Introduction to Anesthesiology Nursing NGR 6091 Principles of Anesthesiology Nursing I

1
Introduction to Anesthesiology NursingNGR 6091
Principles of Anesthesiology Nursing I
Jeffrey Groom, PhD, CRNA, ARNPClinical Associate
Professor Asst Program DirectorAnesthesiology
Nursing Program College of Nursing and Health
SciencesFlorida International University
Miami, Florida
2
Discussion Outline

• Course Expectations Program Context
• Historical Context Anesthesia and CRNAs
• Clinical Expectations
• Core Desk and OR Schedule Board
• Daily Setup
• Machine Check Out
• Pre-Op Evaluation
• Holding Area
• Documentation
• Operating Room
• OR Anesthesia Responsibilities
• Post Anesthesia Care Unit
• Post-Op Evaluation
• OR Environment

3
Course ObjectivesUpon completion of this
course, the graduate student will be able to

• Identify the basic principles of anesthesia
  management.
• Correlate the steps in pre and post anesthetic
  evaluation with standards of care.
• Develop an anesthesia care plan specific to
  patient population.
• Correlate operative anesthetic management with
  anesthetic technique, procedure, and equipment..
• Identify principles of airway management, to
  include landmarks and airway evaluation.
• Position of patient using principles of comfort
  and mobility.
• Correlate prevention of complications and
  standards of anesthesia patient.
• Demonstrate accurate documentation of anesthetic
  record.
• Utilize correct techniques for care of equipment,
  management of patient and procedure preparation.
• Demonstrate critical thinking dispositions in
  assessment of patient, formation of care plan and
  justification for choosing that plan, and state
  expected postoperative expectations.

4
Historical Context

• History of Nurse Anesthesia Practice Nurses were
  the first professional group to provide
  anesthesia services in the United States.
  Established in the late 1800s, nurse anesthesia
  has since become recognized as the first clinical
  nursing specialty. The discipline of nurse
  anesthesia developed in response to requests of
  surgeons seeking a solution to the high morbidity
  and mortality attributed to anesthesia at that
  time. Surgeons saw nurses as a cadre of
  professionals who could give their undivided
  attention to patient care during surgical
  procedures. Serving as pioneers in anesthesia,
  nurse anesthetists became involved in the full
  range of specialty surgical procedures, as well
  as in the refinement of anesthesia techniques and
  equipment.

5
Clinical Expectations Overview

• All NARs are RNs first and NARs second.ANP
  Clinical Policy and Procedures.
• Anesthesia Care Plan required for every case.
• Pre-op and Post-op Evaluations will be completed
  daily.
• Daily NAR evaluation book Case Count.
• Appropriate and professional dress expected at
  all times on hospital campuses.

6

• Daily Routine
• Machine Check
• Cart Setup
• PreOp
• Care Plan
• Post Op

7
FIU NAR Uniform ID Tag Clean Scrubs Eye
Protection Stethoscopes/Ear Piece Pen /
Sharpie Cap / Mask / Shoe Covers White Lab Coat
8
OR Anesthesia Responsibilities

• PreAnesthesia Evaluation
• Anesthesia
• Airway Breathing Circulation
• Patient Safety
• Vital Signs
• Temperature (patient and room),
• Fluids in and out
• Patient Positioning
• Post Anesthesia Care
• Documentation - Billing

9
Post-op Evaluation

• Date, Time Anesthesia post-op note Note
  anesthesia complications if any- review those
  problems with attending anesthesiologist, and
  sign.
• Example Sept. 13, 2007. Anesthesia post-op
  note. No anesthesia complications. John Doe
  CRNA

10
Operating Room Hazards

• General safety cuts sticks, lifting, falls,
  radiation, burns, hand/foot injuries
• Biohazards
• Fire Hazards
• Laser Hazards
• Compressed Gases
• Trace Gases
• Electrical Hazards
• Substances
• Operational hazards

11
(No Transcript)
12
Trace Gas Levels

• Sources
• Providers or techniques
• An improper mask fit will pollute air
• Uncuffed tubes - pediatric cases
• Exhaled by patient after extubation/ LMA removed
• At the end of a case some still washout the gases
  by removing the reservoir bag instead of
  deflating it into scavenging

• NIOSH Allowable waste gasses parts per million
  N2O-25ppm.
  
  Halogenated gasses-2ppm or 0.5 ppm
  when used withN2O. Olfactory
  Threshold 50ppm

13
Control Measures for Trace Gases
Prevention Correctly working scavenging
systems Tight mask fit with mask straps or
LMA Disconnect circuit if agents are on only for
short periods of time otherwise turn off for
intubations patient turning Don't take off bag
? instead open pop off and deflate bag to
scavenging
14
Monitoring trace levels
Without periodic monitoring or sampling,
personnel may be unaware of contamination
Sampling In-house or commercial N2O and
halogenated agents Mask, ETT, and
ventilator Sites - anesthesia area, room,
PACU Frequency Annual comprehensive and quarterly
follow-up in less detail
15
Miscellaneous OR Environment
Allowable equipment leakage current -10micro Amps
(100microamps to heart fatal)
Hygrometer- measures relative humidity- gt50
ideal
Line isolation monitor alarm warns of the
existence of a single fault between live power
and ground. Two faults needed for shock to occur.