Complex Exam 3
Anesthesia & moderate sedation pharm interventions/teaching *** 1. Antibiotics: reduce risk of
infection, one-time dose of IV antibiotic (ancef(Cefazolin), Vanco)
2. Analgesics: reduce pain (opioids, fentanyl, morphine, torodal, IV Tylenol)
3. Anticholinergics: decreases risk of bradycardia, reduces risk of aspiration by decreasing salvation
(atropine)
4. Anxiolytics: reduced anxiety, causes CNS depression causing sedation (benzos)
5. Anesthetics: cause complete sedation or paralysis (nitrous oxide)
- ALWAYS combined w oxygen
- Might cause buzzing noise in ears
- Ketamine: AVOID in schizophrenic pts
6. Antiemetics: given pre-op to help post-op with N/V (Phenergan, Ondansetron)
· Increases gastric emptying
· Phenergan causes sedation
Anesthesia and Moderate Sedation: Risk Factors *** General Anesthesia
- family history of malignant hyperthermia
- respiratory disease (hypoventilation)
- cardiac disease (dysrhythmias/decreased Cardiac Output)
- gastric contents (aspiration)- alcohol or substance use disorder
Local Anesthesia
- allergy to ester-type anesthetics
- alterations in peripheral circulation
Older adult clients are more susceptible than any other population to anesthetic agents (careful titration
and airway patency)
,Anesthesia and Moderate Sedation: Complications *** 1. MALIGNANT HYPERTHERMIA: an acute life-
threatening medical emergency that can be caused by anesthesia (commonly succs)
- a hypermetabolic condition causing an alteration in calcium activity in muscle cells (muscle rigidity-
locked jaw, hyperthermia, and damage to the CNS)
- 1st signs: increased CO2, decreased O2 sat, and tachycardia
- other s/s: dysrhythmias, muscle rigidity, hypotension, tachypnea, cyanosis
- LATE SIGN: extremely elevated temp as high as 111.2 degrees
Treatment: STOP surgery, give IV dantrolene, give 100% O2, infuse iced IV 0.9% NaCl, apply a cooling
blanket, put ice on the armpits, groin, neck, and head; and iced lavage
2. Anesthetic toxicity: increased in older adult clients (bc decreased liver and kidney function)
3. Unrecognized hypoventilation: monitor end-tidal CO2 level
4. Intubation problems: injury to teeth, lips, vocal cord
5. Anesthesia awareness: pre medicate w/ amnesic agent(benzos) & avoid muscle paralytics
Moderate Sedation: airway obstruction, cardiac dysrhythmias, respiratory depression, hypotension
Local Anesthesia *** makes a specific area numb; typically topical application to the skin or mucous
membranes
- not generally monitored
EX: lidocaine or procaine
Regional Anesthesia *** cause total paralysis; a block, but the patient is still awake
- Nerve blocks, epidural, and spinal
Moderate Sedation *** client is relaxed enough that the surgeon can perform minor procedures
without discomfort for the client, yet the client can respond to verbal stimuli, retains a gag reflex, and
has a patent airway
,General Anesthesia *** the patient is totally unconscious(not arousable/loss of response to stimuli);
airway is #1 priority and must be intubated
Anesthesia & moderate sedation nursing interventions *** - Prevent pressure injuries: positioning
- Protect skin/bony prominences, joints, nerves: maintain modesty & privacy as well
- DVT prevention (SCD)
- Educate patient to pee before
Preoperative nursing care risk factors *** · Weight
· Age
· Nutritional status
· Renal/hepatic disease/status
· Endocrine disease/function
· Cardiovascular disease/status
· Immune function/infection
· Pulmonary disease/status
· Electrolyte imbalances
"WAN RECIPE"
Preoperative Nursing Care: Assessment/Management of Care *** preparing the patient for surgery
- patient identification
- assess for allergies (shellfish, contrast, betadine, eggs, and latex)
- Head-to-toe: want baseline VS
- assess anxiety level and get a detailed history
- verify that the informed consent is accurately completed, signed, and witnessed
, - ensure the client remains NPO for at least 6 hr for solid foods and 2 hr for clear liquids before surgery
with general anesthesia to avoid ASPIRATION (clear liquids: water, juice, coffee, tea)
- administer preop medications with a sip of water (beta blockers, thyroid meds, insulin) - NO blood
thinners or herbals (St. Johns can prolong Anesthesia and Garlic enhances bleeding so make sure they
haven't taken any within 14 days or 2 wks)
- Respiratory Status? Dose patient have a BiAP of CPAP? Want to have it after surgery to help better
wake patient up)
- Removable Prostetics? remove dentures, earrings, etc
- Testing: labs, EKG->if pt is over 40 and has heart disease
Preoperative/Intraoperative Nursing Care: Diagnostics *** ABGs: lung function, O2 status
Blood type and cross match: What type of blood they have and if it needs to be matched; transfusion
readiness
Blood electrolyte levels: electrolyte imbalances
Blood creatinine and BUN: renal function
Clotting Studies: PT, INR, aPTT, PLT
CBC: fluid status, anemia, infection/immune status, if CBC high, they have higher risk for infection after
surgery
Pregnancy test: anesthesia can harm fetus
Urinalysis: renal function, rule out infection
Intraoperative Nursing Care: Management of Care *** TIME OUT! happens right before surgery
- everything stops and the surgery team reviews to ensure they have the correct patient, correct
procedure, and correct site
- done to prevent wrong procedure, wrong site, wrong person surgeries
(Ask pt to confirm their name and DOB, and ask pt to confirm the procedure and location of surgery)
Preoperative/Intraoperative Nursing Care: Documentation *** Informed Consent: legal documentation
that describes the procedure/risks/complications of the surgical procedure
Anesthesia & moderate sedation pharm interventions/teaching *** 1. Antibiotics: reduce risk of
infection, one-time dose of IV antibiotic (ancef(Cefazolin), Vanco)
2. Analgesics: reduce pain (opioids, fentanyl, morphine, torodal, IV Tylenol)
3. Anticholinergics: decreases risk of bradycardia, reduces risk of aspiration by decreasing salvation
(atropine)
4. Anxiolytics: reduced anxiety, causes CNS depression causing sedation (benzos)
5. Anesthetics: cause complete sedation or paralysis (nitrous oxide)
- ALWAYS combined w oxygen
- Might cause buzzing noise in ears
- Ketamine: AVOID in schizophrenic pts
6. Antiemetics: given pre-op to help post-op with N/V (Phenergan, Ondansetron)
· Increases gastric emptying
· Phenergan causes sedation
Anesthesia and Moderate Sedation: Risk Factors *** General Anesthesia
- family history of malignant hyperthermia
- respiratory disease (hypoventilation)
- cardiac disease (dysrhythmias/decreased Cardiac Output)
- gastric contents (aspiration)- alcohol or substance use disorder
Local Anesthesia
- allergy to ester-type anesthetics
- alterations in peripheral circulation
Older adult clients are more susceptible than any other population to anesthetic agents (careful titration
and airway patency)
,Anesthesia and Moderate Sedation: Complications *** 1. MALIGNANT HYPERTHERMIA: an acute life-
threatening medical emergency that can be caused by anesthesia (commonly succs)
- a hypermetabolic condition causing an alteration in calcium activity in muscle cells (muscle rigidity-
locked jaw, hyperthermia, and damage to the CNS)
- 1st signs: increased CO2, decreased O2 sat, and tachycardia
- other s/s: dysrhythmias, muscle rigidity, hypotension, tachypnea, cyanosis
- LATE SIGN: extremely elevated temp as high as 111.2 degrees
Treatment: STOP surgery, give IV dantrolene, give 100% O2, infuse iced IV 0.9% NaCl, apply a cooling
blanket, put ice on the armpits, groin, neck, and head; and iced lavage
2. Anesthetic toxicity: increased in older adult clients (bc decreased liver and kidney function)
3. Unrecognized hypoventilation: monitor end-tidal CO2 level
4. Intubation problems: injury to teeth, lips, vocal cord
5. Anesthesia awareness: pre medicate w/ amnesic agent(benzos) & avoid muscle paralytics
Moderate Sedation: airway obstruction, cardiac dysrhythmias, respiratory depression, hypotension
Local Anesthesia *** makes a specific area numb; typically topical application to the skin or mucous
membranes
- not generally monitored
EX: lidocaine or procaine
Regional Anesthesia *** cause total paralysis; a block, but the patient is still awake
- Nerve blocks, epidural, and spinal
Moderate Sedation *** client is relaxed enough that the surgeon can perform minor procedures
without discomfort for the client, yet the client can respond to verbal stimuli, retains a gag reflex, and
has a patent airway
,General Anesthesia *** the patient is totally unconscious(not arousable/loss of response to stimuli);
airway is #1 priority and must be intubated
Anesthesia & moderate sedation nursing interventions *** - Prevent pressure injuries: positioning
- Protect skin/bony prominences, joints, nerves: maintain modesty & privacy as well
- DVT prevention (SCD)
- Educate patient to pee before
Preoperative nursing care risk factors *** · Weight
· Age
· Nutritional status
· Renal/hepatic disease/status
· Endocrine disease/function
· Cardiovascular disease/status
· Immune function/infection
· Pulmonary disease/status
· Electrolyte imbalances
"WAN RECIPE"
Preoperative Nursing Care: Assessment/Management of Care *** preparing the patient for surgery
- patient identification
- assess for allergies (shellfish, contrast, betadine, eggs, and latex)
- Head-to-toe: want baseline VS
- assess anxiety level and get a detailed history
- verify that the informed consent is accurately completed, signed, and witnessed
, - ensure the client remains NPO for at least 6 hr for solid foods and 2 hr for clear liquids before surgery
with general anesthesia to avoid ASPIRATION (clear liquids: water, juice, coffee, tea)
- administer preop medications with a sip of water (beta blockers, thyroid meds, insulin) - NO blood
thinners or herbals (St. Johns can prolong Anesthesia and Garlic enhances bleeding so make sure they
haven't taken any within 14 days or 2 wks)
- Respiratory Status? Dose patient have a BiAP of CPAP? Want to have it after surgery to help better
wake patient up)
- Removable Prostetics? remove dentures, earrings, etc
- Testing: labs, EKG->if pt is over 40 and has heart disease
Preoperative/Intraoperative Nursing Care: Diagnostics *** ABGs: lung function, O2 status
Blood type and cross match: What type of blood they have and if it needs to be matched; transfusion
readiness
Blood electrolyte levels: electrolyte imbalances
Blood creatinine and BUN: renal function
Clotting Studies: PT, INR, aPTT, PLT
CBC: fluid status, anemia, infection/immune status, if CBC high, they have higher risk for infection after
surgery
Pregnancy test: anesthesia can harm fetus
Urinalysis: renal function, rule out infection
Intraoperative Nursing Care: Management of Care *** TIME OUT! happens right before surgery
- everything stops and the surgery team reviews to ensure they have the correct patient, correct
procedure, and correct site
- done to prevent wrong procedure, wrong site, wrong person surgeries
(Ask pt to confirm their name and DOB, and ask pt to confirm the procedure and location of surgery)
Preoperative/Intraoperative Nursing Care: Documentation *** Informed Consent: legal documentation
that describes the procedure/risks/complications of the surgical procedure
