Hypersensitivity, CNS depression, shock, coma, narrow-angle glaucoma, seizures, alcohol intoxication, liver impairment, pregnancy, lactation
Caution: Hepatic or renal dysfunction, suicidal ideation
Experts agree that older adults should not be placed in a physical restraint or sedated just because they are old. Use alternatives 1st
. However, if all other interventions (e.g., reminding patients to call for assistance when needed; asking a family member to stay with patients) are not effective in fall prevention, a physical restraint may be required for a limited period. Check the patient in a restraint every 30 to 60 minutes, and release the restraint at least every 2 hours for turning, repositioning, and toileting. vests have caused serious injury and even death.
Using Restraint Alternatives
• If the patient is acutely confused, reorient him or her to reality as often as possible.
• If the patient has dementia, use validation to reaffirm his or her feelings and concerns.
• Check the patient often, at least every hour.
• If the patient pulls tubes and lines, cover them with roller gauze or another protective device; be sure that IV insertion sites are visible for assessment.
• Keep the patient busy, with an activity, pillow or apron, puzzle, or art project.
• Provide soft, calming music.
• Place the patient in an area where he or she can be supervised. (If the patient is agitated, do not place him or her in a noisy area.)
• Turn off the television if the patient is agitated.
• Ask a family member or friend to stay with the patient at night.
• Help the patient to toilet every 2 to 3 hours, including during the night.
• Be sure that the patient's needs for food, fluids, and comfort are met.
• If agency policy allows, provide the patient with a pet visit.
• Provide familiar objects or cherished items that the patient can touch.
• Document the use of all alternative interventions.
• If a restraint is applied, use the least restrictive device (e.g., mitts rather than wrist restraints, a roller belt rather than a vest).
purpose :e valuation and stabilization of patients to anticipate, prevent, and manage complications after surgery.
Other criteria for discharge (e.g., stable vital signs; normal body temperature; no overt bleeding; return of gag, cough, and swallow reflexes; the ability to take liquids; and adequate urine output)
During the postoperative period, all patients remain at risk for pneumonia, shock, cardiac arrest, respiratory arrest, clotting and (VTE), and GI bleeding. .
When the patient is admitted to the PACU, immediately assess for a patent airway and adequate gas exchange. Although some patients may be awake and able to speak, talking is not a good indicator of adequate gas exchange
-Cardiac sounds/vitals every 15 min
RR <10 could mean opioid/anesthesic respiratory depression
(IV and inhalation)
depresses the CNS, analgesia , amnesia , and unconsciousness, with loss of muscle tone and reflexes. The patient is unconscious and has no sensory perception. General anesthesia is used most often in surgery of the head, neck, upper torso, and abdomen.
-retching, vomiting, restlessness
-shivering, rigidity, slight cyanosis
(conscious sedation) is the IV delivery of sedative, hypnotic, and opioid drugs to reduce sensory perception but allow the patient to maintain a patent airway.
action is short, and the patient has a rapid return to ADLs. Etomidate (Amidate), diazepam (Valium, Vivol , Novo-Dipam ), midazolam (Versed), fentanyl (Sublimaze), alfentanil (Alfenta), propofol (Diprivan), and morphine sulfate are the most commonly used drugs. The airway, level of consciousness, oxygen saturation, capnography (measure of carbon dioxide level), ECG status, and vital signs are monitored every 15 to 30 minutes until the patient is awake and oriented and vital signs have returned to baseline levels.
The dorsal recumbent (supine), prone, lithotomy, and lateral, trendelenberg, jackknife positions are most often used for surgery.
For example, patients in the lithotomy position may develop leg swelling, pain in the legs or back, reduced foot pulses, or reduced sensory perception from compression of the peroneal nerve.
The nurse ensures proper padding and position changes at regular intervals. assesses circulation adequacy by checking pulses and capillary refill below pressure points. Throughout surgery, the nurse prevents obstruction of circulation, respiration, or nerve conduction caused by tight straps, poorly placed pads and pillows, or the position of the bed.