In the recovery room
I am sitting down, and you notice me getting diaphoretic and very pale .. what is the safest way to transfer me to the bed
bring the bed over to me
I just had an SGB my first blood pressure was 137/92 and my 30 min bp was 167/99.. i let the doctor know and i anticipate i will need to get another blood pressure.. upon reevaluation that patients blood pressure was elevated again at 180/102. what can i anticipate needing to do for this patient
giving medication to lower the patient blood pressure for the laible VS/hypertensive crisis
-- meds include hydralazine, labetelol, clonidine
the patient is laying prone during proc and states he is feeling nauseas and sweaty what should i do?
alert the doctor, snif alcohol, check pulse on monitor, ice pack
i am screening at patient at check in , they are here for an SGB. when going through the pre procedure questions they tell me they are being treated for DVT (deep vein thrombosis) .. i have not looked at their med list yet, what should i anticipate will be on their med list? and what else should i anticipate for this patient?
blood thinner; lovenox, eloquis
they will have to reschedule
my ears are ringing very loudly and I have a metalic taste in my mouth i am already laying down.. and one set of vitals was taken on the welch allyn machine.. what is the next thing i should do
put the patient on the monitor asap and obtain another set of vitals
patient had an SGB and now is sitting in the waiting area. you notice under the bandaid some swelling and slight discoloration/bruising.. what should you do ?
the patient has developed a hematoma.. when dark and superficial likely a venous bleed; gently massage apply ice and can even get US to doc can make sure there is not a larger collection of fluid compressing the airway
keep patient longer for extended recovery
the patient has hx of serious v/v , the float nurse has started an iv for me .. and when she gives me hand off what is an additional thing i can ask her to do for me which could be beneficial to have for the procedure
prime fluids for me
have ephedrine readily available
a patient comes into the clinic for a proc and states that they are undergoing chemo .. which specific question in the pre procedure questions will i be thoroughly screening
immunosuppressant drugs ** MTX and steroids
the patient just had TPI , she is now endorsing some difficulty breathing, chest tightness, and angioedema.. what sort of reaction is she having and what is the biggest priority to establish?
allergic reaction, in this case severe.. so establish iv access as the patient will likely require medation intervention
I just had an SGB in the bay and I now state that i feel like i can't take a deep breath and it is difficult to take a breath.. as the nurse what should I anticipate the doctor will need when he comes to assess the patient?
ultrasound machine, and stethoscope.
phrenic nerve damage or paralysis--> affect diaphragm
the patient is having a nerve block done in their inguinal area and is laying supine. they start vomiting violently during the procedure what should i do
if the patient is already vomiting, don't go searching for the bag simply sit the patient up or turn them to the side, also ask the doc to get you the suction !!! **we can clean up after.. the most important thing is airway ***
same goes for seizure; turn to side, protect area, provide suction
bupi- bad cardiac
ropi rules does not bind to cardiac
both long action lido is shorter acting
my heart rate is 44 in the recovery room and I endorse that I feel completely fine.. what is something that i can check to get more information to help me decide how i should treat this patient
baseline HR; HR at time of check in, ask proc nurse what HR in the proc room was
the same patient from earlier after SGB with a hematoma has now developed significant neck swelling, dypsnea, neck pain and severe hoarsness. what should be my biggest priority for this patient
airway management is the most important thing here and why we get concerned about -- compression of trachea and pharynx from a suspected bleed is life threatening. we should be considering intubating this patient , first things should be to apply oxygen place on monitor and get leslie and doctor 111# if this is what the doctor wants as we have the capability to intubate
the patient was administered bupivcaine and lido during their MBB , all the sudden is the patient is speaking incoherently, seems altered, and the spo2 waveform is not picking up great. what should i suspect?
caine toxicity !! call for help***, turn patient over, assisted BVM. est iv access
get the lipids!! -- one nurse admin the bolus while another get the bag primed.
111#
versed (midazolam) can be used for sedation and for this
seizures- not first line ativan is but in a pinch can use midzaolam** benzo
i had a v/v now i am laying down on the monitor my heart rate in WNR and my blood pressure continues to be low despite non pharmacologic interventions; ie passive leg raise, trendeleberg, ice packs, alcohol pad.. what should i anticipate the doctor will want me to give to this patient and i should start gathering supplies for ?
FLUID BOLUS JUST PRIME FLUIDS TO HAVE ON STANDBY!
well, looks like Dr. C is going to intubate the patient above for airway protection.. where is everything i need?
*bring in the crash cart
*succinylcholine 1mg/kg-- in the refrigerator type "succ" into stock search
the doc is doing an ESI; when he injects the contrast it is not visible on the fluro; i get some vitals before bringing the patient to recovery and they are stable, what should i anticipate telling the recovery nurse when i give hand off
this patient has a dura tear; treatment in recovery is laying flat, turn lights off (head ache) keep paitent for extended recovery with additional vitals
potential pharmacologic interventions: caffeine drip per request of provider, blood patch may be required
bactrim
fluconazole
doxycycline
abx
antifungal
abx