Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses
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J. Perianesth. Nurs. · Oct 2004
ReviewThe alarming trend of substance abuse in anesthesia providers.
The role of the anesthesia provider requires a high level of awareness and constant vigilance. Literature indicates, however, that the substance abuse rate in certified registered nurse anesthetists (CRNAs) and anesthesiologists has reached staggering levels. ⋯ It is imperative that perianesthesia nurses be aware of the current problem and take steps when indicated to protect both providers and patients. This article discusses the current trends of addiction in anesthesia providers, treatment, and reentry, as well as the role of the perianesthesia nurse in recognizing, reporting, and preventing substance abuse.
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J. Perianesth. Nurs. · Oct 2004
ReviewManaging do-not-resuscitate orders in the perianesthesia period.
Perianesthesia care often involves the use of pharmacologically potent drugs, increasing the risk of cardiopulmonary depression and arrest. For patients with terminal diseases, it may be difficult to decide whether cardiopulmonary arrest in the perianesthesia period is a result of anesthetic medications, surgical intervention, or the disease process. ⋯ Some hospitals automatically suspend DNR orders for patients undergoing surgery, whereas others provide patients the option of no, limited, or full resuscitation. This article promotes the premise that all DNR orders should be reviewed and reconsidered with patients before consent for surgery.
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J. Perianesth. Nurs. · Oct 2004
Review Case ReportsManaging acute postoperative pain: is 3 hours too long?
This case study discusses a 64-year-old opioid-tolerant patient who underwent amputation below the left knee and received pain management in the PACU. The patient's self-reported pain level remained 9 on a 0 to 10 scale despite having received a total of 62 mg of morphine sulfate (MSO 4 ) and 60 mg of ketorolac in just less than 3 hours. ⋯ The initial patient-controlled analgesia (PCA) order and MSO 4 -loading doses must take into account the patient history of opioid tolerance, increasing the frequency and dosage-loading doses of MSO 4 for treating severe pain until the patient's pain is reduced by at least 50% on a numeric scale, or until the patient states satisfactory relief. The most important rule of pain management is that pain is what the patient says it is.