Anaesthetic nursing

Frage	Antworten
What is anaesthesia	'without perception' aim: perform procedure without discomfort
GA	lack of consciousnes
RA	blocking groups of nerves or spinal cord, pt remains conscious
LA	blocking local nerves
role of anaesthetic assistant	guided by ANZCA set education standards, outlines, responsiblities, nurses vs technicians
preoperative assessment	patient assessment must include: baseline physiology current and past medical history medication sensitivities past anaesthetic experience psychology
airway assessment	length of incisors, mobility of cervical spine, length and thickness of neck, mallampati score, ability to sublux mandible forward ( under bite) thyromental distance (three fingers)
mallampati score	used 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
GA	reversible and characterised by: amnesia, analgesia, suppression of reflexes
GA IV agents barbiturates	thiopentone: rapid induction, short duration, hypotension, tachycardia, minimal post op effect, repeated does = hangover effect
GA IV agents Non-barbiturates	propofol: rapid onset, distribution, metabolism, can be used for maintenance (TIVA), bradycardia, dysrhythmias, severs hypotension, nausea and vomiting, hiccups
GA IV agents dissociative anaesthetics	ketamine: administered IV of IM, potent analgesic and amnesic, hallucinations/nightmares, increased intracranial pressure, increased intraoccular pressure, tachycardia, hypertension
GA Inhalation agents Volatile liquids	sevoflurane: 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
GA - adjuncts	opioids: 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
GA - adjuncts continued	antiemetics: 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)
vortex airway management	prepare interventions prevent hypoxia promote teamwork
gas 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
GA - IV induction (adults)	patient on table apply monitoring insert cannula preoxygenate administer medications insert airway start operation
GA - supraglottic airways	laryngeal mask airway - lma supreme laryngeal mask airway
GA- difficult intubation	10% of population have difficulties 1% severely difficult management: avoid GA different blades videolaryngoscopes fibreoptic scopes
regional anaesthesia central nerve block	spinal (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)
Regional anaesthesis - central nerve block epidural	intermittent 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
regional anaesthesia	peripheral 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)
patient positioning to prevent	pressure injury nerve injury patient vs floor
anaesthestic delivery systm system checks	level1 - performed yearly level 2 - performed at start of list by anaesthetist assistant level 3 - performed inbetween cases by anaesthetic assistant
level 2 check	confirm 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
level 2 check	check vapouriser if changed check breathing system if changed check local and intravenous devices
patient monitoring ANZCA standards	circulation- 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
anaphylaxis - anaesthetic emergency	antibody 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
laryngospasms	irritation 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)
Bronchospasm- anaesthetic emergencies	expiratory wheeze, hard to ventilate, caused by local airway irritation, aspiration, drug hypersensitivity treatment: deepen anaesthetic, reposition tube, administer salbutamol, adrenaline, steroid
aspiration - anaesthetic emergencies	responsible 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
anaesthetic emergencies malignant hyperthermia	rare 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
treatment for malignant hyperthermia	call 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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	Erstellt von Elizabeth Then vor mehr als 6 Jahre