Intraoperative Carlos Flashcards
What is the most important effect during moderate and deep sedation?
Respond purposefully to verbal commands
It is given by the nurse under the direct supervision of physician
Moderate and deep sedation
This is the stage where anesthetic administration is done
Stage I: Beginning Anesthesia (ONSET)
What happens during the “end” of the anesthetic administration in Stage I
During loss of consciousness
What are the nursing interventions done during Stage I?
1 Close the OR door
2 Avoid unnecessary noises or motions
3 Stand by to assisst client
This is the stage where the patient experiences loss of consciousness
Stage II: Excitement (Delirium)
What are the nursing interventions done during Stage II?
1 Assisst anesthesiologist in restraining the client
2 Touch the client only for purpose of restraint
This is the stage where there is loss of eyelid reflexes
Stage III: Surgical Anesthesia
What happens during the “end” of Stage III
1 There is loss of most reflexes
2 Depression of vital functions
3 Client is unconscious, relaxed muslces, blink and gag reflexes are present
What are the goals of anesthesia?
1 Control excessive biologic responses
2 Protection of patients from stress-induced complications
Define general anesthesia
1 Reversible state consisting of complete loss of consciousness and sensation
2 Protective reflexes such as cough and gag are lost
3 Produces amnesia and hypnosis
4 Can be administered through IV or inhalation
This is the stage where fuctions are expressively depressed
Stage IV: Medullary Depression (Stage of Danger)
What happens during the end of Stage IV?
1 There is respiratory and circulatory failure
2 Client is not breathing
3 Heartbeat may not be present
What are some nursing interventions done in Stage IV?
1 Respond immediately to assisst in establishing airway
2 Provide cardiac arrest tray, dru, syringes, etc.
3 Assisst with closed or open cardiac massage
1st Induction
Pulse: Irregular
B.P.: Normal
2nd Excitement
Pulse: Irregular and fast
BP: High
3rd Operative
Pulse: Steady and slow
BP: Normal
4th Danger
Pulse: Weak and thready
BP: Low
Types of general anethsesia
1 Intravenous Anesthesia
2 Inhalation Anesthesia
What happens during intravenous anesthesia?
`1 Px is unconscious over 30 seconds after the administration
2 Rapid transmission from consicous to surgical anesthesia stage
Example of IV anasthesia
Thiopental Sodium and Ketamine
What happens during inhalation anesthesia?
1 Ease administration and elimination through the respi system
2 Maintain client stage III anesthesia following induction
Example of inhalation anesthesia
Halothane and Isoflurane
What are adjuncts to GA?
Drugs are added to an inhalation anesthetic other than IV induction drug
What is dissociative anesthesia?
1 Interrupts associative brain pathways
2 Reduce painful sensation in one region
What is local A?
1 Does not involve sedation or LOC
2 Block only peripheral nerves
What is filled block A?
Injected and infiltrated into area proximal to the planned incision
What is peripheral nerve block A?
Anesthetizes nerve or nerve plexus
What is spinal A?
Surgical procedure involving the lower half of the body
What are the advantages of spinal anesthesia?
1 Reduces N and V
2 Lowers respi complication
3 Early post-op recovery
4 Better pain control
What is epidural block?
Involves an injection of a local anesthetic into an epidural space
What are the nursing managements of spinal and epidural anesthesia
1 Closely observe the manifestation of ANS blockage such as hypotension, bradychardia, N/V
2 Patient may have tingling in the arms and feet
3 Post dural puncture headache such as back pain, isolated nerve injury, and meningitis
What are the classifications of complications of major surgery?
1 Due to Anesthesia
2 Due to Surgery
3
What are some common complications of general anesthesia?
1 Direct trauma to the mouth
2 Hypothermia due to long operations
3 Allergic reaction to anesthetic agent
What are some complications due to surgery?
1 Peri-op complications
2 Post op complicatons
What are some periop complications?
1 Hypotension 2 Inc. BP 3 Cardiac Arrest 4 Hypoxia 5 Asphyxia 6 Chemical causes
What are the signs of chemical causes?
1 Noisy breathing during partial obstruction
2 Cyanosis
How to maintai safety and prevent injury?
1 Position the client 2 Provide quipment safety 3 Maintain surgical asepsis 4 Assist with wound closure 5 Monitoring
What are the things that needs to be documented?
1 Drains, tubes and other devices
2 Types of closure and dressing used
3 Post op diagnosis
What are some gerontologic considerations?
1 Carefully monitor the response to anesthetic agents
2 Consider using warming devices
3 Increase the need for clear and concise communuication
4 Anesthetic drugs nned to be carefully titrated
What are some anaphylactic reactions?
1 Hypotension
2 Tachycardia
What happens during malignant hyperthermia?
1 Characterized by hyperthermia with skeletal muscle rigidity that can result to death
What are other factors of malignant hyperthermia?
1 Stress
2 Trauma
3 Heat
What is the treatment of malignant hyperthermia?
1 Dantrolene (Dantrium)
What does Dantrolene do?
Reduces muscle contraction
