Resuscitation and Monitoring Techniques

This assignment delves into the importance of resuscitation strategies and hemodynamic management in medical settings. It discusses guiding principles of fluid and volume therapy, improving detection of tachypnea at primary triage, and the use of invasive monitoring for burn shock resuscitation. Additionally, it covers the effects of induction agents on hemodynamics and endocrine responses in patients undergoing cardiac surgery.

Running head: PERIANAESTHESIA NURSING CARE
Peri anaesthesia Nursing Care
Name of the Student
Name of the University
Author Note

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PERIANAESTHESIA NURSING CARE
Part 1
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 Katsura’sprevious 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).

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Part 2
Hartmann’s 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 Hartmann’s 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 (Myburgh&Mythen, 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 (Myburgh&Mythen, 2013).
Part 3
The physiological rationale behind the intraoperative monitoring is it helps in
measurement and monitoring of the vital parameters like heart’s 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

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replacement therapy done via normal saline or Hartmann’s solution is not capable of
restoring cardiac preload 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).
Part 4
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.

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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).
Part 5
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-

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operative complications along the proper treatment regime(Gregory, Bolling and Langston
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 body’s 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

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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).

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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., Rösch, 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
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Gregory, S., Bolling, D.R. and Langston, N.F., 2014.Partnerships and new learning models to
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Holm, C., Mayr, M., Tegeler, J., Hörbrand, F., Von Donnersmarck, G. H., Mühlbauer, W., &
Pfeiffer, U. J. (2004).A clinical randomized study on the effects of invasive
monitoring on burn shock resuscitation. Burns, 30(8), 798-807.
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