to pain medications, and nonpharmacologic
methods of pain control (relaxation techniques,
TENS, and PCA) are available.- a.Hygiene and skin preparation: Clean the skin
with antibacterial soap to remove bacteria (the
patient can do this in a bath or shower), sham-
poo the hair, and clean the fingernails. Remove
hair from incisional area with depilatory cream
or hair clipper if indicated.
b.Elimination: Emptying the bowel of feces is no
longer a routine procedure, but the nurse
should use preoperative assessments to
determine the need for an order for bowel elim-
ination. If indwelling catheter is not in place,
the patient should void immediately before
receiving preoperative medications.
c. Nutrition and fluids: Diet depends on the type
of surgery; patients need to be well nourished
and hydrated before surgery to counterbalance
fluid, blood, and electrolyte loss during surgery.
d.Rest and sleep: The nurse can facilitate rest and
sleep in the immediate preoperative period by
meeting psychological needs, carrying out teach-
ing, providing a quiet environment, and admin-
istering prescribed bedtime sedative medication. - a.Maintain intact skin surfaces
b.Remain free of neuromuscular damage
c. Have symmetric breathing patterns - a.Unconsciousness
b.Response to touch and sounds
c. Drowsiness
d.Awake but not oriented
e.Awake and oriented
12.Sample answer:
The person who will be changing the patient’s
dressing at home should demonstrate proper tech-
niques in wound care and dressing change. Teach-
ing should include the following information:
(1) where to buy dressing materials and medical sup-
plies, (2) signs and symptoms of infection, (3) need
to eat well-balanced meals and drink fluids, (4) how
to modify activities of daily living (as needed),
(5) need to wear disposable gloves when changing
the dressing and wash hands before and after don-
ning gloves, and (6) how to dispose of old dressings.
13.Sample answers:
a.Developmental considerations: Infants and older
adults are at a greater risk from surgery than are
children and young or middle-aged adults.
b.Medical history: Pathologic changes associated
with past and current illnesses increase surgical
risk.
c. Medications: Use of anticoagulants before sur-
gery may precipitate hemorrhage.
d.Previous surgery: Previous heart or lung surgery
may necessitate adaptations in the anesthesia
used and in positioning during surgery.
e.Perceptions and knowledge of surgery: The
patient’s questions or statements are important
for meeting his/her psychological needs and
those of the family when preparing the patient
for surgery.
f. Lifestyle: Cultural and ethnic background of the
patient may affect surgical risk.
g.Nutrition: Malnutrition and obesity increase
surgical risk.
h.Use of alcohol, illicit drugs, nicotine: Patients
with a large habitual intake of alcohol require
larger doses of anesthetic agents and postopera-
tive analgesics, increasing the risk for drug-
related complications.
i. Activities of daily living: Exercise, rest, and sleep
habits are important for preventing postoperative
complications and facilitating recovery.
j. Occupation: Surgical procedures may require a
delay in returning to work.
k.Coping patterns: The patient needs information
and emotional support to recover from surgery.
l. Support systems: Family members should be
encouraged to provide support before and after
surgery.
m.Sociocultural needs: The patient’s cultural back-
ground may require that nursing interventions
be individualized to meet needs in such areas as
language, food preferences, family interaction
and participation, personal space, and health
beliefs and practices.- a.Vital signs: Assess temperature, blood pressure,
and pulse and respiratory rates; note deviations
from preoperative and PACU data as well as
symptoms of complications.
b.Color and temperature of skin: Assess for
warmth, pallor, cyanosis, and diaphoresis.
c. Level of consciousness: Assess for orientation to
time, place, and person as well as reaction to
stimuli and ability to move extremities.
d.Intravenous fluids: Assess type and amount of
solution, flow rate, securement and patency of
tubing, and infusion site.
e.Surgical site: Assess dressing and dependent
areas for drainage. Assess drains and tubes and
be sure they are intact, patent, and properly
connected to drainage systems.
f. Other tubes: Assess indwelling urinary catheter,
gastrointestinal suction, and so forth for
drainage, patency, and amount of output.
g.Pain management: Assess for pain and
determine whether analgesics were given in the
PACU. Assess for nausea and vomiting.
h.Position and safety: Place patient in the ordered
position; if the patient is not fully conscious,
place him/her in the side-lying position. Elevate
side rails and place bed in low position.
i. Comfort: Cover the patient with a blanket, reori-
ent him/her to the room as necessary, and allow
family members to remain with the patient after
the initial assessment is completed.
15.Sample answers:
a.Nausea and vomiting: Provide oral hygiene as
needed; avoid strong-smelling foods.
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