preop and intraop Flashcards
(111 cards)
1
Q
how are the different types of surgery classified according to degree of urgency
-eg what type of surgery is kidney stone removal, cataracts?
A
• Sx classified according to degree of urgency:
o Emergent: pt requires immediate attention-burns, stab wounds
o Urgent: within 24-30 hrs, needs prompt attn eg acute gallbladder infection, kidney stones
o Required: within few weeks to months, pt needs to have sx-thyroid disorders, cataracts
o Elective: failure to have sx will not be catastrophic-hernia, vaginal repair
o Optional: personal preference
2
Q
what are the different types of surgery
A
• Sx’s can be diagnostic eg laparotomy, biopsy, curative, or reparative, reconstructive or cosmetic, palliative (to relieve pain or alleviate problem, such as gastrostomy tube to compensate for inability to swallow food)
3
Q
what type of assessments would be done before a pt goes to the hospital for surgery?
why doesnt this happen at hospital?
what do they focus these assessments on?
A
preadmission testing aka PAT
- Aka PAT – has come about as result of pressure to reduce hospital stays and contain costs
- May be done by presurgical services department
- Focus on pt demographics, health hx, other info pertinent to procedure
4
Q
older adults have less ________________ = ability of an organ to return to normal after disturbance in equilibrium
A
physiologic reserve
5
Q
what are the leading causes of post op morbidity and mortality in older adults
A
• Resp and cardiac complications
6
Q
common reason for falls in older adults postop
A
sensory limitations1
7
Q
skin/temp considerations for o adults
A
- Ability to perspire decreases – skin becomes dry and itchy – fragile and easily abraded
- Decreased subcut fat = inc risk of temp changes
8
Q
what type of complications could o adult have in relation to ingestion of food, fluids post op
A
• Dehydration, constipation, and malnutrition may result
9
Q
when placing o adult on operating room bed what is a consideration for them
A
arthritis and proper padding, gentle massage
10
Q
considerations for sx with obese pt
A
- Inc risk of complications
- Fatty tissues esp susceptible to infection
- Difficulty caring for wound
- Inc technical and mechanical problems during sx (ex: intubation difficult)
- Inc risk of dehiscence (wound separation)
- Inc demands on heart as more vessels to perfuse
- Tend to have shallow resps when supine hypoventilation and resp complications. Assessed for obstructive sleep apnea w continuus positive airway pressure
11
Q
what is ambulatory surgery
A
Ambulatory surgery
• Includes outpatient, same-day or short-stay sx that does not require overnight but may require
12
Q
preop assessment
why is nutritional and fluid status assessment performed
how would you determine someones nutritional needs?
A
o Key to promoting healing and resisting infection and other complications
o Nutritional needs may be determined by measurement of BMI and waist circ
o Malnutrition needs to be corrected before sx to ensure adequate nutrients for healing
o Dehydration, hypovolemia, and electrolyte imbalance can lead to sig problems for those with comorbidities and the elderly
13
Q
drug and alcohol use considerations before surgery
A
• Drug and alcohol use: if chronic, often have issues of malnutrition and other systemic problems that inc surgical risk; if acutely intoxicated, will insert nasogastric tube before general anesthesia to prevent vomiting and; aspiration; if acute intox, will often try to delay sx if possible
14
Q
why would an anesthetist look in a patients mouth
A
loose teeth, dentures etc are aspiration/intubation risk and plates etc must be removed during sx
15
Q
pt has resp infection can they have sx
A
no. wait for it to pass
16
Q
smoking preoperatively?
A
Pts who smoke urged to stop doing so 4-8wks prior to sx to sig reduce pulmonary complications and delayed wound healing
17
Q
what type of HTN can postpone a sx
A
uncontrolled HTN
18
Q
why is hepatic and renal fx important to assess preop
A
• Hepatic and renal fx:
o Important so that meds, anesthetic agents, body wastes, and toxins adequately metabolized and removed from body
o Any liver condition affects metabolism of anesthetics
o Acute liver disease associated with high surgical mortality
o Sx contraindicated with acute renal problems because kidneys needed to excrete anesthetic meds and metabolites
19
Q
endocrine considerations preop (especially diabetes)
A
• Endocrine function
o DM pt at risk of hyper and hypoglycemia
o Hypoglycemia may dev during anesthesia or postoperatively from inadequate CHO or excessive insulin
o Hyperglycemia inc risk of wound infection – can result from stress of sx (which causes inc release of catecholamine)
o Strict glycemic control = better outcomes; pt with controlled DM at no greater risk than pt without DM
o Frequent bgm before, during, and after sx
o Corticosteroid use in yr prior important as may lead to adrenal insufficiency
o Pt with uncontrolled thyroid disorders at inc risk of thyrotoxicosis (hyperthyroidism) or respiratory failure (with hypothyroidism)
20
Q
what do you assess preop in relation to immune fx
A
• Immune fx: allergies, sensitivites, if immunodeficiency d/t chemo, HIV, etc requires vigilant monitoring for slight signs of infection (raise in temp. etc)
21
Q
what kind of meds would you tell pt to d/c preoperatively
A
• Previous medication use: get complete hx; aspirin must be discontinued 7-10days prior to sx, esp if bleeding would be significant complication (brain, spinal sx); natural health products (NHP) discontinued 2-3wk prior…includes vitamines, remedies…potential effect on coagulation, etc.
22
Q
preop spiritual beliefs. how to assess politely? why might these beliefs be important?
A
o Nonthreatening approach is to ask pt if his/her spiritual advisor knows about the impending sx•
o Spiritual beliefs important in how people cope with fear and anxiety
o Spiritual beliefs can be as therapeutic as medication
23
Q
t or f: always give detailed explanation during pt teaching
A
false. not all pts want to know the details of their surgery
24
Q
what type of preop teaching to provide. why?
A
DB and couging -mobility skin prep (if they must do it themselves) cognitive coping strategies elderly pain mgmt
the pt may be too uncomfortable to learn these later. or too anxious
25
elderly pain mgmt considerations
what kind of knowledge deficit might they have?
how is their anxiety level often different?
• Elderly pain management: elderly often have more preop anxiety…therefore inc amount of therapeutic touch, encourage family members to be present; must teach about benefits of pain management b/c may see as normal part of aging;
26
what kind of meds might they give preop
abx
| and maybe a preanesthetic med (leave them w side rails up)
27
would it be best to tell pt of possible need of ventilator, drainage tubes, etc?
yes it can dec postop anxiety
28
immediate preop nursing interventions
* Pt puts on gown, left untied and open in back
* Patient with long hair braids it, remove hairpins, cover head completely with paper cap
* Mouth inspected, dentures or plates removed-aspiration precaution
* Jewelry removed to reduce injury – if insists, may secure rings to finger with tape
* All pts except those with urologic disorders void immediately before – particularly important in maintaining continence during low abdominal sx and to make abdominal organs more accessible
* Catheterization performed in OR as necessary
29
when should pt be brought to presurgical area
what should this area look/be like
• Transporting pt to presurgical area: usually 30-60min prior; ensure enough blankets; quiet area to max anesthetic effect; unpleasant sound and conversations limited because may be misinterpreted by sedated pt
30
what might you want to tell family regarding pt in sx
• Ensure family knows that length of surgical procedure does not indicate its severity, are often delays, long preparations, etc
31
what are nursing duties during admission to surgical center
• Admission to surgical center: completes preoperative assessment, assesses for risks of postoperative complications, verifying consent, explains phases in perioperative period
32
summary of nursing duties in intraop phase
* Maintenance of safety: maintains septic environment, manages equipment, transfers pt to operating table and positions, applies ground device to pt, does surgical instrument count
* Physiologic monitoring
* Pyschological support (before induction and when pt is conscious)
33
how does alcohol abuse affect pt postop if pt stops drinking
• Alcohol withdrawal syndrome or delirium tremens can be expected 48-72hrs of stopping thi has serious negative outcomes in postop pt
34
teaching surrounding deep breathing and coughing and IS
o Promote optimal lung expansion and resulting blood o2 after anesthesia
o Teach to splint thoracic or abdominal incision to minimize pressure and pain
o Inform pt that pain medication is available and best taken regularly so these exercises can be completed
o If patient does not cough effectively, atelectasis and pneumonia can occur
o Deep breathing stimulates the cough reflex
35
when should you ideally begin teaching about positioning
before sx
36
exercises to prevent postop complications
```
diaphragmatic breathing
coughing
leg exercises
turning to the side (practice DB/C on this side)
getting out of bed
```
37
how to splint and abd incision
plae palms of hands together over incisional site as
38
what to tell pts generally about how much they can eat before surgery/how close to surgery theyll be NPO
* Major purpose of withholding fluids and food before sx is preventing aspiration
* Now trend towards food for longer-many pts allowed clear liquids up to 2hrs before a procedure
* Cleansing enema or laxative typically used for abdominal or pelvic surgery – allows satisfactory visualization of surgery site, prevents trauma to intestine or contamination of peritoneum by fecal material
39
skin prep for surgery
• Skin prep: if nonemergent sx, may be instructed to wash skin with germicide detergent several days before sx to reduce skin organisms
40
what are immediate preop nursing responsibilities
prep pt with gown, braid hair, take out dentures, jewelry etc
- may give preanaesthetic meds
- transport to OR
41
preanaesthetic med considerations
what type of pt gets them
how soon before sx are they given
• Administering preanesthetic med: is minimal with ambulatory (same day) or outpatient surgery – if given, will be in preoperative waiting area; pt left in bed with side rails up after admin because may become lightheaded; quiet surroundings to promote relaxation
o Often OR time is delayed, etc…med will be given “on call to OR”, nurse has med ready to admin as soon as call is received by OR staff; given before all other preop care so has 15-20min to kick in
42
cues stop at intraoperative notes
general overview of scrub nurse
43
scrub nurses role
• THE SCRUB ROLE
o Performing surgical hand scrub, setting up sterile tables, preparing sutures, ligatures, and special equipment
o Assists surgeon and surgical assistants during procedure by anticipating instruments and supplies that will be required
o Counts equipment while incision is closed
o 1 sponge count before, 2 after procedure
44
circulating nurse responsibilities
-helping w pt positioning
-prep pt skin for sx
-managing surgical specimens
-anticipating needs of surgical team
-documenting
• THE CIRCULATING NURSE
o Works in collaboration with team to plan best course of action for pt
o Leadership role, manages OR and protects pt safety and health by monitoring activities of surgical team, checking OR conditions, continually assessing pt for signs of injury
o Main responsibilities: verifying consent, coordinating the team, ensuring cleanliness, proper temperature, humidity, lighting, safe function of equipment, availability of supplies and materials
o Monitors aseptic practices to avoid breaks in technique while coordinating movement of related, as well as implementing fire safety precautions
o Monitors pt
o Responsible for ensuring second verification of surgical procedure and sites takes place
45
other than fears and risks what doe the surgical patient lose during surgery
their protective reflexes, consciousmess, pain, ability to communicate
46
do older adults need more or less anaesthetic
what changes are happening in their bodies regarding meds/metabolizing etc
o Older adult needs LESS anesthetic d/t dec tissue elasticity (lung and cardio systems) and reduced lean tissue mass-difficult to metabolize the anaesthetics
o Often experience longer duration of effects
o Less plasma proteins = more of drug remains free or unbound = more potent effect
o Older adult tissue made up predominantly of water while those rich in blood supply (liver, kidneys) shrink = reduced metbolism and excretion of meds
47
cardio/resp considerations and risks for o adult surgical pt
o Age alone confers enough surgical risk that it is clinical predictor of cardiovascular complications
o Cardiovascular and pulmonary changes: aging heart and blood vessesl have dec ability to respond to stress, dec CO makes more susceptible to changes in circulating volume and blood O2 levels sudden prolonged dec in BP = risk for cerebral ischemia, thrombosis, embolism, infarction, anoxia
48
other body systems of o adut that put them at risk during surgery and considerations about these changes
o Impaired ability to speed metabolism and reduced thermoregulatory mechanisms = inc risk of hypothermia
o Bone loss necessitates careful manipulation during sx
o Reduced ability to adjust rapidly to emotional and physical stress influences surgical outcomes and requires meticulous observation of vital functions
o *can get pressure sores
o *d/t dec body mass theyre at risk of hypothermia
o ALL OF ABOVE = inc risk of perioperative morbidity and mortality
49
what may result from difficut intubation
laryngeal trauma,
oral trauma
broken teeth
50
what is a "time out" and when does it occur
prior to induction of anesthesia all members of the surgical team verify the pt name, procedure, surgical site
-all team members introduce self
-surgeon, anesthetist, nurse verbally confirm pt site, procedure
anticipated or critical events are reviewed (surgeon r/t procdure, anesthesia r/t pt specific concerns. NURSE: sterility confirmed, equipment fx, concerns)
-Abx prophylaxis in last 60 minutes
-is essential imaging displayed
51
WHO surgical safety checklist what happens before incision or anesthesia (this is called the sign in and happens before the timeout)
```
pt confirmed
site marked
anesthesia checklist completed
pulse oximeter on pt
allergy
difficult airway/aspiration risk
risk of >500ml blood loss
```
52
WHO surgical checklist sign out
nurse verbally confirms with team
- name of procedure recorded
- instrument, sponge and needle counts are correct
- how the specimen is labelled
- whether there are any equipment problems that need to be addressed
-surgeon, nurse, anesthesitist review key concerns for mgmt and recovery for pt
53
• THE REGISTERED NURSE FIRST ASSISTANT
• THE REGISTERED NURSE FIRST ASSISTANT
o Practices under direct supervision of surgeon
o Responsibilities: handling tissue, providing exposure at operative field, suturing, maintaining homeostasis
54
how is the surgical zone divided and why
divided to help decrease microbes
1) Unrestricted zone: street clothes allowed
2) Semi-restricted zone: scrub clothes and caps
3) Restricted zone: scrub clothes, shoe covers, caps, and masks worn
o Top and drawstrings tucked inside pants, wet or soiled garments changed
o Masks worn at all times in restricted zone
o Masks never left hanging around neck, not to be worn outside OR or form one pt to other
o Only personnel who have scrubbed, gloved, and gowned are allowed to touch sterilized objects
o Area considerably larger than requiring exposure during sx is meticulously cleansed and antiseptic solution applied
o Temp maintained at 20-23 degrees, 30-60% humidity
55
what is anesthesia
• Anesthesia = state of narcosis (severe CNS depression produced by pharmacologic agents), analgesia, relaxation, and reflex loss
56
general anesthesia
General anesthesia:
• Pt is not arousable, even with painful stimulation
• Lose ability to maintain ventilatory function and require assistance in maintaining patent airway
• May have impaired cardiovascular fx
57
who is at risk of being awake during general anesthesia
what is this called
• Rare potential for pt being partially awake (phenomenon called anesthesia awareness); those at greatest risk of this are cardiac, obstetric, and major trauma pts
58
4 stages of general anesthesia stage 1
o Stage I: beginning anesthesia
As pt breathes in anesthetic mixture, warmth, dizziness, and feeling of detachment may be experienced
-May have ringing, roaring, or buzzing in ears
-Still conscious but not able to move extremities easily
-Noises become exaggerated (avoid unnecessary noise)
59
general anesthesia stage 2
o Stage II: excitement
Characterized by struggling, shouting, talking, singing, laughing, crying
Often avoided if anesthetic is administered smoothly and quickly
Pupils dilate but constrict if exposed to light
Pulse rapid, resps irregular
Someone at the ready to help anesthesiologist with restraining pt
60
general anesthesia stage 3
Stage III: surgical anesthesia
Reached by continued admin of vapor or gas
Pt unconscious
Pupils small and contract with light
Resps regular, pulse rate and vol reg
Skin pink or lighty flushed
May be maintained for hours, ranging from planes 1-4 depending on depth of anesthesia needed
61
general anesthesia stage 4
o Stage IV: Medullary depression
Reached if too much administered
Resps shallow, pulse weak and thready, pupils widely dilated and will not long constrict
Cyanosis develops
Death if no intervention
Anesthetic agent rapidly removed and life saving measures begin
Stimulants or narcotic antagonists may be administered
62
stage 4 general anesthesia
o Stage IV: Medullary depression
Reached if too much administered
Resps shallow, pulse weak and thready, pupils widely dilated and will not long constrict
Cyanosis develops
Death if no intervention
Anesthetic agent rapidly removed and life saving measures begin
Stimulants or narcotic antagonists may be administered
63
what can cause skipping of some stages of general anesthesi
• When narcotics and relaxants administered, several stages are absent
-stage 2 may be absent if administered quickly
64
how are general anesthesia given. start with small amount and go bigger?
IV or inhaled
• Agents are inhaled or given IV in general anesthesia
• Large doses during induction and early maintenance phases as med is deposited into body tissues
65
how can general anesthesia cause sedation/unconsciousness
• Delivered to brain at high partial pressure that enables them to pass over BBB
66
if pt has lots of peripheral circulation how is general anesthesia dose affected
• Dose need increase with increased peripheral blood flow
67
general anesthesia by inhalation which drug is most commonly used that is a gas anaesthetic
how can this be given
• Inhalation: from gas or volative liquid; usually combined with oxygen and nitrous oxide; can be administered several ways (LMA, nasal or oral endotracheal catheter)
o Nitrous oxide: most commonly used gas anesthetic agent
68
if pt were to vomit during surgery what would prevent their lungs from material
o Endotracheal tube (nasal or oral) seals off lungs from esophagus so if pt vomits, stomach contents do not enter lungs
69
nitrous oxide advantages
- induction and recovery is rapid
- nonflammable
- useful w 02 for short procedures
- useful w other agents for all sx
70
nitrous oxide disadvantages
poor relaxant
weak anaesthetic
may produce hypoxia
71
nitrous oxide implications/ consideration (med surg 4720
- most useful in conjunction w other agents w longer action
| - monitor for chest pain, HTN, stroke
72
inhalation or IV admin of anesthetic which is more pleasant and why
IV anesthesia Advantage is that is more pleasant – no buzzing, roaring or dizziness associated;
- duration is brief and individual awakens w/ little nausea or vomiting
- require little equipment
- easy to admin
- good for short procedures
73
what kind of substances can be used for IV anesthesia
is IV anesthesia for inducing or maintaining anesthesia
is it used separately from inhaled
o Various substances used: barbituates, benzodiazepines, nonbarbituate hypnotics, dissociative agents, and opioids
o Can be used to induce or maintain anesthesia
o Can be used along with inhaled
74
regional anesthesia is
* = anesthetic agent injected around nerves so that region supplied by these nerves is anesthetized
* Effect depends on type of nerve involved
* Pt is awake and aware of surroundings, unless sedated or given anti-anxiety
75
are motor or sensory nerves more easily affeted by regional anesthesia
• Blocks sympathetic nerves more easily than motor
76
are epidural or spinal doses larger and why
o Doses much higher than spinal anesthesia (injected into subarachnoid space) b/c med does not make direct contact with spinal cord
77
epidural anesthesis. where is this given
what does it block
o Inject local anesthetic into epidural space that surrounds dura mater
o Blocks sensory, motor, and autonomic functions
78
advantage and disadvantage of epidural vs spinal
o Advantage: Does not result in headache that can result from spinal anesthesia (Maria directly contradicted this saying that because the needle is much larger, if there is a mistake in insertion there can be a much larger leakage)
o Disadvantage: greater technical challenge to inject it here
79
what happens if during epidural admin the dura is accidentally punctured
how to tx
the anesthetic may travel to head. if it does, high spinal anesthesia can occur this leads to severe HoTN, resp depression, arrest
tx: airway support, IV fluids, vasopressors
80
___ isis the practice of administering minimial doses of multiple anaesthetic drugs to achieve the desired level of anaesthesia for the given surgical procedure
why is this beneficial
balanced anaesthesia
• The combining od several diff drugs makes it possible for GA to be accomplished using smaller amounts of anaesthetic gases (dec the negative effects such as nausea vomiting and confusion)
81
what is a genera anaesthetic
• Drug that induces a state in which the CNs is altered so that varying degrees of pain relief, depression of consciousness, sk muscle relaxation, and reflex reduction are prod
82
examples of general anaesthetics & their routes
propofol-IV
nitrous oxide-gas thats inhaled
isoflurane-volatile liquid thats inhaled
83
MOAof general anaesthetics
varied. Something to do with the lipid solubility and how this allow it to cross te BBB
Propofol is unclear
84
how can gen anaesthetics cause death
- orderly, systematic dec of sensory and motor CNS and spinal fx.
- therapeutic levels cause some medullary depression but excess shuts down medularry centres and causes resp and circ failure
85
moderate or conscious sedation
used for what
what is the goal
how are they monitored
Moderate Sedation
• Previously called conscious sedation
• For relieving pain and anxiety
• Increasingly used for small surgical procedures
• Goal is to depress LOC enough to carry out procedure while ensuring comfort of pt
• Monitored with pulse oximetry, ECG, and frequent vital signs
86
pt's state during moderate sedation
• Pt able to maintain patent airway, retain protective airway reflexes, and respond to verbal and physical stimuli
87
what is local anesthesia and when is it used
advantage
* Injected into tissues of planned incision site
* they interfere w nerve transmission in specific areas of the body, bloking the area that theyre applied to
* often used when loss of consciousness, muscle relaxation or loss of responsiveness isn’t desirable (eg during pregnancy), dental procedures, spinal anesthesia, suturing of skin lacerations, diagnostic procedures
* Advantages: Simple, economic and non-expensive; equipment is minimal; postop recovery period is brief; avoid undesirable effects of general anesthesia;
* Is preferred method of anesthesia if possible
88
who is not suited fr local anesthesia
other disadvantage
* Can be impractical d/t needing many injections
| * Not suitable for those with high anxiety
89
what is local anesthesia often given with that prolongs its use
how long does local anesthesia last in general
* Often given in combo with epinephrine (which causes vasoconstriction, preventing rapid absorption, and thus prolonging the local effect) – rapid absorption into bloodstream can also causes seizures
* Lasts 45min to 3 hours
90
where does intrathecal anesthesia go
into subarachnoid space
91
neuromuscular blocking agent
when is it used
what eqp do you need
* Often used with anaesthetics for surgical procedures
* Used during abdominal and thoracic, Helps w intubation
* Main use is maint of controlled ventilation
* Useful when muscle tissue is part of surgery
• Pt cant breathe while on these (mechanical ventilation nec)
92
how do neuromuscular blocking agents work (succinylholine in this case which may be slightly diff from others)
• Succinylcholine works similarly to Ach but its metabolized much more slowly, the Suc. Combines with cholinergic receptors at motor endplate of muscle nerves.. this allows repolarization and further muscle contraction to be inhibited. This paralysis can be preceded by muscle spasms. Has short duration of action
in gen NMBA are to cause muscular paralysis
93
what might pt experience with NMBA in terms of onset and recovery of effect
• NMBA effects in order: first sensation=muscle weakness, total flaccid paralysis starting infingers and eye then in trunk, neck, limbs, intercostals and diaphragm. When coming out from this the recovery is in the reverse order.
94
how dangerous are NMBA
v dangerous. side effects can be bad
* Key is to use only enough of the durg to block the neuromuscular receptors or else you have side effects
* Can cause HoTN, tachycardia, release of histamines, hyperkalemia, muscle fasciculations, muscle pain, malignant hyperthermia
* If overdosed the concern is prolonged paralysis needing mechanical ventilation; cardiovascular collapse
95
what must you assume when pt is on NMBA
• Does not have sedation or pain control effects (assume pt is anxious and in pain when on these meds)
96
intraop complications that we foused on
```
N and V
anaphylaxis
hypoxia and other resp problms
hypothermia
malignnant hyperthemrrmia
```
97
what do if pt gagging (abt to vomit)
o If gagging, pt turned to side, head of table lowed, basin provided to collect vomitus; suction used
98
what will happen if pt aspirates vomit
o If vomitus is aspirated, asthma-like attack with severe bronchial spasms and wheezing triggered pneumonitis and pulmonary edema can develop, leading to extreme hypoxia
99
what is given preop for N and V
| examples
-antacid (eg sodium citrate) o Pt may be given antacid to inc acidity (b/c acidic = more damage if aspirated)
-ranitidine (an H2RA) is given preop as well
o Antiemetics given by anesthesiology preoperatively sometimes to prevent aspiration
100
what resp complications can occur and why
what is critical to monitor (part of checklist)
• Hypoxia and other resp complications
o Inadequate ventilation, occlusion of the airway, inadvertent intubation of the esophagus, and hypoxia = sig potential complications of general anesthetic
o Resp depression d/t anesthetic, aspiration of resp tract secretions or vomitus, and pt position on OR table all have potential to compromise gas exchange
o Asphyxia d/t foreign bodies in mouth, spasm of vocal cords, relaxation of tongue, or aspiration all possible
o Monitoring O2 sats key (done by anesthesiologist and circulating nurse)
101
intraop hypothermia
why is this angerous
why does it occur
if it happens how do you correct it
• Hypothermia
o Pt temp during anesthesia may drop – glucose metabolism reduced, metabolic acidosis may result = hypothermia (core temp
102
what is malignant hyperthermia
what do if it occurs
• Malignant hyperthermia
o Rare inherited muscle disorder that is chemically induced by anesthetic agents\
o Patho: involves altered mechaniss of calcium fx in skeletal muscle cells; hypermetabolism d/t disruption of calcium causes muscle rigidity and hyperthermia, subsequent damage to CNS
o Need to recognize symptoms and discontinue anesthesia promptly, manage other symptoms
o Usually manifests 10-20 mins after induction of anesthetic, may present up to 24hrs post-op
103
mnfts of malignant hyperthermia
o Earliest sign typically tachycardia; see ventricular dysrhythmia, hypotension, dec CO, oliguria, cardiac arrest, generalized muscle rigidity (often seen in jaw)
-inc temp is late sign
104
who is at risk of malignant hyperthermia
o Those susceptible: those with strong and bulky muscles, hx of muscle cramps or weakness and unexplained temp elevation, unexplained death in family during sx d/t febrile response
-pt on succinylcholine or isoflurane
105
what type of preop prep should be done regarding blood?
- blood cross matching and have several litres avilable
| - as part of WHO checklist during sign in they assess if there will be blood loss >500ml
106
if pt had CSF headache how could you treat it
if a person develops a spinal headache following a procedure, the anesthesiologist can create a blood patch with the person's blood to seal the leak. To administer a blood patch, the anesthesiologist inserts a needle into the same space as, or right next to, the area in which the anesthetic was injected. The doctor then takes a small amount of blood from the patient and injects it into the epidural space. The blood clots and seals the hole that caused the leak.
less invasive but with little evidence to support them
- also will enourage fluids. maybe IV?
- may give caffeine? not sure why
- rest. this may make more sense becuse standing aggravates it.
107
after epidural how is BP affected and why. what goes along with this BP change
what can be given to dec this effect
how can you help prevent a fall.
* These drugs cause significant vasodilation
* Theres no muscle tone, blood pools in extremities and is no longer in the important blood vessels
* Pt may not be able to feel their legs and may feel nauseous.
* After giving pt epidural you may need to put them lying down so they don’t barf
* Often in Iv orders theyll have “give IV bolus”
108
is it preferable to use spinal or epidural with o adult and why
spinal d/t dec amount of med meaning there is a dec risk of CNS, resp, cardiac complications
109
what lasts longer spinal or epidural. which is stronger
| which is OFTEN given continuously
spinal is shorter and stronger
epidural is given continuous sometimes
110
does a spinal or epidural allow you to feel more
epidural
111
pts epidural or spinal insertion site drsg care how often
assess dry and intact q4h
