Exam 10: Postoperative Patient Care and Pain Management

Laryngospasm is a common but serious complication in the immediate postoperative pediatric tonsillectomy and adenoidectomy patient.What is the ideal immediate and last resort response by the anesthesia provider or perianesthesia nurse in an emerging patient who has been in spasm for over 1 minute,is not responding to positive-pressure ventilation,and is in significant distress?

What parameters and questions will the perianesthesia nurse investigate while assessing neurologic status?

Hypothermia is a common side effect of surgery and the perianesthesia setting.Which of the following interventions is most effective in normalizing and maintaining body temperature?

Evidence indicates that early analgesia reduces postoperative problems.Recent studies endorse the multimodal approach to both preemptive (preventative)and postoperative analgesia customized to patient needs based on meticulous preoperative assessment.A 72-year-old physically active woman was seen in the preoperative admission center in preparation for her total knee replacement surgery on Thursday.She has not had any opioid medications in her lifetime that she can remember.She has inflammatory bowel and gastric disease and was told she cannot take ibuprofen in any form.Select a multimodal analgesic treatment plan that would best serve the patient's perianesthesia experience.

Delirium is described as an extreme disturbance of arousal,attention,orientation,perception,affect,and intellectual function accompanied by fear and agitation.What is the most common cause of postoperative agitation?

A 33-year-old female,who had a dilation and curettage (D&C)with laparoscopic tubal ligation and has been in phase II recovery for 3 hours,collapsed while sitting on the toilet.The perianesthesia nurse had recently finished giving the patient her discharge instructions and helped her dress.The patient was assessed for loss of consciousness and airway patency.What action should the phase II nurse take next?

A 49-year-old healthy male is beginning to emerge from general endotracheal anesthesia after a transurethral laser lithotripsy of the left ureter.He is restlessly turning side-to-side and moaning.During the hand-off report from the anesthesia provider and circulating nurse,the perianesthesia nurse learned that the patient will probably continue to pass "sludge" (small granular ureteral stone material)for the next hour.As the surgical team rushes back to the OR to start the next case,the perianesthesia nurse thanks them and tells them they can go,because she knows what is wrong with the patient and will take care of him.The perianesthesia nurse's comment reflects which phase of the nursing process and what will be her next actions?

Unfortunately,patients who are managed with opioids as part of their analgesic program can have adverse events related to the medication.What are two of the most serious opioid-related adverse events?

A 12-year-old developmentally delayed male scheduled for dental rehabilitation became agitated on admission to the preoperative holding unit.In spite of sedation and the calming attention of the nurses and his parents,he was screaming and rapidly turning his head from side-to-side.He vomited and choked twice before he fell into a light but restless sleep.During the short procedure,the anesthesia provider was aware of rigidity and difficulty with ventilation in the patient's chest,yet his oxygen saturation was between 96% and 100% throughout the procedure.On extubation,he presented with coughing,wheezing,dyspnea,use of accessory muscles,and tachypnea.The patient is presenting with ____________ probably caused by ____________.

It is estimated that 9% of women and 24% of men in the United States show disordered breathing while asleep,and 2% of women and 4% of men show overt symptoms of obstructive sleep apnea (OSA).Postanesthesia management concerns with OSA patients include use of analgesia,appropriate oxygenation,patient positioning,and monitoring.What additional therapy is recommended for OSA patients during postoperative recovery?

Postoperative nausea and vomiting (PONV)is a problem that affects approximately 30% of PACU patients.Patients with four or more risk factors have a higher incidence of PONV.Select the option that best reflects relevant risk factors for PONV.

Select the statement below that best reflects the effects of hypothermia in the perianesthesia period.

A key component of postoperative discharge instructions requires verification of patient/family understanding of the instructions.A recent study found that only 67% of the discharge instruction comprehension was retained by day 3 postdischarge.What strategy best ensures patient/family understanding and comprehension of the discharge instructions?

Select three appropriate components of the hand-off report from the perioperative nurse to the perianesthesia nurse as the patient is received in the PACU.

Select the most reliable indicator of pain.

Select the patient who is the most vulnerable and at high risk for hypothermia in the perianesthesia phase based on diagnosis or surgical procedure.

The initial primary assessment by the perianesthesia nurse,on the patient's admission to the postanesthesia care unit (PACU),begins with which criterion?

A healthy 18-year-old was admitted to the PACU spontaneously breathing through his endotracheal tube.Shortly after the perianesthesia nurse extubated the patient,he stopped breathing and his color changed to pale,dusky-beige.What is the most ideal action that should occur immediately?

An opioid-naïve patient,one who has not used short-acting opioids in the last 60 days,resedated on admission to the PACU and received which opioid antagonist to reverse the respiratory depression?

A 46-year-old healthy male,admitted for a diagnostic arthroscopy,was prewarmed in the preoperative holding lounge using a warming device.After transfer to the OR bed,he was continuously warmed using the same device.IV fluids cycled through a fluid warmer and the irrigation bags of sterile saline cycled through a warming device during the procedure.The perioperative nurse had preset the OR ambient temperature to 75° F.Select the statement that best reflects the justification for these practices.