Observe for proper use (to avoid injury, or improper absorption of drug). Monitor for cardiovascular problems. (Could indicate toxicity)

Transcription

1 Assessment Prior to administration: Obtain complete health history including allergies, drug history and possible drug interactions. Assess for presence/history of the following disorders: Stokes-Adams syndrome, severe cardiac problems, and/or decreased liver function. This medication is contraindicated for those with this disorder. Assess for allergies to amide-type local anesthetics Check for the presence of broken skin, infection, burns and wounds where medication is to be used. Assess for character, duration, location, and intensity of pain where medication is to be used NURSING PROCESS FOCUS: Patients Receiving Lidocaine (Xylocaine) Potential Nursing Diagnoses Aspiration, risk for, related to effects of Comfort, impaired, related to source of condition requiring surgery Injury, risk for, related to loss of sensation during Knowledge, deficient, related to lack of previous experience with local Planning: Patient Goals and Expected Outcomes Patient will: Demonstrate absence of pain during surgical procedure Demonstrate absence of side effects/adverse reactions Demonstrate knowledge of drug action and potential side effects Avoid physical injury while anesthetic is in effect Implementation Interventions and (Rationales) Observe for proper use (to avoid injury, or improper absorption of drug). Monitor for cardiovascular problems. (Could indicate toxicity) Observe skin or mucous membranes for infection or inflammation. (Condition could be worsened.) Monitor length of effectiveness (Lidocaine is effective for 1-3 hours. Injury could occur during period of.) Patient Education/Discharge Planning Instruct patient to: Swish and spit out if using for relief of mouth discomfort or pharyngeal discomfort Avoid applying to broken or abraded skin Avoid contact of medication with eyes Instruct patient to: Report any unusual heart palpitations. See their health care provider regularly if using medication on a regular basis.. Instruct patient to report irritation or increase in discomfort in areas medication used. Instruct patient to report any discomfort during procedure. Provide patient safety. ( Injury may occur to Instruct patient that he/she will have no

2 affected area due to lack of sensation) Observe for return of gag reflex. (Xylocaine viscous may interfere with swallowing reflex.) Use cautiously in patients with CHF, renal disease, or respiratory depression. feeling in anesthetized area, so must take extra caution to avoid injury, including heat-related injury. Instruct patient: Not to eat within 1 hour of administration Not to chew gum while any portion of mouth or throat is anesthetized to prevent biting injuries Instruct the patient to notify the health care provider at the first sign of any changes in health condition. Evaluation of Outcome Criteria Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning ).

3 NURSING PROCESS FOCUS: Patients Receiving Nitrous Oxide Assessment Prior to administration: Obtain complete health history, including allergies, drug history and possible drug interactions. Assess for presence/history of severe respiratory, cardiac, renal or liver disorders Obtain baseline vital signs, especially blood pressure, pulse and respirations Obtain blood work: complete blood count and chemistry panel Assess for hypersensitivity Assess patient s knowledge of procedure and level of anxiety Potential Nursing Diagnoses Anxiety, related to upcoming surgery, loss of control secondary to Gas exchange, impaired, risk for, related to respiratory depression Knowledge, deficient, related to no prior surgical or experience Nausea, related to after-effects of Sensory perception, disturbed, related to CNS depression secondary to Planning: Patient Goals and Expected Outcomes Patient will: Demonstrate adequate during surgical procedure Have no side effects or adverse reaction to Demonstrate understanding of perioperative procedures Maintain adequate ventilation during surgical procedrue Implementation Interventions and (Rationales) Monitor for cardiovascular disease, especially along with increased intracranial pressure. (Hypnotic effects of nitrous oxide may be prolonged or potentiated) Obtain history of myasthenia gravis. (Patient may need extra support during surgery and longer monitoring after, to ensure adequate respiratory function nitrous oxide may cause respiratory depression. Hypnotic effects of nitrous oxide may be prolonged or potentiated.) Monitor for respiratory difficulty. (Monitor more closely for adequate O 2 - CO 2 exchange, and for elimination of nitrous oxide.) Monitor emotional state. (Patients who are fearful, extremely anxious may have a more difficult time becoming anesthetized and staying anesthetized.) Patient Education/Discharge Planning Teach patients about possible side effects. Advise patient of the importance of complete disclosure of medical history, to ensure maximum safety. Instruct patient to report any breathing difficulty. Teach patient stress reduction techniques such as deep breathing, imagery, and distraction.

4 Monitor post-operative recovery, i.e. Advise patients about routine and possible LOC, nausea and vomiting, and pain. side effects. Evaluate knowledge level prior to Advise patient what is necessary for him to surgery. (Determine what patient already have a satisfactory surgical experience. knows about pre and post-op procedures and how much is accurate information) Evaluation of Patient Outcomes Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning )

5 Assessment Prior to administration: Obtain complete health history including allergies, drug history and possible drug interactions. Assess for presence/history of respiratory and cardiac disorders, seizure disorders, increased intracranial pressure, myxedema, pregnancy, and underlying neurological disorders. Use with caution Obtain baseline vital signs, esp. blood pressure, pulse and respirations Obtain blood work: complete blood count, liver studies Assess for hypersensitivity Assess patient s knowledge of procedure and level of anxiety. NURSING PROCESS FOCUS: Patients Receiving Thiopental (Pentothal) Potential Nursing Diagnoses Anxiety related to impending surgery Aspiration, risk for, related to increased secretions, respiratory depression Breathing pattern, ineffective, risk for, related to side effects of Knowledge, deficient, related to lack of prior experience with surgery or general Sensory perception, disturbed, related to CNS depression secondary to Planning: Patient Goals and Expected Outcomes Patient will: Experience no pain during surgery Demonstrate no side effects during post-operative period Maintain adequate ventilation during surgery Avoid injury during surgical procedure Implementation Interventions and (Rationales) Patient Education/Discharge Planning Observe for anxiety. (Anxiety prior to surgery is not uncommon. Patient may need sedative, anti-anxiety medication prior to immediate pre-op period.) Monitor for side effects. (Shivering and trembling are most common. Patient may also experience nausea/vomiting, headache, and somnolence.) Monitor LOC and for adverse reactions called emergence delirium postoperatively. (Symptoms include hallucinations, confusion, excitability.). Report immediately. Educate patient concerning pre and post-op care. Inform patients to report to the health care provider any side effects. Inform patients of possible side effects. Monitor vital signs initially every 3-5 Advise patient to report to the health care

6 minutes, then every 4 hours. (May lead to dysrthythmias, tachycardia, bradycardia, myocardial depression, and respiratory depression so severe patient may need ventilatory assistance.) Observe for allergic response. (Symptoms include hypotension, bronchospasm, hives, facial edema). Report immediately. Monitor for thrombophlebitis. (As an intravenous anesthetic, extravasation may cause thrombophlebitis.) provider any side effects. Teach patient any signs and symptoms of side effects and to report to the health care provider any side effects. Inform patients to report immediately to health care provider of symptoms of thrombophlebitis Evaluation of Outcome Criteria Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning ).

7 NURSING PROCESS FOCUS: Patients Receiving Halothane (fluothane) Assessment Prior to administration: Obtain complete health history including allergies, drug history and possible drug interactions. Assess for presence/history of pregnancy, diminished hepatic functioning, cardiac disorders hypotension Assess for the use of the same use within 21 days Assess other medications patient is taking. May influence effectiveness of gas or increase respiratory depression Obtain baseline vital signs, especially. blood pressure, pulse andrespirations Obtain blood work: complete blood count, liver studies Assess for hypersensitivity Potential Nursing Diagnoses Breathing pattern, ineffective, risk for, R/T side effects of halothane Cardiac output, decreased, risk for, R/T side effects of halothane Gas exchange, impaired, risk for, R/T respiratory depression secondary to halothane Knowledge, deficient, R/T no prior experience with surgery or general Nausea, post-operative, risk for, R/T aftereffects of halothane Sensory perception, disturbed, related to CNS depression secondary to Planning: Patient Goals and Expected Outcomes Patient will: Experience no pain during surgery Report no side effects of halothane during peri- or post-operative period Demonstrate understanding of the perioperative phase of their surgical experience Maintain adequate ventilation during the surgical procedure Implementation Interventions and (Rationales) Patient Education/Discharge Planning Obtain history of previous use of halothane. (If used within days, halothane cannot be used. Too frequent use of halothane may lead to halothane hepatitis, potentially fatal adverse reaction which is more common in elderly or obese patients; not seen in children.) Monitor vital signs during procedure and post-operatively, esp. for hypotension, bradycardia, and dysrhythmias. (Halothane can decrease blood pressure. Sensitizes myocardium Instruct patient: To recognize warning signs of halothane hepatitis including unexplained rash, fever. Symptoms of halothane hepatitis usually occur within two weeks of use To obtain follow-up lab studies Advise patient regarding possible side effects.

8 to effects of catecholamines or sympathomimetics, which could lead to serious dysrhythmias.) Monitor for decreased hepatic functioning. (Halothane is metabolized in the liver. Halothane has an increased risk of causing hepatic toxicity.) Monitor for nausea/vomiting post-op. (Common side effects with use of Advise patient to keep all appointments for lab work. Advise patient to immediately report side effects. halothane.) Monitor LOC post-op. Instruct patient not to drive or do activities requiring mental alertness for at least 24 hours after surgery. Evaluation of Outcome Criteria Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning ).