Week 3: Intraop/Periop/Anesthesia Flashcards
Ambulatory Surgery
include outpatient, same day, or short stay surgery that does not require an overnight hospital stay
Bariatrics
having to do with patients that are obese
Informed Consent
the patients autonomous decisions about whether to undergo a surgical procedure, based on the nature of the condition, the treatment options, and the risks and benefits involved
Intraoperative Phase
period of time that begins with transfer of the patient to the operating room area and continues until the patient is admitted to the postanesthetic care unit
Minimally invasive surgery
surgical procedures that use specialized instruments inserted into the body either through natural orifices’ or through small incisions
Perioperative Phase
period of time that constitutes the surgical experience; includes the preoperative, intraoperative, and postoperative phases of nursing care
Postoperative Phase
period of time that begins with the admission of the patient to the post anesthesia care unit and ends after follow up evaluation in the clinical setting or home
Preadmission Testing
diagnostic testing performed before admission to the hospital
Preoperative Phase
period of time from when the decision for surgical intervention is made to when the patient is transferred to the operating room table
Anesthesia
a state of narcosis or severe CNS depression produced by pharmacologic agents
Anesthesiologist
the physician trained to deliver anesthesia and to monitor the patients condition during surgery
Anesthetic Agent
the substance, such as a chemical or gas, used to induce anesthesia
Circulating Nurse (Or Circulator)
RN who coordinates and documents patient care in the OR
Laprascope
a thin endoscope inserted through a small incision into a cavity or joint using fiber optic technology to project live images of structures onto a video monitor; other small incisions allow additional instruments to be inserted to facilitate laparoscopic surgery
Malignant Hyperthermia
a rare life threatening condition triggered by exposure to most anesthetic agents inducing a drastic and uncontrolled increase in skeletal muscle oxidative metabolism that can overwhelm the bodys capacity to supply oxygen, remove CO2, and regulate body temperature, eventually leading to circulatory collapse and death if untreated; often inherited as an autosomal dominant disorder
Moderate Sedation
previously referred to as conscious sedation, involves the use of sedation to depress the level of consciousness without altering the patients ability to maintain a patent airway and to respond to physical stimuli and verbal commands
Monitored Anesthesia Care
Moderate sedation given by an anesthesiologist or certified registered nurse anesthetist (CRNA)
Registered Nurse First Assistance
a member of the OR team whose responsibilities may include handling tissue, providing exposure at the operative field, suturing and maintaining hemostasis
Restricted Zone
area in the OR where scrub attire and surgical masks are required; includes OR and sterile core areas
Scrub Role
RN, license practical nurse, or surgical technologist who scrubs and dons sterile surgical attire, prepares instruments and supplies, and hands instruments to the surgeon during the procedure
Semi restricted Zone
area in the OR where scrub attire is required; may include areas where surgical instruments are processed
Surgical Asepsis
absence of microorganisms in the surgical environment to reduce the risk of infection
Unrestricted Zone
area in the OR that interfaces with other departments; includes patient reception area and holding area
Most common orthopedic procedures in the US
total knee replacement/total knee arthroplasty
What 4 variables can be used to reduce length of stay for those undergoing total knee replacement
Comprehensive Preoperative Patient Education
Pain Control Using Multimodal Analgesic Regimens
Physical Therapy on the Day of Surgery
Proactive Discharge Planning
Self Report
The ability of an individual to give a report - in this case, of pain, especially intensity; the most essential component of the pain assessment
Titration
Upward or downward adjustment of the amount (Dose) of an analgesic agent
Comfort Function Goal
the pain rating identified by the individual patient above which the patient experiences interference with function and quality of life (e.g. activities the patient needs or wishes to perform)
Intraspinal
“within the spine”
refers to the spaces or potential spaces surrounding the spinal cord into which medications can be given
synonymous with neuraxial
Neuraxial
of the CNS
synonymous with intraspinal
Agonist Antagonist
a type of opioid that binds to the kappa opioid receptor site acting as an agonist (capable of producing analgesia) and simultaneously to the mu opioid receptor site acting as an antagonist (reversing mu agonist effect)
Withdrawal
result of abrupt cessation or rapid decrease in dose of a substance upon which one is physically dependent
it is not necessarily indicative of addiction
Ceiling Effect
an analgesic dose above which further dose increments produce no change in effects
Tolerance
a process characterized by decreasing effects of a drug at its previous dose, or the need for a higher dose of drug to maintain an effect
Addiction
a chronic neurologic and biologic disease characterized by behaviors that include one or more of the following:
impaired control over drug use
compulsive use
continued use despite harm
craving to use the opioid for effects other than pain relief
Physical Dependence
the body’s normal response to administration of an opioid for 2 or more weeks
withdrawal symptoms may occur if an opioid is abruptly stopped or an antagonist is given
Opioid Induced Hyperalgesia (OIH)
A phenomenon in which exposure to an opioid induces increased sensitivity, or a lowered threshold, to the neural activity conducting pain perception
it is the “flip side” of tolerance
Hydrophilic
readily absorbed in aqueous solution
Metabolites
the product of biochemical reactions during drug metabolism
Lipophilic
readily absorbed in fatty tissues
Efficacy
the extent to which a drug or another treatment “works” and can produce the effect in question - analgesia in this context
Half Life
the time it takes for the plasma concentration (amount of drug in the body) to be reduced by 50% (after starting a drug, or increasing its dose)
after four to five half lives, a drug that has been discontinued generally is considered to be mostly eliminated from the body
Adjuvant Analgesic Agent
a drug that has a primary indication other than pain (e.g. anticonvulsant, antidepressant, sodium channel blocker, or muscle relaxant) but is an analgesic agent for some painful conditions; sometimes referred to as coanalgesic
Preoperative Phase
period of time from decisions for surgery until patient is transferred into the OR
Intraoperative Phase
period of time from when the patient is transferred into the OR to admission into the PACU
Postoperative Phase
period of time from when a patient is admitted to the PACU to follow up evaluation in the clinical setting or at home
What are the 5 purposes for surgery
Diagnostic
Curative
Palliative
Cosmetic
Functional
What are the 2 types of surgery
outpatient
inpatient
Outpatient Surgery
“Same day, short stay, ambulatory, 23 hour”
Can be done in hospitals or surgi-centers
The majority of surgeries are ____ surgeries at 85%
outpatient
In order to have an outpatient surgery done, what requirement must be met?
They must be a relatively “healthy” individual with no comorbidities or ones that are under control
They have to meet certain criteria -if they are not met they will be admitted overnight to stay incase complications arise
What are the criteria for discharge from outpatient surgery
Ability to drink
Ability to void
Ability to walk on their own
Inpatient Surgery
reserved for complex surgical procedures and/or resource intensive recovery
ex: total joints, neurological, major vascular/cardiac, trauma
Advantages of Outpatient Surgery
Decreased psychological stress
Decreased exposure to nosocomial infections
Economic Benefit
Less separation anxiety, especially for kids
Disadvantages/Challenges of Outpatient Surgery
Difficult to do if they live alone and cannot drive themselves home
Increased patient teaching needs d/t short amount of time in the clinic
No skilled observations for complications occur at home
Pain control - oral meds and pain pumps not present/misuse
What nursing activities are included during the preoperative period
- Establish baseline assessment of patient via a preoperative interview!!
a. Physical and emotional assessment (+ Med history)
b. Anesthesia history
c. Allergies or genetic problems (ex: latex allergy)
d. necessary testing ordered and performed
e. preparatory education about recover from anesthesia and post op care
What are some of the things done during preadmission testing by the healthcare team
initial preoperative assessment
teaching appropriate to the patients needs
involvement of the family in interview
completed preoperative diagnostic testing
verifying patient understanding of surgeon specific preoperative orders
discuss, review advanced directive document
begin discharge planning by assessing patient postoperative transportation, etc
When is preadmission testing usually done
usually this is done for more inpatient surgeries and longer stays
preadmission testing includes all physical/physiological testing and diagnostic testing done and any emotional testing and education
What is preadmission testing like for scheduled out patients
usually minimum amounts of testing are ordered since the patient should be “Healthy” already and due to the type of surgery
This testing will be performed when the patient arrives to the hospital on the day of the surgery most likely
What is preadmission testing like for scheduled in patients
usually performed several days to weeks prior to date of the surgery
urinalysis, blood work (CBC, lytes, H&H), CXR, EKG>40yo, any other MD ordered test done
Due to patient health status or type of surgery these test results may need to be reviewed prior to proceeding with the surgery
Nursing roles and Responsibilities during the Preoperative Phase
- Assessment
- Patient Support
- Patient Preparation and SAFETY
- Patient Education (TEACHING!!!!)
- Patient Advocate
What things are included in the preoperative nursing assessment
nutritional and fluid balance assessment
drug and alcohol usage
respiratory status
cardiovascular status
hepatic and renal function
endocrine status
previous medication use
psychosocial status
spiritual and cultural beliefs
Everything should be included from head to toe to spirit!
Prior to Preoperative Teaching, the nurse should know
history of patient illness
rationale for surgery (WHY)
nature of the surgery (curative, palliative, disfiguring, ostomies, etc)
patient readiness to learn based on factors like: age, mental status, preexisting knowledge about condition, family rxn to surgery
How they learn best
When does preoperative teaching take place
it ideally starts in the physicians office and continues until the patient arrives in the OR
bedside in an emergency
On the day of, inpatients will have it done during the PAT visit but outpatients will have a phone interviews where it occurs or the morning of
What are some useful teaching methods for preoperative teaching
verbal
written information
return demonstration
combination of them
During preoperative teaching, aside from just providing information, what else should the nurse do
guide the patient through the experience and allow ample time for questions
address concerns and fears about anesthesia
provide information that clears up misconceptions
reinforce explanation of the procedure
MD (nurse can be witness) obtains informed consent
What things must be done prior to a surgery (immediate and weeks prior)
explanations of preop procedures
removal of jewelry and nail polish
lab testing
skin prep - cleansing, possible shaving
enemas or bowel preps for intestinal surgery
rationales for withholding food and fluids - like NPO after midnight prior
use of OTC supplements - stop using medications deemed 2-3 weeks prior to surgery
What are some topics to teach the patient about preop
preoperative medications and IV lines
Post op procedures: TCDB, IS, leg exercises, moving in bed/splinting/getting out of bed, equipment expected post op (NG, catheter, drains, NPWT, dressings)
important of reporting pain and discomfort
what will be done to relieve pain like changing position and medications
What are the Criteria for Informed Consent
- Voluntary
- Explains: procedure and risk, benefits and alternatives, offers to answer questions, withdrawal statements, statements if protocol differs from usual
- Competency to sign
- Emancipated minor or not
What are some nurse responsibilities during the informed consent phase
- Have consent signed BEFORE giving any psychoactive medications
- Reinforce information supplied by physician
- WITNESS PATIENT SIGNATURE (be their advocate)
Special Surgical Populations
Geriatric
Pediatrics
Obesity/Bariatrics
Patients w/ physical or mental disability
Patients w/ co morbid conditions
Patients with limited support systems
Geriatric Population Considerations
Pain assessment
May fail to report symptoms
visual and hearing acuity changes
less physical reserve for recovery (cardiac conditions, dehydration, arthritis, skin integrity, endurance)
sensitivity to temp changes
confusion
clear communication
greater risk for anesthesia problems
Due to the high elderly risks in surgery it is very important to do what things
- Skillful preop assessment and treatment
- Skillful anesthesia and surgical technique
- Meticulous and competent post anesthesia management
Pediatric Population Considerations
provide age specific teaching
family oriented teaching should be done - parents can reinforce teaching
sensitivity to temperature change - use warm blankets, a warm room, warming devices
safety concerns
size of equipment an instruments used
Bariatric Population Consideration
increased risk for surgical complications like infection, wound dehiscence, and pulmonary issues
size of equipment and instruments
safety supports
Disabled (Physical or Psychological) Population Considerations
modifications done to preoperative teaching
assistive devices: hearing aids, glasses, braces, prostheses
use of interpreters for signing
mobility issues - may need extra personnel
positioning devices
Emergency Surgery (and Preop considerations)
an unplanned surgery with little time to prepare (ex: trauma, aneurysm, subdural hematoma, acute abdomen, complicated fracture, cardiothoracic, vascular, etc)
Preop assessment - not much time
Family members may be making decisions if proxies
Unconscious patients - informed consent? medical history and allergies?
What are some spiritual and cultural belief considerations to make when doing preoperative teaching
assess primary language spoken and use interpretation services hospital must provide
patient expectations
feelings and attitudes regarding surgery and pain
patient support system (family system)
use of professional interpreters
use of picture cards with various languages
provide printed teaching materials in a variety of languages
What are the immediate preoperative nursing interventions to be done before surgery
Patient Care and Provide information for family members
Patient changes into hospital gown with no hairpins, wigs, braid long hair, surgical cap placed on patient in OR holding area
Dentures, partials, hearing aides - left in until patient gets to OR based on hospital policy
Jewelry should be removed and left with family members - piercings should be removed for safety reasons
have patient void just before going to OR
medications - may or may not have antibiotic or sedative ordered
blood glucose check - high glucose can lead to bacteria thriving
documentation - complete OR checklist
SSI
Surgical Site Infection
__ to __% of all surgeries have an SSI and _% of those will die from infection
2-4%; 3%
If its greater than 3% than something is wrong
SCIP
Surgical Complications Improvement Project
Teaches about proper techniques to help prevent SSIs
What things have we learned from the SCIP
Hari Removal - better to do no to minimal shaving of the surgical site (and do it just prior to surgery) using clippers (NOT RAZORS) to prevent infrection
Beta blocker use
Venous thromboembolism prevention (DVT and PE)
Prophylactic preop antibiotic for appropriate surgery given 30-60 min PRIOR to incision (ex: Bowel, vascular, any implant surgery)
Blood glucose well controlled prior to surgery <200
Preoperative Anesthesia Interview
May be done at PAT or day of surgery
It includes all preop assessment like medical dx, allergies, smoking and ETOH hx, past exp with anesthesia, family hx of problems with anesthesia (like malignant hyperthemia)
What can the history form the anesthesia interview be used for?
It can be used to determine anesthesia to be administered for that person
When/How often are preoperative medications given
They are not given often, sometimes due to morning admissions
they may be given on inpatient units
What is the purpose for giving some sort of preoperative medication
decrease anxiety and relax patient
facilitate smooth induction of anesthesia
decrease amount of anesthetic needed
provide amnesia for the perioperative period
relieve pre and post op pain
minimize side effects of some anesthetic agents: salivation, bradycardia, post op vomiting
5 Major types of drugs used for preoperative medications
Sedatives
tranquilizers
Narcotic Analgesics
Vagolytic Agents (Anticholinergic)
H2 Receptor Antagonists
Sedatives
promote sleep before surgery
ex: Phenobarbitol, Dalmane, Chloral Hydrate
* never let pt walk around after taking these*
Tranquilizers
decreases patient anxiety
ex: Valium
Narcotic Analgesis
Preoperative Analgesia
ex: Dilaudid
Vagolytic Agents
Anticholinergic Agents
Decrease oral secretions and interrupts impulses that would slow the heart
ex: Atropine
H2 Receptor Antagonists
Decreases the amount of gastric secretion and increases pH of secretions
ex: Pepcid (C Section Patients especially)
When does the intraoperative period begin and end
Begins on transfer of client into the OR and ends with entrance to the PACU
What are some of the people that may be in the OR
surgeon with an assistant or resident
anesthesia personnel - anesthesiologist or CRNA
circulating RN
surgical technician
radiology technician
cardiovascular technician
students
pathologist
representatives of supply companies
scrub nurse/scrub tech
What is potentially the number one goal for prevention of infection in the OR?
Traffic Flow (Uninterrupted)
What are some important goals and considerations to prevent infection in the OR
- Surgical environment - traffic flow
- surgical asepsis
- environmental controls (ex: cold)
Unrestricted Zone
area of OR where street clothes are permitted
ex: locker room
Semi Restricted Zone
Once in OR, only scrub attire and hair coverings can be worn and are required
ex: hallways, corridors, offices, equipment rooms, staff break rooms
Restricted Zone
scrub attire, hair covering, and masks at all times
ex: Sterile storage rooms and inside the OR theatre
Circulating Nurse
One of the most important nurse roles in the OR
They act as patient advocate, protect from harm, emotional support
They review charts for completeness (patient ID, procedure, consent, allergies, emotional support)
Their #1 priority IS SAFETY
What are some of the tasks a circulating nurse may do
assist anesthesia staff with induction
Patient ID
operative site verification
maintain aseptic environment
proper function of equipment, ground pads, safety straps
necessary supplies and instruments
positioning to protect nerves, circulation, respiration, and skin integrity
correct surgical counts - no retained items after surgery
appropriate documentation
promote normothermia
distinguish normal from abnormal cardiopulmonary data
monitor blood, fluid, and drainage output
maintain sterile technique of all present
Intraoperative complications that can occur
anesthesia awareness
NV
anaphylaxis (rare)
hypoxia, respiratory complications
hypothermia (big one)
malignant hyperthermia (big one)
disseminated intravascular coagulation (DIC)
infection
Types of Anesthesia
General
Regional
General anesthesia does what
causes complete amnesia and paralysis
Regional anesthesia does what
decreases all painful sensation and motion to a body part or region W/OUT inducing unconsciousness
it is produced by blocking sensory impulses to the brain
General Anesthesia
Depression of CNS with total loss of sensation and complete loss of consciousness
Goal when using General Anesthesia
Keep patient under for the shortest time possible
Balanced Anesthesia
Anesthesia (unconscious, general) that produce effects of:
- Analgesia
- Amnesia
- Muscle Relaxation
- Elimination of Certain Reflexes
* requires multiple types to do all effects, not just one can do all 4*
Is there any one ideal agent of balanced anesthesia
sadly, no one ideal agent exists so a variety of agents are often used to cause balanced anesthesia
Methods of Administering General Anesthesia
Inhalation
IV
Rectal
Oral
Overall Advantages of General Anesthesia
Flexibility
Can be sued in any type of surgery
Adequate for Length Procedures
Better monitoring and control of respiratory and circulatory functions when the patient is fully unconscious and not awake and fearful
Overall Disadvantages of General Anesthesia
Resp and Circ Depression which can cause death
NV
Aspiration during induction
Hepatic (LIVER) Toxicity
Nursing Interventions for General Anesthesia
Must know agents used an expected outcomes (length of action, recovery, amount of pain expected, excretion)
Maintain patent airway
Protect airway and person
orient client
monitor VS
prevent aspiration postoperatively by elevating HOB
be ready to assist with cardiac and respiratory arrest
Methods of Regional Anesthesia
Topical
Local
Nerve Block
Spinal
epidural
Caudal
What does it mean if a medicine ends with “-caine”?
It means it is a medicine that is a type of regional anesthetic
Local Regional Anesthetic
Disrupts the nerve endings to a local area
Never use local anesthetic with what?
EP on fingers
Nerve Block Regional Anesthetic
anesthesia in an area of distribution
ex: If its leg surgery a catheter goes into the spinal cord area to the nerve roots and adjusts the nerve roots so no pain is felt
Spinal Regional Anesthetic
Inject Anesthetic into the CSF that surrounds the lower spinal cord and nerve roots
Spinal Regional Anesthetic is used for what?
Lower extremity, perineum, and lower abdomen surgeries
Why is spinal regional anesthetic only used for lower body surgeries
because if done too high up it can hinder breathing and cause respiratory distress
Epidural Regional Anesthetic
inserted into the epidural space
Caudal Regional Anesthetic
inserted through the sacral canal
Advantages of Regional Anesthetic
better airway control and the patient can control secretions
fewer resp complications because pt can C+DB normally to decrease pooling of mucous in bronchi
safer for patients with cardiorespiratory conditions
good for surgery of lower limbs, lower abdomen, or perineum
better for those with comorbidities
Disadvantages of Regional Anesthetic
fear of paralysis
anxiety and fear r/t patients being able to see and hear during the procedure (may use sedatives to decrease anxiety)
lack of flexibility may be difficult to use with small children, elderly (dementia), uncooperative patients, or for lengthy procedures
Why can the “False Security” of Spinal Anesthesia lead to issues?
Drugs that can cause systemic depression can lead to respiratory depression or circulatory problems
So if inserted too high into the spinal cord it will paralyze the intercostal muscles and diaphragm and cause respiratory depression and the patient unable to breathe on their own
What are the problems with Spinal Anesthesia that can occur
Respiratory depression and inability to breath
amount can be toxic
spinal headache (if pt sits up too quickly)
Nursing Interventions for Spinal Anesthesia
Patient advocate secondary to lack of sensation
Monitor for proper position, pressure points, distended bladder
Monitor VS - watch for sympathetic nerve blocks causing vasodilation and venous pooling which can drop BP and P and could be severe bradycardia
Keep pt flat 8-12 hours after spinal anes to prevent HA
monitor CMS for return of function
encourage oral fluids (but they cannot control bladder so watch catheters)
pt. recovered when VS within normal limits and sensation has returned
Spinal Anesthesia Headache
Due to leakage of CSF, a headache may occur 24-72 hours after anesthesia
It may lead to a stiff neck
What can decrease incidence of Spinal Anesthesia Headaches
use of a small bore needle
Nursing Interventions for Spinal Headache
Analgesics as oprdered
Lie flat 24-72 hours
Force fluids, unless contraindicated
Give caffeine (unless known to cause HA) because increased vascular pressure at the leak site can seal the hole
Keep surroundings dark and quiet
Teach patient to avoid straining with moving in bed or having a bowel movement leading to increased ICP causing increase in headache
What is a last resort nursing intervention for spinal headache
blood patch or saline injection
Epidural Regional Anesthesia
Pain management by infusing analgesic and/or local anesthesia through administration via an infusion pump into the epidural space (outside the spinal cord) at a rate and quantity specific by anesthesiologist
commonly given for labor
Nursing Interventions for Epidural Regional Anesthesia
elevate HOB >30 degrees if an opioid infusion - prevent resp. depression
Pulse Ox monitoring
O2 per protocol
Pain and sedation scale
bladder distention
epidural catheter site and dressing assessment
I&Os
monitor function and sensory block
PRN Medications prescribed
Complications of Epidural Regional Anesthetics
Resp Depression - MOST serious SE (relatively rare: increases with age and combo of other opioids, assess frequently for change in resp status, generally peaks 6-12 hours after epidural is started)
Urinary Retention
Pruritis
NV and Dizziness
Inhalation Anesthetics
administered by inhalation of gases and vaporous fluids into the resp tract
the dose is controlled by an anesthetist and can be stopped STAT (if too deep)
Has a lot to do with the intubation piece - get them relaxed for the breathing apparatus
How does Gaseous and Vaporous Inhalation Anesthetics Differ
Gaseous Anesthetics produce narcosis, analgesia, amnesia, depress CNS, and have greatest use as an induction agent
Vaporous anesthetics differ in that they have slower onset in induction
Side Effects of Inhalation Anesthetics
Hypotension
Postoperative NV
Nursing Interventions for Inhalation Anesthetics
monitor VS
adequate O2!
Advantage of IV Anesthetics
rapid pleasant induction
low incidence of post op NV
Disadvantages of IV Anesthetics
Laryngospasm
bronchospasm
decreased BP
resp arrest
irritating to skin and SubQ tissue
IV Anesthetics are used…
to induce and maintain general anesthesia and amnesia
Nursing Interventions for IV Anesthetics
Monitor VS, especially airways (ABCs), breathing
safety straps for patients
Nitrous Oxide: Is it gaseous or vaporous
gaseous
Halothane and Fluothane: Are they gaseous or vaporous
vaporous
Give 2 examples of IV anesthetics
Barbituates
Narcotics/Neuraleptanalgesics
Barbituates
IV Anesthetic
Short duration with very rapid onset
induction smooth, easy, and pleasant
Narcotics/Neuraleptanalgesics
IV Anesthetic
Ex: Fentanyl, Sublimaze
Used for anesthetic AND analgesia
Fast onset and short duration
Decreases arterial BP d/t vasodilation effects
What IV drug causes “Moderate Sedation”
Fentanyl
What is “Anesthesia on a Continuum”
It means that anesthesia can cause a range of consciousness memory, detachment from environment, etc
ex: moderate sedation compared to general anesthesia
Moderate Sedation
Being put in “Twilight” by Fentanyl
Causes analgesia, quietude, and detachment from environment WITHOUT loss of consciousness
Patient is aware and able to cooperate but feels no pain
more minor procedures do this
Why do you need to decrease use of post op narcotics for about 12 hours following moderate sedation
because the respiratory depression lasts longer than with regular analgesia when using it and fentanyl
SE of Moderate Sedation
Resp Depression (!)
Apnea
Hypotension
Bradycardia
Nursing Interventions for Moderate Sedation
never leave patient alone
constantly monitor airway
look at LOC, pulse ox, ZECG
VS q 15-30 minutes
assess pt ability to maintain airways and respond to verbal commands
What are some complications of surgery following general anesthesia use
NV
Singulitis
Sore Throat
Headache
Muscles Aches and Paresthesia
Hypothermia
Malignant Hyperthermia
Post Anesthesia HTN
Cause of NV following general anesthesia
pain meds, gastric distention, surgical manipulation, lyte abnormalities, pain, shock, and psychological issues all contribute to NV
Nursing Interventions for NV post-general anesthesia
NPO until bowel sounds and flatus observed
withhold oral intake if nauseated
begin with ice water clear liquids - DAT
move pt slowly
control pain
decrease fear and anxiety
good mouth care, provide mouthwash after vomiting
cool cloth on forehead
position on side to prevent aspiration
anti emetics as ordered: Zofran
NG tube
Singulitis
Hiccups
Cause of Singulitis following general anesthesia
surgery near the phrenic nerve
peritonitis
gastric distention
intestinal obstruction
acid base or electrolyte imbalanced
If singulitis is short lived following surgery…
it is not a problem
If singulitis is continuous following surgery…
it can be painful with an abdominal incision which could lead to vomiting which can cause dehiscence or exhaustion
Cause of Sore Throat following general anesthesia
usually due to ET tube placement during the surgery
NIs for Sore Throat following surgery
treat with ice
throat lozenges (Cepacol)
Cause of HA following general anesthesia
usually it is a sinus type headache
NIs for HA following surgery
ice
analgesics as ordered
Cause of Muscle Aches or Paresthesia following General Anesthesia
position during surgery
muscle spasms due to certain medications
NIs for Muscle aches and Paresthesia following general anesthesia
Usually these resolve spontaneously
assess for pain other than at surgical site
assess for numbness in pressure areas from position during surgery, if numbness lasts then call anesthesia
analgesics as ordered
heat to lower back, back rubs, change position, OOB
Cause of Hypothermia following general anesthesia
Cold OR and PACU rooms
exposed “guts”
decreased metabolism
cold IVs
blood and gases
NIs for hypothermia following surgery
warm blankets
frequent VS with continuous monitoring of temperature
Warming devices like a Bair Hugger
keep patient dry
Malignant Hyperthemia
a medical emergency
can occur after general anesthesia
it is an adverse reaction to anesthetic drugs during induction
The most common cause of anesthetic induced deaths is what?
Malignant Hyperthermia
The mortality of Malignant Hyperthermia is ___ to ___% if not treated
60-70% if not treated
What causes malignant hyperthermia
It is an inherited disorder of abnormal increase in muscle catabolism and heat production in response to stress or certain anesthetics
There is usually a family hx
If there is a family hx of malignant hyperthermia, what must be done before surgery?
- Muscle biopsy prior to scheduled surgery
2. Wear medic alert bracelet/necklace
S/S of Malignant Hyperthermia
“Rigid” Jaw upon intubation and “tetany”
tachycardia HR >150 BPM
tachypnea
increased temp up to 106 degrees!
increased metabolism with sustained muscle contractions
How fast can temp increase in malignant hyperthermia
as much as 1 degree every 5 minutes going up to 106 degrees!
Treatments and NIs for Malignant Hyperthermia
d/c anesthesia meds STAT
emergency treatment –> Dantrium
hyperventilate with 100% O2
iced IV solutions
draw labs - ABG, CK, electrolytes
cooling blanket
mannitol and lasix to maintain UO
foley cath - strict I and O
monitor pt closely for the next 36 hours
Dantrium
a skeletal muscle relaxant
Dantrolene
given to malignant hyperthermia as an emergency treatment
Why give mannitol and lasix to those with malignant hyperthermia
to maintain UO
How long should the patient be monitored after onset of malignant hyperthermia
36 hours
What % of O2 is given to those experiencing malignant hyperthermia
100% (hyperventilate them)
Why can a patient end up with post anesthesia hypertension following general anesthesia
If a pt has controlled HTN pre-op thay may have increased or decreased BP r/t pain, decreased temp in the OR leading to vasoconstriction which increases BP, or Hypervolemia
NIs for Post Anesthesia HTN
anti-hypertensives as ordered
treat the cause (hypervolemia, pain, vasoconstriction d/t low temp)
What may cause pain following surgery other than the incision
a full bladder
tight dressing
cast
positioning
When are narcotics usually needed following surgery?
usually needed in the first 24-48 hours
they then use noninvasive pain relieving measures to increase effectiveness or allow use of a lower dose of narcotics
Why should you NOT be afraid to use narcotics for the first few days post-operation
little risk of addiction
patient can do post op exercises without pain which will decrease complications
PCA - patient controlled analgesia can also help
