West Visayas State University COLLEGE OF NURSING La Paz, Iloilo City DRUG STUDY Attending Physician: Dr. B.L.J.

Impression / Diagnosis: Diabetes Mellitus Foot Wagner IV Right; S/P Below Knee Amputation Right Indication Local or regional anesthesia or analgesia for surgical, obstetric, or diagnostic procedures Contraindications Hypersensitivity; cross sensitivity with other amide local anesthetics may occur; Bupivacaine contains bisulfites and should be avoided in patients with known Adverse Reactions Seizure, Cardiovascular collapse, Respiratory arrest, Special Nursing Responsibilities Precautions concurrent use of Assessment other local 1. Systemic Toxicity: anesthetics; Liver Assess for systemic disease; toxicity Concurrent use of (circumoral anticoagulants tingling and (including lownumbness, ringing dose heparin and in ears, metallic anesthetics; Liver taste, dizziness, disease; blurred vision, Concurrent use of tremors, slow anticoagulants speech, irritability, (including lowtwitching, seizures, dose heparin/ cardiac heprinoids) dysrhythmias) each shift. Report to physician or other health care professional. 2. Orthostatic Hypotension:

Name of Patient: N.E.P Age: 46 years old Ward/Bed Number: Room 408

Name of Drug Generic: Bupivacaine Hydrochloride Brand:

Dosage, Route, Frequency, and Timing Dosage:

Mechanism of Action Local anesthetics inhibit initiation and conduction of sensory nerve impulses by altering the influx of sodium and efflux of potassium in neurons, slowing or stopping pain transmission. Epidural administration allows action to take place at the level of the spinal nerve roots immediately adjacent to the site of administration. The catheter is placed as close as possible to the dermatomes (skin surface areas innervated by a single spinal nerve or group of spinal nerves)

Route:

Frequency: Sensorcaine Timing: Classification Functional: Epidural local anesthetics Chemical:

Side Effects BP, bradycardia, dizziness, anxiety,

restlessness,

that, when blocked, will produce effective spread of analgesia for the site of injury. Therapeutic Effects: Decreased pain or induction of anesthesia; low doses have minimal effect on sensory or motor function; higher doses may produce complete motor blockade Source: Deglin J.H., Vallerand A.H (2008) ; Drug Guide for Nurses 11th Edition; F.A. Davis Company; Pages 478480

intolerance. Decreased BP, shock & arrhythmias, local infections at anesthesia site,

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Monitor blood pressure, heart rate, and respiratory rate continuously while patient is receiving this medication. Mild hypotension is common because of the effect of local anesthetic block of nerve fibers on the sympathetic nervous system, causing vasodilation. Significant hypo tension and bradycardia may occur, especially when rising from a prone position or following large dose increases or boluses. Treatment of unresolved hypotension may include hydration, decreasing the epidural rate, and/or removal of local anesthetic from analgesic solution. Unwanted Motor and Sensory

Deficit: The goal of adding low-dose local anesthetics to epidural opioids for pain management is to provide analgesia, not to produce anesthesia. Patients should be able to ambulate if their condition allows, and epidural analgesic should not hamper this important recovery activity. However, many factors, including location of the epidural catheter, local anesthetic dose, and variability in patient response, can result in patients experiencing unwanted motor and sensory deficits. Pain is the first sensation lost, followed by temperature, touch, proprioception, and skeletal muscle tone

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Assess for sensory deficit every shift. Ask pa tient to point to numb and tingling skin areas (numbness and tingling at the incision site is common and usually normal). Notify physician or other health care professional of un wanted motor and sensory deficits. Unwanted motor and sensory deficits often can be corrected with simple treatment. For example, a change in position may relieve nor extremity muscle weakness is often treated by decreasing the epidural infusion rate and keeping the patient in bed until the weakness resolves. Sometimes removing the local anesthetic from the analgesic solution

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is necessary, such as when signs of local anesthetic toxicity are detected or when simple treatment of motor and sensory deficits has been unsuccessful. Advise patient to request assistance during ambulation until orthostatic hypotension and motor deficits are ruled out.

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Patients receiving these blocks should have their circulation and respiration monitored and be constantly observed. Resuscitative equipment and personnel for treating adverse reactions should be immediately available. Dosage recommendation

s should not be exceeded

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Students Name: _______________________________ Clinical Instructor: ______________________________