Diaphragm and Neuromuscular Blockers (Nursing)

by Rhonda Lawes, PhD, RN

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      Slides Nursing Respiratory System Diaphragm Impairment.pdf
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      Reference List Medical Surgical Nursing and Pathophysiology Nursing.pdf
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    00:00 Hi, welcome to our respiratory video series. Now on this one, we're going to look at what happens when a diaphragm goes bad. So let's talk about what can paralyze or damage the diaphragm. Now, they can be drugs like neuromuscular blocker drugs. Those paralyze the larynx, the diaphragm, and we use them in surgery in critical care areas. Now, the goal is not to necessarily paralyze the diaphragm but is to kind of power down the patient. It paralyzes all the skeletal muscles. Since the diaphragm is a skeletal muscle, that's why these neuromuscular blockers paralyze the diaphragm. Now if it's not a drug, it could also be an injury from trauma to the diaphragm or to the phrenic nerve. That's the one that controls the diaphragm, communicates from the brain down to the muscle. So let's take just a quick look at neuromuscular blockers. Now these are drugs, they interrupt the transmission of nerve impulses and the skeletal neuromuscular junction. Remember, skeletal tells us what type of muscle it is. Neuromuscular means the nerve system, the muscular. So that's the space in between where the nerves tell the muscles what to do. Now, neuromuscular blockers just block that transmission in between the nerves and the muscles. So, it really stops acetylcholine from triggering the muscle contraction and that's what causes a paralysis that's why it's helpful in anesthesia, we use it as an anesthesia adjuvant. That means an adjuvant just means something that we use alongside. So if you're having surgery, it's really kind of convenient that the patient not be moving around, that's why a neuromuscular blocker is helpful. We can use it as a relaxant during electroshock therapy. Now, I didn't even realize we still did electroshock therapy and it's not done very often but it is done in cases of severe depression.

    01:58 When other types of treatment and drugs where ineffective, this is one option if it's recognized as I want to try for a patient but we can use it during electroshock for the same purpose. It will help paralyze the patient so they're not moving during the therapy. Now we also use it in critically ill patients, we need to kind of power them down. We want all their energy to be focused on getting better. We've got them on the mechanical ventilator and if you're on a neuromuscular blocker, you can't breathe by yourself so you'll have to have some type of ventilator support which is usually a mechanical ventilator. Now, I'll introduce you to a couple of the drugs just so you recognize the name. Succinylcholine is the long name, you'll often heard it refer to as sucs. Now you can use it in surgical procedures and they want a rapid onset and a brief duration of muscle relaxation, maybe say we're trying to intubate the patient. That would be one use of succinylcholine. So we can use it in endoscopies, in ECT.

    03:00 This is an example of a neuromuscular blocker, goes in quick rapid onset, doesn't last for a very long time so if we just want it for a quick procedure that's an option. Now, rocuronium. Now we use this for inpatient and outpatient so we can use it as an adjunct to general anesthesia because you want to facilitate both the rapid sequence of intubating a patient. We also use this for skeletal muscle relaxation during surgery or on mechanical ventilation. So if someone might be on a drip of this medication or a constant administration of rocuronium to keep them paralyzed over a period of time in a critical care unit. Sucs, quick, in and out, get the procedure done. Rocuronium might be something that they use for a longer period of time. Now at the bottom, we've listed some other examples for you. Rocuronium, you'll see the other names right there. So that kind of gives you a feel, a lot of them end in "onium", that will be a clue to you when you see those drug names. I know it's succinylcholine is a little different, but you can remember that one because of the ending "choline" and you know that impacts acetylcholine in the neuromuscular junction. So those are a couple quick tips to help you remember these drug names.

    About the Lecture

    The lecture Diaphragm and Neuromuscular Blockers (Nursing) by Rhonda Lawes, PhD, RN is from the course Review: Anatomy and Physiology of the Respiratory System (Nursing).

    Included Quiz Questions

    1. Neuromuscular blocking drugs
    2. Injury from trauma to the diaphragm
    3. Injury from trauma to the phrenic nerve
    4. Chronic persistent coughing
    5. Unresolvable hiccups
    1. Succinylcholine
    2. Rocuronium
    3. Vecuronium
    4. Doxacurium
    5. Propofol

    Author of lecture Diaphragm and Neuromuscular Blockers (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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