Exam 2 Week 6 Flashcards
Anesthesia may be administered by (2)
Anesthesiologist or CRNA
Main ND for Anesthesia =
High risk for injury r/t
- Drug reaction
- ineffective airway
- decreased CO, F + E imbalance
- ineffective breathing pattern
- Alteration in thought process, - Ineffective thermoregulation and hypothermia
Desired pt outcome =
successful recovery + return to pre-anesthesia physiological state
Preanesthesia assessment
- Obtain info as a safety check. Make sure important data is known by surgical team
- Ask if patient or family has past hx of malignant hyperthermia
- Ask about PMH, meds, allergies, pregnancy test, etc.
Support the patient - emotional and physiological
Pre-anesthesia instructions - varies w/ procedure and pt condition (4)
- Shower, enema
- NPO - avoid passive regurgitation
- Pre-op meds
- Explain post-op routines
Analgesia =
= Pain relief without anesthesia
Anesthesia =
= Absence of normal sensation
Types of Anesthesia
1) General
2) Regional
3) Local
General Anesthesia
- ____ depression
- physical status controlled by?
- CNS
- anesthesia care provider
General Anesthesia characterized by (3)
Amnesia
Analgesia
Skeletal muscle relaxation
General Anesthesia uses =
= combo of IV + Inhalation agents
Inhalation agents via =
Most ____ method for anesthesia
Mask, ETT, or Laryngeal managed airway (LMA)
- controllable
Inhalation agents (4)
- give with ____
- ____ is common
Nitrous oxide, Isoflurane, Desflurane, Sevoflurane
- O2
- shivering
IV agents (2) - are \_\_\_\_ to inhalation agents
Barbiturates, Non Barbiturates
- Supplement
Barbiturate (1)
Thiopental Sodium (Pentothal) - no pain control, respiratory and CV depressant
Non-Barbiturate (1)
Diprovan (Propofol) - milk of amnesia. Rapid acting, respiratory depression → monitor V/S
Adjuncts to Gen. Anesthesia (3)
- Hypnotics/Tranquilizers
- Narcotics
- Neuromuscular Blocking Agent (Muscle relaxant)
Hypnotics/Tranquilizers (2)
- used for ____ and as adjunct
- produces _____
- Antidote = _______
Versed, Valium
- induction
- amnesia
- Flumazenil (reverses sedation and resp depression)
Narcotics (3)
- used preop or intraop
- produces profound ____ relief and ____ depression
Morphine, Demerol, Fentanyl
- pain relief, respiratory
Neuromuscular Blocking Agent (Muscle relaxant)
- causes muscle ____ and relaxes __ and ___ during intubation
Succinylcholine
- paralysis, jaw, larynx
4 Stages of General Anesthesia
Stage 1: Induction
Stage 2: Maintenance
Stage 3: Surgical Anesthesia
Stage 4: Overdose
Stage 1 Induction =
1
= Begins w/ induction and ends w/ loss of consciousness
- Pt can still feel pain
Stage 2 Maintenance =
1
= From loss of consciousness to loss of eyelid reflex
- some involuntary movements
Stage 3: Surgical Anesthesia =
= Target depth of anesthesia → relaxed muscles, regular breathing, eye movements stop, and loss of pain and hearing sensation
What happens at the end of stage 3?
= emergence starts when pt starts to wake up and ends when pt exits OR
Stage 4: Overdose =
= Marked by hypotension or circulatory failure → can lead to death
Sequence for administration of anesthesia
1) __ site access
2) ______ pt and place mask over nose
3) Inject ___ -> ____ -> ____
1) IV
2) Hyperventilate
3) Narcotic -> Barbiturate -> Muscle relaxant
Nursing action during intubation =
- how?
- (2) uses
= Cricoid pressure (Sellik Maneuver)
- downward pressure w/ thumb and index finger
- Compresses esophagus to aid in visualization of trachea for intubation, prevent regurgitation
Aldrete Postanesthesia Scoring System used to =
4
= evaluate recovery for gen Anesthesia
(ARCO) Activity, Respiration, Circulation, O2 sat
Patients are discharged from PACU if they have a score of?
> /- 9
Malignant Hyperthermia =
= Emergency complication that can ONLY happen with general anesthesia
Earliest sign of malignant hyperthermia?
Unanticipated increase in end-tidal CO2
Other characteristics of malignant hyperthermia?
Tachycardia, jaw muscle rigidity, hyperkalemia, lactic acidosis
Increase body temp → later sign
Drugs that trigger malignant hyperthermia? (2)
Give what inhalation med if pt has hx?
Halothane (inhalation) or Succinylcholine (IV)
- nitrous oxide
How fast can malignant hyperthermia happen?
immediately - up to 24 hrs
Tx of malignant hyperthermia
- What medication?
- Immediately D/C all triggering agents
- Hyperventilate pt - 100% O2
- Administer Dantrolene Sodium (Dantrium) - give until patient responds or up to max 20 doses. And then continued for 48 hrs or more
- Immediately stop surgery
- Cool the patient
- Wound irrigation w/ cold saline
- Cold IV solution
- Surface cooling + cold gastric/rectal lavage
Moderate/Conscious Sedation =
What 2 meds?
= Drug-induced depression of consciousness but still able to respond to verbal commands and can maintain patent airway
- narcotic analgesic + sedative hypnotic
Moderate Sedation can be given by?
RN*
Regional =
3 types
= made insensible to pain → patient is awake (no loss of consciousness) but can’t feel pain
1) Local
2) Nerve blocks
3) Spinal and epidural blocks
Spinal =
Epidural/Caudal =
= Injected into CSF in subarachnoid space and affects from tip of xiphoid down to toes
= Injected into epidural space (safer) or injected into caudal canal of sacrum, Used for OR/OB
IV Block (Bier block) =
- used for what type of surgery?
= involves IV injection of local anesthetic into vein w/ tourniquet occluded extremity on 2 portions of the arm
- Used for shorter surgeries on UE
Nerve Block =
used for what surgeries?
- Injection of local anesthetic into and around nerve/nerve group
- Used for surgeries for orbital socket, cervical, elbow and wrist
Local =
- most common med? topical meds? (2)
- topical applied to?
- used for what type of procedures?
= Injection of anesthetic into SubQ tissue at or close to incision site
- Lidocaine, Lidocaine, Cocaine
- applied to mucous membrane or open wound
- minor/superficial
Risks for regional anesthesia?
- Anaphylaxis, incorrect administration technique, systemic absorption of med, infection
Medication Safety on Sterile Field
- All medications and solutions ___ and ___ sterile field must be labeled
- NO ___-_____
- Label all (4)
- On and Off
- x pre-labeling
- syringes, basins, med cups, bowls
Med safety done by (2)
- Confirm (5)
Circulator + Scrub
- Med name
- Strength
- Dose
- Concentration
- Expiration date
