Nursing: Fluids, Electrolytes and ABGs

electrolytes play an important role in maintaining homeostasis within our body. Our body is constantly transporting nutrients, electrolytes, and oxygen to cells and carrying waste products away from cells. In order for our body to do this, body fluids and electrolytes have to be maintained within the narrow limits of normal in order to maintain homeostasis and promote health

Risk factors
•Hemorrhage
•Emesis/Diarrhea
•Burns
•Large draining wounds
•Diuretic therapy
•Diabetes Insipidus
•Prolonged/high fever
S/S
Decreased
•Mental Status
•Bowel Sounds
•Strength
•Mucous production
•Skin turgor
•Weight
•Temperature
•Tear production
•Urine output
•Intake
BP
Increased
-hemoconcentration, urine specific gravity, tachycardia, tachypnea, thirst, HCT, BUN, sodium levels.
I@O checks
Low level urine production can indicate dehydration
INTERVENTIONS
Hydration therapy/IV fluids
Admiister drugs that can correct cause
Ex: antiemetics, antidiarrheal, antibiotics, and antipyretics

Risk factors
•Excess fluid replacement
•Kidney failure
•Heart failure
•Long-term steroid therapy
•SIADH
•Conditions involving polydipsia
•Water intoxication
•Excess salt intake
S/S
Increases in
•Pulse
•Confusion
•Weakness
•Crackles
•Dyspnea / Respiratory effort
•Ascites
•Mucous production
•Weight
•Intake
•Edema
•BUN/creatinine
•Electrolytes
•BP
Decrease in
HGB, HCT, sodium....related to hemodilution
INTERVENTIONS
•Drug therapy focusing on removing the excess fluid - diuretics if kidney failure is not the cause
•Nutrition therapy involving restrictions of both fluid and sodium intake to control fluid volume
•Stop parenteral fluids and/or change IVF to a hypertonic solution
•Additional monitoring for indicators of increased fluid volume
üVS
üIntake and output
üLab values
üDaily weights

Normal ranges
HGB- women 12.0- 15.5
HGB- men 13.5- 17.5
HCT- women 34.9- 44.5
HCT- men 38.8-50

Think neuro
Causes
•SIADH and heart failure
•Diuretics
•NPO
•Low-salt diet
•Excessive ingestion of hypotonic fluids
•Conditions causing polydipsia
•Excessive diaphoresis
S/S
•Change in LOC, confusion
•Muscle weakness
•Increased intestinal motility, N/D
•Cardiac changes depending if hypovolemia or hypervolemia in bloodstream
Nursing Interventions
-Drug therapy: osmotic diuretics, with FVE states, reduce diuretics that increase sodium loss (ex: loop diuretics).
-Diet therapy to increase sodium intake and restrict fluids to build sodium count
-Safety measures?
-Monitor I & O, daily weights, VS, LOC, encourage changing positions slowly

Think neuro
Causes
•Excessive oral ingestion or IVF
•Fever and diaphoresis
•Infection
•Dehydration
•KIDNEY FALIURE and Cushing's syndrome
Too much salt or IV fluids
S/S
•Lethargic
•Confused
• Agitated
•Muscle twitching and weakness
Decreased cardiac output symptoms
INTERVENTIONS
-replace fluid volume with 0.225% or 0.45% NS
-diet therapy: sodium restriction
-Adequate water intake
-Monitor LOC
-Maintain safety
-Provide oral hygiene
-Monitor I & O

Causes
•Diuretics, steroids
•Diarrhea
•Vomiting
•Excess wound drainage
•TPN
•Water intoxication
•IV therapy without K+
S/S
ALKALOSIS
shallow resp
Irritability
Confucion drowsiness
Weakness fatigue
ARRYTHMIAS (TACHY)
Thready pulse
decreased intestinal motility
INTERVENTIONS
-Potassium replacement
-Monitoring cardiac rhythm
-Monitor respiratory and lung sounds
-02 as needed
-Maintain safety
-Monitor bowel sounds, bowel movements, and abdominal distention

Causes
•Over ingestion of potassium-containing foods or meds
•Potassium-sparing diuretics
•Transfusions
•Addison's disease and Kidney failure
S/S
Muscle twitchs
Anxiety Irrtability
LOW BP
EKG Changes
DYSRYTHMIAS
Abdominal Cramping
Diarrhea
INTERVENTIONS
-Monitor cardiac rhythm (telemetry)
-Maintain safety
-Decrease potassium intake, increase potassium excretion
-Dietary teaching
-Promote movement of potassium (kayexelate) and if it is sever, insulin IV with be give. We want potassium to go to the ICF.
TELLY

Causes
•Inadequate intake of Ca++/Vitamin D
•Malabsorption syndromes
•Lactose intolerance
•ESRD (end stage kidney disease)
•Diarrhea
ABSORPTION OF CALCIUM REQUIRES VID D
S/S
•Painful muscle spasms/cramping in the calf/foot
•Paresthesias
•Muscle twitching - Chvostek's sign and Trousseau's sign
•Bradycardia or Tachycardia
•Weak thready pulse
•Hypotension
•Increased peristalsis activity
INTERVENTIONS
assess/manage pain
oral/IV supplementation
Monitor cardiac status
Teach dietary modifications
Maintain safety
Encourage foods high in calcium
Dietician consult if needed

Causes
•Excessive oral intake of calcium or Vitamin D
•Kidney failure
•Thiazide diuretics
•Malignancy of bone
•Hyperthyroidism
•Dehydration
S/S
•Increased BP & pulse
•Dysrhythmias
•Blood clots
•Severe muscle weakness
•Decrease in peristalsis activity
INTERVENTIONS
-reduce calcium and vitamin D through altered nutrition
-drug therapy
-dialysis
-rehydration
-cardiac monitoring/Resp monitoring FOR CLOTS ETC

Causes
•Malnutrition
•Starvation
•Diarrhea
•Malabsorption syndromes
S/S
•Hyperactive reflexes and paresthesias
•Positive Trousseau's and Chvostek's signs
•Skeletal muscle weakness
•Confusion and psychosis
•Decreased GI motility
Interventions
-Magnesium replacement oral/IV
-Teaching
-Encouraging dietary modifications- green leafy vegetables/spinach. Some beans/nuts are also high in magnesium
-Dietician consult as needed

Causes
•Increased intake - foods and drugs
•Decreased kidney excretion of magnesium from kidney disease
ANTACID CONSUMTIONS
S/S
•Bradycardia, hypotension
•Drowsy/lethargic
•Skeletal muscle weakness
Interventions
Keep hydrated
Lower Mg intake

7.35-7.45 pH
45-35 paCO2 RESP
22-26 HCO3 Metabolic
Acidic-Basic
ROME

•Buffers
Act as sponges by soaking up hydrogen ions when too many are present, and squeezing out hydrogen ions when too few are present

•Respiratory system
•Breathing controls amount of free hydrogen ions by controlling amount of CO2 in arterial blood.
•Hyperventilation and hypoventilation will change amounts of arterial CO2
•More sensitive to acidase changes and can begin compensation within seconds to minutes after a change in pH

•Renal system
•More powerful but are not triggered unless imbalance continues for 24-48 hours
•Kidney movement of bicarbonate, formation of acids, formation of ammonium à all can increase excretion and reabsorption rates of acids or bases, depending on direction of pH changes

If respiratory pH & PaCO2
If metabolic pH & HC03
Respiratory acidosis: occurs whenever there is hypoventilation
Respiratory alkalosis: occurs with hyperventilation
Metabolic alkalosis: occurs when a loss of acid (prolonged vomiting or gastric suction) or a gain in bicarbonate (ingestion of baking soda) occurs
Metabolic acidosis: occurs when an acid other than carbonic acid accumulates in the body or when bicarbonate is lost from body fluids

Diagnostic
pH < 7.35
Pac02 > 45
HC03 22-26 (WNL)
Causes
Lower resp stimulazation
Anesthesia
DRUG OD
COPD
Pnemonia
Atelectasis
S/S
Hyperventaliation=HYPOXIA
Rapid shallow breaths
Dysthrymias (INCREASE IN VIT K)
INTERVENTIONS
Maintain patent airway and enhance gas exchange including drug therapy, 02 therapy, positioning and breathing techniques, ventilation support.
Memorize these with the ABGS

Diagnostic
Ø7.45
ØPac02 <35
ØHC03 22-26 (WNL)
Causes
Hyperventilation
Anxiety fear PE
Mechanical ventilation
S/S
Deep rapid breathing
HYPERVENTILATION
HYPOKALEMIA
Numbness tingling of exremidies
INTERVENTION
-Prevent further loss of C02 from lungs, reduce anxiety and fear, bag for hyperventilation to rebreathe C02.
-
-BROWN PAPER BAG RESETTING LUNGS REBREATING CO2
-PULMANARY EMBOLISM (BLOOD CLOT IN LUNG)

Diagnostic
Ph <7.35
PaC02 35-45 (WNL)
HC03 <22
CAUSES
Dia KETO ACID
Severe diarrhea
Renal failure
Shock
S/S
HYPERKALEMIA
Kussmaul breathing
Warmed flushed skin
Muscle twitches
INTERVENTION
hydration, drugs, treatment to control problem.
-DKA- overproduction of hydrogen ions, insulin is given to correct hyperglycemia
-over elimination of bicarb. In diarrhea: rehydration and antidiarrheal drugs given if prolonged diarrhea
-Under elimination of hydrogen ions in renal failure: leads to decreased excretion.

Diagnostic:
pH > 7.45
PaC02 35-45 (WNL)
HC03 >26
CAUSES
SEVERE VOMITTING
EXCESSIVE GI SUCTIONING
Diuretics
S/S
Restlesness into lethargy
HYPOKALEMIA
Dysthrimias (TACHY)
Tremers tinging in fingers and toes
INTERVENTIONS
-Prevent further losses of hydrogen, potassium calcium, chloride ions.
-Restore fluid balance, monitor changes
-Drugs to restore normal fluid, electrolyte and acid-base balance (fluid and electrolytes given orally or parenterally
-Antiemetic drugs to help with nausea and vomiting
-Monitor lab values

a test performed on arterial blood to determine levels of oxygen, carbon dioxide, and other gases present

oParenteral Fluids
•IV solutions
•Parenteral nutrition (TPN)
•Blood and blood components
•Drugs in solution form
oVascular Access Devices
•Short peripheral catheters (IV insertion)
•PICC
•Central catheters
Implanted ports

oLimited Complications
•Infiltration
•Phlebitis
•Thrombosis
•Ecchymosis/Hematoma
Localized Site Infection
LIFE THREATENING COMP
-Blood infection
-Extravasation: accidental administration of IV infused medications into the extravascular space/tissue around the infusion site
-Circulatory overload
-Allergic reaction
-Pneumothorax/hemothorax: air or blood within the pleural cavity
-Air embolism
-RN is responsible for checking the IV site every hour noting any changes or delays in IV care etc.

NO CHANGE IN CELLS (Hydrate us)0.9% ns 5% Dextrose in water (DSW)5% dextrose in 0.22%LACTATED RINGERS (most popular)Dehydration (LR)open iv solutions Post pre surgury after blood loss dehydration situations

CELL SWELLING0.45% saline0.22% saline 0.33% saline Used for Extreme HIGH BLOOD SUGAR DO NOT GIVE TO INTER-CRANIAL PRESSURE PATIENCE

CELLS SHRINK3% saline 5% saline 10% dextrose in water2% dextrose in 0.9% saline5% dextrose in 0.45% saline 5% dextrose in LR Should be given in central line Pateince who have hypernatrimia (low sodium reconcerntrate it) Cerebral edema

•Quality and Safety Education for Nurses Core Competencies
•Product from the Institute of Medicine (IOM)/ National Academy of Medicine (NAM)
•Six QSEN competencies
•Provide patient-centered care
•Collaborate with the interdisciplinary health care team
•Implement evidence-based practice
•Use quality improvement in patient care
•Use informatics in patient care
•Safety in patient care

Shifts focus of care to the patient or their representative when making informed decisions about the plan of care.
We need to respect their cultural, spiritual beliefs
Looking at a "holistic" approach. The whole person spirituality, etc.
Alternative therapies: pet, massage, reiki,
We all have the same basic needs no matter what: universal needs.... Food clothing shelter

•Respect for patients' values, preferences, and expressed needs
•Coordination and integration of care
•Information, communication, and education
•Physical comfort
•Emotional support and alleviation of fear and anxiety
•Involvement of family and friends
•Transition and continuity
•Access to care

•Values/Ethics for Interprofessional Practice
•Role-Responsibilities
•Interprofessional Communication
•Teams and Teamwork
Team members: patient, family, nurses, doctors, UAPs, RT, PT,OT, APRN, PA

•Formal method of hand-off communication between two or more health care team members
•4 steps
•S—Situation
•B—Background
•A—Assessment
R---Recommendation

Patient is stable
Task is whithin workers descrption
Your able to teach and supervise
You have planned how to monitor

Thinking complex and assesments
Unpredicatble outcomes
Increased risk for harm
Creativity and prob solving are required

1. Right task
2. Right circumstance
3. Right person
4. Right direction/communication
5. Right supervision/evaluation

•Guidance or direction, evaluation, and follow-up by the nurse to ensure a task/activity is performed appropriately

•Integration of the best current evidence and practices to make decisions about patient care
•Considers patient preferences and values
•Considers one's own clinical expertise for delivery of optimal health care care

•Indicators used to monitor care outcomes and develop solutions to change and improve care
•Models
•PDSA
•FOCUS-PDCA
•DMAIC

•Information and technology is used to:
•Communicate
•Manage knowledge
•Prevent errors
•Support decision-making

•The ability to keep the patient and staff free from harm and minimize errors in care
•Nursing Safety Priority boxes
•Critical Rescue
•Action Alert
•Drug Alert
The Joint Commission:

•Blame-free approach
•Patients and families are safety partners with health care providers and organizations.
Serious (sentinel) events must be reported.
When life been altered or dies AND broken policy makes it a sentinel event

-the surgical experience involves an open and dynamic interaction among the patient, surgeon, anesthesiologist, and nurse

•Diagnosis: Determination of the presence and/or extent of pathology (e.g., lymph node biopsy, bronchoscopy)
•Cure: Elimination or repair of pathology (e.g., removal of a ruptured appendix, benign ovarian cyst)
•Palliation: Alleviation of symptoms without cure (e.g., cutting a nerve root [rhizotomy] to remove symptoms of pain, creating a colostomy to bypass an inoperable bowel obstruction)
•Prevention: Examples include removal of a mole before it becomes malignant or removal of the colon in a patient with familial polyposis to prevent cancer
•Exploration: Surgical examination to determine the nature or extent of a disease (e.g., laparotomy)
•Cosmetic improvement: Examples include repairing a burn scar or breast reconstruction after a mastectomy
•
•Surgery may be a carefully planned event (elective surgery) or may arise with unexpected urgency (emergency surgery).
•Both elective and emergency surgery may be performed in a variety of settings. The setting in which a surgical procedure may be safely and effectively performed is influenced by the complexity of the surgery, potential complications, and the general health status of the patient.
•
•For inpatient surgery, patients who are going to be admitted to the hospital are usually admitted on the day of surgery (same-day admission). Patients who are in the hospital before surgery are usually there because of acute or chronic medical conditions.
•
•Most surgical procedures are being performed as ambulatory surgery (also called same-day or outpatient surgery). Many of these surgeries use minimally invasive techniques (e.g., laparoscopic techniques).
•Ambulatory surgery
•May be conducted in emergency departments, endoscopy clinics, physicians' offices, free-standing surgical clinics, and outpatient surgery units in hospitals
•Can be performed using general, regional, or local anesthetic
•Have an operating time of less than 2 hours
•Require less than a 24-hour stay postoperatively
Have to have someone drive you home

•In many ambulatory surgery centers, patients are asked to bring their medications with them when reporting for surgery, to facilitate accurate assessment and documentation of both the name and dosage of current medications. In addition, assess and evaluate the patient's compliance with the medication regimen to identify other concerns.
•Drugs and herbal supplements may interact with anesthetics. The interaction of the patient's current medications and anesthetics can increase or decrease the desired physiologic effect.-St. Johns wort; prolong the effects of anesthetic agents-take longer to recover from the anesthesia. You should ask specifically about the use of herbs and dietary supplements in their list of medications. Patients believe that herbal supplements are natural and therefore do not pose a surgical risk.
•It is also important to consider the effects of opioids and prescribed medications for chronic health conditions (e.g., heart disease, hypertension, depression, epilepsy, diabetes mellitus). For example, tranquilizers may potentiate the effects of opioids and barbiturates, which are agents that can be used for anesthesia. Pregnancy test is important
•Under recreational drugs, the substances most likely to be abused include tobacco, alcohol, opioids, marijuana, cocaine, and amphetamines. Ask questions in a frank manner about the use of these substances.
•You should stress that recreational drug use may affect the type and amount of anesthesia that will be needed. When patients become aware of the potential interactions of these substances with anesthetics, most patients will respond honestly about their using them.
•Surgery is a stressful event, even when the procedure is considered relatively minor. Psychologic and physiologic reactions to the surgical procedure and anesthesia may elicit the stress response (elevated blood pressure, heart rate).
•Because the patient may be admitted directly into the preoperative area from the community or home, you must be skilled in assessing vital psychologic factors in a very short time.
Therapeutic -functional health pattern=value beliefs
-excessive stress response can be magnified and affect recovery

•Most people are anxious when facing surgery because of the unknown. This is normal and is an inherent survival mechanism. However, if the anxiety level is high, cognition, decision making, and coping abilities are diminished. So if you have a patient that may express the fear of dying in surgery, ask more details about why. The surgeon should be informed if the patient has a strong fear of death, which may prompt postponement. Also if the patient requires any additional information or if anxiety seems excessive.
•Anxiety may be a result of past experiences or the experiences provided by friends' stories and the media.
•You can decrease some anxiety for the patient by providing information about what can be expected. (This is often done through classes or the use of educational CDs before the day of surgery).
•Patients fear surgery for many reasons. These are just examples.
•For fear of pain, you should stress that the patient should ask for medications following surgery when pain is present, and that taking these medications will not contribute to an addiction. Instruct the patient on the use of some form of pain intensity scale (e.g., 0-10, FACES) and to request pain medication before the pain becomes severe.
-lack of knowledge, unrealistic expectations
-blood transfusions, religious/cultural beliefs=identify beliefs and discuss with surgeon and operative staff
-may prompt postponement, influence outcome
-consult with anesthesiologist, confirm drugs will be available

-Assess the patients understanding of their planned surgical procedure by asking what they know about it.
-If patient has questions/ concerns about anesthesia, or family has concerns with anesthesia this should be shared with anesthesiologist before surgery. If the patient is unsure of procedure notify anesthesia to find out what is planned and request that they speak with the patient/family prior to surgery.

•Informed consent
•Is an active, shared decision-making process between the health care provider and the recipient of care
• Implies patient has been given information necessary to understand nature of procedure & potential consequences
•Surgeon is ultimately responsible for obtaining the informed consent
Anesthesia provider must legally provide
disclosure of the diagnosis
nature & purpose, risks & consequences of the proposed treatment
Probability of a successful outcome, availability, benefits, and risk of alternative treatments

If your patient indicate they don't understand the procedure-you need to notify the surgeon to come and complete the informed consent

•Informed consent document
•Patient's full legal name
•Surgeon's name
•Specific procedure to be performed
•Signature of patient, next of kin or legal guardian
•Patient must give consent voluntarily
•Witnesses
Date

Patients are required to be informaed of thier rights in making health care decisions
-Durable power of attorney healthcare
Living will
DNR
Written as directive by physician

H&P (Hx & Physical), charts (old & new)
Informed Consent
Marked surgical side (to be initialed by dr)
Name / Allergy Band
Labs, X-rays, EKG, special testing
Jewelry, dentures, glasses, h. aids, prosthesis REMOVED
NPO status (includes gum, vitamins, etc)
Anesthesia see pt?
Pt teaching and understanding for post op procedures

NPO STATUS- what happens if your patient ate breakfast and has surgery scheduled in 3 hours?
PREOP MEDS BEFORE CONSENT
SIDE RAILS UP (SAFETY)- when transporting. Remember that side rails up at any other time is a restraint.
VS STABLE AND DOCUMENTED
PREOP LABWORK REVIEWED
ENSURING PROBLEMATIC MEDS HAVE BEEN STOPPED PRIOR

•Antibiotics
•Anticholinergics
•Antidiabetic
•Antiemetics
•Benzodiazepines
•Beta blockers
•Histamine (H2)-receptor antagonists
•Opioids
WHY
Decrease anxiety, amnesic properties and provide sedation- take safety precautions when giving these medications. Teach patient to remain sitting or laying down and to not get up alone without the help of staff.
Decrease secretion of saliva and gastric juices
Prevent or decrease nausea and vomiting
Relieve pain and discomfort

•The needs of the patient determine the type of care that you provide. These needs are based on the current health status of the patient and the type of surgical intervention anticipated.
•Advancements in surgical technology, improvements in the administration of anesthesia, and changes in the health care environment have changed where and how surgery is performed.
•The trend in surgical settings is a decrease in in-hospital surgical procedures and an increase in ambulatory or outpatient procedures in hospitals, surgery centers, and physician offices.

-anesthesia, pharmacology, surgery, and surgical interventions

-healthier patients, shorter procedures
•Nursing care requires understanding
•Allows you to monitor patient's response
•Historically, took place in OR
•Current trend to ↓ in-hospital surgery and ↑ ambulatory procedures

•Unrestricted
•No need for surgical attire
•Entrance to surgical area
•PACU
•Holding area
•Dressing areas
•Lounges

personnel in street clothes interact with those in scrubs, holding area, locker room, information areas=nursing station ,control desk

•Scrub attire & hair coverings required

•Supply area for clean & sterile supplies

•Hallways to OR

peripheral support areas and corridors with only authorized people, must wear surgical attire and cover all head and facial hair

•Scrub attire, hair covering, masks required
•
•Individual operating rooms

•Scrub areas

operating rooms scrub sink areas clean core, surgical attire, head covers, and masks required

•OR team divided into categories based on their responsibilities
•Scrubbed sterile team
•Scrub hands and arms
•Don sterile gowns and gloves
•Maintain sterility (work in sterile field)
•Primary surgeon, assistants to surgeon, scrub nurse
•Non-scrubbed nonsterile team
•Ensure patient safety
•Position and monitor patient
•Handle nonsterile supplies and equipment
•Circulating nurse, anesthesiologist, anesthetists

Primary surgeon
First assistant
RNFA- registered nurse first assistant-make surgical incisions and suture incisions as needed

•Scrubs, gowns, gloves
•Remains in sterile field
•Prepares instrument table/sterile equipment
•Assists with draping
•Passes instruments to the surgeon
•Counts sponges, needles, & instruments before & after procedure
•Keeps track of irrigating solutions

•Serves as patient advocate
•Responsible for safe environment
•Not scrubbed, gowned or gloved
•Position outside of sterile field
•Provides communication with family, OR charge nurse, lab and radiology
•Makes available items needed for procedure
•Transfers & positions patient; places monitoring devices
•Records, labels & sends tissue specimens to proper place
•Enforces aseptic technique
•Accompanies patient to PACUives report

•Anesthetizing the patient
•Pain relief
•Monitoring physiological status
•Assume patient care in immediate post-operative period

•Gowns unsterile areas
•Neckline
•Shoulder
•Back
Axillary region

•Removes dirt and microorganisms from hands, fingernails, forearms
•Antimicrobial soap
•Scrub minimum of 5 minutes
•Fingernails short, no artificial nails

•An immune reaction to one or more proteins in natural rubber latex
•Examples of latex supplies
•Adhesive tape
•Airways
•Catheters
•Gloves
•Intravenous ports
•Ventilator bags
Wound drains

This should be assessed pre- op and should be documented in the chart immediately. The patient should also be given an allergy band

the choice of anesthetic remains the responsibility of the ACP. Factors contributing to the decision include the patient's current physical, mental,
and emotional status; allergy and pain history; expertise of the ACP; and factors related to the operative procedure (length, position, site,
discharge plans). IV drug med may be given through your IV line 1st, then RN will check with anesthesia care provider
•The ACP obtains anesthesia consent, writes orders for preoperative and postoperative medication, and assigns the patient an anesthesia classification.
•The ASA classifies anesthesia according to the effect that it has on the patient's sensorium and pain perception. These classifications include general anesthesia, regional anesthesia, local anesthesia, and MAC -monitored anesthesia care, formerly know as conscious sedation
•Local or regional anesthesia with MAC is often used for procedures performed outside of the OR (reduction of dislocated joints in the emergency department). Only registered nurses who receive education and training in MAC and are permitted by institutional protocols and state nurse practice acts can administer this type of anesthesia.
•Total intravenous anesthesia (TIVA) and newer inhalation agents exhibit a fast onset, fast elimination, and fewer untoward side effects, facilitating early discharge from the PACU and ambulatory surgery centers.
General anesthesia:
•Additional reasons for general anesthesia include refusal of local or regional techniques; contraindications for other techniques; and uncooperative patients secondary to intoxication, lack of maturity, emotional lability, head injury, or inability to remain immobile for any length of time.

the choice of anesthetic remains the responsibility of the ACP. Factors contributing to the decision include the patient's current physical, mental,
and emotional status; allergy and pain history; expertise of the ACP; and factors related to the operative procedure (length, position, site,
discharge plans). IV drug med may be given through your IV line 1st, then RN will check with anesthesia care provider
•The ACP obtains anesthesia consent, writes orders for preoperative and postoperative medication, and assigns the patient an anesthesia classification.
•The ASA classifies anesthesia according to the effect that it has on the patient's sensorium and pain perception. These classifications include general anesthesia, regional anesthesia, local anesthesia, and MAC -monitored anesthesia care, formerly know as conscious sedation
•Local or regional anesthesia with MAC is often used for procedures performed outside of the OR (reduction of dislocated joints in the emergency department). Only registered nurses who receive education and training in MAC and are permitted by institutional protocols and state nurse practice acts can administer this type of anesthesia.
•Total intravenous anesthesia (TIVA) and newer inhalation agents exhibit a fast onset, fast elimination, and fewer untoward side effects, facilitating early discharge from the PACU and ambulatory surgery centers.
General anesthesia:
•Additional reasons for general anesthesia include refusal of local or regional techniques; contraindications for other techniques; and uncooperative patients secondary to intoxication, lack of maturity, emotional lability, head injury, or inability to remain immobile for any length of time.

Causes
Insect stings
Medication reactions
Food allergies
S/S

patients are anxious, frightened, itching, hives, erythema, angioedema of eyes lips or tongue, respiratory congestion, dyspnea, audible wheezing, laryngeal edema - stridor, hypotensive, weak and rapid pulse, may lose consciousness, respiratory failure follows from laryngeal edema, suffocation, or lower airway constriction causing hypoxemia, shock, and cardiac arrest within minutes.

Nursing interventions:
Call stat team - O2, IV hydration, meds per symptoms (epinephrine, benadryl), intubation, CPR as appropriate.

•A hypermetabolic disorder of skeletal muscle
•Caused by an autosomal dominant enzyme defect
•Induced by a general anesthetic (Halothane)
•Massive release of intracellular Ca+
•Severe muscle rigidity ensues a causing core temperature increases
•Acidosis occurs with breakdown of muscle and myoglobin release
•Increased metabolic demands may result in cardiac failure or death
•Most commonly triggered by certain anesthetic agents (halothane, succinylcholine), & stress, trauma and heat
•Most often occurs during induction phase or during surgical procedure
•Can occur up to 72 hours post-op

Stop surgery and anesthesia
Administer 100% oxygen
Cooling blankets/ice packs
Lavaging body cavities with ice saline
Manage electrlytes
RAPID INFUSION OF DANTRIUM

If patient father died after receiving general anesthesia and fever=this is important to communicate to surgeon
General anesthesia can be administered to patients with MH as long as precautions to avoid MH are taken and preparations are made to treat MH if it does occur.

•Begins immediately after surgery
And continues until the patient is discharged from the surgical facility or hospital

Identify actual of potential problems that may occur as a result of anesthetic administration, surgical intervention, and to intervene appropriately

•Post anesthesia Phase I
•Care of patient emerging from anesthesia until the patient is physiologically stable & does not require one-on-one care
•Post anesthesia Phase II
•Patient's level of consciousness returns to baseline, has a patent airway, intact upper airway reflexes, manageable pain, and stable pulmonary, cardiac, and renal functioning
•Post anesthesia Extended Observation
•Nursing care continues until patient completely recovered from anesthesia and surgery and is ready to resume ADLs

•Airway
•Breathing
•Circulation
•Neurologic
•Genitourinary
•Surgical site
•Pain
•Vital signs

Administer ordered analgesics before encouraging the patient to do these activities. Also with a low grade temp the first 2 days have a patient cough & deep breathe and use incentive spirometer, this is usually caused by atelactasis.

•The # 1 priority in postoperative care PACU is to assess the airway and respiratory status

•Cardiac arrest
•
•Massive blood loss
•
•Anaphylactic reaction
•
•Malignant hyperthermia