CAPA Certification Study Guide 2025/2026 Final Exam
Graded A+ Must Pass!!
Paranesthesia phase - - Focused on preparation for surgery
- Assessment of pts physical, mental, and spiritual needs to complete to identify issues needing to be
addressed
- May also include education on what to expect in the following phases of care and possibly
discharge teaching
- Staffing depends on pt acuity, age of pts and if needed, sedation for preoperative nerve blocks
Postanesthetic Phase 1 - - Immediate post-operative area
- Pt may need assistance with breathing or other life saving measures
- Requires constant attention
- New admissions should be closely monitored until critical needs are met, such as airway and VS are
stable, the initial assessment is completed, and the pt is calm without competitiveness or agitation
- VS every 15min
Postanesthetic Phase 1 staffing - - Staffing should be 1:1 or 2:1
- There should be at least 2 nurses in the unit, 1 who is carding for the pt and one is immediately
available to provide assistance as needed
- 1 nurse in the unit must be competent in phase 1
- The nurse may have 2 pts if both are hemodynamically stable, conscious, over age 8, or under 8
with family/caregiver at bedside
- The nurse may have 1 pt if under 8 years old and unconscious
- The nurse may have 1 pt who is not conscious but hemodynamically stable, with a stable airway
over the age of 8 and 1 pt who is conscious and stable
- Occasionally 1 pt who is critical and unstable may require 2 nurses
Postanesthetic phase 2 - - The pts in this area are preparing to go home
- Here pt receives discharge instructions
- Still requires monitoring for complications related to surgery or medications
- VS every 30-60min (at arrival and discharge)
Postanesthetic phase 2 staffing - - 1:3 if over the age of 8 or under 8 with family present
,- if the pt is under 8 w/out family, ration should be 1:2
- 2 staff members are required to always be in the unit (1 RN competent in phase 2)
- Staffing will be 1 nurse to 1 pt if pt becomes unstable and requires transfer to higher level of care
Extended care - - Area where pts requires extended observation after discharge from phase 2
- Staffing should be 1:3-5
- These pts are typically waiting for transport home/input bed
- 2 staff members should always be in the unit (1 RN who is competent in caring for pt population)
Blended care - - Care of pts who belong in multiple phases of care
- Clinical judgement is required to determine safe staffing
- Pts in different levels may share same physical space
- An effort must be made to ensure privacy and confidentiality
Recommendations to combat alarm fatigue - - Identify important alarms
- Develop policies that identify when alarms can be disabled
- Use alarms that change back to default settings when the pt is discharged from device
- Adjust the alarms to the pt needs
Capnography - - Can detect early hypoxia to allow correction of hypoventilation, apnea, or airway
obstruction
- Can be used in areas other than operating rooms for procedures or peripheral nerve blocks
- Can increase safety for pts when included with use of pulse ox
- O2 supplementation may correct for pulse ox readings but may mask hypoventilation
Minimal sedation, anxiolysis - - Pt responds normally
- Coordination may be impaired
- Pt can maintain airway
Moderate sedation, analgesia - - "Conscious sedation"
- Pt has depressed level of consciousness but can respond to verbal commands or light touch
,- Can maintain their own airway
Deep sedation, analgesia - - Pt responds purposefully to painful stimulation
- Pt may not be able to maintain their own airway
General anesthesia - - Pt loses consciousness, pts are not arousable, usually cannot maintain airway
and ventilatory function
- Cardiovascular function may be compromised
- 3 phases of general anesthesia: induction, maintenance, and emergence
Stages of anesthesia - I: stage of anesthesia and amnesia
II: stage of delirium
III: stage of surgical anesthesia
IV: cessation of respiration to circulatory collapse
Stage I of anesthesia and amnesia - - Begins with initiation of anesthesia and ends with loss of
consciousness
- Pt can follow simple commands
- Protective reflexes remain intact
Stage II of delirium - - Starts with loss of consciousness and ends with disappearance of lid reflex
- Respirations irregular
- May be passed through quickly with newer anesthetic agents
- High risk for aspiration, laryngospasm and bronchospasm
Stage III of surgical anesthesia - - Cessation of spontaneous respirations
- Absence of eyelash response, blink, & swallow reflexes
- Airway management essential
Stage IV cessation of respirations to circulatory collapse - Considered overdose of general anesthetics
Regional anesthesia - - Loss of sensation to specific region of the body
, - Ex: spinal, epidural, and peripheral nerve blocks
Local anesthesia - Local infiltration or topical application of anesthetic agent
Horner's syndrome - - A sign of medical issue that has caused nerve damage
- The nerve from the eye and face to the brain can be damaged and cause drooping eye lid,
decreased pupil size, and decreased sweating
- Can be cause dby tumor, stroke, or spinal cord injury
Retrobublar - Eye nerve block
Intercostal - Block of nerves that supply the ribs and abdominal wall
Brachial plexus - - Block of spinal nerves from C5-T1 vertebrae
- Each bundle divides and eventually end in radial, ulnar, and median nerves
- Used for hand, forearm, and shoulder surgeries
- Interscalene, supraclavicular, infraclavicular, axillary
Lower extremity blocks - - Performed for knee and foot surgeries
- Lumbar and sacral nerves divide into sciatic, gemoral, popliteal, and tibial nerves
To be completed prior to sedation... - - Pre-sedation evaluation by anesthesia provider
- Informed consent
POSS sedation scale - - Assess for unwanted sedation
- S = sleep, easy to arouse (acceptable)
- 1 = awake and alert (acceptable)
- 2 = slightly drowsy, easily aroused (acceptable)
- 3 = frequently drowsy, arousable, drifts off to sleep during conversation (unacceptable; monitor
respiratory status, decrease opioid use or notify prescriber, consider administering a non sedation,
nonopioid such as acetaminophen or NSAID)
Graded A+ Must Pass!!
Paranesthesia phase - - Focused on preparation for surgery
- Assessment of pts physical, mental, and spiritual needs to complete to identify issues needing to be
addressed
- May also include education on what to expect in the following phases of care and possibly
discharge teaching
- Staffing depends on pt acuity, age of pts and if needed, sedation for preoperative nerve blocks
Postanesthetic Phase 1 - - Immediate post-operative area
- Pt may need assistance with breathing or other life saving measures
- Requires constant attention
- New admissions should be closely monitored until critical needs are met, such as airway and VS are
stable, the initial assessment is completed, and the pt is calm without competitiveness or agitation
- VS every 15min
Postanesthetic Phase 1 staffing - - Staffing should be 1:1 or 2:1
- There should be at least 2 nurses in the unit, 1 who is carding for the pt and one is immediately
available to provide assistance as needed
- 1 nurse in the unit must be competent in phase 1
- The nurse may have 2 pts if both are hemodynamically stable, conscious, over age 8, or under 8
with family/caregiver at bedside
- The nurse may have 1 pt if under 8 years old and unconscious
- The nurse may have 1 pt who is not conscious but hemodynamically stable, with a stable airway
over the age of 8 and 1 pt who is conscious and stable
- Occasionally 1 pt who is critical and unstable may require 2 nurses
Postanesthetic phase 2 - - The pts in this area are preparing to go home
- Here pt receives discharge instructions
- Still requires monitoring for complications related to surgery or medications
- VS every 30-60min (at arrival and discharge)
Postanesthetic phase 2 staffing - - 1:3 if over the age of 8 or under 8 with family present
,- if the pt is under 8 w/out family, ration should be 1:2
- 2 staff members are required to always be in the unit (1 RN competent in phase 2)
- Staffing will be 1 nurse to 1 pt if pt becomes unstable and requires transfer to higher level of care
Extended care - - Area where pts requires extended observation after discharge from phase 2
- Staffing should be 1:3-5
- These pts are typically waiting for transport home/input bed
- 2 staff members should always be in the unit (1 RN who is competent in caring for pt population)
Blended care - - Care of pts who belong in multiple phases of care
- Clinical judgement is required to determine safe staffing
- Pts in different levels may share same physical space
- An effort must be made to ensure privacy and confidentiality
Recommendations to combat alarm fatigue - - Identify important alarms
- Develop policies that identify when alarms can be disabled
- Use alarms that change back to default settings when the pt is discharged from device
- Adjust the alarms to the pt needs
Capnography - - Can detect early hypoxia to allow correction of hypoventilation, apnea, or airway
obstruction
- Can be used in areas other than operating rooms for procedures or peripheral nerve blocks
- Can increase safety for pts when included with use of pulse ox
- O2 supplementation may correct for pulse ox readings but may mask hypoventilation
Minimal sedation, anxiolysis - - Pt responds normally
- Coordination may be impaired
- Pt can maintain airway
Moderate sedation, analgesia - - "Conscious sedation"
- Pt has depressed level of consciousness but can respond to verbal commands or light touch
,- Can maintain their own airway
Deep sedation, analgesia - - Pt responds purposefully to painful stimulation
- Pt may not be able to maintain their own airway
General anesthesia - - Pt loses consciousness, pts are not arousable, usually cannot maintain airway
and ventilatory function
- Cardiovascular function may be compromised
- 3 phases of general anesthesia: induction, maintenance, and emergence
Stages of anesthesia - I: stage of anesthesia and amnesia
II: stage of delirium
III: stage of surgical anesthesia
IV: cessation of respiration to circulatory collapse
Stage I of anesthesia and amnesia - - Begins with initiation of anesthesia and ends with loss of
consciousness
- Pt can follow simple commands
- Protective reflexes remain intact
Stage II of delirium - - Starts with loss of consciousness and ends with disappearance of lid reflex
- Respirations irregular
- May be passed through quickly with newer anesthetic agents
- High risk for aspiration, laryngospasm and bronchospasm
Stage III of surgical anesthesia - - Cessation of spontaneous respirations
- Absence of eyelash response, blink, & swallow reflexes
- Airway management essential
Stage IV cessation of respirations to circulatory collapse - Considered overdose of general anesthetics
Regional anesthesia - - Loss of sensation to specific region of the body
, - Ex: spinal, epidural, and peripheral nerve blocks
Local anesthesia - Local infiltration or topical application of anesthetic agent
Horner's syndrome - - A sign of medical issue that has caused nerve damage
- The nerve from the eye and face to the brain can be damaged and cause drooping eye lid,
decreased pupil size, and decreased sweating
- Can be cause dby tumor, stroke, or spinal cord injury
Retrobublar - Eye nerve block
Intercostal - Block of nerves that supply the ribs and abdominal wall
Brachial plexus - - Block of spinal nerves from C5-T1 vertebrae
- Each bundle divides and eventually end in radial, ulnar, and median nerves
- Used for hand, forearm, and shoulder surgeries
- Interscalene, supraclavicular, infraclavicular, axillary
Lower extremity blocks - - Performed for knee and foot surgeries
- Lumbar and sacral nerves divide into sciatic, gemoral, popliteal, and tibial nerves
To be completed prior to sedation... - - Pre-sedation evaluation by anesthesia provider
- Informed consent
POSS sedation scale - - Assess for unwanted sedation
- S = sleep, easy to arouse (acceptable)
- 1 = awake and alert (acceptable)
- 2 = slightly drowsy, easily aroused (acceptable)
- 3 = frequently drowsy, arousable, drifts off to sleep during conversation (unacceptable; monitor
respiratory status, decrease opioid use or notify prescriber, consider administering a non sedation,
nonopioid such as acetaminophen or NSAID)
