University of Luzon

COLLEGE OF NURSING
Perez Blvd., Dagupan City, Philippines 2400

NS 112 SL
CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND
ELECTROLYTE, INFECTIOUS, INFLAMMATORY & IMMUNOLOGIC
RESPONSE, CELLULAR ABERRATION (ACUTE AND CHRONIC)

NAME: JAKE YVAN G. DIZON

YEAR: BSN III

COURSE DESCRIPTION:
This course deals with concepts, principles, theories and techniques of nursing care
management of at risk and sick adult client in any setting with alterations/ problems in oxygenation, fluid
and electrolytes, infectious, inflammatory and immunologic response, cellular aberrations, acute and
chronic. The learners are expected to provide nursing care to at risk and sick adult clients utilizing the
nursing process.

COURSE CREDIT:
Theory 8 units (144 hours)
Skills Laboratory 1 unit (51 hours)
RLE 6 units (255 hours)

MODULE I
PERIOPERATIVE CONCEPTS AND NURSING MANAGEMENT

A. PREOPERATIVE NURSING MANAGEMENT

COURSE OUTCOMES PERFORMANCE OBJECTIVES:

Identifies appropriate nursing concepts and actions Describe scope of perioperative nursing
holistically and comprehensively. practice.
Integrate relevant principles of social, physical, natural Identify members of the surgical team.
and humanities in a given health and nursing situation
based on epidemiologic profile
Adhere to ethico-legal considerations when providing
safe, quality, and professional nursing care.
Implement strategies/policies related to informed consent
as it implies in multiple contexts.

LEARNING OBJECTIVES
1. Define the phases of perioperative patient care.
2. Describe a comprehensive preoperative assessment to identify pertinent health and surgical
risk
 3. Describe considerations related to preoperative nursing care of older adult patients, patients
4. Identify legal and ethical considerations related to obtaining informed consent for surgery.
5. Describe preoperative nursing measures that decrease the risk for infection and other post-
operative complications.
6. Describe the immediate preoperative preparation of the client.
7. Develop a preoperative education plan designed to promote the patient’s recovery from
anesthesia and surgery, thus preventing postoperative complications.

CLINICAL SKILLS:
 Preoperative Checklist
 Instrumentation
 Proper Positioning of patient
 Proper Skin Preparation of Operative Site
 A. PREOPERATIVE NURSING MANAGEMENT

STUDY/REVIEW QUESTIONS:

1. Which statement best describes the preoperative period?

a. It begins when the patient makes the appointment with the surgeon to discuss the need
for surgery.
b. It is the time during which the patient receives education and testing related to the
impending surgery.
c. It is a time during which the patient’s need for surgery and willingness to have it is
established.
d. It begins when the patient is scheduled for surgery and ends at the time of transfer to the
surgical suite.
My Answer: A

Matching type:

- Palliative
- Diagnostic
- Restorative
- Cosmetic
- Curative

2. Alters or enhances personal appearance Cosmetic

3. Improves the patient’s functional ability Restorative
4. Resolves a health problem by repairing or removing the cause Curative

5. Determines the origin or cause of a disorder Diagnostic

6. Relieves symptoms of a disease process, but does not cure Palliative

7. The patient is scheduled for resection of nerve roots. What type of surgery is this?
a. Palliative
b. Restorative
c. Diagnostic
d. Ablative

My answer: A

8. Specify whether the urgency of the surgery is elective (EL), Urgent (U), or emergent (EM).
__EM____ a. A 22 year old nursing student is scheduled for an appendectomy.
___EL__ b. a 77 year old woman is scheduled for a total knee replacement.
____U__ c. A 55 year old man is scheduled for a colon resection due to a small bowel
obstruction.
 9. The nurse screens the preoperative patient for conditions that may increase the risk for
complications during the perioperative period. Which condition is possible risk factor?
a. A patient is 70 years old and obese.
b. The procedure planned is bunionectomy,
c. The patient is 5 feet tall and weighs 100 pounds
d. The surgery is planned as an ambulatory/same day surgical procedure.

My answer: A

True or False? Read each statement and write T for true or F for False in the blanks provided. If the
statement is false, correct the statement to make it true.
10. ______T____ The nurse functions as the patient advocate by reporting to the surgeon and
anesthesiology personnel any abnormalities found on the physical assessment.
11. _____T_____ Throughout the physical assessment, the nurse focuses on the problem areas
identified from the patient’s history that are limited to body systems affected by the surgical
procedure.
12. _____T_____ In the preoperative setting, the nurse is functioning as a patient advocate when
the patient’s home environment, self-care capabilities and support systems are assessed and
used in the discharge planning process.
13. _____T_____ As a patient advocate, the nurse can provide the patient with educational
materials appropriate to the patient’s ability to learn.
14. _____T_____ When the nurse evaluates preoperative laboratory test values, only abnormal
values related to the surgery need to be reported to the surgeon and anesthesiology personnel.
15. _____T_____ Patients who have had minor outpatient surgery do not usually require discharge
planning.

16. The nurse is preparing the patient for surgery. Which common laboratory tests does the nurse
anticipate to be ordered? (Select all that apply)
a. Total Cholesterol
b. Electrolyte levels
c. Uric Acid
d. Clotting Studies
e. Serum Creatinine

My answer: B,D,E

17. Which statement is true regarding the patient who has given consent for a surgical procedure?
a. Information necessary to understand the nature of and reason for the surgery has been
provided.
b. The length of stay in the hospital has been preapproved by the managed care provider.
c. Information about the surgeon’s experience has been provided.
d. The nurse has provided detailed information about the surgical procedure.

My answer: A
 18. Which statement best describes the collaborative roles of the nurse and surgeon when
obtaining the informed consent?
a. The nurse responsible for having the informed consent form on the chart for the
physician to witness.
b. The nurse may serve as witness that the patient has been informed by the physician
before surgery is performed.
c. The nurse may serve as witness to the patient’s signature after the physician has the
consent form signed before preoperative sedation is given and before surgery is
performed.
d. The nurse has no duties regarding the consent form if the patient has signed the
informed consent form for the physician, even if the patient then asks additional
questions about the surgery.

My answer: C

19. The nurse has received the patient in the holding area who is scheduled for a left breast biopsy.
What is the priority safety measure for this patient before surgery?
a. Ensure the patient knows who will be performing the surgery.
b. Ask the patient to mark the site with a marker.
c. Instruct the patient to perform leg exercises to prevent a deep vein thrombosis.
d. Determine who the support persons are for the patient.

My answer: B

20. The diabetic patient is scheduled for surgery in the morning. Which procedure does the nurse
expect on the morning of surgery?
a. Usual dose of insulin will be given to maintain the patient’s blood glucose level.
b. Increased dose of insulin will be given to offset the physical stress caused by the
procedure.
c. Modified dose of insulin will be given, based on the patient’s blood glucose.
d. No insulin will be given because the patient is NPO.

My answer: C

21. Complete the chart below about the aspects of preoperative teaching about postoperative
procedures and exercises.

Procedure/ Exercise Purpose

Breathing exercises and incentive spirometry
Coughing and splinting
Antiembolism stockings and elastic wraps.
To enlarge the chest and expand the lungs
Performed along with deep breathing. Help
expel secretions, keep the lungs clear,
promote full aeration of the lungs, and
prevent pneumonia and atelectasis.
Provide compression of legs to promote
venous return
 Pneumatic compression device Devices that provide intermittent periods of
compression to the lower leg, thus preventing
venous stasis and enhancing venous flow.
Early ambulation. To improve blood flow and circulation which
aids in quicker wound healing
Range of motion Passive or active, these help prevent joint
rigidity and muscle contracture.

University of Luzon
COLLEGE OF NURSING
Perez Blvd., Dagupan City, Philippines 2400

NS 112 SL
CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND
ELECTROLYTE, INFECTIOUS, INFLAMMATORY & IMMUNOLOGIC
RESPONSE, CELLULAR ABERRATION (ACUTE AND CHRONIC)

MODULE I
PERIOPERATIVE CONCEPTS AND NURSING MANAGEMENT

B. INTRAOPERATIVE NURSING MANAGEMENT

COURSE OUTCOMES PERFORMANCE OBJECTIVES:

Use appropriate communication/ interpersonal
techniques/ strategies to ensure a working
relationship with the client and/or support system
based on trust, respect and shared decision
making.
Implement safe and quality interventions with the
 client to address the identified needs and
problems.

LEARNING OBJECTIVES
1. Describe the interdisciplinary approach to the care of the patient during surgery.
2. Specify the principles of surgical asepsis.
3. Describe the roles of the surgical team members during the intraoperative phase of care.
4. Identify adverse effects of surgery and anesthesia.
5. Identify the surgical risk factors related to age-specific populations and nursing interventions
to reduce those risks.
6. Compare types of anesthesia with regard to uses, advantages, disadvantages and nursing
responsibilities.
7. Use the nursing process to optimize patient outcomes during the intraoperative period.

CLINICAL SKILLS:
 Surgical Scrubbing, Gowning, Gloving, Draping
 Instrumentation
 WHO Surgical Safety Checklist
 Intraoperative Nursing Care

B. INTRAOPERATIVE NURSING MANAGEMENT

Review Questions:
1. Which nursing intervention can reduce the preoperative patient’s anxiety?
a. Provide a climate of privacy, comfort, and confidentiality when caring for the patient.
b. Instruct the patient that after the preoperative medication has taken effect, the anxiety
will go away.
c. Avoid discussing the activities taking place around the patient while in the holding area.
d. Assist members of the surgical team preparing in the operating room suite.

My answer: A

Match the perioperative personnel with the descriptions duties in the perioperative area.
- Surgeon
- Holding area nurse
- Anesthesiologist
- Circulating Nurse
- Scrub Nurse
- Specialty Nurse

2. __Circulating Nurse____ Coordinates, oversees, and participates in the patient’s nursing care
while the patient is in the operating room
3. _Surgeon___ Assumes responsibility for the surgical procedure and any surgical judgments
about the patient
4. Holding Area Nurse Manages the patient’s care while the patient is in this area and initiates
documentation on a perioperative nursing record.
5. _Specialty nurse___ Educated in a particular type of surgery and responsible for intraoperative
nursing care specific to patients needing that type that type of surgery.
 6. Scrub Nurse Sets up the sterile field, assists with the draping of the patient, and hands sterile
supplies, sterile equipment and instruments to the surgeon.
7. Anesthesiologist Physician who specializes in the administration of anesthetic agents.

8. During surgery, what things do anesthesia personnel monitor, measure and assess? (select all
that apply)

a. Intake and output

b. Vital Signs
c. Cardiopulmonary function
d. Level of anesthesia
e. Family concerns
f. Room Temperature

My answers: A B,D,C

Match the nursing interventions with their stage of general anesthesia

a. Stage 1
b. Stage 2
c. Stage 3
d. Stage 4

9. _____C_____ Prepare for and assist in treatment of cardiovascular/pulmonary arrest.

Document and record.
10. _____B___ Shield patient from extra noise and physical stimuli. Protect the patient’s
extremities. Assist anesthesia personnel as needed. Stay with patient.
11. ____A___ Close operating room doors and control traffic ion and out of room. Position patient
securely with safety belts. Maintain minimal discussion in operating room.
12. _____D____ Assist anesthesia personnel with intubation of patient. Place the patient in position
for surgery. Prep the patient’s skin in area of operative site.

13. The acute, life threatening complication of malignant hyperthermia (MH) results from the use of
which agents?
a. Hypnotics and neuromuscular blocking agents
b. Succinylcholine and inhalation agents
c. Nitrous oxide and pancuronium for muscular relaxation.
d. Fentanyl and regional anesthesia for spinal block
My answers: B

14. Which clinical features are found in an MH crisis? Select all that apply.
a. Sinus tachycardia
b. Tightness and rigidity of the patient’s jaw area
c. Lowering of the blood pressure
d. A decrease in the end-tidal carbon dioxide level
e. Skin mottling and cyanosis
f. An extremely elevated temperature at on-set
g. Tachypnea
My answers: A,B,C,E,G

15. The surgical team understands that time is crucial in recognizing and treating an MH crisis.
Once recognized, what is the treatment of choice?
a. Danazol gluconate
b. Dilantin sodium
c. Diazepam sulfate
d. Dantrolene sodium

My answers: D

16. Which factor may lead to an anesthetic overdose in the patient?

a. Amount of anesthesia retained in fat cells.
b. Limited muscle relaxant effects in the patient.
c. Slowed metabolism and drug elimination.
d. An uncooperative patient.

My answers: C

17. The patient experiences MH immediately after induction of anesthesia. What are the priority
nursing interventions? Select all that apply.
a. Identifying the triggering allergy
b. Wrapping the extremities with cold towels
c. Assessing ABG’s and serum chemistries
d. Applying a cool blanket over the torso
e. Administering lower doses of the inhalation agents

My answers: B,C,E

Match the nursing interventions with the potential complications, which can be prevented with
appropriate patient positioning and monitoring.

Anatomic area/complication
a. Brachial plexus/paralysis; loss of sensation
b. Radial nerve/wrist drop
c. Medial or ulnar nerves (hand deformities)/peroneal nerve (foot dop)
d. Tibial nerve/loss of sensation on the plantar surface of the foot
e. Joints stiffness/ pain, inflammation

18. _____B____ Support the wrist with padding; do not over tighten wrist straps.
19. ______E__ Place pillow or foam padding under bony prominences; maintain good body
alignment; slightly flex joints and support with pillows, trochanter rolls and pads.
20. _______D___ Place a safety strap above or below the area. Place a pillow or padding under the
knees.
 21. _______A__ Pad the elbow, avoid excessive abduction, secure the arm firmly on an arm board
positioned at shoulder level.
22. ________D__ Place safety strap above or below the area. Place a pillow or padding under the
knees.
23. In which situation is regional anesthesia useful?
a. For procedures performed by robotics
b. When the patient has experienced a previous reaction to blood transfusions
c. For an endoscopy or cardiac catheterization
d. In patients with serious medical problem.
My answers: D