Principles of Anesthesia- Test 1 – Flashcards
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What does MS MAIDS stand for?
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M- Machine S- Suction M- Monitors A- Airway, Alarms, Ambu I- Iv lines D- Drugs S- Specials
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What should be included in your machine check?
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Vaporizers, High-pressure system, Low-pressure system, Scavenging system, Breathing System, Manual/Automatic ventilation system, O2/Air/N20 Tanks, CO2 absorber, AC power
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The Monitor section of MS MAIDS includes which aspects?
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Monitoring: ventilation, oxygenation, CV status (BP q 5 mins), Temp, neuromuscular function, positioning and protection measures.
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The Airway, Alarms, Ambu section of MS MAIDS includes which aspects?
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Mac/Miller blades (2 diff sizes of each), Laryngoscope handles (2), ETT stylet, syringe, 3 different sized ETTs, LMA's (2 sizes immediately avail.), Alarms set appropriately for the patient, and an ambu bag or transport vent
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The IV section of MS MAIDS should include?
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Iv's that are appropriate (peripheral, central, IO), fluids (label them!), fluid warmers.
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The Drugs section of MS MAIDS includes?
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Drugs specialized to each patient- labelled with drug, concentration, date, time, and initials. ONE NEEDLE, ONE SYRINGE, ONE TIME
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What is the Special section of MS MAIDS designed to do?
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It is designed to have you think back through MS MAIDS, but really specialize it to your specific patient and decide what additional equipment or considerations should be addressed.
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What does ADVISE stand for?
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A- Anticipate D- Differential Diagnosis V- Vigilance I- Internal Sense of Suspicion S- Safety Routine E- Evidence- Based
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How do you best ANTICIPATE a patient's needs?
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By becoming familiar with the patient's pre-op hx, pre-op physical exam, and surgical procedure.
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What is important when considering DIFFERENTIAL DIAGNOSES?
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Use the data that you have, but use SEVERAL data points and look at your patient to help draw a conclusion.
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VIGILANCE includes?
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Constant scanning from right to left, focus, using all your senses, and honoring the verbal contract you made with the patient.
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What does INTERNAL SUSPICION do?
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Allows you to be hyper-vigilant, analytical, and enhances your ability to be the patient's advocate.
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What is a SAFETY ROUTINE?
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Should be unique to the provider and include a plan to keep the patient from harm. #1 should be airway!
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Why is EVIDENCE BASED PRACTICE important?
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It helps to shape your anesthesia plan and suspicions and enhances patient advocacy.
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The "Mother of Anesthesia" is?
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Alice Magaw
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This nurse anesthetist went tot France with Dr. George Crile and taught both physicians and nurses from England and France how to administer anesthesia.
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Agatha Hodgins
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This nurse anesthetists founded the NANA which is now known as the AANA?
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Agatha Hodgins
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This nurse anesthetist was instrumental in the development of accreditation standards for nurse anesthesia schools.
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Helen Lamb
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In 1972 this CRNA became the first male AANA president.
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John Garde
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This CRNA was a COL in the Nurse Corps and became the first Fellow of the American Academy of Nursing.
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Ira Gunn
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The IFNA- International Federation of Nurse Anesthetists
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Promotes NA cooperation internationally.
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What does the IOM's Future of Nursing Report Reinforces Findings of Anesthesia Studies in Health Affairs and Nursing Economics say about CRNAs?
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That CRNA's need to have policies lifted that restrict them from practicing to the fullest extent of their education and training.
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Senate Bill (SB) 73 and House Bill (HB) 1052 can be summarized as:
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Independent scope of practice would include collaboration or consultation with a physician to meet patient needs that exceed the APNs scope of practice, education, or experience.
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Summarize House Bill (HB) 1662:
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Only physicians licensed to practice medicine can provide interventional surgical pain procedures for pain medicine in Illinois.
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What is the role of the AANA?
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To provide support and a collective voice for CRNAs
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COA- Council of Accreditation serves whom?
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The public- by setting standards for NA programs
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What is the main role of the NBCRNA?
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Revise credentialing criteria to meet professional and PATIENT SAFETY NEEDS
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What is the estimated mortality rate from anesthesia?
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1:250,000
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What is the SOC (standard of care) definition?
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Level of care generally practiced by members of the profession in the same or similar circumstances.
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Who is responsible for a CRNAs negligence?
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The CRNA him/herself
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An FEV1/FVC Ratio <70% indicates what?
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Obstructive Lung Disease- look at FEV1 to stage
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An FEV1/FVC Ratio that is normal or high indicates?
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Restrictive Lung disease if the FVC is less than 80%.
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A normal or high FEV1/FVC ratio with a FVC 60-80% of predicted is considered?
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Mild restriction
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A normal or high FEV1/FVC ratio with a FVC 50-60% of predicted is considered?
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Moderate restriction
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A normal or high FEV1/FVC ratio with a FVC <50% of predicted is considered?
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Severe restriction
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A normal or high FEV1/FVC ratio with a FVC >80% of predicted is considered?
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Normal spirometry
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A low FEV1/FVC ratio with an FEV1 >80% of predicted is considered?
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Borderline obstruction.
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A low FEV1/FVC ration with an FEV1 65-80% of predicted is considered?
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Mild obstructioin
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A low FEV1/FVC ration with an FEV1 50-64% of predicted is considered?
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Moderate obstruction
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A low FEV1/FVC ration with an FEV1 <50% of predicted is considered?
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Severe obstruction
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When are PFTs indicated pre-operatively?
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For all lung resection patients For COPD or asthma patients without a discernable amount of airflow obstruction reduction
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Patients with a high pre-op PaCO2 of >___mmHg are at a strong risk for
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45. But ABG alone shouldn't be used to exclude patients from surgery
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What are indications for diagnostic urinalysis?
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Signs of UTI, renal disease, diabetes, collagen disease, use of drugs that affect renal function, abnormal prostate exam, FUO, jaundice, costovertebral angle tenderness, generalized edema
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T or F: a positive urinalysis can delay or cancel an elective procedure?
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True- especially for joint replacements
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What are the indications for EKGs pre-op?
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Male > 50 yo, Female >60 yo, known cardiac disease, electrolyte disturbance, poorly controlled DM, Smoking >20 pk yrs, uncontrolled HTN, severe PVD, morbid obesity
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What are indications for Electrolytes and Creatinine pre-op?
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Known RF, DM, or CV disease
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After revascularization procedure, you should delay surgery for how long?
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6 weeks
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What is the RCRI? How is it used?
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It is the Revised Cardiac Risk Index that uses 6 predictors of cardiac complications. 0-1 score= low risk 2+ score= high risk
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What is the ACS NSQIP Calculator?
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A calculator that uses 21 predictors of risk for major cardiac complications. Calculates that risk of: MACE, death, PNA, VTE, ARF, return to OR, unplanned intubation, discharge to rehab/NH, surgical infection, UTI. Predicts hospital stay
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What are the limitations of NSQIP?
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Not validated outside NSQIP ASA Status Functional status/dependence
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A pt going to OR for organ donation would fall into ASA class ____?
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PS-6
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A pt with severe systemic disease (angina, severe COPD, uncontrolled HTN) with functional limitations would be considered ASA class ___?
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PS-3
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How many weeks is optimal for smoking cessation and why?
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More than 8 weeks because at about the 2 week mark is when secretions increase.
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A pt with mild systemic disease that does not have functional limitations would be considered?
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PS-2
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A pt that presents with the need for surgery in order to sustain life (AAA, Head injury) would be considered?
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PS-5
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A pt with severe systemic disease that is a constant threat to life (CHF, unstable angina, advanced organ dysfunction)
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PS-4
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A case is deemed urgent if?
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Life or limb is threatened if not in the operating room within 24 hours
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A case is deemed time sensitive if?
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Delay of 1-6 weeks for further eval would negatively affect outcomes? (i.e.- colon mass)
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A case is deemed elective if?
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It can be delayed up to 1 year
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What is sensitivity?
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the probability of a positive test result if the patient has the disease in question (Correctly identifies a true positive result)
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What is specificity?
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the probability of a negative test result if the patient does not have the target disease. (Correctly identifies a true negative result)
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Indiscriminate use of tests can produce what problem?
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An increase in false positives than identifying a true disease process
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Values that fall outside of ___% of 'normal' are considered abnormal.
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95%
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To determine results of noninvasive tests, you need to know:
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-prevalence of disease in the population -Sensitivity and specificity of the test (Test most useful in a population with moderate probability of disease)
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A patient with significant baseline disease may need additional routine test such as?
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12 lead EKG Electrolytes CXR
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Who mandates the pre-op eval?
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JCAHO
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What constitutes a low risk procedure?
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MACE <1% (This combines surgical and patient characteristics) Cataracts, plastics
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What constitutes a high risk procedure?
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MACE >1% Risk may be lowered by less invasive approach. Emergent procedures increase risk
