the last measure to be performed before surgery

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this is another review question in my textbook:

The nursing measure that should be performed last on the morning of surgery is to:

a. ask client to void in the bathroom

b. check chart for signed consent form

c. administer pre-anesthetic medications

d. lock up client's jewellery and money

I picked c. because I am assuming that preoperative medication is the same as pre-anesthetic medication {maybe I'm wrong?} And because having the client void should be done before the administration of any preoperative medication (and the preoperative medication can interfere with balance or could result in a fall when the client is in the bathroom) - according to my textbook.

The answer at the back of the book is a.

Why?

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I know that valium is the benzodiazepine that is commonly given for "pre-anesthesia," and it's not the general anesthetic that will be used to put the patient under for surgery. I don't know the rationale for voiding afterwards - we haven't gotten there yet - but I would assume you'd want to make sure that the client's consent was signed and his valuables were properly stored before his mental state was at all altered. A valium wouldn't instantly affect the patient's ability to ambulate. I'm not in clinicals or medsurg yet, so I don't know the exact protocols regarding surgery.

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Specializes in Med/Surg.

Preop meds are usually antibiotics. Anesthesia meds are administered by a certified person so unless you are a CRNA you as a nurse can not give them

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Specializes in ER, ICU, Infusion, peds, informatics.

unless they have a foley, they need to void right before they go down to surgery. they need to have an empty bladder when they go into the or. po meds take a while to work, so i wouldn't give them last.

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[color=#483d8b]usually, when the or calls, i go ahead and give any meds that are ordered "on call" to the or. then, when the orderly gets to the floor, i tell the patient to go to the bathroom while the orderly is getting the chart and signing the patient out.

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[color=#483d8b]honestly, though, most of my patients have foleys before they go to the or, so it doesn't come up often.

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Specializes in ER, ICU, Infusion, peds, informatics.
preop meds are usually antibiotics. anesthesia meds are administered by a certified person so unless you are a crna you as a nurse can not give them

i do see quite a bit of abx ordered pre-op, but i also see pepcid, robinal, maalox, and an occasional valium. all of these are considered "preanesthesia" meds, since they are used because of general anesthesia (robinal = decreased secretions, maalox/pepcid = decreased gastric ph, valium = relaxed) but all are appropriate for an rn to give.

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[color=#483d8b]i would probably consider the abx to be a "preop" med; while the others are more "preanesthesia" meds (if you want to be technical :) )

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Specializes in med/surg, telemetry, IV therapy, mgmt.

My guess would be that theoretically, giving a medication is NOT an INDEPENDENT nursing measure and requires a physician's order. In some nursing theorist circles, it's a collaborative intervention that requires no nursing decision, only a doctor's order. On the other hand, visiting the bathroom is attention to an ADL, a very independent nursing thing to do that requires assessment of the patient's condition, abilities and knowledge of nursing procedure.

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thanks

frequently used preoperative medications are (as listed in my textbook):

benzodiazepines (midazolam, diazepam, lorazepam)

narcotics (morphine, meperidine, fentanyl)

histamine H2 receptor blockers (cimetidine, ranitidine)

antacids (sodium citrate)

antiemetics (metoclopramide)

anticholinergics (atropine, scopolamine)

barbiturates are also included

antibiotics may be administered if the client has a history of congenital or valvular heart disease to prevent development of infective endocarditits or is there is the potential for wound contamination.

And my book says that voiding should be done before the administration of any preoperative medication (for the reason stated above).

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I really dislike these types of vague questions.

I'm guessing that A is right this case because all the other choices can and should be done prior to patient being sent for. I'm guessing the point is that pre-anesthetic med administration and any of those other tasks shouldn't be done JUST before the patient leaves the floor. But if that's the point, why not just ask it? Why should I have to guess the reason why A is right? It should be clear to all. Instead, here we are speculating about it.

How about something like this?

You are taking report on an ambulatory patient scheduled for surgery in the morning. It's 7:30am and the patient should be sent for around 9:30am.

When should you check that the consent form has been signed?

a. you don't need to check it; that's not a nursing responsibility

b. you don't need to check it; the off-going nurse reported it has been signed

c. check it as soon as you can after receiving report

d. check it when the patient is sent for

When should pre-anesthetic meds be administered?

a. Don't administer any meds because the patient is NPO.

b. They should be given 60-90 minutes prior to being sent for

c. They should be given 20-30 minutes prior to being sent for

d. They should be given when the patient is sent for

The patient should have an empty bladder for surgery. When should you ask the patient to void?

a. You shouldn't ask the patient to void; they will take care of that in the OR

b. You should ask the patient to void 60-90 minutes prior to being sent for.

c. You should ask the patient to void 20-30 minutes prior to being sent for

d. You should ask the patient to void when the patient is sent for

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Specializes in Geriatrics, Cardiac, ICU.
I really dislike these types of vague questions.

I'm guessing that A is right this case because all the other choices can and should be done prior to patient being sent for. I'm guessing the point is that pre-anesthetic med administration and any of those other tasks shouldn't be done JUST before the patient leaves the floor. But if that's the point, why not just ask it? Why should I have to guess the reason why A is right? It should be clear to all. Instead, here we are speculating about it.

How about something like this?

You are taking report on an ambulatory patient scheduled for surgery in the morning. It's 7:30am and the patient should be sent for around 9:30am.

When should you check that the consent form has been signed?

a. you don't need to check it; that's not a nursing responsibility

b. you don't need to check it; the off-going nurse reported it has been signed

c. check it as soon as you can after receiving report

d. check it when the patient is sent for

When should pre-anesthetic meds be administered?

a. Don't administer any meds because the patient is NPO.

b. They should be given 60-90 minutes prior to being sent for

c. They should be given 20-30 minutes prior to being sent for

d. They should be given when the patient is sent for

The patient should have an empty bladder for surgery. When should you ask the patient to void?

a. You shouldn't ask the patient to void; they will take care of that in the OR

b. You should ask the patient to void 60-90 minutes prior to being sent for.

c. You should ask the patient to void 20-30 minutes prior to being sent for

d. You should ask the patient to void when the patient is sent for

Wow. this would make too much sense for it to happen in nursing school. Asking clear, to the point, easy to answer questions. What a concept. ;)

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Funny this question should pop up now. I have a test on Surg pts tomorrow! And during review today and in reading our text the last thing to be is to have the patient void. Like you, I think and argued that premedicating them and then having them walk to the bathroom to void increaced the patients risk for injury from falling d/t altered mental status from the meds (I was thinking in terms of Maslow and safety being one of the first things you take care of). Teacher said that you would be alert to them being medicated so you would be able to see to safety of the pt by having them ambulate or being in a W/C with assistance. Although most meds do need a bit of time to kick in..so if you took them to the bathroom soon after giving the med the chance for a fall would be lessoned.

The nursing measure that should be performed last on the morning of surgery is to:

a. ask client to void in the bathroom

b. check chart for signed consent form

c. administer pre-anesthetic medications

d. lock up client's jewellery and money

We were lectured and it was in the text that although its the surgeons offices responsiblity to have the Consent form signed, its the nurses responsibility to make sure its done BEFORE sending the pt to the OR (things are often forgotten, lost, or overlooked by the surgeons office) and since you are not supposed to have the patient medicated and then have them sign consent, pre medicating them would occur after checking the consent in case it wasn't signed beforehand. The patients jewerly and money should have been sent home or sent to the safe at admission. Leaving voiding for the last thing to do. (now mind you thats what MY professor said and thats whats in our text..things vary from text to text and teacher to teacher)

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Specializes in Vents, Telemetry, Home Care, Home infusion.
Funny this question should pop up now. I have a test on Surg pts tomorrow! And during review today and in reading our text the last thing to be is to have the patient void. Like you, I think and argued that premedicating them and then having them walk to the bathroom to void increaced the patients risk for injury from falling d/t altered mental status from the meds (I was thinking in terms of Maslow and safety being one of the first things you take care of). Teacher said that you would be alert to them being medicated so you would be able to see to safety of the pt by having them ambulate or being in a W/C with assistance. Although most meds do need a bit of time to kick in..so if you took them to the bathroom soon after giving the med the chance for a fall would be lessoned.

The nursing measure that should be performed last on the morning of surgery is to:

a. ask client to void in the bathroom

b. check chart for signed consent form

c. administer pre-anesthetic medications

d. lock up client's jewellery and money

We were lectured and it was in the text that although its the surgeons offices responsiblity to have the Consent form signed, its the nurses responsibility to make sure its done BEFORE sending the pt to the OR (things are often forgotten, lost, or overlooked by the surgeons office) and since you are not supposed to have the patient medicated and then have them sign consent, pre medicating them would occur after checking the consent in case it wasn't signed beforehand. The patients jewerly and money should have been sent home or sent to the safe at admission. Leaving voiding for the last thing to do. (now mind you thats what MY professor said and thats whats in our text..things vary from text to text and teacher to teacher)

:yeahthat:

Agree with rationale you presented!!!

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