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N1 Anesthesia and moderate sedation
Terms in this set (38)
Risk factors for general anesthesia?
Familyhistory of malignant hyperthermia
Gastric Contents (risk of aspiration)
Alcohol or substance abuse
Risk factors for Local Anesthesia?
Allergy to ester-type anesthetics
Alterations in peripheral circulation
What is the most common anesthetic used and how is it administered?
Propofol, administered IV
What are contraindications for propofol?
Contraindicated in patients with an allergy to soybean oil or eggs.
How do you eliminate inhalation anesthetics?
By exhalation which is why post operative patients are administered oxygen and encouraged to take deep breaths.
What is a priority in the induction phase of general anesthesia?
Securing airway patency, administration of preoperative medications
Why are medications administered with the anesthetic?
For sedation purposes and to relieve preoperative and postoperative pain.
S/E of administering opioids with the anesthesia?
CNS depression, delays awakening post surgery, constipation or urinary retention, n/v
What are patients given with the anesthesia to help reduce preoperative anxiety (mild sedation)?
Benzodiazepines (Diazepam, Midazolam)
Why are patients given a neuromuscular block?
To help with skeletal muscle relaxation, airwayplacement
What do you do if hypotension occurs from a medication?
Lower the head of the bed, administer IV fluid bolus and monitor the patient.
What is Malignant hyperthermia?
A inherited muscle disorder that anesthesia induces chemically. Symptoms present as increase CO2 levels, decreased O2 sat., tachypnea, cyanosis, skin mottling, muscle-cell protein in the urine. The last manifestation is an extremely elevated temperature.
What do you do if your patient starts showing s/s of malignant hyperthermia?
Stop the surgery and administer a muscle relaxant (dantrolene) and 100% O2, infused an iced 0.9% saline solution, apply cooling blankets, ice, and insert an indwelling urinary catheter to monitor the output of the presence of blood.
What type of medication is given concurrently with local anesthesia to prolong its infects and decrease the risk of systemic toxicity?
A vasoconstrictor is given (typically epinephrine)
What can prolonged vasoconstriction lead to?
What type of local anesthesia is one that you inject into or around specific nerves?
Regional nerve block
Reginal nerve block (spinal)
Inserted into CSF. Monitor for hypotension, bradycardia, N/V Risks of CSF leakage - manifests with a severe headache when the HOB is elevated.
Who are at risk of a CSF leakage and what do you do if this occurs?
Patients recieving a spinal or epidural local anesthetic are at risk for CSF leakage. This causes a severe headache when the HOB is elevated and therefore you should keep the HOB flat to promote the dura tear to seal, provide a quiet environment and keep the patient well hydrated to help replace the CSF loss.
What puts a patient at risk for an OD of anesthesia?
Poor liver or kidney function
What nursing action can you take to help prevent unrecognized hypoventilation?
Monitor end-tidal carbon dioxide levels
What are the manifestations of a systemic toxic reaction?
Headache, blurred vision, metallic taste, CNS depression.
If patients present the manifestations of a systemic toxic reactions, what do you do?
Establish airway patency and administer oxygen. Then notify the anesthesiologist and the surgeon. Monitor and report lab values
What type of sedation keeps the patient comfortable during the procedure but able to independently maintain the patency of their airway, respond to verbal stimuli and retains their protective reflexes?
What type of procedures might a anesthesiologist use moderate sedation for?
Dental surgeries, endoscopy, sutures, dressing changes, placement and removal of implanted devices, catheters and tubes.
Risk factors for older adult patients?
Decreased liver and kidney function
Decreased wound healing
Cardiac and respiratory problems can arise faster
What are priority medications a patient is taking that you would need to know about before surgery?
Opioids, diuretics, antihypertensives
How long should a patient remain NPO prior to surgery? How long before the surgery should a client stop drinking clear liquids?
NPO for at minimum 6 hours prior to surgery
No clear liquids for a minimum of 2 hours prior to surgery
During a moderate sedation procedure, what is it important for the nurse to constantly be assessing?
LOC (glasgow coma score), cardiac rhythm, respiratory status, VS.
What is the typical discharge criteria?
Back to the LOC that they were on admission
VS stable for 30-90min
Ability to cough and breathe deeply
Ability to tolerate oral fluids
ABility to urinate
No n/v, SOB, or dizziness
No obvious bleeding
When do you keep the emergency equipment at a patients bedside?
Before, during and after the procedure.
What do you do if you pt has an airway obstruction, cardiac dysrhythmias, hypotension or anaphylaxis?
Insert an oral airway and suction
What do you do if your patient has respiratory depression?
administer O2 and reversal agents such as naloxone (narcan) and insert an oral airway and suction
What do you do if your patient has cardiac dysrhythmias?
Obtain a 12-lead ECG and provide antidysrhythmics and fluids
What do you do if your patient has hypotenstion?
Provide fluids and vasopressors
What do you do if your patient is anaphylatic?
If a patient is experiencing hypotension and an increased pulse do to midazolam that was administered IV. What IV medication should the nurse administer?
What is the greatest risk of a patient receiving nitro oxide by face mask?
The greatest risk is hypoxia and therefore the nurse should assess oxygen sat. levels if the pt presents any hypoxic manifestations.
What is Dantrolene?
A muscle relaxant used if a pt has malignant hyperthermia.
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