Summary : Anaesthetic Management Of Primary Hyperparathyroidism With Hypercalcaemia And Multiple Bone Fractures For Excision Of Parathyroid Adenoma

When there is a complication of the regional anesthesia which might include anaphylaxis, overdose, incorrect delivery technique and systemic absorption, the nurse will monitor for systemic toxic reaction which comprises of monitoring the central nervous system (CNS) stimulation along with CNS and cardiac depression. The nurse will also assess the patient for incoherent speech, restlessness, blurred vision, excitement, headache, nausea, vomiting, metallic taste, seizures, tremors, increase blood pressure, respiration and pulse. The patient may become apnea, hypotensive, unconscious, and have a cardiac arrest which may lead to death if the toxic reaction is not treated. Nursing intervention for the complication of regional anesthesia include establishing an open airway, administering oxygen, and notifying the surgeon. Treatment usually comprise of a fast acting barbiturate with epinephrine being administered for cardiac arrest. Edema and inflammation is an early sign of local complication with abscess formation, tissue necrosis and /or gangrene occurring later (Ignatavicius & Workman, 2013). Since general anesthesia was administer in addition to the regional anesthesia, the nurse and anesthesiologist will have to also monitor for complication of general anesthesia which range from a minor sore throat to death. Certain drugs used for general anesthesia may cause an acute, life threatening complication know as malignant hyperthermia (MH). The exposure of these agent to the skeletal muscle causes an increases in serum calcium and potassium level, metabolic rate leading to increased body temperature, acidosis and cardiac dysrhythmias. MH might occur immediately after the administration of the anesthesia, or several hours into the

In February 2013, a forty-eight years old male with no prior co-morbidities transferred from Quetta to Aga Khan University Hospital, Karachi after sustaining multiple lacerations and left tibia bone closed fracture in a bomb blast. After initial management in the hospital, he underwent an orthopedic procedure (application of illiazarov over left tibia) under general anaesthesia. The surgery went uneventful, and he then shifted to ward. From next day morning, he suddenly developed dyspnea and became hypotensive and tachycardiac (respiratory rate about 40/min, pulse 140 beats per min and blood pressures were around 60/30). He was barely maintaining oxygen saturation 90% on 10 liters of O2 via facemask. Initially, he was given 2 liters of fluid bolus but hemodynamics did not respond. A few minutes later, he went into pulseless electrical activity and

Lack of enough trained staff in conscious sedation available at the time of the procedure

& Donelly, R., 2010). As with DKA, at this stage the body attempts to normalize the osmolality through diuresis, which leads to dehydration, loss of electrolytes, and further hyperosmolality. With HHS evolving over days to weeks, (often either through poor medication compliance/inappropriate prescribing, dietary issues, or illness), the effect is insidious, and often by the time a patient presents to the emergency department either directly or via a GP, they are already critical (Kisiel, M. & Marsons, L., 2009).

Patients can become hypertensive during induction, positioning, or tumor resection (12). Chronic catecholamine excess causes volume contraction and patients can become severely hypotensive, as in this case, if adequate volume resuscitation is not performed (12). It is prudent to evaluate for adverse events following hypertensive and hypotensive episodes. Serial neurological evaluations, CT brain, electrocardiograms, or serial cardiac enzymes may be warranted. Complications of surgery are primarily due to severe preoperative hypertension, high secretion tumors, or repeat intervention for recurrence (13). In one study, adverse perioperative events occurred in 32 percent of cases (14). The most common adverse event was sustained hypertension in 25 percent of the patients. There were no perioperative deaths, myocardial infarctions, or cerebrovascular events. Despite premedication of most patients with phenoxybenzamine and a beta-blocker, varying degrees of intraoperative hemodynamic lability occurred

As statistics report show that in the United States as many as 20% of hospitalized patients are hypokalemic; however, hypokalemia is clinically

This paper briefly touches on a case study by a nursing assistant student who is assisting with an anesthesiologist that she is shadowing. The student was asked to monitor vitals during a knee surgery. The patient was given Halothane and the surgery began. After two hours in surgery, the patient, who was a young athletic female named Sharon Riley, began to show signs of distress. This patient’s temperature elevated to 105 °F and pulse began to rise up to 120 bpm, and her blood pressure began to drop down to 60/56 mmHg. This triggers the monitors alarm because normal vitals for this patient were a temperature of 98.6 °F, 75 bpm pulse and blood pressure of 105/60 mmHg. This causes the doctors to react quickly and begin to assess what is wrong

What is the treatment for abnormal levels of these selected electrolytes? The treatment for hypercalcemia would include avoiding food in high calcium levels and in severe cases, the patient would be taking calcitonin to prevent bone

The positive impact of anesthesia advancements over the last 100 years have made the care that patient receives more effective and less life threatening. These innovations have brought about a transformation in the care of the patient. It has improved how the healthcare institutions operate and the patient has benefited from the advancements and so have the medical staff. The anesthesia used today, and the anesthesia used a century ago is similar because it was created for the welfare of the patient. It was produced to help numb or put the patient to sleep during a surgical procedure. However, the difference today is that research and advancements in the medical field have improved and designed more superior drugs over the years and made them

The parathyroid glands are located in front of the base of the neck around the thyroid gland and secrete parathyroid hormone. Parathyroid hormone regulates blood levels of calcium and phosphorus. This hormone (parathyroid hormone) affects the bones, kidney, and intestine (Shier et al., 2009).

There are many causes of hyperthyroidism, but the symptoms of hyperthyroidism are the same no matter what causes the over expression of thyroid hormones. The main symptoms of hyperthyroidism are fatigue, shortness of breath, weak muscles, anxiety, difficulty sleeping and heart palpitations. Interestingly, even with an increase in appetite the patient will have weight loss.

Systemic glucocorticoids are the leading cause of secondary osteoporosis. Osteoporosis is described by the World Health Organization (WHO) as a ‘progressive systemic skeletal disease characterised by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture’. Oral glucocorticoids are the low bone mass and microarchitectural deterioration main iatrogenic cause of fragility fracture. Relationship between glucocorticoid use and bone loss has been studied and established since 1990. Early studies showed that oral glucocorticoid cause a substantial loss in bone density and other bone markers. Subsequent epidemiological research identified confirmed the link between fracture and oral glucocorticoid use. Fragility fractures are the ultimate clinical endpoint that is targeted to prevent in osteoporosis. Osteoporotic fractures occur in several bone locations. Most osteoporosis-resultant fractures are hip, proximal femur, vertebral, distal radius and ulna, which are often labeled as major osteoporotic fractures. Fracture of the tibia, fibula, patella, ribs, and sacrum are also considered fractures attributable to osteoporosis. A substantial amount of evidence showed increased risk of mortality post fragility fracture. A systematic analysis of epidemiological studies showed that the mortality rate during the first year after hip fracture ranged from 8.4% to 36.0%. Post-fracture mortality rates was associated with vertebral, humerus, and ; while . A significant morbidity

In the pre-op I shadowed Hope, she has a very alert, attentive, focus and organized. Hope verified all the information she had received from Roxie, and went through again with the patient. Hope explained to the patient about drugs being administered before he will be wheeled into the operating room. Various drugs reduce vagal –induced bradycardia, inhibit oral and gastric secretions, and decreased the amount of anesthetic needed for the induction and maintenance of anesthesia (Ignatavicius & Workman, p 234). Before Hope administer all the ordered medications to the patient, the anesthesiologist came in and talked to patient, went through all the information about the past medical history, allergies, and if he had any reaction to any anesthetic agents that they use. The anesthesiologist also had a form explaining to the patient how the doctor preferred the patient to be anesthetized during the procedure which is general anesthesia commonly used in this kind of procedure. After all the anesthesia information was explain to the patient, the patient signed the form. Hope also waited for the surgeon to come and see the patient while the patient still awake before Hope can administer all the preoperative drugs and verify the operating room team that their patient is ready. When all of these are said and done Hope administer all the medications and

Safety is the number one concern during treatment and care of patients in the hospital. When patients receive the electrolyte potassium intravenously is potentially toxic and has been responsible for many deaths in hospitals. If the electrolyte potassium is given incorrectly intravenously, it can cause ectopic heartbeats, ventricular fibrillation and ventricular tachycardia. When the physician orders to the potassium intravenously, it is the responsibility of the nurse to be knowledgeable about the potential risks.

c.i. Understaffing in a high acuity emergency department caused the patient to receive high doses of sedating