Term
Name the Defining Features of General Anesthesia. |
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Definition
Amnestic, Unconscious despite outside stimulation, Spontaneous or Ventilator-Assisted Respirations, Loss of Protective Airway Reflexes, Muscle Relaxants, Assisted Hemodynamics, With or WithOUT regional or local anesthesia. |
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Term
| Name the defining features of Sedation |
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Definition
| Amnestic, Conscious, Maintain Protective Airway Reflexes, No muscle relaxation, Self-Maintain Hemodynamics and Spontaneous Respirations, Sedated despite outside stimuli, With or Without Local or Regional Anesthesia |
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Term
Describe the Goals of Conscious Anesthesia and the continuum. |
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Definition
Awake-Light-Moderate-Deep-General-Death End point of conscious is nystagmus and slurred speech |
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Term
Explain Guedels Different Stages of Anesthesia Stage I |
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Definition
| Awake (when you bring to OR) minimal sedation with all refelxes intact |
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Term
| Explain Guedels stages of Anesthesia Stage II |
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Definition
| Excitatory Stage: (not where you want to be dangerous-from loss of consciousness to onset of automatic rhythmicity of vital signs) Disconjugate pupils, swallowing, salivating, lacrimating, retching, tense muscle tone, heightened laryngeal reflexes, tachypnea, tachycardiac, HTN. |
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Term
| Explain Guedels Stage III of Anesthesia |
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Definition
Surgical Plane MAC-Minimal Alveolar Concentration (where 50% pts wont move w incision). Loss of eyelid reflex, Blocked Autonomic response noxious stimuli |
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Term
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Definition
Respiratory Paralysis Increased Respiratory and Circulatory Depression Profound Hypotension, Cardiac Arrest |
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Term
List the four factors that would cause you to not use Guedels stages. |
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Definition
Use of Barbituates, Muscle Relaxants, Inhaled Agents or Narcotics. |
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Term
There are four stages of anesthetic depth that are divided into 4 planes. Generally they are the same for inhaled agents except for the speed of induciton and the details of the signs: Stages and Planes are defined by: |
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Definition
1) Change in consciousness 2) Respiration 3) Skeletal Muscle Tone 4) Eye Signs 5) Loss of Reflexes |
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Term
Name the DISadvantages of Balanced Anesthesia |
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Definition
cardiovascular depression (pos) Chest wall rigidity with narcotics (pos) muscle relaxants NO2 (not for ear or bowel sx) renarconization after emergence decreased cough reflex |
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Term
| What is Anesthesia? Name the 5 components. |
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Definition
A change n the response to external stimuli Amnesia, Analgesia, Attentuation to noxious stimuli, Immobility, Unconsciousness |
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Term
| What is Alice Magaw famous for? Who did e work with, where? |
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Definition
Mother of Ether with Charles Mayo at St. Mary's in Rochester, Minn. |
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Term
| Who founded NANA? Where did this person work and with whom? |
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Definition
| Agatha Hodkins, with Dr. George Crile in Cleveland, Ohio at the Lakeside hospital. They also taught anesthesia to MD and RN from England and France in WWII. |
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Term
| Who donated the first $100 to ANA? |
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Definition
| Agatha Hodgkins to support Ed programs. |
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Term
| Who was the first anesthesia instructor? Where was he/she appointed? |
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Definition
| Alice M Hunt at Yale with University Rank. |
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Term
Who wrote the book "Anesthesia Principles and Practice: A presentation for the nursing Profession" Who wrote the brochure "Anesthesia: A career for the graduate nurse" and why was it published? |
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Definition
Alice M Hunt Gertrude Fife to inforn the public about the AANA objectives Ed programs and membership requirements. |
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Term
Who was the first CANA President? Who was the first male CRNA? |
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Definition
Sophie Grant Winton Everard Hicks |
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Term
| What and where and who was involved in the early Anesthesia lawsuit? What was the ruling? |
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Definition
Dagmar Nelson vs. Chalmers France in California, ruled in favor of nurse Dagmar. Chalmers claimed "anesthesia was practicing medicine" LA SUPERIOR court of CA ruled practice of nursing Chalmers appealed to CA SUPREME court and was overruled again. |
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Term
| Who was the first Chair of the Education Comittee? Who did he/she replace? What were some of her accomplishments? |
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Definition
| Alice M Hunt replaced Agatha Hodgkins. She sheperded efforts to set accredidation standards for anesthesia schools to promote AANA's efforts to improve anesthesia education. |
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Term
| Who presented the report that recommended an endorsed curriculm for anesthetists? What did that entail? |
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Definition
Helen Lamb Minimal Hours of Classroom Minimal Cases Completed Subjects Taught Presented a plan for visitations |
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Term
| What are the most common causes of medication errors? |
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Definition
1) DRUG SWAP (grabbing wrong syringe) 2)Unlabeled syringe 3)Administering wrong drug 4)Right Drug/Wrong DOSE or ROUTE |
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Term
Name Global Planning Steps to Prevent Anesthesia Emergencies Name the steps for emergency planning |
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Definition
Familiarity with work environment Rehearse situation in advance Early Immobilization of Resourses Expertise with equipment Physician Consults/Lab/Work-up Line Placement |
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Term
List someof the ways you can have Human Error |
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Definition
Medication Administration Airway Management Breathing System Fluid Administration Anesthesia Machine Monitoring Equipment |
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Term
| List ways to prevent human error |
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Definition
Back-up monitoring Training/Supervision on new procedures Protocols Problem Management (how to deal with stress) |
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Term
| What are some of the root causes of these errors? |
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Definition
Procedural Training/Supervisory Environmental Physical/Emotional |
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Term
| What are some ways to prevent Medication errors? |
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Definition
Vigilance and awareness consistent practicies dont leave needles on epidurals label all injection ports label all syringes read label when you: 1)draw up a medication 2)attach it to a syringe 3)Administer to patient |
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Term
| What do you do if a lethal dose of anesthetic enters the breathing system? |
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Definition
1) Turn off system 2) Flush vaporizer 3) Disconnect patient from circuit Use alternate source to ventilate patient CPR might not be successful especially if the breathing circuit has an inhaled agent inside! |
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Term
What are the Standard I & II Monitors for the OR? |
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Definition
1) you! qualified provider present in the OR at all times monitoring and modifying anesthesia 2) oxygen analyzer with low conc alarm to assess blood oxygenation during case to assess ventilaiton adequacy. ENCOURGAED monitoring by the tidal volume and capnography. If under General Anesthesia GA: must have continuous EKG and BP q 5 min |
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Term
| Name 6 ways the anesthesia record assists and provides information: |
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Definition
| Basis for planning pt care, furnish documenting evidence of pts evaluation, treatment, change in condition, facilitates communication between providers, protects legal interest of all involved, provides data for research & education (QA), provides a record for billing purposes. |
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Term
| What is the purpose of the anesthesia record? |
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Definition
Anesthesia is the only OR record of the pts condition. It serves as a: Log Book, Clinical Management Tool, Trend and Pattern Plotter, and Provides Medical/Legal Documentation of the case. |
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Term
| What MUST be included in the Anesthesia Record? What are the MINIMAL monitors? |
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Definition
Patient info: age, name, ID#, sex, weight, Providers Info, Anesthesia Equip, Monitors, Monitoring info,
MINIMAL: EKG, BP, SPO2, Precordial Stethoscope, ETCO2 |
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Term
| There are VIII standards of the AANA for nurse anesthesia practice. Name them. |
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Definition
I pre-anesthesia evaluation (complete)
II Informed Consent
III Specific Patient Care Plan
IV Care Plan implemented and adjusted to adapt to pt.
V monitor pts condition consistent with anesthesia care and pt needs
VI prompt, complete, accurate documentation
VII Transfer of care of Pt is done is complete to assure continuity of care and pt safety
VIII care is Assessed to assure quality. |
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Term
| When dealing with post-operative complications you must follow the three golden rules: |
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Definition
Admit, Recognize, Treat!
Stabalize pt, mitigate injury, prevt further harm, remove threat impaired provider or unsafe system or equipment, sequester the OR, do NOT turn off machines or throw anything out! Cancel all other cases! |
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Term
| Name ways to protect a patient from laser burns. |
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Definition
| Tape eyes, goggles, cover eyes with saline soaked pads, Cover skin around surgical site with wet towels, dressings, drapes. |
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Term
| Name a few fuel sources for fires in the OR. |
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Definition
| ETT (made of PVC) silicone, red rubber, towels, gauze |
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Term
| When using a Bovie, what is the mode the pacer is supposed to change to if there is an electrical interference. |
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Definition
| Asynchronous. Place grounding pad on the SAME side as the surgical site so it doesnt cross the body. Also as far away from pacer as possible. Use bovie sparingly and Bipolar if possible. Have tech convert pacer to FIXED mode before case (asynchronous) and reset when case is done. Have magnet in room if needed. |
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Term
| Name the two electrical safety groups |
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Definition
NFPA National Fire Protection Agency
NECA National Electrical Code Association |
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Term
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Definition
I= V/R (IVaR)& VIR ginia
V= IR
V=voltage
I=current
R=resistance in Ohm's |
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Term
| What are the three components to the fire triangle and give an example. |
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Definition
Fire, Ignition, Oxidizer
Oxidizer, oxygen, air, nitrous oxide
(primary oxidizer is O2! over 21% is enriched)N2o-supports COMBUSTION
Fuel-hair, GI gas, Drapes,ETT, plastic, rubber, dressings, OINTMENTS
Ignion source-Bovie, Laser, Fiber Optic Light, Static Electricity, Misc. Sparks. |
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Term
| Name ways to prevent fires in the OR |
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Definition
| VIGILANCE, turn OFF O2 when using bovie, make sure surgeon buts bovie in holster, TENT drapes to allow o2 to flow out and not pool, Coat facial hair with water, place wet gauze and towels around face and over eyes. wet gauze in mouth, fill ETT with methylene blue. |
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Term
| What is the purpose of the grounding pad? |
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Definition
Protect patient
Make electrical current ground to pad....zero current!
Dispels excess electrons before they can build up a charge and cause a shock. |
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Term
| Name the four major laser hazards |
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Definition
laser induced PNEUMO
vessel perforation (misdirected beam)
smoke (plume)has mutegens and carcinogens w infectious particles
Embolization of resected tumors |
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Term
| What type of ETT do you use for a laser procedure? |
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Definition
Laser Tube, fill BOTH cuffs with saline and methyene blue, the cuffs are flammable and the tube can still become hot and burn the patient.
You can also use no tube at all, Apneic technique. |
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Term
Name what NOT to do with laser surgery:
DO NOT: |
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Definition
Wrap tube in wet dressing or muslin (if dries it will make worse)
wrap tube in metallic tape
coat the tube with metallic sponges
use red rubber or silicone tube |
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Term
| Explain the monopolar bovie, what it does and how often used. |
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Definition
95% most common, needle-like electrode, delivers LOOP current travels through pt to ground pad and back to unit.
CUTS and COAGS
Smoky for big cases like belly |
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Term
| Explain the Biplar Bovie, what it looks like, and what it does. |
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Definition
| looks like a tweezer, delivers current between tips, does NOT need grounding, put one anyway!! little smoke, used for small surgical areas. |
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Term
| Explain the Argon Gas Bovie, what it does, etc. |
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Definition
| Expensive, point uses gas to ionize and concentrate the current to a pinpont spot. No smoke (almost), very good visualization, like a laser, can do large areas (Liver, GYN) |
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Term
| Explain Electrocautery Pearls |
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Definition
| HIGH frequency AC current, MUST have grounding pad! Place over large skin area, must be dry and contact completely, DO NOT place over bone, EKG leads, implants, pacemakers, be sure hooked up! |
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Term
| Explain AC, DC, and Leakage |
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Definition
Alternating current-moves back & forth residential
DC (direct current) one way flow, used for electrical circuits, (lightning to earth)
Leakage-unintended flow if electrons (e.g. interference of a monitor) |
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Term
| 1mA, 10mA, 50mA, 100mA Explain what happens with each |
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Definition
1mA-skin tingle 10mA-muscle contraction 50mA-pain and loss of consciousness 100mA-VF 0.0001 (one-millionth of an amp to an external pacemaker can cause VF) Dry skin acts as resistor, currents can be produced by indwelling catheter. |
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Term
| Explain a 2 prong vs a 3 prong plug |
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Definition
3 prong, 3rd prong acts as a ground because it has lower resistance to the electrons then the pts skin 2 prong, if you touch it, you are the 3rd prong! |
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Term
| What is the most common mask injury? TZBMC? Wat are some additional injureis that may occur? |
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Definition
Buccal is the most common injury from face straps Temporal, Zygomatic, Buccal, Mandible, Cervical Corneal Abrasions can occur |
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Term
What effect does the dorsal decubitus position have on blood pressure? What are the numbers? |
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Definition
The dorsal decubitus OR supine position equalizes blood pressure gradients between heart and arteries in head and lower extremities. A 2.5 cm change will decrease BP by 2 mm Hg. |
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Term
| What can you do in the parturient patient and what are you trying to avoid? |
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Definition
| an IV bag under the RIGHT hip will shift the uterus to the left and will displace the uterus to avoid aorto-caval syndrome. |
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Term
| What are the two appropriate options for hand position? |
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Definition
Supine or at side (lateral) arms legs than 90 degrees The OLECTRANON will protect the nerve if |
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Term
| What injury occurs if the lateral arm is compressed with ether screen? What happens? |
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Definition
| Radial nerve injury results in wrist drop (waiters tip or saturday night) |
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Term
| What happens to the head when you lower the bed? What is the window to the vocal cords? |
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Definition
You have increased venous brain pressure patient may c/o headache, nasal or conjunctiva congestion. The SCLERA is the window to the vocal cords. in head injury, it increases ICP MAP-ICP=CPP |
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Term
| Explain how the autonomic function works. |
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Definition
| AORTIC and CAROTID bodies have baroreceptors that are part of the homeostatic mechanisms to maintain BP. Increased firing of receptors when stretched from an increase in BP is Negative feedback loop, it will lower the BP and slow the heart rate |
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Term
Explain West's Lung Zones and how you have the V/Q mismatch. |
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Definition
| Diaphragm impeded with head down increased work of breathing (higher peak pressures req'd for paralyzed, vented pts) VQ mismatch due to dorsal portion of lung, now zone III, reduced compliance. Normally, Ventilation at top and Perfusion at bottom. |
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Term
| What is the #1 lower extremity injury? What is the result? |
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Definition
| Peroneal branch of sciatic and foot drop |
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Term
| Name some complications associated with dorsal decubitus. |
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Definition
| Alopecia, Pressure Points, (pad elbows, heel, sacrum) back pain from loss of lordosis CHAIR position is best! |
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Term
| Explain the Lithomy position and the injury related to Lithomy. |
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Definition
Lateral Fermoral Cutaneous injury due to stretch of inguinal ligaments >90, numbness in lateral thigh. To prevent, move legs simultaneously. |
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Term
| What is the most responsible caus eof hemodynamic changes in anesthesia? Especially in the Lithomy position? |
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Definition
| Alteration in Pre-Load is the most responsible. Lithomy position increases venous return, CO, and ICP. Injury to the common peroneal nerve is the most common lower body injury 78% from compression to lateral head of fibula. Compartment Syndrome and Rhabdomylosis occur 1 in 9000 for lithomy pts. |
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Term
What Nerve is injured in Lateral Decubitus Position? How do you Prevent it? What types of surgeries require this position? What is flexed lateral position? |
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Definition
Brachial Plexus, Chest or "Axillary" Roll, Thorax or hip surgeries Flexed Lateral is for kidney surgery flex point under iliac crest. |
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Term
| What nerve supplies the serratus muscle and what happens if it is cut? |
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Definition
| The long thoracic nerve, winging of the scapula. |
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Term
| What are some common equipment you can use for patient especially in lateral decubitus? |
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Definition
Opti-Guard Donut Roll Towels Chest/Axillary Roll |
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Term
| In the Prone Position what equipment do you use and when do you intubate? Where do you place the arms? What is a major complication with prone? |
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Definition
Prone View, intubate when supine, bolster thorax from clavical to iliac crest, this allows belly-hang from increase ventilation while preventing aorto-caval syndrome. Place breasts medial and cephalad. Place arms along side or alongside the head. POVL-post-operative vision loss! |
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Term
| Sitting Position/Beach Chair, name major complications/hemodynamics. |
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Definition
Causes decreased cerebral perfusion, major risk is hypotension (blood pools in lower extremities) and CVA, venous air embolus, NEVER do beach chair position with hypotension. venous air embolism may manifest as dysrhythmia, desaturation, cardiac arrest, etc. |
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Term
| What is the #1 nerve injury? What is #2? |
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Definition
Ulnar nerve #1-inability to abductor oppose 5th finger, end result s CLAW HAND. most common in older smoking diabetic cancer men Brachial Plexus #2 from cardiac surgery and sternotomy |
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Term
What nerve is injured when searching for an IV? What post-operative neuropathy must be referred to a neurologist? |
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Definition
Medial nerve MOTOR defecit |
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