Peri Anaesthesia Nursing Care Samples †MyAssignmenthelp.com

Question: Discuss about the Peri Anaesthesia Nursing Care. Answer: Physiological cause for hypotensive is low diastolic blood pressure (less that 60) and marginal systolic blood pressure. Another cause behind low blood pressure or hypotension in Mrs Katsura is blood loss due to gastro-intestinal bleed. According to Pacagnella et al. (2013), extreme blood loss, both internal and external may result in the generation of hypotension. Hypotension arising from internal bleeding is a serious condition as lack of adequate fluid inside the body may compress the vital organs resulting in organ dysfunction. It may eventually lead to haemorrhagic shock (Pacagnella et al., 2013). The main physiological reason behind tachypnoea of Mrs Kate Katsura is her high respiratory rate: 28 breaths per minute (normal range: 12 to 20 breaths per minute) (Bianchi et al. 2013). The reason behind tachypnoea may be due to her gastro-intestinal bleeding which indicates the possible signs and symptoms of gastro-intestinal infection. According to Sagy, Al-Qaqaaand Kim (2013), any form of sepsis or blood infection or allergic reaction is associated with tachypnoea. The compensatory mechanism that may be attributed behind the development of the tachypnoea is Mrs Kate Katsurasprevious acute history of myocardial infarction. In order to increase the blood flow inside the heart, respiratory rate might have increase or loss of blood via gastro-intestinal bleeding might have resulted in increased rate of blood flow in heart. The main physiological reason behind tachycardia is internal gastro-intestinal bleeding. The indication of gastro-intestinal bleeding is indicated via abdominal pain. Since Mrs Katsura is a patient of myocardial infraction, tachycardia might a representation of that disease. According to Makkar et al., (2012) tachycardia is a marker of myocardial infraction. Myocardial infraction results in the generation of the structural abnormalities of the coronary arteries and this lead to the generation of tachycardia (Makkar et al., 2012). Hartmanns solution: Its composition is physiologically close to blood plasma and it is isotonic in nature, which helps in quick restoration of the circulating volume and electrolyte balance (Aditianingsih George, 2014). According to Aditianingsih and George (2014), fluid therapy done via Hartmanns solution is core process for managing peri-operative patients for proper maintenance of the blood volume. 0.9% of Normal Saline: It is an isotonic solution that contains sodium chloride (NaCl) as solute, dissolved in sterile water (solvent). This isotonic fluid helps in resuscitating the circulating blood volume while restoring the electrolyte balance (MyburghMythen, 2013). Packed cells: It contains packed red blood cells which help in replenishing the circulating blood with the haemoglobin and hence can be regarded as an important fluid replacement therapy for circulating blood volume. Increase in the haemoglobin concentration in blood further aids in oxygen delivery to the organs (MyburghMythen, 2013). The physiological rationale behind the intraoperative monitoring is it helps in measurement and monitoring of the vital parameters like hearts electrical activity, respiratory rate, and blood pressure, temperature of the body, cardiac output, oxygen saturation, pulse rate and pulmonary functions. Keeping in mind the vital statistics of Mrs Kate Katsura, intraoperative monitoring is extremely crucial as at the time of MET call her respiratory rate was high along blood pressure was low. According to Holm et al., (2004), intraoperative monitoring results in formulation of more aggressive therapeutic strategies for providing proper care and treatment Mrs Katsura after fluid replacement. Moreover Holm et al., (2004) further opines that crystalloid infusion does not help in the improvement of the preload or the parameters of the cardiac output. This may be because; resuscitation or fluid replacement therapy done via normal saline or Hartmanns solution is not capable of restoring cardiac pr eload Holm et al., (2004). Hence monitoring of the cardiac output and the respiratory parameter is essential as MrsKatsura has previous reported cases of myocardial infarction. Moreover, fluid replacement therapy helps in regulation of the blood pressure and the oxygen balance in the body and hence further signifies the physiological importance of intraoperative monitoring after fluid replacement. Another rationale that can be cited against the intra-operative monitoring include, it is a valuable technique for assessing the proper neuronal functions and it is extremely crucial for the neurologic examination of the patients who are in anaesthesia and are unable to operate face-to-face examination (Stecker, 2012). The main mode of anaesthesia for Mrs Katsura is rapid sequence induction (RSI). This is because, it is an established method for inducing anaesthesia in patients who lies at an increased risk of aspiration of gastric contents inside the lungs (Sinclair Luxton, 2005). Since, Mrs Katsura is suffering from gastro-intestinal bleeding, RSI can be considered ideal for her. According to Sinclair and Luxton, (2005), RSI involves loss of consciousness during the tenure of cricoid pressure followed via the procedure of intubation without the requirement for the face mask ventilation. The importance of this technique is, it aims to intubate trachea quickly and safely. RSI differs from other forms of general anaesthesia induction because, artificial ventilation is not provided to the patient from the point of time the patient stops breathing until after successful itubation is achieved. This helps to minimize insufflations of air into the stomach of the patient which might other may provoke regurgitation. Since Mrs Katsura is suffering from gastro-intestinal bleeding, minimization of the insufflations of air into her stomach will be beneficial. Sinclair and Luxton, (2005) have further opined that since RSI involves loss of consciousness and neuromuscular block without the requirement for mechanically ventilate the lungs, an anaesthetist must be well prepared for all eventualities before starting the process of RSI. This must include good preparation for safe induction, proper equipment to remove secretions and pre-planned drill to follow intubation. However, the choice of the induction agent must be made in such a way that it provides rapid onset and recovery from anaesthesia with minimal cardiovascular and other associated systemic side-effects (Sinclair Luxton, 2005). Mrs Katsura has previous reported case history of myocardial infarction and thus minimal cardiovascular complications arising from RSI will be beneficial. For neuromuscular blocking agent, rocuronium is chosen in comparison to succinylcholine. Rocuronium is regarded as non-depolarizing neuromuscular blocking agents as it produce rapid onset of action along with reduced risk of aspiration and hypoxia (Sinclair Luxton, 2005). Upon admission to PACU, it is the duty of the nurse to perform standard head-to-toe systems physical assessment. However, the current case study lacks any-from of head-to-toe assessment as it only provides the vital statistics of the patients and no information regarding baseline assessment.Preparation is the significant factor of post-operative management of a cardiac patient(Gregory, Bolling and Langston 2014). Under preparation, a nurse is expected to accumulate information regarding the past medical history of the patient along with the intra-operative course. The case study shows that it has successfully accumulated the past medical history of Mrs Katsura. It says that Mrs Katsura has previous reported cases of acute myocardial infraction along with hypertension and her usual medication include aspirin and ramipril. This information is crucial as it helps the nurse to anticipate the potential post-operative complications along the proper treatment regime(Gregory, Bolling and Lan gston 2014). Since MrsKatsura has long history of hypertension, she will likely require intravenous (IV) vasodilator therapy in immediate post-operative period. The case study also reveals that Mrs Katsura is 67 years old and hence might gave increase risk of intra-operative complications and thus nurses are required to remain conscious. Moreover, since Mrs Katsura has previous reported cases of MI such that she might have increased peri-operative mortality rate. Upon encountering syncopal, hypotensive episode, Kate has been suggested for gastroscopy in order to investigate the possible reasons behind gastro-intestinal bleeding. However, according to Denzer et al., (2015), magnetically guided capsule is a better and safer option than gastroscopy as it has comparatively less peri-operative complications and are preferred by patients. Post-anaesthesia nursing management cardiac patients are an important component under the curriculum of peri-anaesthetist nurse(Gregory, Bolling and Langston 2014).One of the main focuses of the immediate post-anaesthesia care is proper drainage catheter place in the operative field. This helps in the elimination of excessive bleeding in the immediate period of post anaesthesia. Bleeding has both surgical and non-surgical reasons (Gregory, Bolling and Langston 2014). In case of Mrs Katsura the main cause behind bleeding will be sustained or transient hypertension. Thus controlling hypertension is critical factor during the immediate post-anaesthesia period. Another cause of bleeding may be associated with scar tissue and adhesions that leads to the generation of initial sternotomy(Gregory, Bolling and Langston 2014). Since Mrs Katsura is having internal gastro-intestinal bleeding this might be another cause and hence must strictly be taken into consideration as non-surgical bleeding affects the bodys ability to clot (Gregory, Bolling and Langston 2014). The post-operative regime of the treatment is another important fact that may contribute to post-operative haemostasis alterations. Haemostatic mechanisms might not return to normal if the patient was on anti-platelet agents prior to admission. Mrs Katsura was on aspirin (anti-platelet agents) and hence this might increase the incidence of excessive post-operative bleeding (Gregory, Bolling and Langston 2014). It is the duty of the peri-operative nurse to effectively manage the bleeding via monitoring the chest tube output closely and treating hypertension or hypotension promptly. In case of Mrs Katsura it is hypertension. The main intervention of nursing management include positioning the patient in supine posture with the legs elevated in-order to promote cerebral perfusion while monitoring coagulation and treating hypertension via using vasodilators (Gregory, Bolling and Langston 2014). References Aditianingsih, D., George, Y. W. (2014).Guiding principles of fluid and volume therapy.Best Practice Research Clinical Anaesthesiology,28(3), 249-260. Bianchi, W., Dugas, A. F., Hsieh, Y. H., Saheed, M., Hill, P., Lindauer, C., ... Rothman, R. E. (2013). Revitalizing a vital sign: improving detection of tachypnea at primary triage.Annals of emergency medicine,61(1), 37-43. Denzer, U. W., Rsch, T., Hoytat, B., Abdel-Hamid, M., Hebuterne, X., Vanbiervielt, G., ... Ogata, N. (2015). Magnetically guided capsule versus conventional gastroscopy for upper abdominal complaints: a prospective blinded study.Journal of clinical gastroenterology,49(2), 101-107. 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A., Mythen, M. G. (2013).Resuscitation fluids.New England Journal of Medicine,369(13), 1243-1251. Pacagnella, R. C., Souza, J. P., Durocher, J., Perel, P., Blum, J., Winikoff, B., Glmezoglu, A. M. (2013).A systematic review of the relationship between blood loss and clinical signs.Plos one,8(3), e57594. Sagy, M., Al-Qaqaa, Y., Kim, P. (2013).Definitions and pathophysiology of sepsis.Current problems in pediatric and adolescent health care,43(10), 260-263. Sinclair, R. C., Luxton, M. C. (2005). Rapid sequence induction.Continuing Education in Anaesthesia, Critical Care Pain,5(2), 45-48. Stecker, M. M. (2012). A review of intraoperative monitoring for spinal surgery.Surgical neurology international,3(Suppl 3), S174.