Perioperative bits and bites

Question 1

after general anesthesia is given how is resp depression countered

Answer 1

the pt is often given oxygen

Question 2

consideration for giving pts opioids after surgery

what complications could be impacted

Answer 2

the pt is already on CNS depressants

Question 3

what should be thought of regarding an older adult and the drugs they take in additionto the ones for sx

Answer 3

often have polypharmacy and look at interactions carefully

Question 4

considerations for giving anesthetics to kids

Answer 4

• Preemies, neonates and kids are more affected by anes. d/t inc sensitivity to rugs, immature kidney and liver (may lead to toxicity)
• CNS more sensitive to effects
• Cardiac and resp rhythms aren’t fully dev yet (theyre more susceptible to CNS depression and accompanying cardiac and resp depression)
• Do v throough head to toe and document

Question 5

risks for neonate during general anesthesia

Answer 5

Neonates are at high risk of upper airway obstr during gen anesthesia;
o : inc risk of laryngospasm d/t the physical characteristics of the larynx and resp structures
o their inc metb rate and small airway diameter also put neoates at inc risk of complications

Question 6

before providing teaching to parents of kid for sx or teaching the kid what must you first decrease and address

Answer 6

anxiety before teaching

Question 7

how to assess parent’s level of knowledge abt sx/prep

Answer 7

ask what what prep they’ve done and what they’ve told the kid about the exp. Is their kid as scared as theyd expect?

Question 8

how to address being given general anesthesia to child

Answer 8

• Say the the child will have a “special sleep” so they aren’t scared to go to sleep after and because they might know dogs and cats get “put to sleep”

Question 9

how much to explain about sx procedure to kid

what to make sure to mention abt environment after sx

Answer 9

• Minimize the surgical procedure “after youre asleep the dr will fix your tummy and you wont feel anything d/t the special sleep. When you wake up youll be in a recovery room where youll stay until wide awake” (this is important to mention. Parents may not be allowed here. You must educate parents about this too)

Question 10

which age is it good to use doll with

Answer 10

preschool age

Question 11

how much to tell them abt postop pain

Answer 11

be honest

Question 12

how quaickly or condensed should surgical prep be

Answer 12

do it in stages

allow for therapeutic play

do lots of demoing using real equipemnt

Question 13

what is the overton meyer hypothesis

Answer 13

• The Overton-Meyer theory explains some of the properties of anesthetic drugs. It implies that theres a relationship bet the lipid solubility of an anesthetic drug and its potency: the greater the solubility o the drug in fat, the greater it effect. Nerve cell membranes have a high lipid content as does BBB. Therefore, anaesthetic drugs can easily cross the BBB and conc in nerve cell membranes

Question 14

subarachnoid space aka

Answer 14

intrathecal space

Question 15

can meds be given intrapsinall with preservatives

Answer 15

no. theyre neurotoxic

Question 16

main benefit of intraspinal admin of opioids

Answer 16

much much smaller doses are nec and the analgesic effects are strong

eg pt needs 300mg morphine orally, 100mg parenterally, 10mg epidural, 1mg intrathecal

Question 17

is spinal or epidural more common for intraspinal opioid delivery

why

Answer 17

epidural d/t the protective nature of dura mater against infection, meningitis etc

Question 18

is there a concern with patency intraspinally

Answer 18

no. no blood there that can clot it

Question 19

because very little of meds are absorbed into systemic circ when intrathecally admin’ what is an important thing to monitor

Answer 19

the drug must circulate through the CSF to be excreted. onset of resp depression can be delayed up until 24hrs after

Question 20

epidural space and how this affects drug admin

Answer 20

there is a lot of fat here and extensive venous system.

fat which means that fat soluble meds can enter systemic circ via venous plexus

Question 21

epidural how do they combine meds to give smaller dose of opioids and dec pruritus, urinary retentiona nd resp depression

Answer 21

give opioid with local anesthetic

Question 22

3 routes of intraspinal analgesia admin

Answer 22

1=bolus
2=continuous infusion by pump
3=continuous plus intermittent bolus

Question 23

if shorter acting med is used would they use epidural or spinal

Answer 23

epidural and leave catheter in (give boluses this way)

Question 24

can continuous infusions by pump be spinal epidural or both

Answer 24

both

Question 25

what are patient controlled epidural analgesics foten used for

Answer 25

for mgmt of acute postop pain, chronic pain, intractable cancer pain

also women iving birth may have one of these that delivers bolus without continuous mode

Question 26

how is intraspinal inserted and secured

Answer 26

typically in lumbar region. numb. insert. thread catheter through. connect catheter to tubin and position along spine of pt. often taped over shoulder
place oclusive drsg overtop for easy visualization

Question 27

who is responsible for monitoring the catheter (intraspinal) once in place

Answer 27

nurse

Question 28

how to maint client safety with intraspinal catheters

Answer 28

• label tubing with epidural
• tape ports to prevent someone accessing wrong one. tape connections to secure them
• dont use alcohol as its neurotoxic
• post sign on pts bed that they have epidural

Question 29

wht to do before givig bolus dose intraspinal

Answer 29

aspirate genty (expect 1m of fluid return).

this is to make sure it isnt in subarachnoid space

Question 30

how often to assess site

Answer 30

with each bolus dose or q8h

Question 31

how to prevent resp depression in pt getting analgesics epidrually

Answer 31

assess resp status q1h for 24hrs and then q4h after

• dont give other CNS depressants or opioids unless ordered
• keep narcan at bedside

Question 32

advantages of PCA

Answer 32

• pts take less total analgesia

- its flexible to pt needs/schedule

Question 33

common adverse effects from general anesthetics

Answer 33

nausea
vomitin
bradycardia
\HoTn with tachycardia

Question 34

common side effect of PPI

Answer 34

diarrhea

Question 35

common side effects of anticholinergics

eg

Answer 35

hypotension, lethargy, confusion, diarrhea, dry mouth

dimenhydrinate although antihistaminic also has strong anticholinergic effects
scopolamine
diphenoxylate with atropine

Question 36

common side effects of dopamine antagonists

eg

Answer 36

dry mouth, urinary retention, extrapyramidal symptoms, pseudoparkinsonism, orthostatic hypotention

prochlorperazine and metoclopramide

Question 37

common side effects of serotonin antagonists

eg

Answer 37

headache and bronchospasm

ondansetron

Question 38

common side effects of antihistamines

Answer 38

hypotension, lethargy, confusion, diarrhea, dry mouth

eg dimenhydrinate

Question 39

which med should be used with caution when giving opioids or other CNS depressants

Answer 39

diphenoxylate with atropine

Question 40

when to give sodium citrate vs ranitidine preop and why

Answer 40

Sodium citrate acts instantly and can be used for emergency surgeries where there has been no time to prepare the gut. Ranitidine is given when surgery is planned and there is 90 minutes to prepare the gut for surgery. Why not always give Sodium Citrate? It tastes terrible and makes most people gag or vomit.