The anatomic nervous system is responsible for body temperature, heart rate, body temperature, and other physiological functions. The epidural infusion for analgesia or anesthetic purposes affects the sympathetic nervous system by blocking it. A routine check on the patient physical signs like temperature indicates any blockage to the automatic control by the autonomic nervous system at an involuntary level. Usually, the blockage happens first, and it is followed by the failure of fibers to carry sensory information. For a patient experiencing a temperature above 38.5 degrees centigrade, nurses are required to inform physicians who then should recommend the removal of an epidural catheter. Nurses can use blood pressure to assess the condition of dermatomes.
The case scenario of Mr. Johnson shows that his temperature was below 38.5 degrees centigrade. His dry skin indicates that the patient is dehydrated. His temperatures were below normal, which is 37.5 degrees centigrade (Meyers, 2004). The dry skin would be an indication of a failure in the autonomic nervous system to regulate temperature. Furthermore, the patient may be having respiratory problems.
The nurse needs to increase the intravenous fluids to remedy the drop in blood pressure. Pressure can fall when the patient is facing anesthetic toxicity (Burch, McAllister, & Meyer, 2011). Mr. Johnston could be having a total spinal blockade or hypertension. This explains the need to increase intravenous fluids. The nurse should continue with the intervention and monitor the temperature and pressure hourly until the situation changes or the anesthetist reviews the case.
The patient is having a dural puncture. The complication is not dangerous; however, in Mr. Johnston’s case, the complication is accompanied by a headache. Therefore, the patient has postdural headaches (Kim & Yoon, 2011). The intervention by the nurse should aim at preventing the advancement of the current block into a high block or a total spinal blockade (Baker & Norton, 2004). The nurse has to administer a simple analgesic and ensure the patient is well hydrated (Darvish, et al., 2011).
The hydration and analgesia will assist in repairing the damage by increasing the cerebrospinal fluid (CSF). An opioid would be the most likely cause of the postural headache. When injected, the opioid crosses the dural and arachnoid membrane to enter the CSF. The CSF assists to make the opioid lipid-soluble. When the drug is lipid-soluble, it reaches its intended action centers faster. Hence, the onset of analgesia is rapid (Varela & Burns, 2010).
High lipid solubility increases the systemic absorption rate of the drug. The nurse should increase the intravenous fluids to make the patient hydrated. Adequate hydration will increase the discharge of the drug from the CSF. Otherwise, when the drug remains in the CSF and the volume of CSF remains unchanged, there will be delayed sedation. The increased respiration rate would be a result of a less lipid-soluble drug that reached the medulla. If the problem persists, the nurse may have to use naloxone as an emergency drug to reverse the effect of opioids (Darvish, et al., 2011). During the care provision, the nurse should check on the patient regularly, at intervals of at least twenty minutes, and report any change of the symptoms to the physician responsible.
References
Anderson, E., & McFarlane, J. (2012). Community as partner: Theory & practice in nursing. Philadelphia: Lippincott Williams Wilkins.
Apok, V., Gurusinghe, N. T., Mitchell, J. D., & Emsley, H. C. (2011). Dermatomes and dogma. Practical Neurology, 11(2), 100-105.
B, B., M, D., H, K., S, J. T., & L, N. (2011). Mechanosensitivity before and after hysterectomy: a prospective study on the prediction of acute and chronic postoperative pain. British Journal Of Anaesthesia, 107(6), 940-947.
Baker, G., & Norton, P. (2004). The Canadian adverse events study: The incidence of adverse events among hospital patients in Canada. CMAJ, 170(11), 34-41.
Baysinger, C. L., Pope, J. E., Lockhart, E. M., & Mercaldo, N. D. (2011). The management of accidental dural puncture and postdural puncture headache: a North American survey. Journal Of Clinical Anesthesia, 23(5), 349-360.
Bird, A., & Wallis, M. (2002). Nursing knowledge and assessment skills in the management of patients receiving analgesia via epidural infusion. Journal of Advanced Nursing, 40(5), 522-531.
Bösenberg, A. T., Thomas, J., Cronje, L., Lopez, T., Crean, P. M., Gustafsson, U., et al. (2005). Pharmacokinetics and efficacy of ropivacaine for continuous epidural infusion in neonates and infants. Pediatric Anesthesia, 15(9), 739-749.
Burch, M…, McAllister, R. K., & Meyer, T. A. (2011). Treatment of local-anesthetic toxicity with lipid emulsion therapy. American Journal of Health-System Pharmacy, 68(2), 125-129.
Bush, N. J., & Griffin-Sobel, J. P. (2003). Acute postoperative pain management and malfunctioning epidural catheter. Clinical challenges, 30(2), 217-218.
Carrel, D. (2011). My dream to trample AIDS: What everyone at any age should know about HIV/AIDS. Indianapolis: Dog Ear Publishers.
Cichoki, M. (2009). Living with HIV: A Patient’s Guide. New York: McFarland.
Darvish, B., Gupta, A., Alahuhta, S., Dahl, V., Helbo-Hansen, S., Thorsteinsson, A., et al. (2011). Management of accidental dural puncture and post-dural puncture headache after labour: a Nordic survey. Acta Anaesthesiologica Scandinavica, 55(1), 46-53.
Forero, M., Neira, V. M., Heikkila, A. J., & Paul, J. E. (2011). Continuous lumbar transversus abdominis plane block may spread to supraumbilical dermatomes. Canadian Journal Of Anaesthesia, 58(10), 948-951.
Jackson, S.-R., Williams, G. N., Lee, J., Baer, J. F., Warburton, D., & Driscoll, B. (2011). A Modified Technique for Partial Pneumonectomy in the Mouse. Journal of Investigative Surgery, 24(2), 81-86.
Kim, M., & Yoon, H. (2011). Comparison of post-dural puncture headache and low back pain between 23 and 25 gauge Quincke spinal needles in patients over 60 years: randomized, double-blind controlled trial. International Journal Of Nursing Studies, 48(11), 1315-1322.
Lim, Y., Chakravarty, S., Ocampo, C. E., & Sia, A. T. (2010). Comparison of automated intermittent low volume bolus with continuous infusion for labour epidural analgesia. Anaesthesia & Intensive Care, 38(5), 894-899.
Meyers, S. (2004). Balanced scorecards help the board make the patient safety their no. 1 priority. Trustee, 2(4), 1-4.
Mulcahey, M. J., Gaughan, J., & Betz, R. R. (2009). Agreement of repeated motor and sensory scores at individual myotomes and dermatomes in young persons with complete spinal cord injury. Spinal Cord, 47(1), 56-61.
Murdoch, J. (2005). Ensuring prompt diagnosis and treatment of epidural abscess. Nursing Times, 101(20), 36.
N, S. E., & T, K. A. (2010). The extent of temperature sense and pain appreciation recovery in the dermatomes of cauda equine roots after lumbar intervertebral dischernia elimination. Fiziologiia Cheloveka, 36(3), 95-101.
Okutomi, T., Saito, M., Mochizuki, J., & Kuczkowsk, i. K. (2009). Combined spinal-epidural analgesia for labor pain: Best timing of epidural infusion following spinal dose. Archives Of Gynecology And Obstetrics, 279(3), 329-334.
Parker, R. K., Connelly, N. R., Lucas, T., Serban, S., Pristas, R., Berman, E., et al. (2007). Epidural clonidine added to a bupivacaine infusion increases analgesic duration in labor without adverse maternal or fetal effects. Journal of Anesthesia, 21(2), 142-147.
Ruan, X., Tadia, R., Liu, H., Couch, J. P., & Lee, J. K. (2008). Edema caused by continuous epidural hydromorphone infusion: a case report and review of the literature. Journal Of Opioid Management, 4(4), 255-259.
Shipton, E. A. (2011). The transition from acute to chronic post surgical pain. Anaesthesia And Intensive Care, 39(5), 824-836.
Tixier, S., Bonnin, M., Bolandard, F., Vernis, L., Lavergne, B., E, B. J., et al. (2010). Continous patient-controlled epidural infusion of levobupicacaine plus sufentanil in labouring primiparous women: effects of concentration. Anaesthesia, 65, 673-680.
Türe, H., Eti, Z., G, F. Y., Düzgün, O., Mutlu, Z., & Karabağli, P. (2010). Histopathological effects on epidural tissue of bolus or continuous infusions through an epidural catheter in ewes. Anaesthesia, 65(5), 473-477.
Vallejo, M. C., Ramesh, V., Phelps, A. L., & Sah, N. (2007). Epidural labor analgesia: continuous infusion versus patient-controlled epidural analgesia with background infusion versus without a background infusion. The Journal of Pain, 8(12), 970-975.
Varela, H., & Burns, S. M. (2010). Use of lipid emulsions for treatment of local anesthetic toxicity: A case report. AANA Journal, 78(5), 359-364.
Vaughn, T. (2006). Engagement of Leadership in Quality Improvement Initiatives: Executive quality improvement survey results. Journal of Patient Safety, 2(2), 4-16.
White, L. (2001). Effective governance through complexity thinking and managment science. System Research and Behavioral Science, 18(1), 23-44.
Zablocki, E. (2007). IHI calls on boards to lead on quality and safety: An interview with Jim Conway. Great Boards, 7(2), 1-3.