Med/Surg anesthetics

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  1. -AKA endoscopic surgery
    -used during abdominal surgery
    -injection of gas (insufflation) is used  to separate organs.
    -DaVinci device is used in this area.
    -Surgeon inserts necessary components then leaves the sterile field to complete the surgery at a computer console.
    MIS
  2. How does the surgeon decide btwn a MIS and an open surgery
    • Risk vs. benefits
    • pt wishes
  3. -Causes a reversible loss of consciousness.
    -Depresses the CNS to achieve analgesia, amnesia, and loss of muscle tone/reflexes.
    -Can be inhaled or IV.  May be used together.
    General anesthia
  4. What are the complications for general anesthesia
    • overdose
    • unrecognized hypoventilation
    • intubation complications
    • myocardial depression
    • hepatotoxicity
    • N/V
    • confusion
    • Malignant hyperthermia
  5. What patients are at a greater risk for general anesthetic overdose
    • old
    • young
    • renal impaired
  6. When giving a pt general anesthesia what should be watched to prevent unrecognized hypoventilation
    • Monitor CO2 status by end tidal CO2 monitor
    • Have system in place to detect any break in ventilator equipment
  7. What are the complications of intubation with general anesthesia
    • Broken teeth
    • sore throat
    • damaged vocal cords
  8. Describe the process of MH
    Skeletal muscle reacts to anesthesia causing an increase in serum calcium and potassium levels which leades to acidosis, cardiac dysrythmias, and increased body temp.
  9. What drugs is MH usually associated with
    • volatile inhaled anesthetics (Fluranes)
    • neuromuscular blocking drugs.
  10. What should an S&S of MH should a nurse watch for
    • tachycardia and dysrythmias,
    • muscle rigidity (esp. in the jaw)
    • hypotension
    • skin mottling
    • cyanosis, tachypnea, and decreased O2 sats
    • increased pCO2
    • increased body temp(late sign)
  11. What pt are at a higher risk for MH from anesthesia
    • Children,adolescents, and patients with musculoskeletal abnormalities (MD, pstosis, strabismus)
    • Family history
  12. How is MH treated
    Dantrolene Sodium (Dantrium)
  13. What anesthetic
    -disrupts nerve impulses to specific body area,
    -often given with sedatives, opioid analgesics, and hypnotics
    -Allows th pt to remains conscious and follows instructions
    -maintains airway
    -may be parental (IV), topical, or intrathecal
    Local/regional anesthesia
  14. When is local anesthesia used
    • Contraindications for general anesthesia
    • Pt request
    • To manage post op pain
  15. What are the different types of local anesthesia
    • Field block – inject around the op. site
    • Nerve block – into or around the nerves of the involved area
    • Spinal– injected into the CSF
    • Epidural– injected into the epidural space
    • Topical– applied to skin
  16. What are the complications of local anesthesia
    • allergic reaction
    • systemic absorption
    • overdose
    • systemic toxic reaction
    • Spinal headache(if dura is punctured)
  17. What should an RN watch for a pt is receiving local anesthesia
    • restlessness
    • excitement
    • incoherent speech
    • HA
    • blurred vision
    • metallic taste
    • N/V
    • tremors, seizures,
    • increased HR, resp., and BP.
  18. A spinal headache can occur __ days after a procedure
    5
  19. What are some interventions for a spinal headache
    • bed rest(self limiting)
    • analgesics
    • caffine
    • blood patch
  20. What are the nursing interventions if someone is experiencing an adverse effect to anesthesia
    • ABC;
    • Apply O2
    • Call Surgeon
    • Surgeon may order barbiturates
  21. What anesthia:
    -Prevents nerve transmission in skeletal and smooth muscle
    -Create paralysis
    -Requires mechanical ventilation
    -EXTREMELY important to give sedation and/or analgesia with these medications.  These people are wide awake with theses meds– just cannot move!
    NMBD
  22. What are the two types of NBBD
    • depolorizing(mimic Ach, competitive agonist)
    • nondepolorizing(competitive antagonist)
  23. Describe the two stages of paralysis
    • 1-muscle facilitates(twitches)
    • 2-as depolarization continues, muscles no longer respond to Ach released because NMBD has filled receptor sites.  Muscles become paralyzed
  24. What is a common depolarizing NMBD
    Succinylcholine
  25. What are the examples of nondepolarizing NMBD
    Vecuronium and Pancuronium
  26. What are the rare adverse reactions of NMBD
    • depolarizing: Muscle damage,Muscle pain,Hyperkalemia (due to muscle damage)
    • Nondepolarizing:Hypotension,Tachycardia
  27. What causes NMBD toxicity
    • prolonged use
    • ie., management of a prolonged mechanical ventilator
  28. What drugs are used as an antidote for NMBD
    Anticholinesterase drugs (Neostigmine, pyridostigmine, and endrophonium) – used to reverse muscle paralysis.
  29. What else is Neostigmine used for besides NMBD
    myasthenia gravis

Card Set Information

Author:
 tville01
ID:
 191728
Filename:
 Med/Surg anesthetics
Updated:
2013-01-09 11:33:00
Tags:
Med Surg anesthetics
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Description:
Med/Surg anesthetics
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