In preparing a patient with a history of mild asthma for surgery, which intervention is essential to ensure respiratory safety during the procedure?

B) Ensuring the patient has her albuterol inhaler available.

A) Administering a preoperative dose of penicillin.

B) Ensuring the patient has her albuterol inhaler available.

C) Increasing the patient's fluid intake to thin respiratory secretions.

D) Withholding all medications to avoid interactions with anesthesia.

A patient scheduled for elective knee arthroscopy expresses mild anxiety about the surgery and the use of anesthesia. Which of the following interventions should the nurse prioritize to address the patient's anxiety?

B) Explain the anesthesia process and reassure the patient.

A) Administer a mild sedative as prescribed.

B) Explain the anesthesia process and reassure the patient.

C) Encourage the patient to practice deep breathing exercises.

D) Distract the patient with conversation unrelated to the procedure.

What is the primary reason the nurse encourages the patient to perform deep-breathing exercises during the procedure?

B) To help stabilize the patient's heart rate

A) To increase the patient's oxygen saturation

B) To help stabilize the patient's heart rate

C) To prevent post-operative nausea

D) To ensure the patient's comfort during sedation

What is the most appropriate immediate nursing intervention if a post-operative patient with a history of mild asthma begins to show signs of respiratory distress?

C) Position the patient in a semi-Fowler's position

A) Administer prescribed bronchodilator

C) Position the patient in a semi-Fowler's position

D) Call the anesthesiologist immediately

What is the primary reason for teaching deep-breathing exercises to a post-operative patient?

A) To reduce post-operative nausea

What is the primary reason for encouraging deep-breathing exercises in post-operative patients?

D) To reduce the risk of infection

What is the primary reason for the nurse to encourage fluid intake in a postoperative patient experiencing mild nausea?

D) To enhance medication absorption

What is the primary rationale for the nurse encouraging the patient to drink more fluids after surgery?

D) To decrease surgical site pain

Which of the following interventions is the nurse using to manage the patient's nausea in addition to medication?

C) Providing a cool, damp cloth for the forehead

A) Encouraging increased fluid intake

B) Administering a higher dose of analgesic

C) Providing a cool, damp cloth for the forehead

D) Monitoring the surgical site for signs of infection

Which of the following vital sign assessments indicates a positive response to pain management in the patient?

B) Blood pressure of 140/90 mmHg

C) Respiratory rate of 20 breaths per minute

anesthesia - Nursing Case Study

Pathophysiology

• Primary mechanism: Anesthesia primarily works by enhancing the inhibitory neurotransmitter GABA in the central nervous system, which slows down brain activity and results in loss of consciousness and sensation.

• Secondary mechanism: It also inhibits excitatory neurotransmitter glutamate, further reducing neural activity, which contributes to muscle relaxation and suppression of reflexes.

• Key complication: A minor complication can include respiratory depression, where reduced neural signaling can slow down breathing, necessitating careful monitoring during anesthesia.

Patient Profile

Demographics:

32-year-old female, school teacher

History:

• Key past medical history: Mild asthma

• Current medications: Inhaler (albuterol) as needed

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Scheduled for elective knee arthroscopy

• Key symptoms: Mild knee pain, no other symptoms

• Vital signs: Blood pressure 120/80 mmHg, heart rate 72 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F, oxygen saturation 98% on room air

Section 1

As the scheduled time for the elective knee arthroscopy approaches, the nursing team conducts an initial assessment to ensure the patient is ready for the procedure. The nurse notes that the patient, while alert and oriented, expresses mild anxiety about the surgery and the use of anesthesia, which is common in preoperative settings. The nurse reassures the patient, explaining the anesthesia process and measures in place to ensure safety. During the assessment, the nurse checks the patient's vital signs: blood pressure remains stable at 118/78 mmHg, heart rate is consistent at 70 bpm, respiratory rate is slightly elevated at 18 breaths per minute due to anxiety, and oxygen saturation remains at 98% on room air. The patient's lungs are clear upon auscultation, and there are no signs of respiratory distress.

Given the patient's history of mild asthma, the nurse pays close attention to respiratory status, mindful that anesthesia can sometimes exacerbate respiratory issues. The patient confirms she has her albuterol inhaler on hand, and the preoperative team ensures it will be readily available if needed. The anesthesia plan includes monitoring the patient's respiratory function closely, with the anesthesiologist prepared to adjust dosages to prevent respiratory depression.

The nurse collaborates with the surgical team to implement a calm environment and uses relaxation techniques to help ease the patient's anxiety. This also helps to ensure that vital signs remain stable, reducing the risk of complications. As the patient is prepped for surgery, the nurse cross-checks her allergy to penicillin to confirm that no related medications will be used. With the initial assessment complete, the patient is deemed ready for surgery, with protocols in place to address any minor complications that might arise during anesthesia.

Section 2

As the patient is moved to the operating room, the nurse continues to monitor her vital signs and overall condition. The patient remains alert and her vital signs are stable, with blood pressure at 116/76 mmHg, heart rate at 72 bpm, and respiratory rate at 17 breaths per minute, slightly reduced due to successful relaxation techniques. Oxygen saturation is steady at 98% on room air. The nurse, maintaining a calm demeanor, provides reassurance to the patient as they review the anesthesia plan together. The anesthesiologist explains that they will use a combination of local and light sedation to minimize any potential respiratory complications given her history of mild asthma.

During the procedure, the patient experiences a slight increase in heart rate to 78 bpm, which the anesthesiologist attributes to mild discomfort. The nurse promptly intervenes by guiding the patient through deep-breathing exercises, which helps to stabilize her heart rate. Throughout the surgery, the patient’s oxygen saturation remains within normal limits, hovering steadily at 97-98%, indicating effective respiratory function and the absence of significant respiratory depression. The anesthesiologist and surgical team remain vigilant, ready to address any changes.

Post-surgery, the patient is transferred to the recovery area where the nurse conducts an initial post-operative assessment. The patient is slightly groggy but responsive, with vital signs showing blood pressure at 114/74 mmHg, heart rate at 74 bpm, and respiratory rate at 16 breaths per minute. Oxygen saturation is a healthy 98% on room air. The nurse notes that the patient’s respiratory status remains stable with no signs of distress or wheezing. The patient reports mild discomfort at the surgical site, which the nurse addresses with prescribed analgesics. The care team remains attentive, ready to support the patient's smooth transition through recovery, with plans for continued monitoring and the provision of education for home care and follow-up.

Section 3

As the patient continues to recover in the post-operative area, the nurse diligently monitors her vital signs and performs a thorough initial assessment. The patient's vital signs remain stable, with blood pressure at 112/76 mmHg, heart rate at 73 bpm, and respiratory rate at 15 breaths per minute. Oxygen saturation is consistently at 98% on room air. The nurse conducts a focused respiratory assessment, listening for any wheezing or abnormal breath sounds, but finds the patient's lungs are clear bilaterally. The patient's skin is warm and dry, with good color and capillary refill under two seconds, indicating adequate peripheral perfusion.

The nurse also assesses the surgical site for any signs of excessive bleeding or infection. The dressing is dry and intact, with no signs of drainage or swelling. The patient reports feeling slightly nauseous, a common post-operative symptom, which the nurse addresses by administering a prescribed antiemetic. The nurse ensures the patient is comfortable, repositioning her slightly to alleviate any pressure and offering sips of water to manage mild dehydration from fasting before surgery.

As the patient becomes more alert, the nurse provides education on deep-breathing exercises and the importance of early mobilization to prevent complications such as atelectasis and venous thromboembolism. The patient is receptive and begins practicing the exercises with guidance. The nurse plans to reassess the patient's pain level and comfort regularly, ensuring that the prescribed analgesics effectively manage her discomfort while keeping a close watch for any adverse reactions. The care team prepares for the patient's eventual discharge, focusing on reinforcing home care instructions and emphasizing the importance of follow-up appointments to ensure a smooth recovery.

Section 4

As the nurse continues to monitor the patient, she notices a slight change in the patient's condition. The patient's heart rate has increased to 85 bpm, still within normal limits but slightly elevated from the previous assessment. Blood pressure remains stable at 110/74 mmHg, and respiratory rate is unchanged at 15 breaths per minute. The nurse observes that the patient is slightly more restless and reports discomfort at the surgical site. A pain assessment reveals the patient's pain level has increased to a 5 out of 10 on the pain scale. In response, the nurse administers the prescribed analgesic, ensuring it is given in a timely manner to address the patient's discomfort.

The nurse also takes note of the patient's mild nausea, which persists despite the administration of an antiemetic earlier. She reassesses the patient's hydration status, noting that the patient has only taken small sips of water. To promote better hydration and alleviate nausea, the nurse encourages the patient to drink more fluids as tolerated. She also revisits the patient's position, adjusting it slightly to enhance comfort and to facilitate lung expansion.

Given the increase in pain and persistent nausea, the nurse decides to review the latest laboratory results. The results show a slight elevation in the patient's white blood cell count, which could indicate a mild inflammatory response post-surgery. However, all other values, including hemoglobin and electrolytes, remain within normal ranges. The nurse communicates these findings to the healthcare team and discusses the potential need for further pain management strategies and continued monitoring of the patient's symptoms. This collaborative approach ensures that any emerging complications are addressed promptly, setting the stage for a successful recovery.

Section 5

As the nurse continues to monitor the patient's response to the administered analgesic, she observes that the patient's heart rate has stabilized at 82 bpm, indicating a positive response to the pain management strategy. The patient's blood pressure remains consistent at 110/74 mmHg, and the respiratory rate is steady at 15 breaths per minute. These stable vital signs suggest that the patient is responding well to the interventions in place. However, the patient's pain level has only slightly decreased to a 4 out of 10, suggesting the need for ongoing assessment and potential adjustment of pain management strategies.

The nurse takes the opportunity to re-evaluate the patient's nausea. Despite increased fluid intake, the nausea persists, albeit at a slightly reduced level. The patient reports a mild sense of relief but continues to feel queasy. The nurse decides to implement non-pharmacological interventions to complement the antiemetic medication. She encourages the patient to practice deep breathing exercises and provides a cool, damp cloth for the patient's forehead to enhance comfort. These simple measures aim to enhance the patient's overall sense of well-being and assist in managing the nausea effectively.

To ensure comprehensive care, the nurse remains vigilant for any signs of new complications. She continues to monitor for changes in the surgical site, assessing for signs of infection such as increased redness, swelling, or drainage, but finds no such indications at this time. The nurse also maintains regular communication with the healthcare team, sharing updates on the patient's condition and collaborating on any necessary adjustments to the care plan. This proactive approach ensures that the patient remains on a steady path to recovery, with the healthcare team ready to address any new challenges that may arise.