A nurse is caring for a client who is postoperative following the administration of general anesthesia.
Exhibits
Select from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client’s progress.
Answer and Explanation
Following general anesthesia, clients may experience a variety of conditions due to the effects of the anesthetic agents and the surgical procedure. The condition most likely experienced in the immediate postoperative period is hypoventilation or respiratory depression. This condition occurs due to the effects of anesthetics on the respiratory centers in the brain and the potential for residual effects of the anesthetics.
Actions the Nurse Should Take:
- Monitor Respiratory Status:
- Regularly assess the client’s respiratory rate, depth, and pattern.
- Administer supplemental oxygen if indicated, based on oxygen saturation levels.
- Encourage Deep Breathing and Coughing:
- Encourage the client to take deep breaths and cough to promote lung expansion and reduce the risk of atelectasis and pneumonia.
- Use incentive spirometry if prescribed.
Parameters to Monitor to Assess the Client’s Progress:
- Oxygen Saturation:
- Continuously monitor the client’s oxygen saturation levels using a pulse oximeter. This helps assess the effectiveness of breathing and oxygenation.
- Respiratory Rate:
- Regularly measure the respiratory rate to ensure it is within the normal range and to detect any signs of hypoventilation.
Explanation:
- Hypoventilation is a common concern following general anesthesia due to the impact of anesthetics on respiratory function. The nurse must ensure that the client’s breathing is adequate and that oxygenation is maintained.
- Monitoring oxygen saturation and respiratory rate provides essential information on the client’s respiratory status and overall recovery from anesthesia.
Taking these actions and monitoring these parameters helps ensure that the client recovers safely from the effects of general anesthesia and that any complications are addressed promptly.