Nursing Implications Always assess past history of surgeries and response to anesthesia Assess past history, allergies, medications

ns Assess use of alcohol, illicit drugs, opioids Assessment is vital during pre-, intra-, and postoperative phases Vital signs Baseline labwork, ECG Pulse oximeter (PO2) ABCs (airway, breathing, circulation) Monitor all body systems Nursing considerations during the perioperative phase include the: Preoperative phase Intraoperative phase Postoperative phase Each phase has its own complex and very specific nursing actions Close and frequent observation of the patient and all body systems During a procedure, monitor vital signs, ABCs Watch for sudden elevations in body temperature, which may indicate malignant hyperthermia During recovery, monitor for cardiovascular depression, respiratory depression, and complications of anesthesia Implement safety measures during recovery, especially if motor/sensory loss occurs due to local anesthesia Reorient patient to his/her surroundings Provide preoperative teaching about the surgical procedure and anesthesia Teach the patient about postoperative turning, coughing, deep breathing PREVENTION OF RESPIRATORY DISTRESS

8-12.

a. Monitor respiratory status as frequently as prescribed. Respiratory function is assessed by monitoring the patient's respiratory rate, rhythm, and depth, and by observing skin color. The following observations indicate ineffective ventilation: (1) Restlessness and apprehension. (2) Unequal chest expansion with use of accessory muscles. (3) Shallow, noisy respirations. (4) Cyanosis.

(5) Rapid pulse rate. b. Report labored respirations to supervisor. c. Report shallow, rapid respirations to the supervisor. d. Maintain a patent airway with or without an oropharyngeal tube. e. Maintain the patient in a position to facilitate lung expansion, usually in Fowler's position. f. Administer oxygen as ordered. g. Prevent aspiration of vomitus. (1) Maintain the position of the patient's head to one side and place an emesis basin under the cheek, extending from just below the eye to the lower edge of the bottom lip. (2) Wipe vomitus or secretions from the nose or mouth in order to avoid possible aspiration of these fluids into the lungs. h. Suction the patient either through the nose or mouth as ordered. 8-13. HYPOVOLEMIC SHOCK . The primary nursing care goal is to maintain tissue perfusion by eliminating the cause of the shock. (1) The blood loss from surgery that causes hypovolemic shock may be internal or external. (2) The loss of fluid or blood volume does not have to be rapid or copious amounts to cause shock. d. The primary purposes of care for the patient having a hemorrhage include stopping the bleeding and replacing blood volume. 8-14. DETECTION OF PENDING HYPOVOLEMIC SHOCK

a. Inspect the surgical dressing frequently and report any bleeding to the supervisor. Also inspect the bedding beneath the patient because blood may drain down the sides of a large dressing and pool under the patient. When reporting bleeding, note the color of the blood. Bright red blood signifies fresh bleeding. Dark, brownish blood indicates that the bleeding is not fresh.

b. Outline the perimeter of the blood stain on the original dressing. Reinforce the original dressing, and make note on the dressing of the date and time the outline was made. c. Document your observations and the action taken in the nurse's notes. d. Monitor the patient's vital signs as ordered and report any of the following abnormalities to the supervisor. (1) A drop in blood pressure (systolic reading below 90 in an adult indicates possible shock; systolic below 80 means actual shock). (2) A rapid, weak pulse. (3) Restlessness. (4) Cool, moist, pale skin. (5) Tingling of the lips. (6) Pallor or blueness (cyanosis) of the lips, nailbeds, or conjunctiva (a dark-skinned persons lips will appear a dusky gray). e. Administer narcotics only after checking doctor's orders and consulting with supervisor. If shock is imminent, it may be precipitated by administration of narcotics. f. Administer fluids to replace volume in accordance with the doctor's orders. The doctor may order that blood volume be replaced by intravenous (IV) fluids, plasma expanders, or whole blood products.

Nurhani Tulawie Name/Classific ation Generic Name Bupivacaine HCl Action For surgical & Contraindication IV Regional anesth Adverse Reaction Hypotension, Nursing Intervention A period of

Sensorcaine

Regional and Local Anesthetic Agent

Brands Sensorcaine

obstetrical procedures; abdominal, urological and lower limb surgery. Administration Epidural, spinal, peripheral intravenous anesthesia, and local infiltration.

Halothane
Inhalation Anesthetic Agent

Fluothane

Induction and maintenance of general anesth Administration Inhalation; speciail vaporizer

(Biers block) Diseases of the CNS eg meningitis, poliomyelitis, intracranial hemorrhage. Local pyogenic infection at or adjacent to the inj site. Spinal stenosis & active disease eg spondylitis, tumor. Trauma eg fracture of the spine. Septicemia, pernicious anemia w/ subacute degeneration of the spinal cord. Patients in shock, w/ coagulation disorders or on anticoagulation treatment. Obstetrics; malignant hyperthermia; porphyria.

bradycardia & post lumbar puncture headache, vomiting. Urinary retention & incontinence, neurological reactions.

analgesia persists after return of sensation; therefore, need for stronger analgesics is reduced. Use cautiously in patients with known drug allergies or sensitivities.

Bradycardia, hypotension, cardiac arrhythmias, respiratory depression, shivering during recovery (occasional), hepatitis (multiple exposure) Potentially fatal: Fulminant hepatic

In addition to observation of pulse and respiration postoperatively, blood pressure must be monitored frequently.

Isoflurane
Inhalation Anesthetic Agent

Forane

Induction and maintenance of general anesth Administration Inhalation

Brands Aerrane liqd, Florane inhalation soln, Forane soln, Pascual Isoflurane soln, Phil Pharmawealth/Minra d Isoflurane inhalation soln (bottle)

Known or suspected susceptibility to malignant hyperthermia. Porphyria.

Ketamine HCl
Intravenous Anesthetic Agent

Ketalar Brands Ketazol Ketamax International Apex Ketamine

Anesth for short operations that do not require skeletal muscle relaxation & for painful diagnostic interventions. Induction of anesth prior to the administration of IV anesth

Eclampsia, elevated BP, tachycardia, hallucination, psychomotor agitation. Post anest restlessness &mental confusion. Presence of eye injury or increased intraocular pressure

failure, malignant hyperpyrexia and pulmonary edema. Respiratory depression, hypotension, arrhythmias, malignant hyperthermia. Shivering, nausea, vomiting, ileus. Breath holding, coughing and laryngospasm. Rarely, postoperative hepatic dysfunction and hepatitis. Hypersensitivity reactions. Transient WBC elevation. Unpleasant dreams, confusion, hallucination and irritational behavior: increased muscle tone, sometimes resembling seizures. Temporarily increased BP and heart rate. Depressed

Respirations must be monitored closely and supported when necessary.

Need darkened, quiet room for recovery; often used in trauma cases.

Administration Induction, occasional maintenance (IV or IM)

Propofol
Intravenous Anesthetic Agent

Diprivan Brands Diprifol Amp emulsion inj, Diprivan amp, Diprivan pre-filled syringe, Fresofol 1% amp, Hospira Propofol vial, IV-Pro soln for IV infusion, Lipuro amp, Lipuro Iv infusion Pentothal Brands Penthal

IV induction and maintenance of general anesth Sedation in diagnostic and surgical procedures Administration Induction and maintenance; sedation with regional anesthesia or MAC Induction of anesthesia prior to administration of other anesth agents

Electroconvulsive therapy, obstetrics. Sedation in children <16 yr. Pregnancy, lactation

respiration, apnea and laryngospasm; diplopia & nystagmus; nausea & vomiting; lacrimation, hypersalivation; increased intraocular & CSF pressure; transient skin rashes & pain at inj site. Involuntary muscle movements; nausea, vomiting, headache, fever, pain, burning or stinging at inj site. Potentially Fatal: Apnea, bradycardia, hypotension, convulsions, anaphylaxis.

May cause pain when injected.

Thiopenthal sodium
Intravenous Anesthetic Agent

Absence of suitable veins; status asthmaticus; porphyria

Drwsiness; tolerance, dependence, withdrawal effects including seizures.

Monitor breathing, pulse and bp, large doses may cause apnea and cardiovascular depression

Always assess past history of surgeries and response to anesthesia Assess past history, allergies, medications Assess use of alcohol, illicit drugs, opioids Assessment is vital during pre-, intra-, and postoperative phases Vital signs Baseline labwork, ECG Pulse oximeter (PO2) ABCs (airway, breathing, circulation) Monitor all body systems Each phase has its own complex and very specific nursing actions. Close and frequent observation of the patient and all body systems During a procedure, monitor vital signs, ABCs Watch for sudden elevations in body temperature, which may indicate malignant hyperthermia During recovery, monitor for cardiovascular depression, respiratory depression, and complications of anesthesia Implement safety measures during recovery, especially if motor/sensory loss occurs due to local anesthesia Reorient patient to his/her surroundings Provide preoperative teaching about the surgical procedure and anesthesia Teach the patient about postoperative turning, coughing, deep breathing