Question

1. What are nursing interventions for evisceration of the wound?
2. What are criteria for discharge from the post anesthesia recovery unit?
3. What are assessment criteria for a patient who will undergo spinal anesthesia?
4. What is the treatment for malignant hyperthermia?

Answer 1

Ans) • Nursing interventions for evisceration of the wound:

- Assessment of the wound

- Provide adequate nutrition

- Have patient avoid strain

- Use binders to support incision

- Monitor for infection

• Criteria for discharge from the post anesthesia recovery unit:

Phase 1 of post anesthesia recovery:

- May transfer care to appropriately qualified personnel when a stable, patent airway with adequate ventilation and oxygenation is achieved, and the patient is hemodynamically stable.

Phase 2 of post anesthesia recovery:

- A lower level of care, may be transferred to Phase II directly if the patient meets the Phase I discharge criteria.

The aldrete recovery score evaluate:

- Oxygenation, respiration, circulation, consciousness, and activity key assessment points.

Factors are considered for discharge:

- Pain control, N/V control, temperature, signs of postsurgical bleeding, and resolution of regional blocks.

- 9 or more points of aldrete score is for recovery to be confirmed.

• A pre-operative physical examination is generally performed upon the request of a surgeon to ensure that a patient is healthy enough to safely undergo anesthesia and surgery. This evaluation usually includes a physical examination, cardiac evaluation, lung function assessment, and appropriate laboratory tests.

• Malignant hyperthermia is characterized by a HYPERMETABOLIC state and SKELETAL MUSCLE RIGIDITY.

It is triggered by exposure to INHALATIONAL agents or SUCCINYLCHOLINE in susceptible individuals

Treatment of Malignant hyperthermia:

1) Stop offending agent
2) 100% oxygen
3) Hyperventilation
4) Dantrolene 2mg/kg every 5 minutes
5) Cool patient
6) Treat hyperkalemia
7) Treat acidosis
8) Treat arrhythmias (do NOT use calcium channel blocker)
9) Send labs - ABG, mixed venous O2, creatinine, coags, CK)
10) Foley catheter