Nerve blocks o Monitor degree of blockade bpdt vasodialation and respiratory

Nerve blocks o monitor degree of blockade bpdt

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Ex: epidural and spinal anesthesisa. Nerve blocks o Monitor degree of blockade, bp(d/t vasodialation) and respiratory rate of depth MONITORED ANESTHESIA CARE (MAC) o Administration of sedatives, anxiolytics, and/or opioids o Patient is deeply sedated and may require airway management o Commonly used outside of the or with endoscopic procedure and eye surgeries o Must be administers by and anesthesia care provider bc it may be necessary to change to general anethesis during the procedure MODERATE TO DEEP SEDATION o AKA conscious sedation o Administratin od sedatives , anxiolytics and/or opioids o Patient is sedated but responsive and able to breath w/out assistance o Used for minor procedures outside of the OR(closed reduction of a fracture,dislocated joints) o May be administered by RNS demonstrating competency under physician supervision Reversal agents Opioid reversal o Naloxone (Narcan) o 0.4 to 2 mg IV/IM/SC; repeat every 2-3 minutes as needed (not to exceed 10 mg) o Administer slowly—pt may not require entire dose Benzodiazepine reversal o Flumazenil (Romazicon) o 0.2 mg IV push over 15-30 seconds; dose may be repeated/increased if not response Older Adults patients Careful titration of anesthetic medications. Physiologic changes may alter responses to anesthetics, blood loss, hypothermia, pain, and tolerance of procedure. Sensory alterations Increased risk of complications due to positioning. Complications: Anaphylactic reactions o Initial signs may be masked by anesthesia o Can cause tachycardia, hypotension,bronchospasma o Antibiotics ans latex are common causes Postoperative: 14 questions
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Focus on care in the PACU, on clinical unit, and discharge Prevention, identification/assessment, and treatment for complications PACU Management o Priorities o Respiratory o Cardiovascular o Pain o Temperature o Surgical site o Monitoring o Pulse oximetry o ECG o Frequent VS o Airway o Patancu o Oral or nasal airway o Endotracheal tube o Breathing o Respiratory rate and quality o Auscultated breath sounds o Pulse oximetry o Supplemental oxygen o Circulation o Ecg monitoring – rate ang rhythm o Blood pressure o Temperature o Cap refill o Color of skin o Peripheral pulses o neurologic o Level of consciousness o Orientation o Sensory and motor status o Pupil size and reaction o Genitourinary o Intakes(fluids and irrigations) o Output(urine and drains) o Surgical site o Dressings/ drainage
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o Pain o incision o other REPIRATORY COMPLICATIONS o Hypoxemia – may be causes by airway abostruction, ate;ectasis, aspiration, pulmonary edema, pulmoney embolism, bronchospasm and hypoventilation o Prevention = o Positioning o Coughing and deep breathing o Incentive spirometry o Ambulation o Ensure pain is well controlled CARDIOVASCULAR COMPLICATIONS In the PACU o Hypotension and tachycardia o Oxygen o Assess volume status o Assess for bleeding o IV fluid bolus o Hypertension o Analgesics o Assist with voiding o If hypothermis, rewarming measure o Dysrhythmias o Assess for myocardial injury o Other causes include hypoxemia, hypercapnia, electrolyte/acid base imbalances, circulatory instability, preexisting heart disease In the clinical unit o
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