Advanced Health Assessment, day 1 - Leersnyder

Question 0

“Mother of anesthesia” as deemed by Dr. Charles Mayo at St. Mary’s Hospital in Minnesota

Answer 0

Alice Magaw, delivered more than 14,000 anesthetics without a single complication

Question 1

First nurse anesthetist at St. Vincent’s in Erie, PA

Answer 1

Sister Mary Bernard

Question 2

ASA 1

Answer 2

Healthy

Question 3

ASA 2

Answer 3

Mild Systemic Disease

Question 4

ASA 3

Answer 4

Activity-limiting disease

Question 5

ASA 4

Answer 5

Constant threat to life - CHF, renal failure

Question 6

ASA 5

Answer 6

Not expected to survive 24 hours

Question 7

ASA 6

Answer 7

Donor

Question 8

ASA ____ E

Answer 8

“E” indicates emergency surgery

Question 9

Organizations involved in the practice of nurse anesthesia

Answer 9

ASA, AANA, school, hospital, board exam, state and federal government, state nursing association

Question 10

standards of care - preop assessment and eval

Answer 10

standard 1

Question 11

standard of care obtaining and documenting informed consent

Answer 11

standard 2

Question 12

standard for formulating a patient specific plan of anesthesia care

Answer 12

standard 3

Question 13

six steps for preop assessment per ASA taskforce 2002

Answer 13

1. interview patient
2. physical exam
3. order tests
4. review tests
5. ASA
6. make plan and obtain consent

Question 14

ASA basic standards for pre-anesthesia 2010

Answer 14

1. review record
2. interview and exam
3. order and review tests
4. order preop meds
5. receive consent
6. document in chart

Question 15

Joint Commission H and P

Answer 15

within 30 days, also requires surgical reassessment to be documented within 24 hours

Question 16

CMS H and P requirements

Answer 16

completed or updated within past 7 days

Question 17

six elements of effective communication

Answer 17

Professional
Empathy
Language, lay
Touch, personal
Eye contact
Eye level

Question 18

7 steps of physical exam

Answer 18

airway
heart
breath
vitals
height/weight
neuro
mobility/disability

Question 19

METS assessment - metabolic equivalent of task

Answer 19

58.2 W/m squared (18.4 Btu/h x feet squared) - just kidding!

1 met = 1 kcal/kg/hour or sitting quietly
0.9 met = sleep
2.3 mets = very slow stroll
4.0 mets = gentle bike ride
23 mets = running

Question 20

3-3-2

Answer 20

3-3-2 rule
3 finger mouth opening
3 finger hyoid to chin
2 finger hyoid to floor of mandible (jaw)

Question 21

lemon

Answer 21

lemon
look externally
eval 3-3-2 rules
mallampati
obstruction
neck mobility

Question 22

components of airway exam

Answer 22

1. upper incisors
2. teeth condition
3. relation of maxilla to mandible
4. ability to extend mandible anterior to maxilla >3cm
5. tongues size and mobility
6. uvula
7. facial hair
8. thyromental distance
9. big fat neck
10. ROM of head and neck

Question 23

stop bang

Answer 23

stop bang
snore
tired
observed apnea
pressure (blood pressure)
BMI
age
neck circumference
gender

Question 24

upper airway sounds

Answer 24

upper airway - croup, stridor d/t epiglotitis, obstruction, upper resp infection

Question 25

lower airway sounds

Answer 25

lower airway - asthma, pneumonia, chf, pulm edema

Question 26

BMI

Answer 26

BMI - KG / meters squared

or pounds / inches squared x 703

Question 27

teens and smoking

Answer 27

3x more likely to use alcohol
8x marijuana
22x cocaine
increased fighting and unprotected sex

Question 28

number one cause of death from anesthesia

Answer 28

malignant hyperthermia

Question 29

Humphrey Davey used this for his personal use, recreation

Answer 29

nitrous oxide

Question 30

risk factors for surgery

Answer 30

greater than 85 years old
ASA class greater than 2
CHF
functionally dependent
COPD

Question 31

cardiac risk factors / does your patient need an echo?

Answer 31

class 1-
class 2-
class 3-

Question 32

if your patient has a murmur…

Answer 32

is it symptomatic?

Question 33

insulin rec’s

Answer 33

Nagelhout pg. 368

Question 34

James Simpson - obstetrician

Answer 34

chloroform

Question 35

three A’s of anesthesia

Answer 35

analgesia
amnesia
anesthesia

Question 36

surgeon’s requirements

Answer 36

immobile patient
positioning requirements
muscle relaxation
ability to post op test
pain control
go home same day
to remain intubated