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.
Substance Abuse
Substance abuse, or substance use disorder (SUD), has many consequences for the patient and anesthesia.
Long-term SUD results in increased anesthetic and analgesic requirements
Acute SUD results in additive effects
It is challenging to predict analgesic or anesthetic requirements for either
Cocaine
Highly addictive
Sympathetic nervous system stimulation is done by blocking the presynaptic uptake of norepinephrine and dopamine, thereby increasing the postsynaptic concentrations of these neurotransmitters
Cocaine abuse causes coronary vasospasm, MI, and ventricular cardiac dysrhythmias
Elevated BP, tachycardia, increasing O2 demand
Can cause hypotension and myocardial ischemia for as long as 6 weeks from last usage
Excessive sensitivity to catecholamines
Agitated behavior, paranoid thinking, and heightened reflexes
An alpha-adrenergic blockade may be effective in treating coronary vasoconstriction due to cocaine, as B-adrenergic blockade accentuates cocaine-induced coronary artery spasm (un-opposed alpha constriction will increase the risk of coronary artery spasm)
Plasma cholinesterase (pseudocholinesterase) is essential for breaking down cocaine
Marijuana
It produces euphoria, increases signs of sympathetic nervous system activity, and decreases parasympathetic activity
Smoking Marijuana increases the availability of tetrahydrocannabinol (THC)
Increased resting heart rate
Chronic use leads to increased tar deposits in the lungs, impaired lung defense mechanisms, and decreased pulmonary function
Seizures and drowsiness are possible side effects
After IV administration of THC, you might see increased drowsiness and decreased dose requirements for volatile anesthetics
Opioid-induced respiratory depression may be potentiated
Alcohol
May see decreased drug requirements due to additive effects from co-existing sedation or from Disulfiram's ability to inhibit the metabolism of drugs (last longer)
Risk for hypotension during surgery (possible from inadequate stores of norepinephrine due to disulfiram-induced inhibition of dopamine B-hydroxylase (pre-stage to epinephrine))
If the patient is on disulfiram (Antabuse) and drinking, it causes flushing, vertigo, diaphoresis, nausea, and vomiting