Chap 94- Anesthesia & Sedation Flashcards
General anesthesia
Causes loss of sensation, consciousness, reflexes, and memory of sx.
It is used for major surgeries, or one that requires complete muscle relaxation
Regional anesthesia
Used for local conduction, field block, epidural, spinal, or nerve block.
- causes reduction of sensation in selected areas of the body due to blockage of peripheral nerves, or the spinal cord.
Local Anesthesia
Involves topical application of an anesthetic agent to the skin or mucous membranes
Risk Factors of General Anesthesia
- Family HX of malignant hyperthermia
- Respiratory depression ~ hypo ventilation
- Cardiac disease ~ dysrhythmias, alter cardiac output
- Gastric contents ~ aspiration
- Alcohol or substance use disorder
Risk factors for Local Anesthesia
- Allergy to ester-type anesthetics
2. Alterations in peripheral circulation
What patient population is more susceptible to anesthetic agents than any other population?
Older adult clients
- Careful titration of meds helps control unwanted effects
- Airway patency is main priority but cardiac problems can arise as well
- Pay attention to older clients during procedures b/c they can deteriorate rapidly.
Examples of inhalation anesthetic agents for general anesthesia
Halothane
Isoflurane
Nitrous oxide in combo w/ oxygen
Examples of IV anesthetic agents for general anesthesia
Benzodiazepines Etomidate Propofol Ketamine Short-acting barbiturates (Methohexital)
Considerations before/after administrating anesthesia/sedatives
- Have client sign consent form
- Have client urinate before so they will not need to get out of bed
- Ensure bed is low and side rails are up
- Monitor airway and oxygen saturation
- Monitor and report lab values
- Monitor cardiac status
- Monitor temp
- Monitor drains, tubes, catheters, IV access
- If hypotension occurs, lower HOB, administer IV fluids, and monitor
Malignant Hyperthermia
Acute life-threatening medical emergency
Inherited muscle disorder that anesthesia induces chemically
Triggering agents include inhalation anesthetic agents and succinylcholine
Actions to take for malignant hyperthermia
Assist w/ terminating surgery
Administer IV Dantrolene ~ a muscle relaxant
Check ABGs to monitor metabolic acidosis and blood tests to check for hyperkalemia
Infuse iced IV 0.9% NaCl
Apply cooling blanket
Insert indwelling urinary cath to monitor output and for hematuria
Monitor cardiac rhythm
Transfer to ICU
What patients are at risk for anesthetic toxicity
Older clients
Clients w/ poor liver or kidney function
Regional anesthesia
Used when prevention of post-op pain is also a desired effect (total joint replacement)
Beneficial in emergency sx when the pt has not been NPO for a sufficient time
Methods of administration for regional anesthesia
- Spinal ~ inj goes into cerebrospinal fluid in the subarachnoid space to provide autonomic, sensory, and motor blackade below the level of innervation
- complications= HA, nausea, vomiting, pain, cardiac arrest (rare) - Epidural ~ inj goes into epidural space in thoracic or lumbar areas of spine to block sensory pathways, but leaves motor function intact.
- complications = high spinal anesthesia which is a possible complication if the dura is punctured. This leads to depressed respiration, resp arrest, and sever hypotension,
Also causes HA - Nerve block ~ inj around or into an area of nerves to block sensation often for sx on an extremity or for chronic pain
- Field block ~ inj around the operative field for procedures of the chest, plastic sx, dental, and hernial repairs
Local anesthesia agents
Procaine and lidocaine
Local anesthesia is usually combined w/ a ___________ block
Regional block
Complications of local anesthesia and treatment for toxicity
Edema and inflammation of the injection site (early)
Risk for gangrene, necrosis, and tissue abscess
Systemic toxicity ~ presents as restlessness, alter speech, blurred vision, metallic taste, tremors, tachycardia ~ can lead to hypotension, cardiac arrest, apnea, and death.
— Treatment = airway support and administration of rapid-acting barbiturate
Post-procedure checklist and discharge criteria
Monitor and document vital signs and level of consciousness until client is fully awake
Typical discharge criteria:
- Level of consciousness
- Vital signs stable for 30-90 mins
- Able to cough and deep breathe
- Able to tolerate oral fluids
- Able to urinate
- No nausea, vomiting, SOB, or dizziness
- No obvious bleeding
- Adequate resp status
Nursing action for airway obstruction, cardiac dysrhythmia, hypotension, anaphylaxis
Insert oral airway and suction
Nursing action for respiratory depression
Administer oxygen and reversal agents (naloxone and Flumazenil)
Insert oral airway and suction
Nursing action for cardiac dysrhythmias
Obtain a 12-lead EKG and provide anti-dysrhythmics and fluids
Nursing action for anaphylaxis
Administer epinephrine
Nursing action for hypotension
Provide fluids and vasopressors
A nurse is assisting an anesthesiologist who is delivering nitrous oxide by face mask to a pt during the induction of anesthesia. Which of the following is the priority nursing action? A) assess oxygen saturation B) measure BP C) palpate pulse rate D) check temp
A
The greatest risk for the pt is injury from hypoxia.
A nurse is caring for a client who develops a systemic toxic reaction following regional block. Which of the following actions should the nurse take? A) monitor blood creatinine levels B) provide airway support C) turn the client to the right side D) administer a diuretic
B
A systemic toxic reaction results in CNS depression. In this event, it is important to support the pts airway w/ maintaining patency and administering supplemental oxygen
A nurse is caring for a client who report a HA following an epidural regional nerve block. Which of the following actions should the nurse take? A) decrease the clients fluid intake B) apply pressure to the puncture site C) place the HOB flat D) instruct client to lie prone
C
Phases of general anesthesia
- Induction- initiation of IV access, administration of preop meds given, securing of airway patency
- Maintenance- performance of sx, airway maintenance
- Emergence- completion of sx, removal of assistive airway device
