Fichas
Anaesthetic nursing
Fichas del conjunto (34)
- 1What is anaesthesia'without perception'
aim: perform procedure without discomfort - 2GAlack of consciousnes
- 3RAblocking groups of nerves or spinal cord, pt remains conscious
- 4LAblocking local nerves
- 5role of anaesthetic assistantguided by ANZCA
set education standards, outlines, responsiblities, nurses vs technicians - 6preoperative assessmentpatient assessment must include:
baseline physiology
current and past medical history
medication sensitivities
past anaesthetic experience
psychology - 7airway assessmentlength of incisors, mobility of cervical spine, length and thickness of neck, mallampati score, ability to sublux mandible forward ( under bite) thyromental distance (three fingers)
- 8mallampati scoreused to predict ease of intubation,
class 1 - complete visualisation of soft palate
class 2 - complete visualisation of uvula
class 3 - view of base of uvula
class 4 - soft palate not visible - 9GAreversible and characterised by:
amnesia, analgesia, suppression of reflexes - 10GA IV agents barbituratesthiopentone: rapid induction, short duration, hypotension, tachycardia, minimal post op effect, repeated does = hangover effect
- 11GA IV agents Non-barbituratespropofol:
rapid onset, distribution, metabolism, can be used for maintenance (TIVA), bradycardia, dysrhythmias, severs hypotension, nausea and vomiting, hiccups - 12GA IV agents dissociative anaestheticsketamine:
administered IV of IM, potent analgesic and amnesic, hallucinations/nightmares, increased intracranial pressure, increased intraoccular pressure, tachycardia, hypertension - 13GA Inhalation agents Volatile liquidssevoflurane:
predicatable on CVS/resp, rapid acting, non-irriitating, emergency delirium
Desflurane:
rapid onset/offset, bradycardia, hypotension, airway irritnt
isoflurane:
less cardiac depressing, unpleasant odour, airway irritant
nitrous oxide:
reduce volatile dosage, increased induction rate, nausea and vomiting, must be administered with oxygen, adjunct, not a true anaesthetic - 14GA - adjunctsopioids:
pain relief, induction/maintenance, resp depression, nausea, vomiting, bradycardia, pruritius, e.g. fentanyl, morphine, remifentanil, alfentanyl
benzodiazapine:
sedative, induction/maintenance, increase effect of opioid, resp depression, hypotension, tachycardia e.g midazolam - 15GA - adjuncts continuedantiemetics:
prevent nausea and vomiting, headache, dizziness, shivers, diarrhoea, fatigue e.g. ondansatron,dexamethasone, droperidol
neuromuscular blocking agents:
depolarising - suxamethonium
non-depolarising - rocuronium, vecuronium, atracurium
* non-depolarising can be reversed with anaticholinesterase (neostigmine) - 16vortex airway managementprepare interventions
prevent hypoxia
promote teamwork - 17gas induction - GA (PAEDS)parent present, hold face mask on with oxygen and nitrous oxide
slowly increase sevo
child begins to wrestle
place on operating table and apply monitoring
insert iv and airway - or hold face mask
start procedure - 18GA - IV induction (adults)patient on table
apply monitoring
insert cannula
preoxygenate
administer medications
insert airway
start operation - 19GA - supraglottic airwayslaryngeal mask airway - lma
supreme laryngeal mask airway - 20GA- difficult intubation10% of population have difficulties
1% severely difficult
management:
avoid GA
different blades
videolaryngoscopes
fibreoptic scopes - 21regional anaesthesia central nerve blockspinal (subarchnoid)
single dose
motor and sensory
L3-4 OR L4-5
spinal needle inserted until CSF flashback, then solution injected
bupvicicaine (hyperbaric vs isobaric)
can include fentanyl
complications: hypotension (metaraminol and fluids), spinal headache (bloodpatch) - 22Regional anaesthesis - central nerve block epiduralintermittent or continuous
sensory only block
use saline to make the space, loss of resistance
complications: hypotension, dural puncture (combined spinal/epi), nerve damage, haematome, abscess - 23regional anaesthesiaperipheral nerve block
-US guided, nerve stimulator, or landmark
-medication depends on type of block, and length required, medications commonly mixed
common blocks: retrobulbar, peribulbar, subtenon (eye)
-transverse abdominus plan (TAP) (abdomen)
-femoral plexus block - fascia llliaca, femoral nerve (leg)
-brachial plexus - interscalene, supraclavicular, axillary (arm) - 24patient positioning to preventpressure injury
nerve injury
patient vs floor - 25anaesthestic delivery systm system checkslevel1 - performed yearly
level 2 - performed at start of list by anaesthetist assistant
level 3 - performed inbetween cases by anaesthetic assistant - 26level 2 checkconfirm level 1 check is up to date
test reserve oxygen for leaks and volumes
ensure pipeline gas at appropriate pressure
test flow controls and anti-hypoxic system
check vapourisers are full and leak free
check breathing circuit in manual and automatic modes, leak less than 150ml/min
check suction
check scavange
check monitoring
check local and intravenous devices - 27level 2 checkcheck vapouriser if changed
check breathing system if changed
check local and intravenous devices - 28patient monitoring ANZCA standardscirculation- monitored clinically appropriate intervals, detection of arterial pulse and blood pressure
ventilation - monitored constantly, both direct and indirect
oxygenation - oximetric values interpreted in conjunction with clinical observations of pt
oxygen analyser - continuous, audible signal for low oxygen
breathing circuit disconnect/ventilator
failure alarm- automatic
pulse oximetry - variable tone
ECG
Intermittent non-invasive BP
continuous BP invasive
CO2 volatile gas monitor
temperature
neuromuscular function
monitor anaesthetic effect on brain - 29anaphylaxis - anaesthetic emergencyantibody mediated reaction
90% occur in first 3 min of induction
treatment:
cease causative agent if known
cease all anaesthetic drugs
100% oxygen
commence fluid resuscitation
treat bronhospasm with salbutamol
administer adrenaline 1mcg/kg bolus
administer adrenaline infusion - 30laryngospasmsirritation of vocal cords, complete or total obstruction
caused by pain, instrumentation of airway or secretions
treatment: deepen anaesthetic, suction airway, administer 100 oxygen, provided CPAP/PEEP, if unsuccessful administer suxamethonium (1-2mg/kg) - 31Bronchospasm- anaesthetic emergenciesexpiratory wheeze, hard to ventilate, caused by local airway irritation, aspiration, drug hypersensitivity
treatment: deepen anaesthetic, reposition tube, administer salbutamol, adrenaline, steroid - 32aspiration - anaesthetic emergenciesresponsible for 10-30% of all anaesthetic deaths
cause by gaastric contents in lungs, severity of injury related to ph of stomach
treatment:
100 oxygen, suction airway/lungs, bronchoscopy to check for soiling/suction, ABG, antibiotics, ventilate in ICU - 33anaesthetic emergencies malignant hyperthermiarare autosomal muscle disorder, life theatening
caused by inhalational agents and suxamethonium
presentation: sudden increase in ETCO2
unexplained tachycardia, tachypnoea, liable BP and arrhytmias, acidosis, muscle rigidity jaw, fever late sign, myoglobinuria, mottled cyanotic skin - 34treatment for malignant hyperthermiacall for help
cease anaesthetic, hyperventilate
100% oxygen
administer dantrolene 2.5mg/kg IV up to 10mg/kg
administer sodium bicarbonate
correct hyperkalaemia with insulin/glucose
maintain urine output of up to 2mg/kg
remove all warming
use cold fluids
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- El usuario ha eliminado su información de asignaturas Fichas sobre Anaesthetic nursing, creado por Usuario eliminado el 13/06/2018.
- Creado por
- Usuario eliminado · jun 2018
- Actualizado
- 13 jun 2018
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- Creado por Elizabeth Then · 13 jun 2018
- Copiado por Elizabeth Then · 13 jun 2018
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