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Stages of General Anesthesia

From To Patient’s Reaction Nursing Action

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

Excitement/ delirium, Relaxation May be excited with irregular breathing and movements Secure patient properly, remain at
Loss of consciousness of the extremities the side of the patient quietly but
Susceptible to external stimuli ready to assist anesthesiologist as
(e.g. noise, touch) needed

Regular respiration
Contracted pupils Position patient and prep skin only
Surgical Anesthesia Loss of reflexes;
Reflexes disappear when anesthesiologist indicates this
Relaxation Depression of vital function
Muscle relax stage in reached
Auditory sensation loss

Danger Stage
Respiratory failure; possible Not breathing Prepare for cardiopulmonary
Vital functions too
cardiac arrest Little or no pulse or heartbeat resuscitation
depressed
`

3) ATROPINE Classification: Other Action: An anti- Indications • These side effects Nursing
SULFATE Cardiovascular Drugs, cholinergic that inhibits Systemic administration may occur: Measures:
Muscle Relaxants, acetylcholine at the • Antisialagogue for Dizziness,
preanesthetic • Ensure
Mydriatic Drugs, parasympathetic medication to prevent confusion (use
Antidotes, Detoxifying neuroeffector junction, or reduce respiratory caution driving or adequate
Brand Names: Anespin Agents & Drugs Used in enhances the tract secretions performing hydration;
amp Atropol amp Substance Dependence conduction of AV node • Treatment of hazardous tasks); provide
Euro-Med Atropine parkinsonism; relieves environment
and increases heart rate constipation
Sulfate amp Isopto tremor and rigidity
Drug classes (ensure adequate al control
• Restoration of cardiac
Atropine eye drops Phil Anticholinergic Therapeutic actions fluid intake, (temperature
rate and arterial
Pharmawealth/Atlantic Antimuscarinic Competitively blocks the effects ) to prevent
pressure during proper diet); dry
Parasympatholytic of acetylcholine at muscarinic
Atropine amp anesthesia when vagal mouth (suck hyperpyrexia
Antiparkinsonian cholinergic receptors that stimulation produced .
Antidote mediate the effects of sugarless
by intra-abdominal
Diagnostic agent (ophthalmic parasympathetic postganglionic lozenges; perform
traction causes a
preparations) impulses, depressing salivary decrease in pulse rate, frequent mouth • Have patient
Belladonna alkaloid and bronchial secretions, dilating void before
lessening the degree of care; may be
the bronchi, inhibiting vagal AV block when taking
influences on the heart, relaxing transient); blurred
increased vagal tone is medication if
the GI and GU tracts, inhibiting a factor (eg, some vision, sensitivity
gastric acid secretion (high to light urinary
cases due to digitalis)
doses), relaxing the pupil of the • Relief of bradycardia (reversible; avoid retention is a
eye (mydriatic effect), and and syncope due to problem.
preventing accommodation for tasks that require
hyperactive carotid acute vision; wear
near vision (cycloplegic effect); sinus reflex • When used
also blocks the effects of sunglasses in
acetylcholine in the CNS.
• Relief of pylorospasm, preoperativel
hypertonicity of the bright light);
y or in other
small intestine, and impotence
acute
hypermotility of the (reversible);
colon situations,
• Relaxation of the difficulty in incorporate
spasm of biliary and urination (empty teaching
ureteral colic and
the bladder prior about the
bronchospasm
• Relaxation of the tone to taking drug). drug with
of the detrusor muscle teaching
of the urinary bladder • Report rash; about the
in the treatment of flushing; eye pain; procedure;
urinary tract disorders difficulty the
• Control of crying and
breathing; ophthalmic
laughing episodes in
patients with brain tremors, loss of solution is
lesions coordination; used mainly
irregular acutely and
heartbeat, will not be
palpitations; self-
headache; administered
abdominal by the
distention; patient; the
hallucinations; following
severe or apply to oral
persistent dry medication
mouth; difficulty for
swallowing; outpatients:
difficulty in
urination; • Take as
constipation; prescribed,
sensitivity to light. 30 min
before
Adverse Reactions: meals; avoid
Dry mouth, dysphagia, excessive
constipation, flushing dosage.
and dryness of skin,
tachycardia, Avoid hot
palpitations, environments; you
arrhythmias, mydriasis, will be heat
photophobia, intolerant, and
cycloplegia, raised dangerous reactions
intraocular pressure. may occur
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.

Generic Name Indication Mechanism of Action Contraindication Nursing Consideration

Metoclopromide GI motility disturbances Dopamine Antagonist that acts GI hemorrhage epilepsy, >Inject slowly IV every 1-2
by increasing sensitivity to obstruction or perforation minute to prevent transient
acetylcholine; results in feelings of anxiety &
increased motility of the upper restlessness
Nausea & vomiting of central & GI tract and relaxation of the
peripheral origin associated with pyloric sphincter & duodenal
Brand Name: infectious diseases & drug bulb.
induced. >N&V, anorexia, constipation
abdominal distention before 7
after administration.
Placil

>Report lack of response ,


Classification:
persistent side effect so that
they can be properly evaluated.

Anti emetic
>Frequent monitor BP of pt’s
taking IV form of drug
Adverse Effect:
Dosage:

Restlessness, drowsiness, >Assess pt’s GI complaints


fatigue, dizziness, nausea,
1 amp IV every 8 hours headache.

19) METOCLOPRAMIDE

Brand name: Apo-Metoclop (CAN), Maxeran (CAN), Maxolon, Nu-Metoclopramide (CAN), Octamide PFS, Reglan
Classification: antiemetic & anti-spasmodic
Dosage: 10 mg/ 2mL
Indication: 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 GIT
Action: stimulates motility of upper GI tract, increases lower esophageal sphincter tone, and blocks dopamine receptors at the
chemoreceptor trigger zone
Adverse 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: Morin


Classification: 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- 30 mg IVP Q 6 hrs PRN


inflammatory agents,
nonopioid analgesics

Peak Onset Duration Normal dosage range

1-2 hrs 10 min 6 hrs or longer 30 mg q 6 hr (not to exceed 120 mg/day)

Why is your patient getting this medication For IV meds, compatibility with IV drips and/or solutions

Severe back pain 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 Nursing Implications (what to focus on)


Contraindications/warnings/interactions
(Why med ordered)
Concurrent use with aspirin may ↓ effectiveness, ↑ adverse GI effects with
Inhibits prostaglandin synthesis, producing peripherally mediated analgesia, aspirin , other NSAIDs , potassium supplements , corticosteroids , or alcohol.
Also has antipyretic and anti-inflammatory properties. 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 Contraindications Adverse Reaction Nursing
Action Consideration

100mg/5ml 5ml ○ Mild to Unknown. ○ Contraindic CNS: headache, ○ Check renal


moderat Produces anti- ated in dizziness, and hepatic
Name: Ibuprofen PRN, Oral e pain inflammatory, patients nervousness, function
periodically
analgesic, and hypersensiti aseptic minigitis
in patients
○ Fever anti-pyretic ve to drug on long-
effects, possibly and in CV: peripheral
Brand Name: term
○ Juvenile by inhibiting those with edema, fluid therapy.
arthritis prostaglandin angio- retention, edema Stop drug if
Children’s Motrin
synthesis. edema, abnormaliti
EENT: tinnitus es occur
syndrome
and notify
of nasal
GI: epigastric prescriber.
Classification: polyps, or
distress, nausea,
bronchospa ○ Because of
Non-steroidal occult blood loss,
stic reaction their
anti-inflammatory peptic ulceration,
to aspirin or antipyretic
drugs diarrhea,
other and anti-
constipation,
NSAIDs. inflammato
abdominal pain, ry actions,
bloating, GI NSAIDs
○ Contraindic
fullness, dyspepsia, may mask
ated in
flatulence, heart signs and
pregnant symptoms
burn, decreased
women. of infection
appetite
○ Use ○ Blurred and
GU: acute renal
cautiously diminished
failure, azotemia,
in patients vision and
cystitis, hematuria changes in
GI
disorders, color vision
Hematologic: have
history of prolonged bleeding occurred
peptic ulcer time, anemia,
disease, neutroenia, ○ It may take
hepatic or pancytopenia, 1 or 2
renal thrombocytopenia,
weeks
disease, before full
aplastic anemia,
cardiac anti-
leucopenia, inflammato
decompens agranulocytosis ry effects
ation,
occur
hypertensio Metabolic:
n, hypoglycemia, ○ Serious GI
preexisting hyperkalemia toxicity,
asthma, or including
known Respiratory: peptic
intrinsic ulcers and
bronchospasm
bleeding, in
coagulation
patient

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