CABAHUG, VICTORIA MAE I

SESSION 3

LESSON PREVIEW

Instruction: Enumerate the three areas in a surgical environment. Explain each briefly.
1. Unrestricted Area
- Provides an entrance and exit from the surgical suite for personnel, equipment
and patient
- Street clothes are permitted in this area, and the area provides access to
communication with personnel within
- the suite and with personnel and patient’s families outside the suite
2. Semi-restricted Area
- Provides access to the procedure rooms and peripheral support areas within the
surgical suite.
- Personnel entering this area must be in proper operating room attire and traffic
control must be designed to prevent violation of this area by unauthorized
persons
- Peripheral support areas consist of: storage areas for clean and sterile supplies,
sterilization of equipment and corridors leading to procedure room
3. Restricted Area
- Includes the procedure room where surgery is performed and adjacent sub
sterile areas where the scrub sinks and autoclaves are located
- Personnel working in this area must be in proper operating room attire

CHECK FOR UNDERSTANDING (60 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point
will be given to correct answer and another one (1) point for the correct ratio. Superimpositions or
erasures in you answer/ratio is not allowed. You are given 60 minutes for this activity:

Case Study: Read and examine the case thoroughly.

Patient Profile: S.B., a 28-year-old female school teacher, is admitted to the PACU following a
cystoscopy for recurrent bladder infections and hematuria. The procedure was scheduled as
outpatient surgery and was performed under IV sedation.

Postoperative Orders
• Vital signs per routine
• Discontinue IV before discharge
• Patient to void before discharge
• Cipro 500 mg PO every 6 hr. for 10 days
• Tylenol #3 1–2 tabs every 3–4 hr. PRN for pain
• Patient to call office to schedule follow-up appointment

Discussion Questions
1. Priority Decision: What priority nursing actions will be required to progress S.B. toward
discharge?

Priority nursing actions for this patient are orienting as the patient recovers from the
sedating medication, promoting voiding, and providing oral fluids and intake.

2. What precautions will be required in ambulating S.B. after surgery?

Syncope is possible because of the effects of the drug and instrumentation of the bladder.
The patient should be slowly progressed to ambulation by elevating the head of the bed, then
dangling the legs, and then standing at the side of the bed before attempting ambulation.

3. What problems might interfere with discharging S.B. home in a timely manner?

Inability to void is the most likely problem. The patient could also have respiratory
depression or unstable vital signs because of the effects of the drugs or have complications such
as bladder bleeding.

4. How will the nurse determine that S.B.is ready to be discharged home?

The nurse can determine this by using standard discharge criteria for PACUs—stable vital
signs, oxygen saturation >90%, awake and oriented, no excessive bleeding or drainage, and no
respiratory depression—in addition to the specific criteria ordered for this patient.

5. What are the unique needs of discharging a patient home as opposed to a clinical unit?

In an outpatient setting, the patient also needs to be alert and ambulatory with the ability to
provide self-care near the level of preoperative functioning. Postoperative pain, nausea, and
vomiting must be controlled and the patient must be accompanied by an adult to drive her home.
No opioids should have been given for 30 minutes before discharge.

6.Priority Decision: Based on the data presented, what are the priority nursing diagnoses?

Nursing diagnoses are as follows:

• Impaired urinary elimination related to bladder irritation
• Acute pain related to bladder irritation
• Risk for infection related to incomplete bladder emptying
• Risk for injury related to sedation

MULTIPLE CHOICE:
1. A.
Rationale: How fast and through which levels of care patients are moved depend on the
condition of the patient (Choice A). A physiologically unstable outpatient may stay an
extended time in Phase I, whereas a patient requiring hospitalization but who is stable and
recovering may well be transferred quickly to an inpatient unit.
2. C
Rationale: Physiologic status of the patient is always prioritized with regard to airway;
breathing, and circulation, and respiratory adequacy is the first assessment priority of the
patient on admission to the PACU from the operating room.
3. C.
Rationale: The admission of the patient to the PACU is a joint effort between the ACP,
who is responsible for supervising the postanesthesia recovery of the patient, and the
PACU nurse, who provides care during anesthesia recovery. The ACP gives a verbal report
that presents the details of the surgical and anesthetic course, preoperative conditions
influencing the surgical and anesthetic outcome, and PACU treatment plans to ensure
patient safety and continuity of care.
4. B.
Rationale: Even before patients awaken from anesthesia, their sense of hearing returns and
all activities should be explained by the nurse from the time of admission to the PACU to
assist in orientation and decrease confusion.
5. B.
Rationale: ECG monitoring is performed on patients to assess initial cardiovascular
problems during anesthesia recovery. Fluid and electrolyte status is an indication of renal
function and determinations of arterial blood gases and direct arterial blood pressure
monitoring are used only in special cardiovascular or respiratory problems.
6. A.
Rationale: Hypoxemia occurs with atelectasis and aspiration as well as pulmonary edema,
pulmonary embolism, and bronchospasm.
7. D.
Rationale: An unconscious or semiconscious patient should be placed in a lateral position
to protect the airway from obstruction by the tongue.
8. C.
Rationale: Incisional pain is often the greatest deterrent to patient participation in effective
ventilation and ambulation and adequate and regular analgesic medications should be
provided to encourage these activities.
9. C.
Rationale: Hypotension with normal pulse and skin assessment is typical of residual
vasodilating effects of anesthesia and requires continued observation. An oxygen
saturation of 88% indicates hypoxemia, whereas a narrowing pulse pressure accompanies
hypoperfusion. A urinary output >30 mL/hr is desirable and indicates normal renal
function.
10. A.
Rationale: The most common cause of emergence delirium is hypoxemia and initial
assessment should evaluate respiratory function.