By C. Karlen. Virginia International University. 2018.
The pulse oximeter therefore This is the most common method of obtaining the gives information about both the circulatory and patient’s blood pressure during anaesthesia and respiratory systems and has the advantages of: surgery order 100 mg lasix mastercard. A pneumatic cuff with a width that is 40% • providing continuous monitoring of oxygena- of the arm circumference must be used and the inter- tion at tissue level buy lasix 40mg overnight delivery; nal inﬂatable bladder should encircle at least half • being unaffected by skin pigmentation 40mg lasix amex; the arm buy lasix 100 mg mastercard. If the cuff is too small, the blood pressure • portability (mains or battery powered); will be overestimated, and if it is too large it will be • being non-invasive. Auscultation of the Korotkoff Despite this, there a number of important limita- sounds is difﬁcult in the operating theatre and au- tions of this device: tomated devices (Fig. An • There is failure to realize the severity of hypoxia; electrical pump inﬂates the cuff, which then un- dergoes controlled deﬂation. A microprocessor- controlled pressure transducer detects variations in cuff pressure resulting from transmitted arterial pulsations. Initial pulsations represent systolic blood pressure and peak amplitude of the pulsa- tions equates to mean arterial pressure. The frequency at which blood pressure is estimated can be set along with values for blood pressure, outside which an alarm sounds. Such devices cannot measure pressure continually and become increasingly inaccurate at extremes of pressure and in patients with an arrhythmia. Hypoventilation can be compensated for by increasing the inspired oxygen concentration to maintain oxygen saturation. A single device embolus), the gap between arterial and end-tidal can be calibrated for all of the commonly used carbon dioxide increases (end-tidal falls), mainly inhalational anaesthetics. The gap also increases monitors are integrated and displayed on a single in patients with chest disease due to poor mixing screen (Fig. Urine Temperature output needs to be measured at least hourly, aim- During anaesthesia the patient’s temperature is ing for a ﬂow of approximately 1mL/kg/h. The most com- to produce urine indicates that renal blood ﬂow is monly used device is a thermistor, the resistance of inadequate, as well as the ﬂow to the other vital which is temperature dependent. Catheterization also placed in the oesophagus (cardiac temperature) or eliminates bladder distension or incontinence. An infrared tympanic membrane thermome- This is measured by inserting a catheter via a cen- ter can be used intermittently, but the external tral vein, usually the internal jugular or subclavian, auditory canal must be clear. Most patients’ core so that its tip lies at the junction of the superior temperature falls during anaesthesia as a result of vena cava and right atrium. It is then connected via exposure to a cold environment, evaporation of a ﬂuid-ﬁlled tube to a transducer that converts the ﬂuids from body cavities, the administration of pressure signal to an electrical signal. This is then cold intravenous ﬂuids and breathing dry, cold ampliﬁed and displayed as both a waveform and anaesthetic gases. It is nula is inserted into a peripheral artery and con- affected by a variety of other factors apart from ﬂuid nected to a transducer that converts the pressure balance (Table 2. This is usually achieved using a fuel cell • coughing oxygen analyser that produces a current propor- • straining tional to the oxygen concentration, displayed as a • Pulmonary embolism numeric value of oxygen concentration. It must be • Pulmonary hypertension remembered that the inspired oxygen concentration •Tricuspid valve disease does not guarantee adequate arterial oxygen saturation • Pericardial effusion, tamponade as it may be insufﬁcient to compensate for the • Superior vena cava obstruction effects of hypoventilation and ventilation/perfu- sion mismatch (see page 72). Irrespective of whether the patient is breathing spontaneously or being ventilated, capnography Pulmonary artery catheter and cardiac will detect most of the common problems, for output example disconnection (loss of reading), inade- See page 126. In addition, when a patient is venti- Blood loss lated, airway pressures must be monitored to avoid Simple estimates of blood loss during surgery are excessive pressures being generated within the easily performed. Airway pressure monitoring can also be used wet, the increase in weight giving an indication of as a secondary indicator of inadequate ventilation the amount of blood they have absorbed. The vol- in ventilated patients; high pressures may be the ume of blood in the suction apparatus can be meas- result of obstruction (e. Such bronchospasm), and loss of pressure the result of a methods are only estimates, as blood may remain disconnection. The latter function may be speciﬁ- in body cavities, be spilt on the ﬂoor and absorbed cally used as a ‘disconnection alarm’. In paediatric practice, where small volumes of blood loss are relatively more Many other physiological parameters can be, and important, all absorbent materials are washed to are, monitored during anaesthesia when appropri- remove the blood and the resultant solvent as- ate. Cephalic vein The anaesthetic record On every occasion an anaesthetic is administered, a comprehensive and legible record must be made. The details and method of recording will vary with each case, the type of chart used and the equip- Dorsal metacarpal veins ment available.
If the client refuses to sign the form buy 100 mg lasix, document the fact on the form and have another health professional witness this 6 generic lasix 40mg with amex. Provide the patient with the original of the signed form and place a copy in the record 7 buy lasix 40mg lowest price. When the patient leaves the agency lasix 100 mg on-line, notify the physician, nurse in charge, and agency administration as appropriate • Assist the patient to leave as if this were a usual discharge from the agency (the agency is still responsible while the patient is on premises) Charting Chart: is a written record of history, examinations, tests, diagnosis, prognosis, therapy and response to therapy Purpose Basic Nursing Art 14 • To document diagnosis or treatment of a patient while in the hospital and after discharge if the patient return for treatment at a future time. Nausea, headache, numbness Basic Nursing Art 15 As part of the admission process a new chart should be opened and certain forms must be filled Orders of Assembling Patients Chart a. Cotton Rings: are small circles of cotton rolled with gauze or bandage with hole in the middle. Air Rings: • Should be filled with air and covered with pillow case • Not commonly used • Should be changed frequently • Used to relieve pressure from the buttocks (to prevent bed sore) 3. Pillow: • Placed under head, back, between knees or at the foot of the bed to prevent foot drop and keep the patient. Basic Nursing Art 16 • Are used to give comfort, support and to position a patient properly. Splints: Are rigid supports that help maintain the wrists in hyperextension as a means of Preventing palmar flexion and constructors. Lifting and Moving a Patient Body Mechanics: is the effort; coordinated, and safe use of the body to produce motion and maintain balance during activity • A person maintains balance as long as the line of gravity passes through the center of the body and the base support Line of gravity: an imaginary vertical line drawn through an object’s center of gravity • The point at which all of the mass of an object is centered • Base of support: the foundation on which an object rests Principles • Balance is maintained and muscle strain is avoided as long as the line of gravity passes through the base of support • The wider the base of support and the lower the center of gravity, the greater the stability • Objects that are close to the center of gravity are moved with the least effort Purpose of Proper Body Mechanics • Promotes body musculoskeletal functioning • Reduces the energy required to move and maintain balance • Reduce fatigue and decreases the risk of injury • Facilitates safe and efficient use of appropriate groups of muscles The center of gravity of a well-aligned standing adult is located slightly anterior to the upper part of the sacrum. Standing position posture: is unstable because of a narrow base of support, a high center of gravity and a constantly shifting line of gravity. Basic Nursing Art 18 Person resting in a chair or bed o The presence of the chair gives wider base of support o The center of gravity is lower o The line of gravity is less mobile thus; a person has greater stability and balance in a sitting or lying position than a standing position. Moving a Patient Purpose: o To increase muscle strength and social mobility o To prevent some potential problems of immobility o To stimulate circulation o To increase the patient sense of independence and self-esteem o To assist a patient who is unable and move by himself o To prevent fatigue and injury o To maintain good body alignment Ensure that the client is appropriately dressed to walk and wears shoes or slippers with non-skid. Facilitates blood flow to the brain ⇒ If a chair is not close by assist the client to a horizontal position on the floor before fainting occurs Controlling Postural Hypo tension o Sleep with the head of the bed elevated (8-12 inches). Mention some of the nursing responsibilities during admission and discharge of the patient. In most instances beds are made after the client receives certain care and when beds are unoccupied. Closed bed: is a smooth, comfortable and clean bed, which is prepared for a new patient • In closed bed: the top sheet, blanket and bed spread are drawn up to the top of the bed and under the pillows. Open bed: is one which is made for an ambulatory patient are made in the same way but the top covers of an open bed are folded back to make it easier of a client to get in. Occupied bed: is a bed prepared for a weak patient who is unable to get out of bed. To conserve patient’s energy and maintain current health status Basic Nursing Art 22 Anesthetic bed: is a bed prepared for a patient recovering from anesthesia ⇒ Purpose: to facilitate easy transfer of the patient from stretcher to bed Amputation bed: a regular bed with a bed cradle and sand bags ⇒ Purpose: to leave the amputated part easy for observation Fracture bed: a bed board under normal bed and cradle ⇒ Purpose: to provide a flat, unyielding surface to support a fracture part Cardiac bed: is one prepared for a patient with heart problem ⇒ Purpose: to ease difficulty in breathing General Instructions 1. Linen for one client is never (even momentarily) placed on another client’s bed 5. Soiled linen is placed directly in a portable linen hamper or a pillow case before it is gathered for disposal 6. Soiled linen is never shaken in the air because shaking can disseminate secretions and excretions and the microorganisms they contain Basic Nursing Art 23 7. When stripping and making a bed, conserve time and energy by stripping and making up one side as completely as possible before working on the other side 8. To avoid unnecessary trips to the linen supply area, gather all needed linen before starting to strip bed 9. Make a vertical or horizontal toe pleat in the sheet to provide additional room for the clients feet. Vertical - make a fold in the sheet 5-10 cm 1 to the foot Horizontal – make a fold in the sheet 5-10 cm across the bed near the foot 10.
Dimehydrinate and promethazine are employed in the prevention and treatment of motion sickness order 40 mg lasix overnight delivery, other vomiting disorders associated with labyrinthine dysfunction as well as nausea and vomiting associated with pregnancy buy lasix 100 mg. Diphenhydramine is frequently used in the treatment of cough as combination preparation with other agents cheap 100mg lasix mastercard. Highest concentration in mammals is found in the pineal gland lasix 40 mg cheap, acting as a precursor for melatonin. It is synthesized from the amino acid tryptophan and acts on several types of receptors. Altered functions may be responsible for disturbances in sleep, mood, sexual behavior, motor activity, pain perception, migraine, temperature regulation, endocrine control, psychiatric disorders and extra-pyramidal activity. It relieves the nausea and vomiting, but the headache may recur, necessitating repeated administrations. The bioavailability of oral dose is only 14 %; thus, the oral dose is several times larger than the subcutaneous dose. Adverse effects include flushing and heat at the injection site, neck pain, dizziness, and tingling of the hands. The drug is contraindicated with symptomatic ischemic heart diseases, angina, and hypertension as it may cause coronary vasoconstriction. Adverse reactions include gastrointestinal irritation, drowsiness, vertigo, and psychic disturbances. It is mainly used to relieve the itching associated with skin disorders such as allergic dermatitis. Given orally or intravenously, it is useful in the management of nausea and vomiting associated with cytotoxic therapy. Prostaglandins: They were named so because of their presumed origin from the prostate gland. Human seminal fluid is the richest known source, but they are also present in various tissues. The prostaglandins are synthesized from polyunsaturated fatty acids at their sites of action. They play an important role in the development of the inflammatory response in association with other mediators. Smooth muscle: most stimulate myometrium and are known to be important in the initiation and maintenance of labor. Natural prostaglandins have no therapeutic application because of short duration of action, but their derivatives such as carboprost, dinoprostone and misoprostol find clinical application. They are also finding several other uses more recently such as erectile dysfunction, glaucoma, etc. Adverse Effects include fever, diarrhea, abdominal cramps, headache, nausea, and vomiting. Respiration is the exchange of gases between the tissue of the body and to outside environment. It involves breathing in of an air through the respiratory tract, uptake of oxygen from the lungs, transport of oxygen through the body in the blood stream, utilization of oxygen in the metabolic activities (cells and removal of carbon dioxide from the body. Drug therapy of pulmonary disorders is generally directed towards altering a specific physiologic function. The chapter will focus on drugs used to treat some of the more common disorders affecting the respiratory system particularly bronchial asthma, allergies and congestions associated with certain respiratory disorders. Inspissations in the airway lumen of abnormally thick, viscid plugs of excessive mucus. Extrinsic asthma is associated with history of allergies in childhood, family history of allergies, hay fever, or elevated IgE. Intrinsic asthma occurs in middle-aged subjects with no family history of allergies, negative skin tests and normal serum IgE. Immunologic model Asthma is a disease mediated by reaginic (IgE) antibodies bound to mast cells in the airway mucosa. Non- antigenic stimuli like viral infections, exercise, and cold air stimulate bronchial spasm.