Post-Op Anesthesia meds
Atelectasis, hypotension, loss of gag reflexes are all _______ effects of General anesthesia.
Undesirable. This also includes: Decr ciliary, Snoring, Decr peristansis, Decr peristalsis.
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What are the 4 phases of Anesthesia in order? Bonus if you can describe them?
Pre Induction- pre-anesthesia evaluation and sedation to reduce pt anxiety
Induction- administration of anesthetic with endotracheal intubation
Maintenance – positioning pt, prepping skin, surgical procedure, anesthesia maintained
Emergence – surgery complete, anesthetics are decreased, pt begins to waken, airway removed
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Hypoxia/Hypoventilation can result from:
Pain
Constricting dressing
Obesity
Respiratory center depression
Increased airway resistance
Decreased lung compliance
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Symptoms of SVT? Bonus if u tell me the treatments.
Symptoms: palpable, cordlike vein. Surrounding area may be itchy, tender, reddened and warm.
Treatment: arm/leg exercises, TEDS, ambulation, ASA, NO massage/rubbing to area, (anticoagulant therapy is not usually needed for superficial vein thrombus)
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Causes of Nausea and vomiting in a post-op pt?
Anesthesia, pain, manipulation of internal organs.
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What are wound drains used for?
Reduce edema, drainage.
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A 16-year old patient with cystic fibrosis is admitted with increased shortness of breath and possible pneumonia. Which nursing activity is most important to include in the patient’s care?
A. Perform postural drainage and chest physiotherapy every 4 hours.
B. Allow the patient to decide whether she needs aerosolized medications.
C. Place the patient in a private room to decrease the risk of further infection.
D. Plan activities to allow at least 8 hours of uninterrupted sleep.
Correct Answer: A. Perform postural drainage and chest physiotherapy every 4 hours.
Remember your ABC’s
Airway, Breathing, & Circulation
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Isoflurane is an example of ______.
Inhalation agents. others include: desflurane, sevoflurane, halothane. They all end in ANE.
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What is regional anesthesia?
Loss of pain sensation in an area without Loss of consciousness. Blocks nerve transmission resulting in muscle paralysis. Examples: Spinal, epidural, nerve block.
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What are the treatments for Atelectasis?
C&DB- H.T. splinting
Incentive spirometer
Medication for pain/early pain control
Early ambulation (T&P if on bedrest)
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SVT and/or DVT are caused by:
Venous stasis, injury to vessel wall, Increased blood coagulability.
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A pt has not had flatus or bowel sounds for 6 days post op. They're experiencing nausea, discomfort in her abdomen, and distention. What might this pt be suffering from? Bonus tell me what med is commonly prescribed to treat this?
Paralytic Ileus. Metoclopramide(Reglan).
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A pt is recovering from an abdominal surgery, they're trying to sit up when they here a pop followed by pain and a gush of fluid. What is this a S/S of? Bonus , what do you do?
Evisceration. NS soaked sterile Dressing call surgeon STAT.
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After a change of shift, you are assigned to care for the following patients. Which patient should you assess first?
A. A 60-year old patient on a ventilator for whom a sterile sputum specimen must be sent to the lab.
B. A 55-year old with COPD and a pulse oximetry reading from the previous shift of 90% saturation.
C. A 70-year old with pneumonia who needs to be started on intravenous (IV) antibiotics.
D. A 50-year old with asthma who complains of shortness of breath after using a bronchodilator.
Correct Answer: D. A 50-year old with asthma who complains of shortness of breath after using a bronchodilator.
•The patient with asthma did not achieve relief from shortness of breath after using the bronchodilator and is at risk for respiratory complications.
•This patient’s needs are urgent.
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Benzodiazepines have what anesthetic effect on the pt?
amnesia and anxiety reduction.
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WHY use MAC?
MAC anesthesia is used for uncomfortable procedures or minor surgeries that do not usually require general anesthesia.
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What are the 2 types of Pneumonia? Describe them.
Hypostatic pneumonia – due to ¯ mobilization of secretions/stasis – RT poor C&DB, secretions, lying in bed, poor resp effort
Aspiration pneumonia – mechanical / chemical reaction in the lungs.
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Pts at highest risk for DVT or SVT:
Dehydrated, stroke, GYN, drugs(hormonal), Family hx, bedrest, varicosities(obese, elderly, smokers).
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How are mechanical bowel obstructions treated?
NPO, Monitor VS, minimal pain meds until dx, NG tube, endoscopy, exploratory laparoscopy/laparotomy.
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Which dressing drain needs to be compressed?
Jackson Pratt drain.
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The nurse plans care for a client in the post-anesthesia care unit. Which of the following should the nurse assess first?
A. Respiratory status
B. Level of consciousness
C. Level of pain
D. Reflexes and movement of extremities
Correct Answer: A. Respiratory status
Assessing respiratory status is the first priority.
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Odanseetron(Zofran) and reglan are examples of ________. They reduce _______ and _______.
Antiemetics, Nausea, Vomitting.
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What kind of meds are used with MAC? what 3 examples did they give us?
Meds used with MAC: sedative hypnotics- propofol, midazolam (Versed) and fentanyl.
What are the nursing interventions for post-op Hypoxia/Hypoventilation?
Monitor :
VS- esp HR, RR, resp. effort
chest sounds
SpO2
LOC
Labs
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S/S of pulmonary embolus:
Chest pain, tachyardia, tachypnea, dyspnea, skin changes, LOC changes, hemoptysis, cough
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What complications are associated with NG tubes.
nDehydration
nFluid &Electrolyte imbalance
Hyponatremia – low sodium (Na+)
Hypokalemia –low potassium (K+)
Metabolic alkalosis
Hunger-irritable- assess depression
Good oral care
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Define Dehiscence.
wound edges open and disintegration of underlying layers.
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Nurse Janus enters a room and finds a client lying on the floor. Which of the following actions should the nurse perform first?
A. Call for help to get the client back in bed
B. Establish whether the client is responsive
C. Assist the client back to bed
D. Ask the client what happened
B. Establish whether the client is responsive
Assess the client’s current level of consciousness first to determine whether the patient has had a loss of consciousness
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What kind of Anesthetic med decreases secretions? Give me an example.
Anticholinergics. Atropine.
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What are the concerns with a Prolonged Surgical procedure?
Pts with more extensive surgery requiring anesthesia of longer duration recover more slowly, esp. older age -Slower to wake up, delayed pt extubation. Require close monitoring in the PACU of T, and VS, pulse ox
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Atelectasis can result from:
Airway obstruction, decreased lung expansion d/t pain, decreased mobility, not doing C&DB exercises, Not using incentive spirometer.
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What is the preferred INR for a pt coming out of orthopedics surgery?
DVT prophylaxis 1.5-2.0
Orthopedic surgery 2.0-3.0
DVT treatment 2.0-3.0
Pulmonary embolism 3.0-4.0
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What are the rules to KCL use in IV?
Check lab values of K+ and Na+ often
EKG done if ordered
Must have urine output >30cc/hr- KCL is excreted by kidneys
Never more than 80 mEq / liter of IV flds -40 mEq/L preferred amt
IVPB – NEVER IV PUSH
Rate of infusion
Assess IV placement in vein carefully. Infiltration will destroy tissue
Use large vein for IVPB – not hands. It is very irritating to vein.
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A pt has been healing a wound on their foot. It has been 16 days, what phase of healing are they most likely in?
Collagen-Building phase.
Inflamed phase: 1-5 days
Collagen- Building phase: 6-20 days
Remodeled skin phase: 3-24 months.
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A client presents to the emergency room with dyspnea, chest pain, and syncope. The nurse assesses the client and notes that the following assessment cues: Pale, diaphoretic, blood pressure of 90/60, respirations of 33. The client is also anxious and fearing death. Which action should the nurse take first?
A. Administer pain medications
B. Administer IV fluids
C. Administer dopamine
D. Administer oxygen via nasal cannula
D. Administer oxygen via nasal cannula.
The promotion of adequate oxygenation is the most vital to life and therefore should be given the highest priority by the nurse.
When the nurse needs to prioritize patients, Maslow’s hierarchy of needs theory is used to decide which patient is to be seen first.
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