meticulous observation of vital functions. Older adults do not have more angular bones than younger people.
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A patient waiting in the presurgical holding area asks the nurse, Why exactly do they have to put a breathing tube into me? My surgery is on my knee. What is the best rationale for intubation during a surgical procedure that the nurse should describe?
- A. The tube provides an airway for ventilation.
- B. The tube protects the patients esophagus from trauma.
- C. The patient may receive an antiemetic through the tube.
- D. The patients vital signs can be monitored with the tube.
Correct Answer: A
Rationale: The anesthetic is administered and the patients airway is maintained through an intranasal intubation, oral intubation, or a laryngeal mask airway. The tube also helps protect aspiration of stomach contents. The tube does not protect the esophagus. Because the tube goes into the lungs, no medications are given through the tube. The patients vital signs are not monitored through the tube.
A 21-year-old patient is positioned on the OR bed prior to knee surgery to correct a sports-related injury. The anesthesiologist administers the appropriate anesthetic. The OR nurse should anticipate which of the following events as the teams next step in the care of this patient?
- A. Grounding
- B. Making the first incision
- C. Giving blood
- D. Intubating
Correct Answer: D
Rationale: When the patient arrives in the OR, the anesthesiologist or anesthetist reassesses the patients physical condition immediately prior to initiating anesthesia. The anesthetic is administered, and the patients airway is maintained through an intranasal intubation, oral intubation, or a laryngeal mask airway. Grounding or blood administration does not normally follow anesthetic administration immediately. An incision would not be made prior to intubation.
The nurse is packing a patients abdominal wound with sterile, half-inch Iodoform gauze. During the procedure, the nurse drops some of the gauze onto the patients abdomen 2 inches (5 cm) away from the wound. What should the nurse do?
- A. Apply povidone-iodine (Betadine) to that section of the gauze and continue packing the wound.
- B. Pick up the gauze and continue packing the wound after irrigating the abdominal wound with Betadine solution.
- C. Continue packing the wound and inform the physician that an antibiotic is needed.
- D. Discard the gauze packing and repack the wound with new Iodoform gauze.
Correct Answer: D
Rationale: Sterile surfaces or articles may touch other sterile surfaces or articles and remain sterile; contact with unsterile objects at any point renders a sterile area contaminated. The sterile gauze became contaminated when it was dropped on the patients abdomen. It should be discarded and new Iodoform gauze should be used to pack the wound. Betadine should not be used in the wound unless ordered.
A circulating nurse provides care in a surgical department that has multiple surgeries scheduled for the day. The nurse should know to monitor which patient most closely during the intraoperative period because of the increased risk for hypothermia?
- A. A 74-year-old woman with a low body mass index
- B. A 17-year-old boy with traumatic injuries
- C. A 45-year-old woman having an abdominal hysterectomy
- D. A 13-year-old girl undergoing craniofacial surgery
Correct Answer: A
Rationale: Elderly patients are at greatest risk during surgical procedures because they have an impaired ability to increase their metabolic rate and impaired thermoregulatory mechanisms, which increase susceptibility to hypothermia. The other patients are likely at a lower risk.
As a perioperative nurse, you know that the National Patient Safety Goals have the potential to improve patient outcomes in a wide variety of health care settings. Which of these Goals has the most direct relevance to the OR?
- A. Improve safety related to medication use
- B. Reduce the risk of patient harm resulting from falls
- C. Reduce the incidence of health care-associated infections
- D. Reduce the risk of fires
Correct Answer: D
Rationale: The National Patient Safety Goals all pertain to the perioperative areas, but the one with the most direct relevance to the OR is the reduction of the risk of surgical fires.