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107 Cards in this Set
- Front
- Back
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What is Anesthesia?
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a STATE OF DEPRESSED CNS ACTIVITY, marked by depression of consciousness, loss of responsiveness to stimulation, and/or muscle relaxation
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What is General Anesthesia?
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-Loss of senstation, consciousess, and reflexes
-Method used when the client is undergoing MAJOR SURGERY, one that will require COMPLETE muscle relaxation |
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What is Local Anesthesia?
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-Loss of sensation, W/O loss of consciousness
-Local anesthetics block transmission among nerves -Provides for loss of autonomic function and muscle paralysis in a SPECIFIC area of the body |
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What are the risk factors for GENERAL anesthesia complications?
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-Family History of malignant HTN
-Respiratory distress (Hypoventilation) -Cardiac Disease (dysrhytmias, cardiac output) -Gastric Contents (aspiration) -Preoperative use of ALCOHOL or ILLICIT drugs |
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What are the risk factors for LOCAL anesthesia complications?
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-Allergy to ESTER-Type anesthetics
-Alterations in peripheral circulation |
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What is the INDUCTION PHASE of General anesthesia?
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-Preoperative med given
-IV lines initiated -Placement to monitoring -Airway Secured |
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What is the MAINTENANCE PHASE of General anesthesia?
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-Surgery Performed
-Airway Maintenance |
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What is the EMERGENCE PHASE of General anesthesia?
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-Surgery Completed
-Removal of assisstive airway device |
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What are INHALED anesthetics?
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-Volatile gases/liquids that are dissolved in oxygen
EX: Halothane(Fluothane) Isoflurane(Forane) Nitrous Oxide |
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What are INJECTABLE anesthetics?
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-Anesthetics given IV
EX: Benzodiazepines Etomidate(Amidate) Propofol(Diprivan) Ketamine(Ketalar) Droperidol + Fentanyl |
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How are inhalation anesthetics eliminated?
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-through EXHALATION
- |
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What is the rate of inhalation anesthetics elimination dependent upon?
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-Pulmonary Ventilation and blood flow to the Lungs
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What are important interventions, POST-op, for elimination of inhalation anesthetics?
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-Administration of O2
-Encourage pt to take DEEP BREATHS |
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Adjunct Medication Class drugs are?
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-Drugs added with anesthetics
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Adjunct Medication Class:
OPIOIDS [DRUGS] [USE] |
[DRUGS]
-Fentanyl(Sublimaze) -Sufentanil(Sufenta) [USE] -Sedation -Analgesia |
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Adjunct Medication Class: BENZODIAZEPINES
[DRUGS] [USE] |
[DRUGS]
-Dizepam(Valium) -Midazolam(Versed) [USE] -Amnesia -Anxiety reduction |
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Adjunct Medication Class: ANTICHOLINERGICS
[DRUGS] [USE] |
[DRUGS]
-Atropine -Glycopyrrolate(Robinul) [USE] -Dry up excessive secretions -Decrease risk of aspiration |
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Adjunct Medication Class: ANTIEMETICS
[DRUGS] [USE] |
[DRUGS]
-Promethazine(Phenergan) [USE] -Reduce N/V -Decrease risk of Aspiration |
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Adjunct Medication Class: SEDAIVES
[DRUGS] [USE] |
[DRUGS]
-Pentobarbital(Nembutal) -Secobarbital(Seconal) [USE] -Amnesia -Sedation |
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Adjunct Medication Class: NEUROMUSCULAR BLOCKING AGENTS
[DRUGS] [USE] |
[DRUGS]
-Succinylcholine(Anectine) -Vecuronium(Norcuron) [USE] -Muscle relaxation for surgery -Airway Placement |
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RN Responsibilities for administration of LOCAL Anesthetics?
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-Monitor: Airway & O2 sat
-Draw/Report LAB Values (ABG, CBC) -CONSTANT monitoring of pt cardiac status (rhythm, HR, BP) -Assessment of pt's TEMP -Monitoring of: Drains, rubes, cetheters, and IV access throughout anesthesia and surgery -Assessment lvl of sedation and anesthesia (lvl of consciousness, vital signs) -Notification of surgeon and anesthesiologist if abnormalities are noted |
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Three main types of adminstration of LOCAL anesthesia are?
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-Topical
-Local infiltration - Regional Nerve block |
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Topical
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-Applied directly to the skin or mucous membranes
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Local Infiltartion
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-Injected into tissues through which a surgical incision is to be made
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Regional Nerve Block
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-Injected into or around specific nerves
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Four types of Regional Nerve Block are?:
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-Spinal
-Epidural -Bier -Peripheral |
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SPINAL nerve block?
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-Injected dirctly inot the subarachnoid spance cerbvral splain fluid (CSF)
-Provides autonomic, sensory, and motor blockade to the body below the level of innervation that the are of the spine where the injection was made |
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EPIDURAL nerve block?
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-Injected into the epidural space in the lumbar or thoracic areas of the spine
-Sensory pathways are BLOCKED, but motor function REMAINS |
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BIER nerve block?
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-IV injection of anesthetic into extremity following mechanical exsaguination with a tourniquet
-Provides analgesia and a bloodless surgical site |
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PERIPHERAL nerve block?
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-Injection into a specific nerve
-For ANALGESIC and ANESTHETIC use |
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Examples of LOCAL anesthetics are?
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-Procaine(Novocaine)
-Lidocaine(Xylocaine) |
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Why is there concurrent administration of a vasoconstrictor with local anesthetics?
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-To prolong the effects
-To decrease the risk of systemic toxicity -Vasoconstrictor EX = Epinephrine |
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Where is the practice of concurrent administration of a vasoconstrictor with local anesthetics avoided?
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-For distal injuries (ex: finger) due to increased cicrulation
-Prolonged VC could lead to tissue necrosis |
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RN Responsibilities for administration of LOCAL Anesthetics?
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-Observer for: systemic absorption (reselessness, excitement, seizures, tachycardia, tachypnea, hypertension)
-Montioir: Airway and pt O2 sat -Draw/Report: Lab values (ABG, CBC) -Constant monitoring of pt's cardiac status (thythmn, HR, BP) -Montioring of: Drains, tubes, catheters, and IV access throughotu anesthesia and surgery -Assessment lvl of: Sedation and anesthesia (lvl of conciousness, VS) -Notification of the surgeon and anestheologist if abnormalites are noted -Assessment of the motor function to ensure paralysis does not ensue (movement returns first, then sense of touch, pain, warmth, and fnially senstation of cold) |
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Potential complications from use of anesthesia are?
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-Myocardial depression
-Anaphylaxis -Malignant Hyperthermia -ANS system blockade -CSF leakage |
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Myocardial Depression:
[SS] |
-Bradycardia
-Hypotension -Cyanosis -Edema |
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Anaphylaxix:
[SS] |
-Cardiac Failure
-Allergic Symptoms -Abnormal VS |
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Malignant Hypterthermia (due to admin of succinylcholine):
[SS] |
-Tachycardia
-Tachypnea -Hypercarbia -Dysrhythmias |
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ANS system blockade (Epidural & Spinal)
[SS] |
-Hyptension
-Bradycardia -Nausea -Vomiting |
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CSF leakage (Spinal & Epidural)
[SS] |
-Headache
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Meeting the needs of Older Adults regarding anesthetics:
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-More susceptible to anesthetic agents than any other population
-Meds: have to be titrated carefully to control incidence -Airway always main priority -Cardiac problems can rise more quickly -Clien'ts condition can DETERIORATE more quickly |
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Conscious Sedation:
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-Admin of sedatives and/or hypnotics to the pint where the pt is relaxed enough that minor procedures can be performed w/o discomfort
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What can the PT still do under conscious sedation?
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-Respond to verbal stimuli
-Retain protective reflexes (ex: gag reflex) -Easily arousable -Independently maintains a patent airway (Most important) |
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Who can admin a conscious sedation?
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-CRNA
-Anesthesiologist -Attending Physicians -RN under supervision of one of the above professionals |
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What must the RN do for a PT undergoing concsoiuc sedation?
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-Continuously MONITOR the PT
-Must be with PT at all times: before, during, and immediately after the procedure |
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Procedures that require conscious sedation?
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-Endoscopic procedures (bone marrow aspiration & cardioversion)
-Opthalmic, dental, & plastic surgical procedures -Wound suturing, incision & drainage of abscesses & burn debridement -Placement or removal of implanted devices, tubes, and catheters -Reduction of fractures and case placement -Vasectomy |
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What are common drugs used for conscious sedation?
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Opiods = [Morphine, Fentanyl, Hydromorphone, Meperidine(Demerol)
Anestheics - Propofol(Diprivan) Benzodiazepines = Midazolam(Versed), Diazepam(Valium), Lorazepam(Ativan) |
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What equip. is present during a procedure?
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-Crash cart = (emergency + resuscitative drugs, airway + ventilatory equip, defibrillator)
-BP = Pulse Ox monitor -Stethoscope + Temp. Probe -ECG Monitor w/display -IV Cath + Fluids -Oxygen, Airway, Masks, & Endotracheal tubes -Suction & Suction Caths |
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RN responsibilites BEFOREthe Procedure include?
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-Obtain: Full Hist (med use, allergy, preX med cond., prev. sedation or anesthesia, NOTE: Last dsg of each med and type (htnisve, diuretic, narcotic)
-Educate about Procedure & Meds that will be used -Perfom FULL ASSESSMENT -Determine last time pt ate/drank **usually NPO 4hrs before procedure -Establish IV access and keep vein-open fluids -Verify INFORMED CONSENT -Attach monitoring equipment -Remove PT's dentures |
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Meeting the needs of Older Adults regarding anesthetics:
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-More susceptible to anesthetic agents than any other population
-Meds: have to be titrated carefully to control incidence -Airway always main priority -Cardiac problems can rise more quickly -Clien'ts condition can DETERIORATE more quickly |
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Conscious Sedation:
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-Admin of sedatives and/or hypnotics to the pint where the pt is relaxed enough that minor procedures can be performed w/o discomfort
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What can the PT still do under conscious sedation?
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-Respond to verbal stimuli
-Retain protective reflexes (ex: gag reflex) -Easily arousable -Independently maintains a patent airway (Most important) |
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Who can admin a conscious sedation?
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-CRNA
-Anesthesiologist -Attending Physicians -RN under supervision of one of the above professionals |
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What must the RN do for a PT undergoing concsoiuc sedation?
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-Continuously MONITOR the PT
-Must be with PT at all times: before, during, and immediately after the procedure |
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Procedures that require conscious sedation?
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-Endoscopic procedures (bone marrow aspiration & cardioversion)
-Opthalmic, dental, & plastic surgical procedures -Wound suturing, incision & drainage of abscesses & burn debridement -Placement or removal of implanted devices, tubes, and catheters -Reduction of fractures and case placement -Vasectomy |
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What are common drugs used for conscious sedation?
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Opiods = [Morphine, Fentanyl, Hydromorphone, Meperidine(Demerol)
Anestheics - Propofol(Diprivan) Benzodiazepines = Midazolam(Versed), Diazepam(Valium), Lorazepam(Ativan) |
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What equip. is present during a procedure?
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-Crash cart = (emergency + resuscitative drugs, airway + ventilatory equip, defibrillator)
-BP = Pulse Ox monitor -Stethoscope + Temp. Probe -ECG Monitor w/display -IV Cath + Fluids -Oxygen, Airway, Masks, & Endotracheal tubes -Suction & Suction Caths |
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RN responsibilities BEFORE the Procedure include?
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-Obtain: Full Hist (med use, allergy, preX med cond., prev. sedation or anesthesia, NOTE: Last dsg of each med and type (htnisve, diuretic, narcotic)
-Educate about Procedure & Meds that will be used -Perfom FULL ASSESSMENT -Determine last time pt ate/drank **usually NPO 4hrs before procedure -Establish IV access and keep vein-open fluids -Verify INFORMED CONSENT -Attach monitoring equipment -Remove PT's dentures |
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abase
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lower; degrade; humiliate
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RN responsibilites AFTER the Procedure include?
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-Continually record VS & lvl of consciousness until PT wakes up
-When PT wakes up you can remove monitors from bedise |
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Typical discharge criteria includes?
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-Lvl of consciousness
-VS stable for 30 - 90 mins -Ability to cough & deep breathe -Ability to take oral fluids -NO N/V, SOB, or Dizziness |
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Complications and RN Implications: Procedure
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-Airway Obstruction: INSERT ariway, suction
-Respirtatoy depression: Admin. Oxygen & reversal agents ( Naloxone(Narcan), & Flumazenil(Romazicon)). -Cardiac Arrhythmia's: SET UP 12-lead, ECG, provide antidyrhythmics & fluids Hypotension: PROVIDE fluids + Vasopressers -Anaphylaxis: Admin. EPINEPHRINE NOTE: Most hospitals require your ACLS or PALS in case of emergency |
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Needs of OLDER Adults during a Procedure
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-Are at GREATER risk of ADR to sedation meds
-May needs surgical consent form signed by legal guardian -May be more FEARFUL due to financial concerns and lack of social support -Have less physcilgoic reserve than younger clients -Have sensory limitations so nurse bust be alert to mainatin SAFE environment -RN needs to pay attention to CARDIAC and RESPIRATORY status, as problems arise more quickly |
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What forms of surgery are there?
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-Curative
-Palliative -Cosmetic -Functional |
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Where can surgeries be performed?
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-Inpatient
-Same Day -Outpatient |
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When does preoperative care take place?
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-From the time the PT is scheduled for surgery until care is transferred to the operating suite
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Who is INFORMED consent obtained by?
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-The Provider
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Who explains all RISK and BENEFITS to the client or surrogate?
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-The Provider
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What are one of the maj. aspects of preoperative care?
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-Assessment of Risks
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Preoperative Care includes:
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-Thorough assessment of PT's physicial, emotional, and psy. status prior to surgery
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Preoperative teaching includes instructions concering:
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-Pain Mgmt
-Deep Breathing & Coughing techniques -Leg & Foot exercises for prevention of thrombi formation |
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Risk Fctors: Surgery
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-Infection:Risk of Sepsis
-Anemia(oxgenation, healing impact) -Hypovolemia form dehydration or blood loss (circulatory compromise) -Electrolyte imbalance through inadequate diet or disease process (dyrhtyhmias) -Age (older adults and infants are at greater risk) -Pregnancy (fetal risk with anesthesia) -Respiratory disease (COPD, Pneumonia, asthma) -Cardiac Disease (CVA, CHF, MI, HTN, dysththmias) -Diabetes ( decreased inteestinal motility, delayed healing) -Liver disease (altered drug metabolism) -Kidney disease (altered elimination) -Endocrine disorders (hypo/hyperthyroidism, Addison's, Cushing, Diabetes mellitus) -Immune Sys. Disorders (allergies, immunocompromise) -Coagulation defect (increased risk of bleeding) -Malnutrition (delayed healing) -Obesity (impact on anesthesia, elimination, wound healing) -Use of some meds (anti-hypertensives, anticoagulants) -Substance use (tobacco, alcohol) -Family history (malignant hyperthermia) -Allergies (latex, anesthetic agents) |
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Diagositc Procedures and Nursing Interventions: Surgery
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-Urinalysis: Rule out infection
-Blood Type & Crossmatch: Transfusion readiness -Hemoglobin & Hemocrit: Fluid status, Anemia -Clotting Studies: (PT, INR, aPTT, platelet count) -Electolyte levels: Hypo/HyperKalemia -Serum Creatinine: Renal Status -Pregnancy Test: Fetal risk of anesthesia -Arterial Blood gas: Oxygenation Status -Chest X-Ray: Heart & Lung status -12-Lead ECG: Baseline Heart Rhythm, dysrhythmias |
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Preoperative Assessment:
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-Detailed Hist (med problems, allegeis, med use, substance abuse, psy. problems, & cultural considerations)
-Anxiety lvl regarding procedure -Lab results -Head-to-Toe assessment -VS Deficient Knowledge -Anxiety -Anticipatory grieving -Ineffective individual coping |
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Informed Consent
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-Responsibiltiy of Primary Care Provider to get consent NOT RN!
-RN can clarify any ifno that remains unclear after providers explanation -RN role is to WITNESS client's signing of consent form after client acknowledges understanding of procedure |
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Preoperative Teaching
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-PostOP pain control techniques (meds, mobilization, PCA pumps, splinting)
-Demonstration & importance of coughing and deep breathing -Demonstartion and importance of ROM exercises & early ambulation for prevention of thrombi and resp. complications -Invasive devices (drains, catheters, IV lines) -Post. Operative diets -Use of incentive spirometer -PreOP instructions (avoid smoking 24hr preoperatively, meds to hold, bowel preparation) |
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PreOP RN ACTIONS:
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-Verification of informed consent completed, signed, and witnessed
-PT undergoing bowel surgery: admin of Enemas/laxatives the night before or am of sugery required -Reg. scheduled meds may need to be altered (hld antihypertensives, increase coricosteriods) -PT will be NPO for at least 6 - 8 hrs before SURGERY w/GENERAL anesthesia avoid aspiration -PT NPO 3-4 hrs before LOCAL anesthesia to avoid aspiration -Note on chart last time PT ate/drank -Skin prep: cleansing with antimicrobial soap & clipping of hari in areas that will be involved with surgery -Removal of jewelry, dentures, prothestics, makeup, nail polish, & glasses. [Given to family or locked away] -Establish IV access -Admin preOP meds: (prophylactic antimicrobial, antiemetics, sedatives) as ordered by Primary care provider -Have pt void prior to admin -Montior: PT response to med -Raise side rails after admin -Ensure preOP checklist complete -Transfer PT to PACU |
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Complications of Meds given PreOP: Sedatives
[Drugs] [Complications] |
[Benzodiazepines, Barbiturates]
Resp. Depression, drowsiness, dizziness |
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Complications of Meds given PreOP: Narcotics
[Complications] |
Resp. Depression, drowsiness, dizziness
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Complications of Meds given PreOP:IV Infusions
[Drugs] [Complications] |
[NaCl, Lactated Ringer's]
Cardiac abnormalities (esp, in CHF), Hypernatremia |
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Complications of Meds given PreOP:GI Meds
[Drugs] [Complications] |
[Antiemetics, Antacids, h2 receptor blockers]
Alkalosis, Cardiac abnormalities (certain h2 receptor blockers), Drowsiness |
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3 areas of surgical suites?
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-Unrestricted
-Semi restricted -Restricted |
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Unrestricted
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-street clothes & scrubs, holding area & stafff areas
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Semi restricted
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-surgical attire required, corridors & support area
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Restricted
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-full surgical gear, OR
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How is the surgical suite arranged?
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-So cross contamination is prevented form CLEAN to STERILE areas
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Perioperative RN functions as:
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-Client advocate & educator throughout intraoperative experience
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Two RN roles during OR
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-Scrub RN: monitor aseptic technique, handles surgical equip for surgeon, must remain sterile during entire procedure
-Circulating RN: plans * coordinates intropertive care, maintis documentation, reports off to the PostACU at transfer from OR |
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Other roles in OR include:
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-Surgical Techs
-Surgeon & surgeon assistants -Anesthesiologist & CRNA |
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RF: General Anesthesia Complications
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-Family History of malignant hyperthermia
-Respiratory, liver, and or renal problems (altered drug metabolism, & elimination) -Age (risk assoc. w/age-related alterations in elimination) -Cardiac problems (altered circulation, risk of dyshythmias) |
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RF: Positioning Complications Intraoperative RNing
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-Age (older adults lose skin elasticity)
-Arthritis |
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Radiology procedures: Intraoperative RNing
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-verify placement may be performed during surgical procedure
-measures to protect surgical staff from uncneccesary radiation exposure should be employed |
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Periopative Intraoperative RNing: Assessments of Perioperative RN
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-Preforms inital assessment after transfer
-assesses client's identity, physical, psychosocial, and cultural PT findings for risk factors and consideration for operative procedure |
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Periopative Intraoperative RNing: Assessments of Circulating RN
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-Preforms frequent assessments of client positiong, maintenance of sterile techniques & sterile field, and of clients I&O throughout procedure
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Malignant Hyperthermia:
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-acute, possibly fatal reaction caused in a small segment of population by certain anesthetics
-Can occur during induction (w/admin of succinylcholine) or hours into procedure - Characterized by HIGH body temp and rigid skeltal muscles -Other findings include: tachycardia, hypotension, cyankosis (increased CO2 & decreased O2) & myoglobinuraion (protein in urine) |
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Response to Malignant Hyperthermia:
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-STOP admin of causative anethetic agent
-IF PT not intubated, INTUBATE -Ventilate w/100% O2 -Use cooling techniques & monitor body temp -Monitor urinary output for amt & presence of blood or myoglobin -Admin diuretics as prescribed -End surgery ASAP |
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Whose responsibility is it to transfer the PT from the OR to the PACU? Circulating RN?
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-Anesthesiologist
-Circulating RN will give report to PACU RN |
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Where is postOP care usually provided initially?
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-PACU
skilled RN's closely monitor PT's recovery |
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Initial postOP care involves?
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-Makin assessments
-provide meds -manage PT's pain -prevent complications -determine when PT is ready to be discharged from PACU |
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During immediate postOP stage?
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-Maintain airway patency & ventilation are the main priorities for care
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What do clients who received General anesthesia require postOP?
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-Frequent assessment of their respiratory status
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What do clients who received epidural or spinal anesthesia postOP require?
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-Ongoing assessment of motor and sensory fuction
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PostOp Compliations/Risk Factors
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-Immobility(respirtoary comprimise, thrombophlebitis, pressure ulcer)
-Anemia (oxygenation, healing impact) -Hypovolemia (tissure prefusion) -Older age (age-related changes) --Respiratory disease (respiratory compromise) -Immune disorder (risk for infection, delayed healing) -Diabetes mellitus (gastroparesis, delayed wound healing) -Coagulation defect (increased risk of bleeding) -Malnutrition (delayed healing_) -Obesity (wound healing, dehiscence) |
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Diagnostic Procedures & RN Interveintons: PostOP RNing
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-CBC: (infection/immune status)
-Hemoglbin and Hemocrit (fluid status, anemia) -Electrolyte levels (hypo/hyperkalemia) -Serum creatinine (renal staus) -Arterial blood gas (oxygenation status) -Lab tests (ex. glucose) based on precdure and other health problems |
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PostOP Rning: [Assess/Monitor}
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-Continually for airway patency & adequte ventilation
-VS until stable (ex. every 15 mins x 4; every 30 mins x 4; every 2 hr x 4: ) -For evidence of bleeding -Client skin color and conditon -Mucous membranes, lips, & nail beds for cyanosis -For hypothermia -For signs of fluid and electrolyte imbalance -N/V -Drainage tubes for patency and proper fucntion -For after-effects of anethesia -I&O every 15 mins to hourly as directed in PACU -For sigsn of Hypo/Hypervolemia -Bladder distension -Urinary catheters for patency -Color, consitency, odoer and amt of urine -Surgical wound, incision site, and dressing -For pain -Movement of extremeties -Lvl of consciousiness -Blood oxygen lvls -ECG readings -Aldrete Soring System |
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Aldrete Scoring System:
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-Five factors given a score based on RN observations of client and totaled to determine PT's Aldrete score. [Factors = activity, consciousness, respiration, color, circulation]
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Criteria indication READINESS FOR DISCHARGE from PACU include:
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-Aldrete score of at least 10
-Stable VS -No evidence of bleeding -Return of reflexes (gag, cough, swallow) -Wound drainage minimal to moderate -Urine output of at least 30mL/hr |
