CHAPTER 5: PERIOPERATIVE PATIENT CARE: ANESTHESIA & NURSING IMPLICATIONS QUESTIONS AND ANSWERS WITH SOLUTIONS 2024

CHAPTER 5: PERIOPERATIVE PATIENT CARE: ANESTHESIA & NURSING IMPLICATIONS QUESTIONS AND ANSWERS WITH SOLUTIONS 2024 General Anesthesia -Emergency Assessments -Post Op Assessments - ANSWER Unconsciousness with amnesia, analgesia, reflex suppression, and muscle relaxation. - Cricoid Pressure may need to be used - Apply warm blankets pre and post op for shivering - Emergency assessments include airway patency, return of the reflexes, muscle strength, ability to follow commands. - Post Op Assessment: LOC, airway patency, CV status, temp, fluid balance, return of neuro function. Assess for Nausea and vomiting, post -operative analgesia, operative site condition. Cricoid Pressure - ANSWER During induction of general anesthesia - may need to apply CRICOID pressure to displace the cricoid cartilage and close the esophagus when passing the ET tube to decrease the risk of aspiration - Assess for bilateral breath sounds after passing the ET tube. Regional Anesthesia 2 types Signs and Symptoms of Toxicity Management of Toxicity - ANSWER Local anesthetic acts on cell membrane, interrupting sensory pathways between surgical site & brain. Lidocaine Hcl (Xylocaine) acts for 1 -3 hours. Bupivacaine (Marcaine) - 3-10 hours Signs and Symptoms of toxicity: CNS first affected, THEN CV affected ---> drowsiness, numbness tongue, blurred vision, tinnitus, dizziness, restlessness, slurred speech, muscular twitching, followed by convulsions. Also Hypotension, bradycardia, heart bloc k, cardiac arrest can occur. Management of the above includes: STOP administation of local anesthetic, resuscitation with epi, 02, IVF, aminophylline & hydrocortisone. Lidocaine Hydrochloride (Xylocaine) - ANSWER Regional anesthesia - Acts 1 -3 hours - commonly used for infiltration, regional IV anesthesia, peripheral nerve block, epidurals, and spinal. Bupivacaine (Marcaine) - ANSWER Regional anesthesia - Acts for 3 -10 hours - commonly used for infiltration, regional IV anesthesia, peripheral nerve block, epidurals, and spinal. Infiltration Techniques: Local infiltration - ANSWER Local: subcutaneous injection at the operative site. Provides sensory blockade of skin & subcutaneous tissue. Infiltration Techniques: Intravascular Techniques & Nursing considerations. - ANSWER aka Bier Block - Used for surgeries below elbow or knee. Double bladder tourniquet applied to operative extremity & inflated. Local anesthetic is injected into the distal peripheral vein which provides blockade to the level of the tourniquet. Tourniquet Time is Crucial - Cannot be less than 30 minutes and greater than 90 minutes in UE and 2 hours in LE (can cause ischemia). Must deflate the tourniquet slowly to prevent systemic bolus. Must assess for return of normal senstation, color, cap refill. Peripheral Nerve Blockade Name the block used for each type: Upper Extremity Knee Foot & Toes - ANSWER Sensory and motor nerve blockade due to local anesthetic injected around major nerve trunk that supplies the surgical site. Upper Extremity: Brachial Plexus Block Knee: Femoral Block Foot and Toes: Ankle Block Nursing Considerations: Postop: assess for return of sensory and motor function. If able to ambulate, support the LE until recovery is complete - use resistive device for ambulation.