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Flashcards in Exam 1 Chapter 5 Deck (141)
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91

intermittent high temp with shaking chills and diaphoresis indicates?

Septicemia

92

Nursing assessment for pts with altered temperature

frequent temperature
observe for early signs of inflammation and infection

93

what are some nursing implementations for pts with altered temperature after surgery?

encourage airway clearance
chest X-ray
culture if infection is suspected
check order for antipyretics (temp 101.5)
body cooling of temp over 103

94

conscious sedation

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.

95

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.

96

A rare inherited muscle disorder that is chemically induced by anesthetic agents such as halothane, enflurane and muscle relaxants succinylcholine?

Malignant Hyperthermia (MH)

97

When does malignant hyperthermia occurs?

anytime from anesthesia induction to 24 hours post-op
it can result in death.

98

what is the earliest sign of malignant hyperthermia

Tachycardia (heart rate >150)

99

what can trigger malignant hyperthermia?

trauma
heat
stress
medications (epinephrine, atropine, digitalis)

100

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).
hypothermia blanket
diuretics to clear filtered myoglobin in urine.
Increase fluid to maintain urinary output.

101

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

102

S&S of malignant hyperthermia

rapid onset of a high temp (110 F and can rise 1-2 degrees q.5min
tetanus
muscle rigidity (jaw tightening)
elevated CO2
Tachycardia >150
Tachypnea
decreased cardiac output (CO)
Oliguria ( low urine output 300-500ml/day)
Dark brown urine
hypotension

103

what happens in malignant hyperthermia?

A biochemical chain reaction results in a sudden calcium rise in skeletal muscle cells.

104

Bloodless surgery

uses all available alternatives to decrease blood loss.
hemodilution
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

105

General anesthesia is used for?

procedures requiring ..
significant skeletal muscle relaxation, long periods
awkward positions
extremely anxious patients

106

Stage 1 of general anesthesia

Beginning 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.

107

Stage 2 of general anesthesia

Excitement
struggling, shouting, talking, singing, laughing or crying
uncontrolled movement.

RN: pt should be touch only for restrained purposes.

108

stage 3 of general anesthesia

pt is unconscious
lies quietly on the table
with proper administration of anesthetic, may be maintained for hours.

109

Stage 4 of general anesthesia

medullary depression
too much anesthesia has been administered
cyanosis develops = rapid death.

Tx: D/C immediately, initiate respiratory and circulatory support

110

what are the phases of general anesthesia

induction
maintenance
Emersion

111

what are the purpose of general anesthesia

Loss of sensation
absence of pain
amnesia
LOC
muscle relaxation

112

Implications for general anesthesia recovery

ABCs
airway
breathing
circulation

113

What are some ways local anesthesia can be administer

Topically
intracutaneously
subcutaneously

114

Local Anesthesia

autonomic nervous system blockade
anesthesia in area affected
skeletal muscle paralysis in area of affected nerve
little systemic absorption
rapid recovery
little residual "hangover"

115

what are some possible discomfort for local anesthesia?

hypotension
seizures

116

purpose for regional anesthesia

Loss of sensation
absence of pain (in body region)
pt remains awake

117

spinal regional anesthesia

sensation loss and paralysis from umbilicus to toes
into subarachnoid space (CSF) below L2

Precautions: have HOB flat

118

Epidural regional anesthesia

sensation loss = waist to thighs
injection into epidural space
does not enter CSF
No LOC

119

identify some factors that influence pain tolerance

energy level
stress level
culture background
meaning of pain to patient

120

Nursing management to prevent fluid volume excess in patient with existing cardiovascular or renal disease, advance age and stress from surgery.

assessing the patency of the IV lines
ensuring the correct fluids are administered at the prescribed rate
recording I&Os.
reporting urinary catheter rate of less than 30mL/hour
if output of patient voiding is less than 240 mL/8hr
Monitor electrolyte and H&H levels