Principles of Anesthesia Nursing 1 - Exam 1 Review Update 2023

Principles of Anesthesia Nursing 1 - Exam 1 Review Update 2023 Anesthesia care consists of? - ANS-Rendering patients insensible to pain and managing their condition during surgery or diagnostic procedures Includes preoperative evaluation and treatment, anesthetic administration, postoperative care, and other contributions (resuscitation, invasive lines, ventilatory management, acute and chronic pain relief) Where does anesthesia care occur? - ANS-Hospitals, free standing surgical centers, offices (dental), "forward areas" (war/combat zones) What is the triad of general anesthesia? - ANS-analgesia, hypnosis (amnesia), & immobility Types of anesthesia techniques? (4) - ANS-General anesthesia, regional anesthesia, local anesthesia, and monitored anesthesia care (MAC) TEFRA 1982 - ANS-Tax Equity and Fiscal Responsibility Act Direct payment to the CRNA under Medicare Part B Medical direction payment if 7 conditions were met 3 parts of HIPPA - ANS-Privacy Rule Security Rule Electronic Data Exchange Preoperative phase includes: - ANS-Preop evaluation Choice of anesthesia Premedication Intraoperative phase includes: - ANS-Physiologic monitoring and vascular access General anesthesia (plan for induction, maintenance, and emergence) Regional anesthesia (plan for type of block, needle, local anesthetic) Postoperative phase includes: - ANS-Postoperative pain control method Special monitoring or treatment based on surgery or anesthetic course Disposition (home, PACU, ward, stepdown, ICU) Is the CRNA required to accompany the patient to the PACU? - ANS-YES! General anesthesia - ANS-A reversible depression of the CNS sufficient to permit surgery to performed without movement, obvious distress, or recall Preparation: MSMAID - ANS-Machine check Suction Monitors Airway IV Drugs Medications given during preoperative period? - ANS-"Drug of trust" Versed Fentanyl Medications given during induction? - ANS-Propofol (mcg/kg) (sometimes with lidocaine to reduce burning and reduces sympathetic response of DL) Etomidate (not as common) Succinylcholine Medications given for maintenance of anesthesia? - ANS-Gases/VAA (Sevoflurane, Isoflurane, Desflurane, etc.) Muscle relaxants (Rocuronium, Vecuronium) - may or may not give Narcotics (Fentanyl, Morphine, Dilaudid) What are some emergency medications? - ANS-Ephedrine (if BP low and HR low) Phenylephrine (if BP low and HR normal) Robinol/Glycopyrulate (like atropine but not ACLS drug; increases HR) Succinylcholine (in case of laryngospasm with LMA) Nitroglycerin (to drop BP fast) Medications used during emergence? - ANS-Reversal agents (Neostigmine; usually given with Robinol/Glycopyrulate to increase HR that is lowered by neostigmine) -Sugamadex Narcotics for post-operative pain Antiemetics (Zofran, scopalamine patch) What is the purpose of preoxygenation/denitrogenation? - ANS-Air is mostly nitrogen so you want to give them mostly oxygen so they have the reserve to give you time needed to intubate What drugs blunt sympathetic response to DL during induction? - ANS-Fentanyl Lidocaine *Monitored anesthesia care (MAC) becomes general anesthesia when? - ANS-When you have to support the patient's airway (even a jaw thrust) *You want to wait to push a paralytic/muscle relaxant until what? - ANS- Continues...