Module 2

1.
Preoperative phase, it begins with the decision to have surgery and ends when the patient is
wheeled into surgery. Its goals is to manage the anxiety that may arise, either as a result of an
emergency situation or having to wait for inordinately long periods of time.
2. Intraoperative phase, where it involves surgery itself.
3. Postoperative phase, it is the period immediately following surgery. Its period can be brief,
lasting a few hours, or require months of rehabilitation and recuperation.
CASE STUDY
1. What is the priority nursing actions that should be taken when T.M. arrives in the OR?
Answer: Ensure that enough help is available to transfer the patient from the stretcher to the
OR table. Position the patient carefully to prevent injury. Apply safety straps. Place
electrocardiogram (ECG) leads, blood pressure (BP) cuff, and pulse oximetry. Check the IV to
verify insertion and patency. Ensure that the grounding pad is placed correctly. Complete the
patient safety checklist. Implement the universal protocol; take a surgical timeout with a team
members to verify patient name birth date and operative procedure and location and to
compare the hospital ID number on the patient ID band with the chard. Aseptic technique must
be maintained by all surgical team members. A fire risk assessment may also be completed.
2. What specific precautions should be taken when positioning T.M. for surgery?
Answer: The patient position should be allowed for operative site accessibility. Place in correct
musculoskeletal alignment. Be sure that no undue pressure is occurring to bony prominences,
nerves, earlobes, and eyes. Be sure that there can be adequate thoracic wall movement.
Prevent any pressure or occlusion of veins and arteries. Secure the patient extremities and
provide adequate padding. Respect patient modesty. Respect the patient's specific aches and
pain or deformities.
3. What complications of spinal anesthesia should T.M. be monitored for during surgery?
Answer: T.M. should be monitored for hypotension, bradycardia, nausea and vomiting,
respiratory difficulties, and apnea.
4. T.M. is 76 years old. What gerontologic considerations should be taken?

Answer: Monitor the effect of anesthetic agents and adjuncts closely. Ensure clear
communication and verify patient understanding. Closely monitor the patient’s skin, especially
where the tape, electrodes, and pads have been applied. Position of the older patient carefully
with close attention to patient alignment and joint support. Consider using warming devices and
monitor closely if these are used. Assess the postoperative recover from the anesthetic agents
before the patient is transferred out of the post-anesthesia care unit (PACU).
5. Based on the data presented, what are the priority nursing diagnoses?
Answer: Top 3 priority nursing diagnosis are acute pain, as surgical repair may cause pain
especially in older patients who are already having various complications. Second is risk for fluid
volume deficiency, it is due to postoperative NPO status or dehydration that have been caused
in patient in his hospital stay. Third is risk for injury, as inguinal hernia can cause intestinal
obstruction that can develop complications in patient if not treated early.
ANSWER RATIONALE
1.A Surgical asepsis means that the defined area contains no microorganism
2.D Circulating nurse is responsible for ensuring that the operating room is sterile, and
their duties involve helping all surgical staff present during the operation
3. C Surgeon and scrub nurse are the members for sterile team in the operating room
4. D The nurse is responsible and accountable for the verification of and witnessing that
the patient or the legal representative has signed the consent document in their
presence and that the patient, or the legal age representative, is of legal age and
competent to provide consent.
5.A The primary responsibility of the nurse is to take the vital signs before any surgery.
6. C The client require special positioning for this type of anesthesia it is because to
prevent cerebrospinal fluid (CSF) leakage.
7. D The nurse should instruct the client to remain supine for the time specified by the
physician. Local anesthetics used in a subarachnoid block don't alter the gag reflex.
No interactions between local anesthetics and food occur. Local anesthetics don't
cause hematuria.
8. A Spinal is the common anesthesia used for appendectomy
9. B The vital signs are abnormal and should be reported to the doctor immediately.
10. B It certainly has analgesic benefit when used with short and intermediate acting local
anesthetics, there are limited data regarding the efficacy of epinephrine for
prolonging the analgesic duration of long acting local anesthetics (ropivacaine,
bupivacaine, levobupivacaine)

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4. T.M. is 76 years old. What gerontologic considerations should be taken?

8. A Spinal is the common anesthesia used for appendectomy

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