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Goals
1. Promote the principle of asepsis asepsis.
2. Homeostasis
Nursing Functions
Circulating Nurse
The circulating nurse manages the operating room and protects the safety and
health needs of the patient by monitoring activities of members of the surgical
team and checking the conditions in the operating room. Responsibilities of a
circulation nurse are the following:
The anesthesiologist should visit the patient before the surgery to provide
information, answer questions and allay fears that may exist in the patient’s mind.
The choice of anesthetic agent will be discussed and the patient has an opportunity
to disclose and the patient has opportunity to disclose previous reactions and
information about any medication currently being taken that may affect the choice
of an agent. Aside from that, the patient’s general condition must also be assessed
because it may affect the management of anesthesia. Thus, the anesthesiologist
assesses the patient’s cardiovascular system and lungs.
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Anesthesia
Anesthesia controls pain during surgery or other medical procedures. It includes
using medicines, and sometimes close monitoring, to keep you comfortable. It can
also help control breathing, blood pressure, blood flow, and heart rate and rhythm,
when needed. Anesthetics are divided into two classes:
1. Those that suspend sensation in the whole body – General anesthesia
2. Those that suspend sensation in certain parts of the body – local, regional,
epidural or spinal anesthesia
General Anesthesia
This type of anesthesia promotes total loss of consciousness and sensation.
General anesthesia is commonly achieved when the anesthetic is inhaled or
administered intravenously. It affects the brain as well as the entire body. Types of
general anesthesia administration:
Volatile liquid anesthetics – this type of anesthetic produces anesthesia when their
vapors are inhaled. Included in this group are the following:
1. Halothane (Fluothane)
2. Methoxyflurane (Penthrane)
3. Enflurane (Ethrane)
4. Isoflurane (Forane)
Gas Anesthetics – anesthetics administered by inhalation and are ALWAYS
combined with oxygen. Included in this group are the following:
1. Nitrous Oxide
2. Cyclopropane
Stages
General anesthesia consists of four stages, each of which presents a definite group
of signs and symptoms.
This stage extends from the administration of anesthesia to the time of loss of
consciousness. The patient may have a ringing, roaring or buzzing in the ears and
though still conscious, is aware of being unable to move the extremities easily. Low
voices or minor sounds appear distressingly loud and unreal during this stage.
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Stage II: Excitement or Delirium.
Stage II extends from the time of loss of consciousness to the time of loss of lid
reflex. This stage is characterized by struggling, shouting, talking, singing, laughing
or even crying. However, these things may be avoided if the anesthetic is
administered smoothly and quickly. The pupils become dilated but contract if
exposed to light. Pulse rate is rapid and respirations are irregular.
This stage extends from the loss of lid reflex to the loss of most reflexes. It is
reached by continued administration of the vapor or gas. The patient now is
unconscious and is lying quietly on the table. Respirations are regular and the pulse
rate is normal.
This stage is reached when too much anesthesia has been administered. It is
characterized by respiratory or cardiac depression or arrest. Respirations become
shallow, the pulse is weak and thread and the pupils are widely dilated and no
longer contract when exposed to light. Cyanosis develops afterwards and death
follows rapidly unless prompt action is taken. To prevent death, immediate
discontinuation of anesthetic should be done and respiratory and circulatory
support is necessary.
Local Anesthesia
Local anesthetics can be topical, or isolated just to the surface. These are usually in
the form of gels, creams or sprays. They may be applied to the skin before the
injection of a local anesthetic that works to numb the area more deeply, in order to
avoid the pain of the needle or the drug itself (penicillin, for example, causes pain
upon injection).
Regional anesthesia
Regional anesthesia blocks pain to a larger part of the body. Anesthetic is injected
around major nerves or the spinal cord. Medications may be administered to help
the patient relax or sleep. Major types of regional anesthesia include:
1. Peripheral nerve blocks. A nerve block is a shot of anesthetic near a
specific nerve or group of nerves. It blocks pain in the part of the body
supplied by the nerve. Nerve blocks are most often used for procedures
on the hands, arms, feet, legs, or face.
2. Epidural and spinal anesthesia. This is a shot of anesthetic near the spinal
cord and the nerves that connect to it. It blocks pain from an entire region
of the body, such as the belly, hips, or legs.
With regional anesthesia, an anesthetic agent is injected around the nerved so that
the area supplied by these nerves is anesthetized. The effect depends on the type
of nerve involved. The patient under a spinal or local anesthesia is awake and
aware of his or her surroundings.
Regional anesthesia carries more risks than local anesthesia, such as seizures and
heart attacks, because of the increased involvement of the central nervous system.
Sometimes regional anesthesia fails to provide enough pain relief or paralysis, and
switching to general anesthesia is necessary.
Spinal Anesthesia
This is a type of conduction nerve block that occurs by introducing a local
anesthetic into the subarachnoid space at the lumbar level which is usually
between L4 and L5. Sterile technique is used as the spinal puncture is made and
medication is injected through the needle. The spread of the anesthetic agent and
the level of anesthesia depend on:
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Nursing Assessment
The following are nursing assessment after anesthesia:
Side Effects
Positioning
The nurse should have an idea which patient position is required for a certain
surgical procedure to be performed. There are lots of factors to consider in
positioning the patient which includes the following: