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Nurse Anesthesia Summer 19 > Intro to NA > Flashcards

Intro to NA Flashcards

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1
Q

Triad of Anesthesia

A
  1. Hypnosis
  2. Analgesia
  3. Muscle relaxation (dependent on the surgery/ what the surgeon is doing)
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2
Q

Dyad of Regional Anesthesia

A
  1. Analgesia

2. Muscle Relaxation

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3
Q

Analgesia

A

Main component of what we do NO PAIN

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4
Q

Sedative- hypnotics

A
  • propofol (doesn’t help with pain)
  • etomidate
  • ketamine** (helps with pain and sedation)
  • benzodiazepines (not used as frequent, longer 1/2 life)
  • barbiturates
  • anesthetic gases (desflurane, sevoflurane, isofluarne)
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5
Q

Prerequisites

A
  • oxygen (any time you give an anesthetic)
  • suction
  • OR
  • bed/ stretcher (drugs affect gait/ mobility)
  • resuscitation bags
  • monitors (EKG, BP, end tidal)
  • Anesthesia provider
  • drugs
  • machine
  • airway equipment
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6
Q

Recovery

A
  • turn off agents
  • reverse relaxants
  • extubate/ remove LMA
  • ensure return of motor/ sensory blockade (ex train of 4)
  • monitor in pacu/ icu
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7
Q

Disadvantages of Anesthesia

A
  • effects various systems
  • allergic reaction
  • recovery time varies
  • post op N/V
  • pain
  • awareness
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8
Q

Local Anesthesia

A

**No anesthesia provider needed

-anesthetic drug usually injected into the tissue to numb the specific location requiring minor surgery

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9
Q

Regional Anesthesia

A

**Anesthesia Provider needed

-injection near a cluster of nerves will numb (larger) area that requires surgery; pt can be awake or given a sedative

ex; epidural, spinal, peripheral nerve blocks

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10
Q

Minimal sedation (anxiolysis)

A

**May or may not need Anesthesia provider

  • responds normally to verbal commands, can follow instructions, pt feels relaxed, can be awake
  • cognitive function and coordination may be impaired
  • ventilation and cardiovascular functions are unaffected
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11
Q

Moderate sedation (conscious sedation)

A
  • pt drowsy, may sleep through procedure, can wake them up with voice/ touch, can respond purposefully
  • minimal memory
  • no interventions required to maintain a patent airway, spontaneous ventilation is adequate
  • cardiovascular function usually maintained
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12
Q

Deep sedation

A
  • pt sleeps through procedure (not easily aroused, can respond purposefully to repeated/ painful stim)
  • no memory
  • breathing can slow, ability to maintain ventilation and airway can be impaired, supplemental oxygen given
  • cardiovascular function usually maintained
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13
Q

General Anesthesia

A

**unconscious/ Not Arouseable/ No sensation

  • ability to independently breath is impaired, requires assistance maintaining patent airway, + pressure ventilation may be required
  • gases or vapor are inhaled through a breathing mask or tube and other drugs often given IV
  • cardiovascular function may be impaired
  • if risk of malignant hypothermia present, total IV propofol can achieve general (200-300 mcg/kg/min)
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14
Q

Monitored Anesthesia Care

(MAC)

A

MAC is a billing term

  • uses sedatives and other agents
  • dose low enough pt remains responsive and breaths without assistance

**simple procedures and minor surgery

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15
Q

Combination Technique

A
  • MAC/ sedation and local/ regional anesthesia

- regional and general anesthesia

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16
Q

Pre-op medications

A
  • patient comfort
  • reduce anxiety
  • prevent aspiration
  • abx per surgeons request
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17
Q

Induction drugs

A

-can be IV or inhaled to induce anesthesia

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18
Q

Neuromuscular blockade

A
  • facilitate intubation

- optimize surgical conditons

19
Q

Inhalation Drug

A
  • to maintain general anesthesia (can also be IV)

ex. propofol, etomidate, ketamine

20
Q

Opioid

A

-minimize physiological effects of pain and promote comfort

21
Q

Antiemetic

A

-prevent nausea likely with opioids/ inhalation agents

22
Q

Neuromuscular Blockade Reversal Agent

A

-reverse the paralyzing effects

23
Q

Alice Magaw

A

-published her work (ether and chloroform with open gtt; 14,000 anesthetics with no complications)

24
Q

Agatha Hodgins

A
  • taught physicians in Europe on nitrous/ oxygen anesthesia

- began first NA program and founded the AANA

25
Q

Operating Room Areas

A

Restricted

Semi Restricted

Unrestricted

26
Q

Unrestricted Area

A
  • Traffic is NOT limited
  • street clothes
  • if in OR scrubs put lab coat on

ex. break room, administrative space

27
Q

Semi-restricted

A

traffic IS limited

  • surgical scrubs
  • surgical caps

ex. storage area for clean medical supplies

28
Q

Restricted

A

Traffic restricted to necessary personnel
-mask up if sterile field/supplies open

ex. where procedures are performed.

29
Q

Sterile Team

A
  • surgeon
  • scrub tech
  • first assist
30
Q

Non- sterile team

A
  • anesthesia
  • OR. nurse
  • other techs (x-ray)
31
Q

OR temperature

A

68-75 F

32
Q

Humidity

A

30-55%

less than 30%

  • increased risk for fire
  • alters sterile indicator strips
  • increased infection risk

greater than 55%

  • increased risk for infection
  • mold/mildew
  • uncomfortable
33
Q

OR Ventilation

A
  • Positive Pressure Room
  • 80/20 mixture of recycled/ fresh air (from ceiling)
  • 25 air exchanges per hour
  • removes 90% of particles in the air
34
Q

OR Noise

A
  • normal operating room levels 75-90dB

* to be heard voices need to be 20dB above background noise

35
Q

Ionizing Radiation

A
  • enough energy to detach electron from atom
  • nuclear decay (alpha, beta, gamma, neurons)
  • gamma rays and X-rays
  • ultraviolet light
36
Q

Radiation Protection

A

-As little as reasonable practice (ALARP)

  • Law of inverse squares (amount of radiation changes inversely with distance (1/d2)
    ex. 16% less at 4m than 1m
37
Q

Types of Shock

A

Macroshock

Microshock

38
Q

Macroshock

A
  • current applied to the body through intact skin
  • measured in milliamps (mA)
  • 1000 – 3000 mA Ventricular fibrillation
39
Q

Microshock

A
  • current applied directly to the heart/internal organs
  • measured in microamps
  • 30 microamps VF potential in humans
  • 10 microamps in dogs
40
Q

LASER

A

Light Amplification by the Stimulated Emission of Radiation (LASER)

class 4- medical lasers

41
Q

Laser Safety Precautions

A
  • room lights as bright as possible (pupils are really constricted bc light is on and small pupil less surface area for laser to damage)
  • restrict access to area
  • close doors/windows, signs on doors
  • eye protection you and pt (human eye very vulnerable to laser beams)
  • cover all skin
  • n95 mask (smoke plume from cautery/ laser surgery, fine particles can be 0.1-0.8 micrometer)can be deposited into lower airways)
  • remove all extra shiny things
  • alarm to indicate when laser in use
  • keep LASER beam above/below normal line of sight, avoid looking into the primary beam at all times
42
Q

LASER safety with Anesthesia

A
  • oxygen <30%
  • avoid N20
  • don’t wrap ETT in foil
  • double cuff tube to prevent leaking of gas if cuff ruptures
  • LMAs can be sensitive to Lasers
43
Q

Waste Anesthesia Gas

A

-if you can smell it you are over the limit

threshold for smell 5-300ppm

44
Q

Equipment cleaning

A
  • Critical: sterilization
    ex. surgical instruments
  • Semi- critical: highly disinfected
    ex. anesthesia blades/scopes
  • Non-critical: wipe down in between cases
    ex. BP cuff, cables

Single use: 1 and done, single pt

Nurse Anesthesia Summer 19 (11 decks)

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