Postspinal headache RX

1. Postspinal headache RX • Vigorous hydration • Abdominal binders • Epidural infusion of saline • Injection of 5 to 20 ml of autologous blood into the epidural space at the puncture site that is blood patch

2. Perioperative nursing consideration related to anaesthesia • Verify the pat identity and the scheduled procedure • Operative permit is properly signed • Allergies • Laboratory tests and diagnostic studies are complete and on the chart • The nurse should assist during insertion of intravenous, central venous pressure, arterial or pulmonary artery catheters

3. Perioperative nursing consideration related to anaesthesia • During induction of anesthesia particularly with a traumatized patient or for an emergency procedure the nurse should stand at the right side of the pat and be ready to apply cricoid pressure to prevent regurgitation of stomach contents and to assist the anesthesiologist in visualizing the vocal cord

4. Perioperative nursing consideration related to anaesthesia • When cricoid pressure is used to prevent aspiration, it should not be released until the intubation is accomplished, the cuff on the endotracheal tube has been inflated and proper placement of the endotracheal tube has been verified • When the pat is appropriately positioned for surgery the nurse should always check the arms and legs to ensure that no pressure points exist and that the extrimities are appropriately positioned and padded

5. Perioperative nursing consideration related to anaesthesia • Prior to the patient being trasported to the PACU following completion of the procedure, circulating nurse calls the PACU to give the preliminary status report of the patient´s condition • Report includes the surgical procedure performed, type of anaesthesia care provided, information specific to the patient´s preoperative diagnosis and subsequent outcome related to intraoperative intervention and any special equipment such as a ventilator that will be needed in the PACU

6. Postanesthetic Recovery • When the pat arrives in the PACU, the anesthesiologist provides the PACU nurse with pertinent information, including • name, age, surgical procedure and complications type of anesthesia, • preoperative medications and anesthesia drugs, • preoperative and intraoperative vital signs, • estimated blood loss and intraoperative fluid intake and output, • allergies, orders for analgesia during recovery

7. Postanesthetic Recovery • For graphic summery of the patient´s recovery the postanesthetic recovery score (PARS) originally proposed by Aldrete • PARS is recorded every 15-30 min until discharge • A score of 9 or 10 usually indicates the pat is ready for transfere to the postoperative nursing unit • Please read figure 9-12, page 170

8. Common problemsNausea and vomiting • Nausea is believed to be caused by stimulation of the vomiting center in the medulla by impulses from the gastrointestinal tract, other cerebral centers, or drugs. • It occurs more frequently in females than males • Contributing factors include a history of motion sickness, pain, perioperative medications, anesrthetic technique, gastric distention, duration of surgery, surgical site in uupper abdomen or thorax more than lower abdomen or extrimities), perioperative hypotension, respiratory insufficiency, obesity, patient positioning, rapid patient movement

9. Common problemsNausea and vomiting • Prophylactic measures that decreases the instance of nausea and the risk of aspiration include nonparticulate antacids (sodium citrate, H2 antagonists (cimetidine or ranitidine ) to reduce gastric acid secretion, gastrokinetic agent (metoclopramide) to improve gastric emptying and the choice of anesthetic agents and drugs • Postoperative management for nausea is directed toward minimizing rapid patient movements, prompt and satisfactory relief of pain, ensuring adequate respiratory function and stable signs, use of antiemetics and prevention of aspiration

10. Common problemsPain • Newer methods of pain relief including intrathecally or epidurally administered narcotics and patient controlled analgesia (PCA) given intravenously are commonly used

11. Common problemsAlteration in mental status • Agitation, shivering, hyperreflexia, hypertonicity and clonus are commonly observed • Common causes include pain, respiratory dysfunction, gastric or urinary distention, perioperative medications, anesthetic technique, electrolyte imbalance (e.g.dilutional hyponatremia after prostatic resection, drug abuse and preexisting psychological factors

12. Common problemsRead page 170-17 • Hypoxia • Carbon Dioxide • Hypotension • Hypertension • Cardiac dysrhythmias

13. Anesthesia for ambulatory surgery • In an effort to reduce health care costs, hospitals are admitting patients the day of surgeryfor major elective procedure • 2-5 days before the date for the surgery , the patient visits the ambulatory surgery center for preoperative interview, appropriate lab test and diagnostic studies • Pat is instructed to be NPO after midnight evening preceding surgery • On the day of surgery the pat arrives 1 hour before the procedure and changes into an operating room gown plus a robe

14. Anesthesia for ambulatory surgery • In the preoperative area an i.v is started and pat reads magazines.listen to music or visit with family or friends until going to thr OR • The surgion speaks with the pat in the oreoperative area • The pat walks to OR and lies down on the operating room bed • Induction of anesthesia commences • Shortacting anesthetic drugs are used , all medications are given i.v • After surgery pat is transfered to a stretcher and taken to the Phase 1 PACU

15. Anesthesia for ambulatory surgery • When recovered significantly , the pat is assisted II recovery area and sits in a reclining chair • In phase II a family member or responsible adult joins the patient and the patient is offered water, ginger, cola, tea or coffee • When ready to go home, the pat is evaluated by the anesthesiologist and receives discharge instruction from the PACU nurse • A mail in questionnaire is given to the pat for comments about ambulatory surgey experience • 2-5 days after surgery a follow up telephone call is made to the patient by one of the nursing staff

16. Lasers • Less invasive pocedure • Decreas in inpatient hospitalization • Diminishing postoperative complications • Saving health care dollars • Ruby laser was used for dermatologic applications and for retinal photocoagulation in patient with diabetic retinopathy,it was not very efficient • Other media as argon, CO2 & neodymium: yttrium aluminum garnet lasers are developed

17. Lasers • Advancement in laser technology have provided the physician with a precision tool for cutting, coagulating, vaporizing welding (The process of joining metal surfaces by heating them until they are slightly molten, then hammering them together) tissue during surgical intervention

18. Principles of light • Laser is an acronym that describes a process in which light energy is produced • This term refers to the device that generates the laser energy • Light is a form of electromagnetic energy that can be graphically illustrated on a continuum known as the electroromagnetic spectrum • The unit of measurement that delineates the continuum is called a wavelength which is the distance between two successive peaks of a wave • Wavelength determines color and is usually measured in nanometers (10 –9 meter) or microns (100 nanometers)

19. Principles of light • The various wavelength of laser energy extend from the shorter waves in the ultraviolet area to the longer waves in the infrared region along this perpetual (motion that continues indefinitely without any external line) line • The visible laser wavelengths occupy only a small portion of this continuum (whole)

20. Principles of light • A negatively charged electron orbits (range of control or influence) a positively charged nucleus while the atom is in its ground or resting state • An outside source of energy can excite the atom and cause an electron to jump to a higher, less stable orbit • The electron immediately returns to resting state • As it does , it spontaneously emits a tiny bundle of surplus energy called a photon • If an atom that is already excited is struck (used in combination) affected by something overwhelming) or stimulated by a photon of equal energy, two identical photons are emitted

21. Principles of light • This process is stimulated emission (The release or discharge of a substance into the environment. Generally refers to the release of gases or particulates into the air) • This activity occurs in the resonating (resonance is the tendency of a system to oscillate with high amplitude when excited by energy at a certain frequency. This frequency is known as the system's natural frequency of vibration or resonant frequency) chamber of the laser where the lasing medium is contained

22. Principles of light • The name of the laser is derived from the actual medium that causes the lasing action • The stimulation of radiation continues as the number of excited atoms surpasses (Distinguishoneself) the number of resting atoms • The photons are reflected back and forth (Out into view) between two mirrors at each end as the process is amplified (Increase in size, volume)until the state of ”population inversion” (Abnormal condition in which an organ is turnedinward or inside out) has been reached • One mirror is partially reflective and when activated allows astream of laser photons to escape the unit • These photons are then introduced to the target area via a special delivery system