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.
Smoking
Etiology
Approximately 20% of American adults smoke
Smoking is a risk factor for COPD and death due to lung disease. Decreased mucociliary activity, airways become hyperreactive, and pulmonary immune function is reduced. Smoking is also a risk factor for CAD, as carbon monoxide reduces oxygen delivery and increases myocardial work. Smoking releases catecholamines, causing coronary vasoconstriction and decreasing exercise capacity. Smoking impairs wound healing
Decreased PaO2 levels
Cessation just before surgery can cause Increased sputum production, inability to handle stress, and nicotine withdrawal symptoms such as irritability, restlessness, sleep disturbance, and depression
For best pulmonary status, the person should quit 6-8 weeks before surgery to restore pulmonary function
Anesthetic Considerations
Reactive airway and increased secretions
Cessation 12-24 hrs before surgery decreases carboxyhemoglobin, shifts the oxyhemoglobin dissociation curve to the right, and increases the oxygen available to tissues
Bronchociliary function improves within 2-3 days, but a significant decrease in adverse effects comes after 6-8 weeks of cessation
Higher risk for post-op respiratory complications
May see ST-segment depression on ECG if pt smoked just before surgery
Increased risk for nerve injury and delayed healing
Nicotine is a stimulant (BP and HR)
- Improves after 12 hours of cessation