Exam 17: Perioperative Care

The postoperative nurse is planning care for a client recovering from major thoracic surgery.Which nursing diagnoses should the nurse select to plan for this client's immediate care needs? Select all that apply.

While receiving report from the operating room,the nurse learns that a client's surgical wound for gallbladder removal is classified as III.What could have caused this wound classification? Select all that apply.

The postoperative care nurse reviews the documentation from the intraoperative phase and determines that several areas are missing.Which areas did the nurse identify as being missing from the intraoperative documentation? Select all that apply.

A client is informed that a surgical procedure is to be scheduled in 2 weeks.Which teaching points should the nurse focus to prepare the client for the surgery? Select all that apply.

The nurse is discussing the various people whom the client will see when in the operating room suite.Which individuals should the nurse emphasize when discussing this aspect of the surgical process with the client? Select all that apply.

The nurse is preparing a client for emergency surgery to repair liver and colon lacerations caused by a motor vehicle crash.Which information about this type of surgery will the nurse use to guide the client's care? Select all that apply.

The postoperative recovery room nurse determines that a client in the postoperative phase of care can be transitioned to Phase II of recovery.The client is able to take deep breaths and cough,is using oxygen to maintain a saturation of greater than 90%,is fully awake,has a systolic blood pressure that is 130 mmHg now but the preoperative systolic blood pressure was 100 mmHg,and is able to move all four extremities independently.Using the following scale,this client's Aldrete score is ________. The Aldrete score Respiration 2 = Able to take deep breath and cough 1 = Dyspnea/shallow breathing 0 = Apnea O₂ Saturation 2 = Maintains > 92% on room air 1 = Needs O₂ inhalation to maintain O₂ saturation > 90% 0 = Saturation < 90% even with supplemental oxygen Consciousness 2 = Fully awake 1 = Arousable on calling 0 = Not responding Circulation 2 = BP+ 20 mmHg preop 1 = BP+ 20-50 mmHg preop 0 = BP+ 50 mmHg preop Activity 2 = Able to move 4 extremities 1 = Able to move 2 extremities 0 = Able to move 0 extremities

The nurse is preparing an older adult client for surgery.Which topics should the nurse focus when preparing this client's preoperative teaching? Select all that apply.