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The policies and procedures on a preoperative unit are being amended to bring them closer into alignment with the focus of the Surgical Care Improvement Project (SCIP). What intervention most directly addresses the priorities of the SCIP?
- A. Actions aimed at increasing participation of families in planning care
- B. Actions aimed at preventing surgical site infections
- C. Actions aimed at increasing interdisciplinary collaboration
- D. Actions aimed at promoting the use of complementary and alternative medicine (CAM)
Correct Answer: B
Rationale: SCIP identifies performance measures aimed at preventing surgical complications, including venous thromboembolism (VTE) and surgical site infections (SSI). It does not explicitly address family participation, interdisciplinary collaboration, or CAM.
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A 90-year-old female patient is scheduled to undergo a partial mastectomy for the treatment of breast cancer. What nursing diagnosis should the nurse prioritize when planning this patients postoperative care?
- A. Risk for Delayed Growth and Development related to prolonged hospitalization
- B. Risk for Decisional Conflict related to discharge planning
- C. Risk for Impaired Memory related to old age
- D. Risk for Infection related to reduced immune function
Correct Answer: D
Rationale: The lessened physiological reserve of older adults results in an increased risk for infection postoperatively. This physiological consideration is a priority over psychosocial considerations, which may or may not be applicable. Impaired memory is always attributed to a pathophysiological etiology, not advanced age.
One of the things a nurse has taught to a patient during preoperative teaching is to have nothing by mouth for the specified time before surgery. The patient asks the nurse why this is important. What is the most appropriate response for the patient?
- A. You will need to have food and fluid restricted before surgery so you are not at risk for choking
- B. The restriction of food or fluid will prevent the development of pneumonia related to decreased lung capacity
- C. The presence of food in the stomach interferes with the absorption of anesthetic agents
- D. By withholding food for 8 hours before surgery, you will not develop constipation in the postoperative period
Correct Answer: A
Rationale: The major purpose of withholding food and fluid before surgery is to prevent aspiration. There is no scientific basis for withholding food and the development of pneumonia or interference with absorption of anesthetic agents. Constipation in patients in the postoperative period is related to the anesthesia, not from withholding food or fluid in the hours before surgery.
The nurse is caring for a 78-year-old female patient who is scheduled for surgery to remove her brain tumor. The patient is very apprehensive and keeps asking when she will get her preoperative medicine. The medicine is ordered to be given on call to OR. When would be the best time to give this medication?
- A. As soon as possible, in order to alleviate the patients anxiety
- B. As the patient is transferred to the OR bed
- C. When the porter arrives on the floor to take the patient to surgery
- D. After being notified by the OR and before other preoperative preparations
Correct Answer: D
Rationale: The nurse can have the medication ready to administer as soon as a call is received from the OR staff. It usually takes 15 to 20 minutes to prepare the patient for the OR. If the nurse gives the medication before attending to the other details of preoperative preparation, the patient will have at least partial benefit from the preoperative medication and will have a smoother anesthetic and operative course.
The nurse admitting a patient who is insulin dependent to the same-day surgical suite for carpal tunnel surgery. How should this patients diagnosis of type 1 diabetes affect the care that the nurse plans?
- A. The nurse should administer a bolus of dextrose IV solution preoperatively
- B. The nurse should keep the patient NPO for at least 8 hours preoperatively
- C. The nurse should initiate a subcutaneous infusion of long-acting insulin
- D. The nurse should assess the patients blood glucose levels vigilantly
Correct Answer: D
Rationale: The patient with diabetes who is undergoing surgery is at risk for hypoglycemia and hyperglycemia. Close glycemic monitoring is necessary. Dextrose infusion and prolonged NPO status are contraindicated. There is no specific need for an insulin infusion preoperatively.
The nurse is preparing a patient for surgery. The patient states that she is very nervous and really does not understand what the surgical procedure is for or how it will be performed. What is the most appropriate nursing action for the nurse to take?
- A. Have the patient sign the informed consent and place it in the chart
- B. Call the physician to review the procedure with the patient
- C. Explain the procedure clearly to the patient and her family
- D. Provide the patient with a pamphlet explaining the procedure
Correct Answer: B
Rationale: While the nurse may ask the patient to sign the consent form and witness the signature, it is the surgeons responsibility to provide a clear and simple explanation of what the surgery will entail prior to the patient giving consent. The surgeon must also inform the patient of the benefits, alternatives, possible risks, complications, disfigurement, disability, and removal of body parts as well as what to expect in the early and late postoperative periods. The nurse clarifies the information provided, and, if the patient requests additional information, the nurse notifies the physician. The consent form should not be signed until the patient understands the procedure that has been explained by the surgeon. The provision of a pamphlet will benefit teaching the patient about the surgical procedure, but will not substitute for the information provided by the physician.