Stages of General Anesthesia

From To Patient’s Reaction Nursing Action

AnalgesiaInduction stage

Loss of consciousness Drowsy, dizzy Close suites door, keep room quiet stand by to assist

Excitement/ delirium, Loss of consciousness

Relaxation May be excited with irregular breathing and movements of the extremities

Susceptible to external stimuli (e.g. noise, touch)

Secure patient properly, remain at the side of the patient quietly but

ready to assist anesthesiologist as needed

Surgical Anesthesia Relaxation

Loss of reflexes;Depression of vital function

Regular respirationContracted pupils

Reflexes disappearMuscle relax

Auditory sensation loss

Position patient and prep skin only when anesthesiologist indicates this

stage in reached

Danger StageVital functions too

depressed

Respiratory failure; possible cardiac arrest

Not breathingLittle or no pulse or heartbeat

Prepare for cardiopulmonary resuscitation

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3) ATROPINE SULFATE

Brand Names: Anespin amp Atropol amp Euro-Med Atropine Sulfate amp Isopto Atropine eye drops Phil Pharmawealth/Atlantic Atropine amp

Classification: Other Cardiovascular Drugs, Muscle Relaxants, Mydriatic Drugs, Antidotes, Detoxifying Agents & Drugs Used in Substance Dependence

Drug classesAnticholinergicAntimuscarinicParasympatholyticAntiparkinsonianAntidoteDiagnostic agent (ophthalmic preparations)Belladonna alkaloid

Action: An anti-cholinergic that inhibits acetylcholine at the parasympathetic neuroeffector junction, enhances the conduction of AV node and increases heart rate

Therapeutic actionsCompetitively blocks the effects of acetylcholine at muscarinic cholinergic receptors that mediate the effects of parasympathetic postganglionic impulses, depressing salivary and bronchial secretions, dilating the bronchi, inhibiting vagal influences on the heart, relaxing the GI and GU tracts, inhibiting gastric acid secretion (high doses), relaxing the pupil of the eye (mydriatic effect), and preventing accommodation for near vision (cycloplegic effect); also blocks the effects of acetylcholine in the CNS.

IndicationsSystemic administration

Antisialagogue for preanesthetic medication to prevent or reduce respiratory tract secretions

Treatment of parkinsonism; relieves tremor and rigidity

Restoration of cardiac rate and arterial pressure during anesthesia when vagal stimulation produced by intra-abdominal traction causes a decrease in pulse rate, lessening the degree of AV block when increased vagal tone is a factor (eg, some cases due to digitalis)

Relief of bradycardia and syncope due to hyperactive carotid sinus reflex

Relief of pylorospasm, hypertonicity of the small intestine, and

These side effects may occur: Dizziness, confusion (use caution driving or performing hazardous tasks); constipation (ensure adequate fluid intake, proper diet); dry mouth (suck sugarless lozenges; perform frequent mouth care; may be transient); blurred vision, sensitivity to light (reversible; avoid tasks that require acute vision; wear sunglasses in bright light); impotence (reversible); difficulty in urination (empty the bladder prior to taking drug).

Report rash; flushing; eye pain; difficulty breathing; tremors, loss of coordination; irregular heartbeat, palpitations; headache; abdominal distention; hallucinations; severe or persistent dry mouth; difficulty swallowing; difficulty in urination; constipation; sensitivity to light.Adverse Reactions: Dry

Nursing Measures: Ensure adequate

hydration; provide environmental control (temperature) to prevent hyperpyrexia.

Have patient void before taking medication if urinary retention is a problem.

When used preoperatively or in other acute situations, incorporate teaching about the drug with teaching about the procedure; the ophthalmic solution is used mainly acutely and will not be self-administered by the patient; the following apply to oral medication for outpatients:

Take as prescribed, 30 min before meals; avoid excessive dosage.

Avoid hot environments;

hypermotility of the colon

Relaxation of the spasm of biliary and ureteral colic and bronchospasm

Relaxation of the tone of the detrusor muscle of the urinary bladder in the treatment of urinary tract disorders

Control of crying and laughing episodes in patients with brain lesions

mouth, dysphagia, constipation, flushing and dryness of skin, tachycardia, palpitations, arrhythmias, mydriasis, photophobia, cycloplegia, raised intraocular pressure. Toxic doses cause tachycardia, hyperpyrexia, restlessness, confusion, excitement, hallucinations, delirium and may progress to circulatory failure and respiratory depression. Eye drops: Systemic toxicity especially in children, on prolonged use may lead to irritation, hyperemia, edema and conjunctivitis. Increased intraocular pressure. Inhalation: Dryness of mouth, throat. Potentially Fatal: Atrial arrhythmias, AV dissociation, multiple ventricular ectopics.

you will be heat intolerant, and dangerous reactions may occur

Generic Name Indication Mechanism of Action Contraindication Nursing Consideration

Metoclopromide

Brand Name:

Placil

Classification:

Anti emetic

Dosage:

1 amp IV every 8 hours

GI motility disturbances

Nausea & vomiting of central & peripheral origin associated with infectious diseases & drug induced.

Dopamine Antagonist that acts by increasing sensitivity to acetylcholine; results in increased motility of the upper GI tract and relaxation of the pyloric sphincter & duodenal bulb.

GI hemorrhage epilepsy, obstruction or perforation

Adverse Effect:

Restlessness, drowsiness, fatigue, dizziness, nausea, headache.

>Inject slowly IV every 1-2 minute to prevent transient feelings of anxiety & restlessness

>N&V, anorexia, constipation abdominal distention before 7 after administration.

>Report lack of response , persistent side effect so that they can be properly evaluated.

>Frequent monitor BP of pt’s taking IV form of drug

>Assess pt’s GI complaints

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19) METOCLOPRAMIDE

Brand name: Apo-Metoclop (CAN), Maxeran (CAN), Maxolon, Nu-Metoclopramide (CAN), Octamide PFS, ReglanClassification: antiemetic & anti-spasmodicDosage: 10 mg/ 2mLIndication: disturbances of GI motility, nausea & vomiting of central & peripheral origin associated w/ surgery, metabolic diseases, infectious & drug induced diseases, facilitate small bowel intubation & radiological procedures of GITAction: stimulates motility of upper GI tract, increases lower esophageal sphincter tone, and blocks dopamine receptors at the chemoreceptor trigger zoneAdverse Reactions: extrapyramidal reactions, drowsiness, fatigue & lassitude, anxiety, less frequently, insomnia, headache, dizziness, nausea, galactorrhea, gynecomastia, bowel disturbances.Nursing Measures:

Monitor BP carefully during IV administration. Monitor for extrapyramidal reactions, and consult physician if they occur. Monitor diabetic patients, arrange for alteration in insulin dose or timing if diabetic control is compromised by alterations in timing of food absorption. Keep diphenhydramine injection readily available in case extrapyramidal reactions occur (50 mg IM). Have phentolamine readily available in case of hypertensive crisis (most likely to occur with undiagnosed pheochromocytoma).

21) MORPHINE SULFATE

Brand name: MorinClassification: Analgesics (Opioid)Dosage: Adult 5-20 mg IM/SC 4 hrly. Severe or chronic pain Childn 10 mg IM/SC 4 hrly, range: 5-20 mg; 6-12 yr 5-10 mg, 1-5 yr 2.5-5 mg, 1-12 mth 200 mcg/kg, <1 mth 150 mcg/kg 4 hrly. Max: 15 mg. Analgesic effect Ped 100-200 mcg/kg SC 4 hrly, max: 15 mg/dose; or 50-100 mcg/kg slow IV. Pre-op 50-100 mcg/kg IM, max: 10 mg/dose.Indication: Relief of moderate to severe pain not responsive to non-narcotic analgesics. Premed. Analgesic adjunct in general anesth esp in pain associated w/ cancer, MI & surgery. Alleviates anxiety associated w/ severe pain. Hypnotic for pain-related sleeplessness.Action: alters perception and emotional response to pain Adverse Reactions: Lightheadedness, dizziness, sedation, nausea, vomiting, constipation & sweating.Nursing Measures:

Caution patient not to chew or crush controlled-release preparations. Dilute and administer slowly IV to minimize likelihood of adverse effects.

Tell patient to lie down during IV administration. Keep opioid antagonist and facilities for assisted or controlled respiration readily available during IV administration. Use caution when injecting SC or IM into chilled areas or in patients with hypotension or in shock; impaired perfusion may delay absorption; with repeated doses, an excessive

amount may be absorbed when circulation is restored. Reassure patients that they are unlikely to become addicted; most patients who receive opioids for medical reasons do not develop dependence syndromes.

CODEINE

1. Name & class of drug – generic and trade name.

GENERIC NAME: Codeine sulfate

BRAND NAME: Paveral

CLASSIFICATION: CNS agent, analgesic, narcotic (opiate) agonist analgesic, antitussive

2. Dose range and routes for adult & geriatric client. PREPARATIONS: PO, IM, SC

DOSING: Analgesia Adult (PO/IM/SC) 15 – 60 mg q.i.d.

Antitussive (PO) 10 – 20 mg q4 – 6h prn (max 120 mg/24h)

3. Purpose prescribed. Underline reason your client is prescribed drug. THERAPEUTIC EFFECTS: Analgesic potency is about one-sixth that of morphine; antitussive activity is also a little less than that of morphine.

USES: Symptomatic relief of mild to moderately severe pain when control cannot be obtained by nonnarcotic analgesics and to suppress hyperactive or nonproductive cough.

4. Major side effects & drug interactions. DRUG INTERACTIONS: Alcohol and other CNS depressants augment CNS depressant effects. Herbal – St. John’s Wort may cause increase sedation.

SIDE EFFECTS: Nausea, constipation, dizziness, drowsiness, pruritus

5. Nursing Implications & teaching. Make position changes slowly and in stages particularly from recumbent to upright posture. Lie down immediately if light-headedness or dizziness occurs. Lie down when feeling nauseated and to notify physician if this symptom persists. Nausea appears to worsen with ambulation. Avoid driving and other potentially hazardous activities until reaction to drug is known. Codeine may impair ability to perform tasks requiring mental

alertness and therefore to. Do not take alcohol or other CNS depressants unless approved by physician. Hyperactive cough may be lessened by avoiding irritants such as smoking, dust, fumes and other air pollutants. Humidification of ambient air may provide

some relief. Do not breast feed while taking this drug.

Generic Name Trade Name Classification Dose Route Time/frequency

ketorolac Toradol nonsteroidal anti-inflammatory agents, nonopioid analgesics

30 mg IVP Q 6 hrs PRN

Peak

1-2 hrs

Onset

10 min

Duration

6 hrs or longer

Normal dosage range

30 mg q 6 hr (not to exceed 120 mg/day)

Why is your patient getting this medication

Severe back pain

For IV meds, compatibility with IV drips and/or solutions

Administration in higher-than-recommended doses does not provide increased effectiveness but may cause increased side effects. Duration of ketorolac therapy, by all routes combined, should not exceed 5 days Use lowest effective dose for shortest period of time. Coadministration with opioid analgesics may have additive analgesic effects and may permit lower opioid doses.

Y-Site Compatibility: dexmedetomidine, fentanyl, hydromorphone, morphine, remifentanil, sufentanil

Y-Site Incompatibility: azithromycin, fenoldopam

Mechanism of action and indications

(Why med ordered)

Inhibits prostaglandin synthesis, producing peripherally mediated analgesia, Also has antipyretic and anti-inflammatory properties.

Nursing Implications (what to focus on) Contraindications/warnings/interactions

Concurrent use with aspirin may ↓ effectiveness, ↑ adverse GI effects with aspirin , other NSAIDs , potassium supplements , corticosteroids , or alcohol. Chronic use with acetaminophen may ↑ risk of adverse renal reactions, ↑ bleeding risk with arnica, chamomile, clove, dong quai, feverfew, garlic, ginger, ginkgo, Panax ginseng.

Common side effects

Drowsiness, GI BLEEDING, EXFOLIATIVE DERMATITIS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, anaphylaxis.

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically)↑ adverse GI effects with alcohol. Chronic use with acetaminophen may ↑ risk of adverse renal reactions (Tylenol). May ↓ effectiveness of antihypertensives (Norvasc, Lopressor).

Drug Name Dosage Indications Mechanism of Action

Contraindications Adverse Reaction Nursing Consideration

Name: Ibuprofen

Brand Name:Children’s Motrin

Classification:Non-steroidal anti-inflammatory drugs

100mg/5ml 5mlPRN, Oral

o Mild to moderate pain

o Fevero Juvenile

arthritis

Unknown. Produces anti-inflammatory, analgesic, and anti-pyretic effects, possibly by inhibiting prostaglandin synthesis.

o Contraindicated in patients hypersensitive to drug and in those with angio-edema, syndrome of nasal polyps, or bronchospastic reaction to

CNS: headache, dizziness, nervousness, aseptic minigitisCV: peripheral edema, fluid retention, edemaEENT: tinnitusGI: epigastric distress, nausea,

o Check renal and hepatic function periodically in patients on long-term therapy. Stop drug if abnormalities occur and notify prescriber.

o Because of their antipyretic and

aspirin or other NSAIDs.

o Contraindicated in pregnant women.

o Use cautiously in patients GI disorders, history of peptic ulcer disease, hepatic or renal disease, cardiac decompensation, hypertension, preexisting asthma, or known intrinsic coagulation defects

occult blood loss, peptic ulceration, diarrhea, constipation, abdominal pain, bloating, GI fullness, dyspepsia, flatulence, heart burn, decreased appetiteGU: acute renal failure, azotemia, cystitis, hematuriaHematologic: prolonged bleeding time, anemia, neutroenia, pancytopenia, thrombocytopenia, aplastic anemia, leucopenia, agranulocytosisMetabolic: hypoglycemia, hyperkalemiaRespiratory: bronchospasm

anti-inflammatory actions, NSAIDs may mask signs and symptoms of infection

o Blurred and diminished vision and changes in color vision have occurred

o It may take 1 or 2 weeks before full anti-inflammatory effects occur

o Serious GI toxicity, including peptic ulcers and bleeding, in patient taking NSAIDs, despite lack of symptoms

o If patient consumes three or more alcoholic drinks per day, use of ibuprofen may lead to stomach bleeding

o Alert: don’t confuse Trendar with Trandate