Flashcards in Exam 1 Chapter 5 Deck (141)
intermittent high temp with shaking chills and diaphoresis indicates?
Nursing assessment for pts with altered temperature
observe for early signs of inflammation and infection
what are some nursing implementations for pts with altered temperature after surgery?
encourage airway clearance
culture if infection is suspected
check order for antipyretics (temp 101.5)
body cooling of temp over 103
drug induced depress of consciousness
patient maintains own airway but yet achieves pain control.
combination of anxiolytic (midazolam, versed) and Opioid (fentanyl).
provides analgesia relieves anxiety and or provides amnesia.
Patients at risk for malignant hyperthermia
strong and bulky muscles
family genetic mutations
first degree relatives of persons who have been diagnosed or suspected.
an unexplained death of a family member during surgery that was accompanied by febrile response.
A rare inherited muscle disorder that is chemically induced by anesthetic agents such as halothane, enflurane and muscle relaxants succinylcholine?
Malignant Hyperthermia (MH)
When does malignant hyperthermia occurs?
anytime from anesthesia induction to 24 hours post-op
it can result in death.
what is the earliest sign of malignant hyperthermia
Tachycardia (heart rate >150)
what can trigger malignant hyperthermia?
medications (epinephrine, atropine, digitalis)
what is the immediate response when pts experience malignant hypperthermia
discontinuation of the triggering agent and hyperventilation (100% O2).
Dantrolene sodium 2.5mg/kg=20 vials by 2 RNs via 2 IV lines.
Procainamide for arrhythmias.
IV glucose and insulin, calcium chloride for hyperkalemia
sodium bicarbonate for metabolic acidosis based upon ABGs.
Reduce temp (ice bags to armpits, groin).
diuretics to clear filtered myoglobin in urine.
Increase fluid to maintain urinary output.
Treatment of MH on the floor
call for help
start icing patient
start second IV line
Administer O2 via non-rebreather mask
Expect patient to be transferred to ICU
S&S of malignant hyperthermia
rapid onset of a high temp (110 F and can rise 1-2 degrees q.5min
muscle rigidity (jaw tightening)
decreased cardiac output (CO)
Oliguria ( low urine output 300-500ml/day)
Dark brown urine
what happens in malignant hyperthermia?
A biochemical chain reaction results in a sudden calcium rise in skeletal muscle cells.
uses all available alternatives to decrease blood loss.
reduce temp (cold temp in OR causes increase platelet aggregation.
Re-use pt's blood (cell saver)
Maximize blood production (FeSO4, EPO, Vit K)
use other blood components
plasma proteins, fibrinogen
General anesthesia is used for?
procedures requiring ..
significant skeletal muscle relaxation, long periods
extremely anxious patients
Stage 1 of general anesthesia
pt feels warmth, dizziness and detachment
ringing, roaring, buzzing in the ears
inability to move extremities easily.
RN, unnecessary noise and motion should be avoided.
Stage 2 of general anesthesia
struggling, shouting, talking, singing, laughing or crying
RN: pt should be touch only for restrained purposes.
stage 3 of general anesthesia
pt is unconscious
lies quietly on the table
with proper administration of anesthetic, may be maintained for hours.
Stage 4 of general anesthesia
too much anesthesia has been administered
cyanosis develops = rapid death.
Tx: D/C immediately, initiate respiratory and circulatory support
what are the phases of general anesthesia
what are the purpose of general anesthesia
Loss of sensation
absence of pain
Implications for general anesthesia recovery
What are some ways local anesthesia can be administer
autonomic nervous system blockade
anesthesia in area affected
skeletal muscle paralysis in area of affected nerve
little systemic absorption
little residual "hangover"
what are some possible discomfort for local anesthesia?
purpose for regional anesthesia
Loss of sensation
absence of pain (in body region)
pt remains awake
spinal regional anesthesia
sensation loss and paralysis from umbilicus to toes
into subarachnoid space (CSF) below L2
Precautions: have HOB flat
Epidural regional anesthesia
sensation loss = waist to thighs
injection into epidural space
does not enter CSF
identify some factors that influence pain tolerance
meaning of pain to patient