Presentation on theme: "Common Medications in OR-DR"— Presentation transcript:
1 Common Medications in OR-DR Prepared by: Ryan Matira, RN
2 OverviewThe extent of anxiety appears to be associated with the particular procedure being performed to the patient.Primary goals for premedication :Anxiolytic effectsReduction in preoperative painAmnesiaReduction in secretionIncrease in gastric fluid pH with a decrease in gastric fluid volumeReduction of autonomic nervous system reflex responses
3 Reduction in required anesthetic amounts Prophylaxis with respect to allergic reactionReduced cardiac activityReduction/avoidance of postoperative nausea and vomitingPostoperative analgesia
4 Factors that influence the choice those drugs for premedications and associated dosages: Whether the surgery is classified as "inpatient" or "outpatient"Whether the surgery is being performed as an elective or emergency procedureConcerns about the ability of the patient to tolerate the drugPatient age & weight & physical statusAnxiety level of the patient-Recall that an anxious patient is likely to have elevation of circulating catecholamines which may cause a suboptimal cardiovascular preoperative stateWhether the patient has had an adverse response to the particular medication during a previous procedure
5 Benzodiazepines Most commonly used sedative/anxiolytic These agents may also cause some degree of retrograde amnesia as well like midazolam (Dormicum) and lorazepam (Ativan)may also be used the night before schedule surgery in management of pre-surgical insomniaAdverse Effects:Major adverse effectsRespiratory depression cautious use in view of possible respiratory depression leading to inadequate oxygenation.Reduction in cognitive & motor function
6 Nursing Considerations: Avoid alcohol & hazardous activities that requires alertnessInstruct patient to avoid standing after taking the drugCheck RRMonitor BP, PR, RR during IV – medical equipment should be nearby
7 Opioids Advantages for use in preoperative medication: Absence of myocardial depressant effectsAlleviate the preoperative painManagement of discomfort associated with invasive monitor insertionManagement of pain which may be associated with establishing regional anesthesiaCommonly used opioids:MorphineMeperidine (Demerol)
8 Nursing Considerations: Adverse Effects:Respiratory depressionOrthostatic hypotensionNausea & vomitingDelayed gastric emptyingmay also cause smooth muscle constrictionpinpoint pupilsNursing Considerations:Check BP at least not less than 90/60 mmhgCheck RR not > 12 CPMCheck Urine output >30 cc/hr – Monitor I&OMonitor LOCIncrease bulk & fluids in dietMay be given by PCA pump in terminal illnessPlace Naloxone (Narcan) at Bedside
9 AntihistaminesPurpose of premedication: prevention of intraoperative allergic reactionsExample: Diphenhydramine (Benadryl)Common S/E:Dizziness; drowsiness; dry mouth, throat, nose, thickening of mucus in nose or throat, photosensitivity, excessive perspiration, thickening of bronchial secretions, tightness of chest and wheezingNursing Considerations:Assess respiratory status, rate and rhythm, increase in bronchial secretions, chest tightness & wheezingcaution when driving, operating machinery, or performing other hazardous activities.caution in patients with a history of lower respiratory disease including asthma
10 H2 Receptors Antagonists reduction of gastric acid secretionpremedication for patients with aspiration pneumonia riskSpecific medications:Cimetidine (Tagamet)Ranitidine (Zantac)Famotidine (Pepcid)Nizatidine (Axid)Nursing Considerations:Assess abdominal pain, acute presence of blood in emesis, stool or gastric aspirateTake at bedtime for best effectMay be taken with or without mealsAvoid smoking
11 Anticholinergics Purposes: use to dry up secretion in preparation for awake intubationfor operative procedure that requires upper airway topical anesthesia or for bronchoscopiesto reduce/prevent reflex bradycardia secondary to:laryngospasmlaryngeal stimulationhypoxiaExamples: Atropine, Glycopyrolate, Scopolamine
12 Watch for tachycardia – may lead to ventricular fibrillation Nursing considerations:Watch for tachycardia – may lead to ventricular fibrillationUse sunglasses – potential sensitivity to the sunThe drug will make the patient sweat less (Sweat glands are normally innervated by sympathetic cholinergic fibers), causing the body temperature to increase not to become overheated during exercise or hot weathermay cause some people to have blurred vision instruct patient to avoid driving or operating a machine if he or she is not able to see wellmay cause some people to become dizzy or drowsyFor temporary relief of mouth dryness, use sugarless candy or gum, melt bits of ice in your mouth
13 Antiemetic drugsAntiemetic agents are included in anesthetic premedication with the objective decreasing postoperative nausea and vomiting incidence.Drug used for prophylaxis against postoperative nausea and vomiting:Gastrointestinal prokinetic agents: metoclopramide (Reglan)not be given to patients who are taking dopamine antagonists, tricyclic antidepressants, sympathomimetic agents, or monoamine oxidase inhibitors (metoclopramide (Reglan) may cause hypertensive crises in patients with pheochromocytoma).
14 Nursing Considerattions: Assess GI complaints: N/V, anorexia, constipation, abdominal distension before & after administrationAssess involuntary movements and inform physicianAvoid driving/ operating hazardous machines or alcohol intake because the drug has a sedating effectAdminister very slow IV
15 AntibioticsAntibiotics are considered for administration immediately before surgery for "contaminated, potentially contaminated, or dirty surgical wounds.“The reason that the anesthesia provider is involved in antibiotic administration is that the antibiotics will be administered immediately preceding the surgical procedure-just before potential contamination could occurExamples: Cefazolin, Penicillin Na, Vancomycin
16 Nursing Considerations: Side effects and complications may occur with antibiotic administration.Allergic reactionHypotensionBronchospasmNephrotoxicityNursing Considerations:Do ANST prior to administer the drugAlways administer at the right time and right length of timeAssess any allergic reaction if ANST is not prescribed by the Physician
17 Anesthesia: Types of anesthesia Local anesthesia An anesthetic drug (which can be given as a shot, spray, or ointment) numbs only a small, specific area of the body (for example, a foot, hand, or patch of skin).a person is awake or sedated, depending on what is neededIt lasts for a short period of time and is often used for minor outpatient procedures (when patients come in for surgery and can go home that same day)
18 Regional anesthesiaAn anesthetic drug is injected near a cluster of nerves, numbing a larger area of the body (such as below the waist, like epidurals given to women in labor).It is generally used to make a person more comfortable during and after the surgical procedure. Regional and general anesthesia are often combined.
19 Two common types of regional anesthesia include: Epidural anesthesia - The anesthesiologist injects the medicine into the lower back in the area surrounding the spine.Spinal anesthesia - goes directly into the spinal canal and it also causes you to lose feeling in the lower part of your body.
21 Example: Lidocaine, Procaine, Tetracaine General anesthesiaThe goal is to make and keep a person completely unconscious (or "asleep") during the operation, with no awareness or memory of the surgery.General anesthesia can be given through an IV (which requires sticking a needle into a vein, usually in the arm) or by inhaling gases or vapors by breathing into a mask or tube.Example: Lidocaine, Procaine, Tetracaine
22 Risks from any type of anesthesia include: Allergic reaction to the medicines usedBreathing problemsRisks from local and regional anesthesia include:Bleeding and infection (rare)Long-term nerve damage (very rare)Temporary weakness or paralysis in the area that received the anesthesiaRisks from general anesthesia may include:Irregular heartbeatHeart attack (rare)Nausea and vomitingStroke (rare)Temporary mental confusion (delirium)
23 Nursing Considerations: Monitor VS q 15 mins after induction of the anesthesiaAdminister prescribed anticholinergic drug preoperativelyMedical equipment should be placed nearbyProvide quite environment for recovery to decrease psychotic symptomsPlace in flat position at least 8 hrs postoperativelyMinimize sudden movementPlace basin for emesis at bedside
26 Terbutaline (Brecanyl)/ Ritrodine (yutopar): Used most commonly to treat asthma, terbutaline is thought to relax the muscles of the uterusNursing precautions:A racing heartbeat or palpitations. These medications should not be used for women with known heart condition because it can cause increase in heartbeat and palpitationAspiration precaution can cause nausea & vomitingNot given to pt with poorly controlled DM can cause increase Blood glucoseCan decrease potassium level: caution to pt w/ heart problem & muscle spasm may occur
28 Indomethacin (Indocin): NSAIDGiven as a suppository in the short term.Delays premature labor by reducing uterine contractions through inhibition of prostaglandins.Nursing Precautions:Avoid operating machine/vehicle may cause drowsinessDo not stand or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells.
29 Magnesium sulfate: Usually given for eclamptic pt. Magnesium prevents or controls convulsions by blocking neuromuscular transmission and decreasing the amount of acetylcholine liberated at the end plate by the motor nerve impulseAntidote: Ca Gluconate - injectable calcium salt should be immediately available to counteract the potential hazards of Magnesium intoxication in eclampsiaNursing checks:Knee jerk reflexBP≥ 90/60mmHGRR≥ 16CPMTake ECGSerum K determination
30 Glucocorticoids:Administered, often in two doses, to stimulate growth in the lungs of the fetus.Example: DecadronNursing precaution:Avoid contact with people who have colds or infections.Take adequate calcium and vitamin D supplements.Check blood sugar levels closely.
31 Mesoprostol (Cervidil and Cytotec): Both are administered as vaginal suppositories to ripen the cervix prior to delivery.This is the first step in preparing the cervix to respond to contractions.Cytotec, while very effective, has been implicated in some uterine ruptures and should not be used under certain circumstances.Misoprostol has been shown to produce uterine contractions that may endanger pregnancy
32 Nursing Considerations: Assess dilatation and effacement of the cervix & fetal heart tonesMonitor for N/V & DiarrheaMisoprostol can cause abortion (sometimes incomplete which could lead to dangerous bleeding and require hospitalization and surgery), premature birth, or birth defectsRemain in supine 2 hrs after administration
33 Pitocin:The synthetic form of oxytocin, which is a natural hormone produced by a woman's body, Pitocin is used to start or improve contractions and control postpartum bleeding.Pitocin, when given for induction of labor or augmentation of uterine activity, should be administered only by the intravenous route and with adequate medical supervision in a hospital.Overstimulation of the uterus by improper administration can be hazardous to both mother and fetus.
34 Nursing consideration Assess labor and contraction, FHTTurn pt to left side to increase oxygen to the fetusAssess for water retentionWatch for fetal distressMonitor VS & I&O