Question

Pearl Richards, 69years of age, is a female patient who is in the operating room for a repair of an abdominal aortic aneurysm. The patient has a history of hypertension controlled with medications, osteoporosis, chronic obstructive pulmonary diseases, and has smoked two packs of cigarettes per day for 40years. (Learning objective 2,6,and 9).
a. what nursing interventions are instructed to reduce the surgical risk factors related to the patient's age.
b. Explain the role of the nurse in providing patient safety measures during the intraoperative period.

Answer 1

a. ANS: Nursing intervention:

Clinical Manifestations: Tachycardia (rate > 150) is often the earliest sign. Rigidity and tetanuslike movements occur, often in the jaw due to abnormal transport of calcium in the muscles. The rise in temperature is actually a late sign that develops rapidly ~ 1-2°C every 5 minutes and core body temperature can exceed 107°C.

Although malignant hyperthermia usually manifests about 10-20 minutes after induction of anesthesia, it can also occur during the first 24 hours after surgery.

Anesthesia awareness: patient becoming aware of surgical interventions while under general anesthesia and then recalling the incident. Neuromuscular blocks, sometimes required for surgical muscle relaxation, intensify the fear of the patient experiencing awareness because they are then unable to communicate during the episode.

Hypothermia: During anesthesia, the patient’s temperature may fall. Glucose metabolism is reduced, and as a result, metabolic acidosis may develop. This condition is called hypothermia and is indicated by a core body temperature that is 36.6°C or less.

Malignant Hyperthermia: a rare often inherited muscle disorder that is chemically triggered by anesthetic agents. Susceptible people include those with strong and bulky muscles, a history of muscle cramps or muscle weakness and unexplained temperature elevation, and an unexplained death of a family member during surgery that was accompanied by a febrile response.

Medical Management:

Recognizing symptoms early and discontinuing anesthesia promptly are imperative.

Administering Dantrolene Sodium (Dantrium).

Pack the patient in ice.

Cold IV fluids

Infection:

Maintaining asepsis

Appropriate skin preparation

Antibiotic administration within 30 minutes of incision.

Using clippers to remove hair from the surgical site as needed instead of shaving

Positioning

Blood flow decreased puts at increased risk of blood clot, *** prolonged or sudden decrease BLOOD PRESSURE, HEART RATE,

High ris of cerebral hypoxia d/t COPD

Keep warm blankets handy to regulate body temperature

I/O to monitor blood loss if any- maintain homeostasis

b. ANS: Nurse role during the intraoperative period:

Positioning- Patient should be as comfortable as possible- circulating nurse

Operative field must be adequately exposed

Position must not obstruct/compress respirations, vascular supply, or nerves

Extra safety precautions for older adults, patients who are thin or obese, and anyone with a physical deformity

Light restraint before induction in case of excitement

Monitoring/modifying physical environment

Safety measures (grounding of equipment, grounding pads, safety straps, not leaving a sedated patient)

Proper verification and adm. of blood

Patient identification

Correct informed consent

Verification of records of health history; assessment

Results of diagnostic tests

Allergies (include latex allergy)