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OR Nurse:
doi: 10.1097/01.ORN.0000390691.98217.35
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Perioperative care of the laparoscopic adrenalectomy patient

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INSTRUCTIONS Perioperative care of the laparoscopic adrenalectomy patient

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Perioperative care of the laparoscopic adrenalectomy patient

GENERAL PURPOSE: To provide the professional registered nurse with updated information about laparoscopic adrenalectomy. LEARNING OBJECTIVES: After reading this article and taking the test, the nurse should be able to: 1. Discuss the anatomy, physiology and pathology of the adrenal glands. 2. Identify steps taken to prepare the OR and patient for laparoscopic adrenalectomy. 3. Explain intraoperative and postoperative care for laparoscopic adrenalectomy patients.

1. In the case study, the patient's headaches and hypertension were caused by a(an)

a. left adrenal mass.

b. pheochromocytoma.

c. cortisol-producing adrenal adenoma.

d. aldosterone-producing adrenal adenoma.

2. The adrenal glands have an essential role in regulating all of the following except

a. stress.

b. electrolytes.

c. body temperature.

d. blood pressure.

3. Which statement about functional adrenal adenomas is accurate?

a. Most are malignant.

b. Cortisol-producing adenomas are one cause of Cushing's syndrome.

c. Aldosteronoma-induced hypertension is usually well controlled medically.

d. They're generally larger than 4 cm.

4. Pheochromacytomas are known to secrete

a. glucocorticoids.

b. mineralocorticoids.

c. catecholamines.

d. cortisol.

5. Which diagnostic tool is used to identify adipose tissue within lesions?

a. MRI scan

b. CT scan with contrast

c. CT scan without contrast

d. needle biopsy

6. Traditional open adrenalectomy is associated with increased risk of

a. peroneal nerve damage.

b. intra-abdominal adhesions.

c. pneumonia and deep vein thrombosis.

d. catecholomine-induced hypertensive crisis.

7. When and by whom should the surgical site be marked?

a. by the attending surgeon during the Time Out

b. by the patient during the Time Out

c. by the attending surgeon prior to transport to the OR

d. by the patient prior to transport to the OR

8. For a laparoscopic procedure, supplies for a laparotomy

a. do not need to be available.

b. should be available but do not need to be opened and counted.

c. should be available, opened, and counted.

d. are always used during the surgery.

9. Prophylactic I.V. antibiotics should be administered within

a. 1 hour of scheduled surgery time.

b. 30 minutes of scheduled surgery time.

c. 2 hours of the initial incision.

d. 1 hour of the initial incision.

10. The recommended number of team members needed to move and position the patient is at least

a. 2.

b. 3.

c. 4.

d. 5.

11. To increase the area between the patient's iliac crest and the costal margin,

a. abduct the dependent arm more than 90 degrees.

b. gently flex the table.

c. place an axillary roll below the dependent axilla.

d. flex the dependent leg at the hip and knee.

12. Which is not part of the Time Out procedure?

a. verify marking of the surgical site by the patient

b. verify accuracy of signed consents

c. verify administration of antibiotics

d. verify correct positioning

13. Where should the scrub person stand during the procedure?

a. to the left of the surgeon

b. to the right of the surgeon

c. opposite side of the surgeon

d. foot of the table

14. What's the most common complication during a laparoscopic adrenalectomy?

a. bleedin.

b. injury to the kidne.

c. injury to the colon

d. injury to the liver

15. Following laparoscopic adrenalectomy, pain control is usually

a. not needed.

b. administered by patient-controlled analgesia.

c. administered at regular intervals on an as needed basis.

d. provided by epidural analgesia.

16. In the PACU, nursing priorities include all except

a. monitoring for hemorrhage.

b. obtaining chemistry screen and CBC.

c. monitoring blood pressure.

d. monitoring serum calcium levels.

17. Following unilateral adrenalectomy, patients usually

a. don't need permanent glucocorticoid replacement therapy.

b. need only ongoing cortisol replacement therapy.

c. need only ongoing catecholamine replacement therapy

d. need ongoing replacement therapy for both cortisol and catecholamine.

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