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what should you as a nurse check for postanesthesia?
abc, asses for aspiration, v/s 20-30 min, admis o2 therapy, assess incisions, suction as needed
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what should aldrete score meet before leaving unit?
8 and nurse should document
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4 stages of anethesia?
analgesia, delirum, surgical analgesia, resp paralysis
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beings with the admin of the anesthesia and last until loss of consciousness
stage 1
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pt moves, mumble, sounds are amplified, if surgery is attempted pt woud physically react but not remember it
stage 2
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differentiation is made upon eval, resp, eye contact and pupil size
stage 3
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4 substages of this anethesia stage?
stage 3- light, 2 and 3 are ready for surgery and 4 is deep
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stage of resp paralysis, dangerous stage due to risk of resp arrest and cessation of v/s
stage 4
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how are anethesia readings based to monitor the pt?
on BIS monitor, gives therapeutic range of numbers to determine
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role of the nurse for preanethesia?
lab results, chart for consent, asst physician, remove all jewelry, insert cath, NG, etc and instruc pt on remining in bed for safety
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what drug can be admin alone or with other drugs preop or as analgesic post op?
fentanyl
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why are skeletal muscle relaxants used?
to produce relaxation of the muscles during surgeries such as chest or abd, to facilitate intubation
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ex of skeletal muscle relaxants?
Tracirum, nimbex, mivacron, pavulon, anectine
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what other drugs are used for anethesia?
gases (nitrous oxide- most common) and volatile gases are ethrane, fluthane, forane, penthrane, suprane, ultane
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unpleasant sensory and or emotional perception associated with actual or potential tissue damage?
subjective pain
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how should we rate pain for children?
with the wrong bakers faces
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whats SOAPIE?
subjective, objective, assessment, plan, intervention, evaluate
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pain relieving that inhibits the prostaglandins?
analgesic
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peripheral blood vessel dilater?
antipyretic
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also inhibits prostaglandins?
anti- inflammatory
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inhibits the aggregation of platelets and prolongs bleeding time?
anti-platelet
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what is the life of a platelet?
7-10 days
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acetylsalicylic acid or ASA?
asprin
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used for moderate pain, fever, inflammation, decrease risk of mi, cva, tias, to treat uterine placental blood flow?
asprin
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adverse reactions of asprin?
GI upset, heatburn, n/v, anorexia, GI bleeding, hives, rash, angioedema, bronchospask, asthma like symptoms, anaphylaxis
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toxicity reactoins of asprin?
tinnitus, impaired hearing, n/v, flushing, sweating, rapid deep breathing, tachycardia, diarrhea, confusion, lassitude (tired), resp depression, coma
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APAP or acetaminophen?
Tylenol
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adverse reactions of tylenol?
hives, hemolytic anemia, pancytopenia, hypoglycemia, jaundice
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toxicity symptoms of tylenol?
GI smpytoms
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how is toxicity handled on tylenol?
mucomyst by iv
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products containing APAP should be given cautiously to pt with whaat dysfunction?
hepatic and kidney
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pt with what disorder should be careful or not take asprin?
bleeding disorders
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these block the synthesis of prostaglandins and responsible for the synthesis of cycloxygenase 1 and 2
NSAIDS
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COX 1 does what?
helps maintain lining of the stomach
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COX 2 does what?
triggers pain and inflammation
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adverse reactions of NSAIDS?
n/v, dyspepsia, anorexia, dry mouth, constipation and diarrhea, epigastric pain, indigestion, abd distress, discomfrot and bloating, uslcers, stomatitis, jaundice, dizzy, somnolence, insomnia, confusion, decrease or increase BP, arrythmia, plyuria, hematuria, acute renal failure, taste change, rhinitis, neutropenia, tash, irritation, ecchymosis, purapura, steven johnson syndrome
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cataflam, advil, mortin, nuprin, orudis, mobic, aleve, anaprox, naprosyn, daypro
NSAID tade names
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derived from the inripe seed of the opum poppy
opiod analgesics
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treat moderate to severe pain
opiod analgesics
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names of opiod analgesics?
subimaze,(fentanyl), duragesic, dilaudid, demerol, dolophine, roxanol, ms contin, oxycotin, darvon, roxicodone, ultram
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binds to receptor and causes a response
agonist
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bind to a resceptor and cause no response
antagonist
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some drugs can be mixed with agonist and antagonist what are they?
stadol, nubain, talwin
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adverse reactions of agonist and antagonist?
MANY!!! dizzy, HA, hypotension, constipation, sedation, n/v, resp depression, miosis (pinpoint pupils), urticaria, pruritis and rash
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may be administered with other drugs for the same sedation effects and pain relief with caudal blocks
anesthetic adjuct
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primarily codeine
antitussive
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TMT of opiod dependence?
methadone, levomethadyl (opiates) and subutex (agonist and antagonist)
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choice of drug for an MI?
Morphine sulfate
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bind to opiod receptors and therefore block the reception of the opiod
opiod antagonist
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examples of opiod antagonist?
narcan, revex, naltrexxone
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natlrexone is used for what?
deritive of narcan and used for drug addicts
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how long do opiod antagonist last for in the body?
24-72 hrs
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uses for opiod antagonist?
post op resp depression, opiod adverse effect and overdose
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what should nurses monitor when on an opiod antagonist?
cardiac, resusitation equipment should be on hand, pt may vomit bc of resp rate and depth and to control pain
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loss of feeling or sensation?
anethesia
-
sensation free in an area or region, pt may be awake and sedated?
local anethesia
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sensation free all over the entire body, loss of consciousness, swallowing and gag reflexes?
general anesthesia
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how is local anethesia applied?
applied ot the skin, mucus membrane or open area, applied with cotton swab.
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can the nurse administer local anesthesia?
YES!
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what is local infiltration anesthesia?
its injected into a tissue, used for suturing, dental procedures, small incisions, superficial biopsies or lesion removal
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this ins an injection of med around nerves that prevents the transmission of painful nerve signals?
regional anesthesia
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drug injected into the sub-arrachnoid space of the spinal cord around L-2, it causes a loss of feeling and movement of the lower extremities, abd and perineum
Regional spinal anesthesia
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drug injected near or into a nerve trunk
regional conduction block
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ex of conduction blocks?
epidural, trans sacral brachial plexus
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role of the nurse before giving anesthesia?
reguard allergies, educate pt on admin and what to expect, prepare skin, observe the are and apply dressing
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what is give nto the pt before a surgery to pre sedate them?
opiod or anti- anxiety drug (giving these may decrease dose of anesthetic)
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what is something given to a pt before surgery and why?
cholinergic blocking drug and bc in decreases secretions to reduce aspiration risk
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why is an anitemtic given before surgery?
to reduce risk of vomitting
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frequently used pre-anesthetic drugs?
opiods, barbiturates and cholinergic blocking drugs
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nembutal and seconal?
barbiturates
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atropine, glycopyrrolate or robinul, scopolamine?
cholinergic blocking drugs
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antianxiety drugs with antiemetic properties?
hyproxzine (atarax, vistaril)
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Librium, valium, ativan, versed??
anti anxiety meds used for pre sedation drugs
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Droperidol or Inapsine??
sedative pre operation drug
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what type of drugs are used for general anesthesia?
barbiturates
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this is a short acting med that be used for infuction, short surgeries with little pain and in conjuction with other anesthetics
Methohexital, (Brevital)
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used to supplement other anesthetics for short procedures
Etomidate (amidate)
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used for induction and maintenance of anesthesia, sedation for a local block and a continuous sedation?
Propofol (Diprivan)
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short acting on the CNS, used to reduce anxiety, induction of anesthesia, conscious sedation
Midzolam (versed)
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rapid acting general anesthetic, produces a "stare", used for procedures that do not require muscle relaxation and used also to supplement other anesthetic drugs
Ketamine (ketalar)
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