SECTION II: APPLYING YOUR KNOWLEDGE

Activity E: Consider the scenario and answer the questions.

The nurse is caring for the patient who is scheduled for an inguinal hernia repair with general
anesthesia. While performing a preoperative history and physical assessment, the nurse begins to
suspect that the patient may have a history of substance abuse. The patient does admit to
smoking a pack of cigarettes daily.
1. What important interventions should the nurse instruct the patient to do in order to
prevent complications postoperatively?
Instruct the patient about diaphragmatic breathing, coughing, leg exercises, turning to
the side and how to get out of bed.
2. What is the best method for the nurse to obtain information about the patients possible
use of substances?
The nurse who is obtaining the patient's health history needs to ask frank questions
with patience, care, and a nonjudgmental attitude. If alcohol abuse is suspected, additional
information may be obtained by using common alcohol screening questionnaires such as
the CAGE (Cutting down, Annoyance by criticism, Guilty feelings, and Eye-openers)
(Ewing, 1984), AUDIT (Alcohol Use Disorders Identification Test), TWEAK (Tolerance,
Worry, Eye-opener, Amnesia, Kutdown) (Chan, Pristach, Welte, et al. 1993), or SMAST
(Short Michigan Alcohol Screening Test). The MAST (Michigan Alcohol Screening Test)
has been updated to include drug use and has a geriatric version (The New York State
Office of Alcoholism and Substance Abuse Services [OASAS], 2007).

3. What education regarding smoking should the nurse provide to the patient prior to
scheduling the patient for the surgical procedure?
Patients who smoke are urged to stop 4 to 8 weeks before surgery to significantly
reduce pulmonary and wound healing complications. Preoperative smoking cessation
interventions can be effective in changing smoking behavior and reducing the incidence of
postoperative complications. Patients who smoke are more likely to experience poor wound
healing, a higher incidence of surgical site infection, and complications that include
venous thromboembolism and pneumonia.