Anesthesia and Post Op phase

What are the four main categories of anesthesia used during surgery?

General anesthesia, Regional anesthesia, Sedation (monitored anesthesia care), Local anesthesia.

What is the effect of intravenous sedation in general anesthesia?

It takes effect immediately after thirty minutes of introduction and prepares the client for a smooth transition to surgical anesthesia.

What does inhalation anesthesia comprise?

Volatile liquids or gas and oxygen.

What are the four stages of anesthesia?

1. Onset induction/Beginning/Analgesia, 2. Excitement and Delirium, 3. Surgical anesthesia, 4. Medullary Depression/Danger stage/Respiratory paralysis.

What characterizes the Onset Induction stage of anesthesia?

Analgesia without amnesia, feeling of warmth, dizziness, and detachment; patient is still conscious.

What occurs during the Excitement and Delirium stage of anesthesia?

Patient may shout, struggle, and hold breath; muscle tone increases, reflexes are enhanced.

What defines the Surgical Anesthesia stage?

Onset of regular respiration to cessation of spontaneous breathing; patient is unconscious and surgical procedure begins.

What happens during the Medullary Depression stage?

Respiration is shallow, pulse is weak, pupils are dilated and non-reactive; without intervention, death can follow rapidly.

What is Regional Anesthesia?

Anesthesia that makes an area of the body numb to prevent the patient from feeling pain.

Name two common types of Regional Anesthesia.

Spinal anesthesia and epidural anesthesia.

What is the purpose of a continuous epidural catheter?

To allow continuous pain relief during procedures.

What is Sedation in the context of anesthesia?

Also known as monitored anesthesia care, it involves medications through an IV to make the patient feel drowsy and relaxed.

What are the levels of sedation?

Mild sedation, moderate sedation, and deep sedation.

What is Local Anesthesia?

Medications such as lidocaine injected or applied to numb a small area for limited procedures.

What is a major complication of General Anesthesia?

Malignant Hyperthermia, characterized by tachycardia, muscle rigidity, and extreme hyperthermia.

What are some important complications of General Anesthesia?

Nausea and vomiting, damage to teeth, sore throat, anaphylaxis, cardiovascular collapse, and respiratory depression.

What is aspiration pneumonitis?

Lung inflammation caused by aspirating vomitus contents into the lungs due to reduced consciousness.

How can the risk of aspiration pneumonitis be reduced?

By fasting before the procedure and using cricoid cartilage pressure during induction.

What is a potential consequence of spinal anesthesia if the level of spinal block is too high?

Paralysis or impairment of the vocal cords and respiratory impairment.

What is a common effect of nerve blocks in Regional Anesthesia?

They provide pain relief to a smaller area, such as an arm or leg.

What are the signs of overdose in General Anesthesia?

Hypertension, bradycardia, dysrhythmias, respiratory depression.

What is the treatment for Malignant Hyperthermia?

Dantrolene (Dantrium).

What complications can arise from endotracheal intubation?

Broken caps, teeth, swollen lip, trauma to vocal cords.

What can cause peripheral nerve damage during anesthesia?

Nerve compression can occur with all types of anesthesia.

What is the significance of monitoring during sedation?

To ensure patient safety and manage any complications that may arise.

What are the symptoms of anaphylaxis related to anesthetic agents?

Rash, urticaria, bronchospasm, hypotension, angioedema, vomiting.

What is a common cause of peripheral nerve damage during anesthesia?

Exaggerated positioning for prolonged periods of time.

Which nerves are commonly affected by peripheral nerve damage?

Ulnar nerve and common peroneal nerve.

What is the most common cause of claims made against anesthetists?

Damage to teeth.

What is embolism in the context of anesthesia?

A rare but potentially fatal complication during anesthesia.

What are the main types of nerves blocked by regional anesthesia?

Motor nerves, sensory nerves, and nerves of the autonomic system.

How does epidural anesthesia differ from spinal anesthesia?

Epidural anesthesia takes longer to take effect and provides predominantly analgesic properties.

What serious complication can occur if a regional anesthesia block is too high?

Respiratory failure.

What is a common symptom of post-dural puncture headache?

Headache, photophobia, vomiting, and dizziness.

What treatment options are available for post-dural puncture headache?

Analgesia, bed rest, hydration, and occasionally an epidural blood patch.

What can cause hypotension during elective caesarean delivery?

Blockade of sympathetic nerves.

What is cauda equina syndrome?

A condition that may occur due to nerve damage during spinal anesthesia.

What is adhesive arachnoiditis?

A long-term sequela of spinal anesthesia characterized by proliferation of the meninges.

What are some important complications of local anesthesia?

Pain, bleeding, nerve injury, infection, and ischemic necrosis.

What are the duties of an anesthesia nurse regarding patient preparation?

Document relevant times, ensure room readiness, and provide emotional support.

What should be checked before anesthesia induction?

Working suction, catheter in place, and safety equipment like ECG leads and blood pressure cuff.

How can an anesthesia nurse assist during intubation?

By pulling gently on the corner of the patient's mouth to improve visualization of the vocal cords.

What is the importance of monitoring fluid balance during surgery?

To assess fluid output, replacement, blood loss, and blood product replacement.

What should be done before repositioning a patient during surgery?

Confer with the anesthesia provider to ensure airway and ventilation safety.

What is the role of caffeine in treating post-dural puncture headache?

Caffeine acts as a CNS stimulant and has shown benefit in treatment.

What is the purpose of an epidural blood patch?

To treat post-dural puncture headache by injecting the patient's blood at the site of the meningeal tear.

What can result from direct nerve injury during local anesthesia?

Nerve injury and potential complications such as pain and infection.

What are the presenting symptoms of a total spinal block?

High sensory level and rapid muscle paralysis.

What is the significance of monitoring blood pressure during anesthesia?

To prevent myocardial ischemia, especially in patients with cardiac history.

What are the potential consequences of spinal infection?

It can lead to serious complications including meningitis and neurological deficits.

What is the role of the anesthesia nurse in patient emotional support?

To reassure patients, explain procedures, and provide nonverbal support.

What is the purpose of the anesthesia nurse's critical review during surgery?

To ensure patient positioning does not compromise airway or ventilation.

What is the postoperative phase?

The period from when the patient is transferred to the recovery room until they are discharged or follow-up care begins.

What are the primary goals of postoperative nursing care?

Reestablishing physiologic balance, pain management, and prevention of complications.

What does PACU stand for?

Post Anesthesia Care Unit.

What is the purpose of the PACU?

To provide immediate care to patients recovering from anesthesia with access to skilled nurses and necessary equipment.

What are the key features of an ideal PACU?

Quiet, clean, free of unnecessary equipment, well-ventilated, soundproof, and painted in soft colors.

What does the mnemonic 'POSTOPERATIVE' stand for?

Observing fluid intake, preventing complications, promoting nutrition, ensuring fluid balance, optimal respiratory function, renal function maintenance, psychosocial support, encouraging mobility, tissue perfusion maintenance, thorough wound care, infection control, vigilance for anxiety, and eliminating hazards.

What should be assessed when transferring a patient to PACU?

Incision site, vascular status, and exposure.

What is important to consider regarding the surgical incision during patient transfer?

To prevent strain on the sutures and adjust positioning if there are drainage tubes.

What are the key assessments for a patient in PACU?

Air exchange status, skin color, identity verification, neurologic status, level of consciousness, cardiovascular status, and operative site examination.

What is the recommended positioning for a patient in PACU?

Patients should be moved slowly and carefully to avoid arterial hypotension.

What safety measures should be taken when transferring a patient to a stretcher?

Cover the patient with blankets, secure with straps, and raise side rails to prevent falls.

What does the acronym 'SAFE' stand for in patient transfer safety checks?

Securing restraints, assisting to an appropriate position, fall precaution, and eliminating injury sources.

What is the role of airway management in postoperative care?

To keep the airway open until the patient is fully awake to prevent airway obstruction.

What should be monitored for breathing in postoperative patients?

Bilateral lung auscultation, patient positioning, encouraging deep breaths, and regular turning.

What vital signs should be monitored in postoperative care?

Vital signs should be obtained as ordered, and any abnormalities should be reported.

What are signs of hypovolemia in a postoperative patient?

Decreased blood pressure, decreased urine output, increased pulse rate, increased respiration rate, and decreased central venous pressure.

What are signs of hypervolemia in a postoperative patient?

Increased blood pressure, increased central venous pressure, and changes in lung and heart sounds.

What is the importance of thermoregulation in PACU?

To detect and address hypothermia or hyperthermia and provide a therapeutic environment.

What should be monitored regarding fluid volume in postoperative patients?

Skin color and turgor, mental status, body temperature, and signs of fluid imbalances.

What is the role of GI function and nutrition in postoperative care?

To maintain nasogastric tube patency, provide symptomatic therapy for nausea, and assist in gradual dietary intake return.

What should be done if a patient has a nasogastric tube postoperatively?

Monitor its patency and drainage.

What is the significance of monitoring intake and output in PACU?

To recognize fluid and electrolyte imbalances and ensure proper recovery.

What is the importance of patient safety in the postoperative phase?

To prevent falls, nerve damage, and muscle strain through proper support and monitoring.

What should be done to prevent falls in postoperative patients?

Raise side rails and ensure bed wheels are locked.

What is the recommended action for managing postoperative pain?

Provide pain relief measures and monitor the patient's comfort levels.

What should be assessed regarding the patient's neurological status in PACU?

Level of consciousness and responsiveness using the Glasgow Coma Scale.

What are potential postoperative complications in patients undergoing intestinal or abdominal surgery?

Paralytic ileus and intestinal obstruction.

What should be arranged for a patient post-surgery regarding nutrition?

Consultation with a dietitian to plan appealing, high-protein meals that provide sufficient fiber, calories, and vitamins.

What supplements may be prescribed for a patient postoperatively?

Multivitamins, iron, and vitamin C.

What should be observed and assessed for pain management post-surgery?

Behavioral and physiologic manifestations of pain.

What is important to document regarding pain management?

The efficacy of administered pain medications.

What should be regularly inspected and documented in wound care?

The amount and type of wound drainage.

What is a key practice to maintain skin integrity post-surgery?

Perform hand washing before and after contact with the patient.

What should be done to encourage voluntary voiding post-surgery?

Assess for bladder distention and urge to void; initiate methods to encourage voiding.

What is the time limit for a patient to void after surgery?

Within 8 hours of surgery.

What should be done if a patient cannot void after 8 hours?

Obtain an order for catheterization.

What should be done to assist a patient who cannot use a bedpan?

Help them use a commode or stand/sit to void, unless contraindicated.

What are the risks for elderly patients postoperatively?

Higher risk for complications due to age-related physiologic changes and comorbid conditions.

What should be monitored closely in elderly postoperative patients?

Electrolyte levels, hemoglobin, hematocrit, and urine output.

What is a common medication used for confusion in older adults post-surgery?

Haloperidol (Haldol) or lorazepam (Ativan).

What is essential for evaluating patients in the PACU?

Assessment of breathing, lung sounds, vital signs, and body temperature.

What is the minimum urine output expected for discharge from the PACU?

At least 30 mL/hour.

What scoring system is used to assess patients in the PACU?

A modified APGAR scoring system.

What is the minimum score required for discharge from the PACU?

At least 7 to 8 points.

What should be done to prevent orthostatic hypotension in postoperative patients?

Assist the patient to change positions gradually.

What is the importance of early mobility for surgical patients?

It helps prevent complications and improves recovery.

What should be done to stimulate circulation in postoperative patients?

Encourage frequent position changes and perform bed exercises.

What is a key consideration for wound care post-surgery?

Proper wound care and reinforcement of dressings as necessary.