Case Study 1: The circulating nurse in the operating room (OR) is assisting with initiation of the surgical procedure. The
patient is unconscious and is receiving a general anesthetic. While repositioning the patient, the nurse
notes that the patient feels unusually warm to the touch. The nurse takes the patient’s temperature and
notes that it is 104° F. The anesthesiologist reports that the patient’s pulse is 128 beats/min, and the
respiratory rate is 32 breaths/min.
1. Given the assessment findings, what condition does the nurse suspect the patient is experiencing?
2. In addition to assisting in the provision of cardiorespiratory support, the nurse should be prepared to
administer which medication?
3. The patient recovers and is transferred to the postanesthesia care unit (PACU). After the patient
stabilizes, what additional teaching regarding the occurrence of MH will the nurse provide?
SOLUTIONS TO THE CASE STUDY
The patient is experiencing malignant hyperthermia. The condition is a skeletal muscle pharmacogenetic condition that manifests as a hypermetabolic reaction to potent volatile anesthetic gases like halothane, sevoflurane, desflurane, isoflurane, and depolarizing muscle relaxant succinylcholine (Rosenberg et al., 2015). It’s characterized by hyperthermia, tachycardia, and tachypnea. The patient is experiencing all of those symptoms. The syndrome is fatal if left untreated. Therefore, immediate interventions are necessary.
The nurse should administer Dantrolene sodium, a postsynaptic muscle relaxant that acts as an antagonist to anesthetic agents (Ratto & Joyner, 2020). The drug is administered intravenously over at least 1 minute to prevent malignant hyperthermia. All facilities where patients are undergoing general anesthesia should have dantrolene sodium at hand to be used in case malignant hyperthermia occurs.
Malignant hyperthermia can occur at any point during the administration of anesthetic agents or the early period of the postoperative period. The cardinal signs of the condition include tachycardia, increased levels of expired carbon dioxide, tachypnea, and hyperthermia. The nurse should educate on the importance of monitoring the patient vital signs to monitor any elevations and take the appropriate measures (Rosenberg et al., 2015). Vital signs should be monitored every 15minutes post-op, and knowing the appropriate normal ranges is crucial. It’s also important to take adequate family history because the risk is higher if there is a positive family history of malignant hyperthermia. The potential to have MH is hereditary. The patient’s family members must be taught about the likelihood of having a similar reaction.
Ratto, D., & Joyner, R. W. (2020). Dantrolene. StatPearls [Internet].
Rosenberg, H., Pollock, N., Schiemann, A., Bulger, T., & Stowell, K. (2015). Malignant hyperthermia: a review. Orphanet journal of rare diseases, 10(1), 1-19.
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