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Ex: epidural and spinal anesthesisa. Nerve blocksoMonitor degree of blockade, bp(d/t vasodialation) and respiratory rate of depth MONITORED ANESTHESIA CARE (MAC)oAdministration of sedatives, anxiolytics, and/or opioidsoPatient is deeply sedated and may require airway managementoCommonly used outside of the or with endoscopic procedure and eye surgeries oMust be administers by and anesthesia care provider bc it may be necessary to change to general anethesis during the procedure MODERATE TO DEEP SEDATION oAKA conscious sedation oAdministratin od sedatives , anxiolytics and/or opioidsoPatient is sedated but responsive and able to breath w/out assistance oUsed for minor procedures outside of the OR(closed reduction of a fracture,dislocated joints) oMay be administered by RNS demonstrating competency under physician supervision Reversal agents Opioid reversaloNaloxone (Narcan)o0.4 to 2 mg IV/IM/SC; repeat every 2-3 minutes as needed (not to exceed 10 mg)oAdminister slowly—pt may not require entire doseBenzodiazepine reversaloFlumazenil (Romazicon)o0.2 mg IV push over 15-30 seconds; dose may be repeated/increased if not responseOlder Adults patients Careful titration of anesthetic medications.Physiologic changes may alter responses to anesthetics, blood loss, hypothermia, pain, and tolerance ofprocedure.Sensory alterationsIncreased risk of complications due to positioning.Complications:Anaphylactic reactionsoInitial signs may be masked by anesthesiaoCan cause tachycardia, hypotension,bronchospasmaoAntibiotics ans latex are common causes Postoperative: 14 questions
Focus on care in the PACU, on clinical unit, and dischargePrevention, identification/assessment, and treatment for complicationsPACU Management oPrioritiesoRespiratory oCardiovascularoPain oTemperatureoSurgical siteoMonitoringoPulse oximetryoECGoFrequent VSoAirwayoPatancuoOral or nasal airwayoEndotracheal tube oBreathingoRespiratory rate and quality oAuscultated breath sounds oPulse oximetryoSupplemental oxygenoCirculationoEcg monitoring – rate ang rhythmoBlood pressureoTemperatureoCap refill oColor of skinoPeripheral pulses oneurologicoLevel of consciousnessoOrientationoSensory and motor statusoPupil size and reactionoGenitourinaryoIntakes(fluids and irrigations)oOutput(urine and drains)oSurgical siteoDressings/ drainage
oPainoincision oother REPIRATORY COMPLICATIONS oHypoxemia – may be causes by airway abostruction, ate;ectasis, aspiration, pulmonary edema, pulmoney embolism, bronchospasm and hypoventilationoPrevention =oPositioningoCoughing and deep breathing oIncentive spirometryoAmbulation oEnsure pain is well controlled CARDIOVASCULAR COMPLICATIONSIn the PACUoHypotension and tachycardiaoOxygen oAssess volume status oAssess for bleedingoIV fluid bolus oHypertension oAnalgesicsoAssist with voiding oIf hypothermis, rewarming measureoDysrhythmiasoAssess for myocardial injury oOther causes include hypoxemia, hypercapnia, electrolyte/acid base imbalances, circulatory instability, preexisting heart disease In the clinical unit o