Examkin

Soru

Zorluk: Çok zorPharmacological and Parenteral Therapies

A client is in the post-anesthesia care unit (PACU) following an open abdominal surgery under general anesthesia utilizing desflurane and succinylcholine. The nurse notes new-onset masseter muscle rigidity, tachycardia of 145 beats/minute145 \text{ beats/minute}, tachypnea, and an end-tidal carbon dioxide (EtCO2EtCO_2) level of 65 mm Hg65 \text{ mm Hg}. The client's temperature is rapidly rising. Based on these findings, which of the following pharmacological and parenteral interventions should the nurse anticipate implementing? (Select all that apply)

  1. A
    Reconstitute intravenous dantrolene sodium using sterile water containing a bacteriostatic preservative.
  2. Hyperventilate the client with 100%100\% oxygen using a bag-valve-mask or through the endotracheal tube.Cevap
  3. C
    Administer intravenous diltiazem to manage the client's sustained tachycardia.
  4. Initiate a rapid intravenous infusion of chilled 0.9%0.9\% sodium chloride.Cevap
  5. Administer intravenous regular insulin concurrent with 50%50\% dextrose.Cevap
  6. F
    Administer a subsequent dose of intravenous succinylcholine to overcome the masseter muscle rigidity.

Cevap

The nurse should hyperventilate the client with 100% oxygen, initiate a rapid intravenous infusion of chilled 0.9% sodium chloride, and administer intravenous regular insulin concurrent with 50% dextrose.
Malignant hyperthermia is a severe hypermetabolic state. The correct interventions address the critical pathophysiological changes: 100%100\% oxygen flushes out the massive amounts of carbon dioxide produced; chilled intravenous normal saline provides active core cooling; and the combination of regular insulin and 50%50\% dextrose drives extracellular potassium back into the cells, treating the life-threatening hyperkalemia caused by continuous muscle rigidity and breakdown.

Adım Adım Çözüm

1
Identify the clinical emergency based on the assessment findings.
The combination of exposure to desflurane and succinylcholine, new-onset masseter muscle rigidity, tachycardia, hypercarbia (EtCO2EtCO_2 65 mm Hg65 \text{ mm Hg}), and rapidly rising temperature indicates malignant hyperthermia.
Early recognition of malignant hyperthermia is essential to prevent irreversible cardiovascular collapse and death.
2
Determine the priority respiratory intervention.
Hyperventilate the client with 100%100\% oxygen.
The hypermetabolic state produces massive amounts of carbon dioxide and depletes oxygen stores, requiring immediate enhanced ventilation.
3
Determine the priority parenteral cooling intervention.
Initiate rapid intravenous infusion of chilled 0.9%0.9\% sodium chloride.
Core body temperature can rise rapidly in malignant hyperthermia, necessitating immediate active core cooling to prevent cellular death.
4
Determine the priority pharmacological intervention for the metabolic complications.
Administer intravenous regular insulin and 50%50\% dextrose.
Sustained muscle rigidity causes rhabdomyolysis and severe hyperkalemia. Insulin drives potassium back into the cells, preventing lethal cardiac arrhythmias.

Anahtar Kavram

Malignant hyperthermia is a life-threatening pharmacogenetic hypermetabolic crisis triggered by volatile anesthetics and succinylcholine, requiring immediate discontinuation of triggers, administration of dantrolene, oxygenation, active cooling, and management of hyperkalemia.
Bu soruyu puanla

Konular

Pharmacological and Parenteral Therapies

Bu konudan daha fazla soru