A small compilation of nurse anesthesia care plans

These anesthesia care plans are meant to inspire nurse anesthesia residents when they are making their care plans. Always make sure you fully understand and "own" your care plan. Your plan must be specific for your patient and should always be with the most up-to-date information.

Explorative Laparotomy

Abdominal trauma or other acute abdominal catastrophes

Control active bleeding before systematic examination

Fever of unknown origin

Staging of patients with Hodgkin's disease/other lymphomatous disorder - splenectomy, wedge and needle biopsies of both lobes of the liver, biopsies of the periaortic, celiac, mesenteric, and portohepatic lymph nodes

Anesthetic considerations

Supine position

Midline or transverse incision

Significant blood loss is possible. In addition to adequate hydration, have colloid and PRBC available

Standard monitors with the possibility of an art line and CVP

Hypothermia is likely to develop due to an open abdomen. Use bair hugger and fluid warmers

Respiratory

If splenomegaly, the patient may have some LLL atelectasis and compromised ventilation

Decreased FRC, increased A-a gradient, and decreased Pao2 due to V/Q mismatch

If on chemotherapy, they may have pulmonary fibrosis as a side effect. Smoking will worsen issues

Cardiac

May be chronically ill with decreased cardiovascular reserve - may see CHF and dysrhythmias

Neurological

Compromised if post-chemotherapy. Document status of peripheral neuropathies/CNS side effects

Hematologic

Expect myelosuppression if active chemotherapy

Hepatic

Consider LFT evaluation if on chemotherapy

Renal

Suspect impaired function if on chemotherapy. Maintain urine output >0.5ml/kg/hr

Preop

Prevent aspiration using an H2 antagonist (Ranitidine 50mg iv), Metoclopramide 10mg iv (contraindicated for bowel obstruction or perforation), and Na citrate 30ml 10 min prior to surgery. If on steroids during chemotherapy, a steroid dose of 25-100mg hydrocortisone may be needed.

Use ERAS protocol if applicable

Pain

6-8

  • Consider Epidural for pain management
    • Note the risk of hypotension, delayed sedation/respiratory depression from hydrophilic opioids (morphine/hydromorphone)
  • If using epidural local anesthetics, ensure hemodynamically stable before administration
    • The critical part of the surgery is done
  • The removal of large amounts of ascites
    • May lead to fluid shifts and intravascular volume depletion intraoperatively and postop
    • May need to leave pt intubated postop until hemodynamically stable and the edema resolving

Common complications

Bleeding

Atelectasis/respiratory insufficiency

PONV

Venous thromboembolism

  • Surgery, immobility, history, increased age, smoking, obesity