NORA Flashcards
What is NORA?
NORA stands for Non-Operating Room Anesthesia, which is anesthesia provided outside traditional operating rooms.
Locations for NORA include radiology, endoscopy, MRI, and dental clinics.
What are the three steps in the NORA approach?
- The Patient
- The Procedure
- The Environment
What is the significance of thorough preanesthetic evaluation in NORA?
It allows for consideration of reasons for sedation/anesthesia and adjustment of plans for special populations.
What are key challenges in the NORA environment?
- Limited space for anesthesia setup
- Staff unfamiliar with anesthesia protocols
- Adherence to ASA standards
- Equipment checks before starting
What is Office-Based Anesthesia (OBA)?
OBA is performed in an outpatient venue (office/procedure room) not accredited as an ASC or hospital.
What are some advantages of Office-Based Anesthesia?
- Cost containment
- Patient and surgeon convenience
- Reduced nosocomial infection risk
- Improved privacy and continuity of care
What are the potential risks and challenges of Office-Based Anesthesia?
- Increased risk of injury due to remote location
- Policy, legal, and financial considerations
- Variable governmental oversight by state
Who is the ideal patient for Office-Based Anesthesia?
The ideal OBA patient is classified as ASA I or II.
What is the primary reason for delayed discharge from Office-Based Anesthesia?
Post Operative Nausea and Vomiting.
What does MAC stand for?
Monitored Anesthesia Care.
What is the difference between sedation and Monitored Anesthesia Care (MAC)?
Sedation is typically provided by non-anesthesia providers, while MAC is provided by anesthesia professionals and allows for deeper sedation.
What are the components of a Monitored Anesthesia Care (MAC)?
- Preprocedure: Examination & evaluation
- Intraprocedure: Continuous presence of anesthesia provider
- Postprocedure: Appropriate recovery & management
What are the ASA requirements for Monitored Anesthesia Care (MAC)?
- Continuous physical or proximate presence of an anesthesia provider
- Adherence to anesthesia-related institutional policies
- Documentation and informed consent
What are the goals of Monitored Anesthesia Care (MAC)?
- Provide patient comfort & anxiolysis
- Maintain cardiorespiratory stability
- Improve operating conditions
- Prevent recall of unpleasant events
What is TIVA?
Total IV Anesthesia, which is maintained solely with IV medications.
What are some key differences between TIVA and inhalational anesthesia?
- TIVA uses IV agents; inhalational uses volatile agents
- TIVA requires IV infusion pumps; inhalational uses vaporizers
- TIVA has less environmental pollution
What are some advantages of TIVA?
- Less environmental pollution
- Smoother emergence
- No risk of malignant hyperthermia from volatile agents
What are some potential disadvantages of TIVA?
- Risk of awareness if under-dosed
- Requires precise pump management
What is the ASA Physical Status Classification?
A system to classify patients based on their physical status prior to anesthesia.
What is Standard 1 of the AANA Standards for Nurse Anesthesia Practice?
Respect the patient’s autonomy, dignity, and privacy, and support the patient’s needs and safety.
What does Standard 2 of the AANA Standards entail?
Perform and document a preanesthesia evaluation of the patient’s general health and anesthesia history.
What is the purpose of obtaining informed consent according to AANA Standards?
To ensure that the patient or legal representative has given informed consent for planned anesthesia care.
What is the importance of documentation in anesthesia practice as per AANA Standards?
To communicate anesthesia care data and activities through accurate and complete documentation in the patient’s healthcare record.
What does Standard 6 of the AANA Standards focus on?
Adherence to manufacturer’s operating instructions and safety precautions for anesthesia equipment.
What is one of the key responsibilities of the anesthesia provider during MAC?
To monitor vital signs (cardiovascular & respiratory).
What is the focus of Standard 8 in the AANA Standards for Nurse Anesthesia Practice?
Collaborate with the surgical or procedure team to position, assess, and monitor proper body alignment
Use protective measures to maintain perfusion and protect pressure points and nerve plexus.
What does Standard 9 emphasize regarding patient monitoring during anesthesia?
Monitor, evaluate, and document the patient’s physiologic condition as appropriate for the procedure and anesthetic technique
Document blood pressure, heart rate, and respiration at least every five minutes for all anesthetics.
What is the primary goal of Standard 10?
Verify and adhere to infection control policies and procedures to minimize the risk of infection
This applies to patients, the CRNA, and other healthcare providers.
What is the responsibility of a CRNA under Standard 11?
Evaluate the patient’s status and determine when it is appropriate to transfer the responsibility of care to another qualified healthcare provider
Communicate the patient’s condition and essential information for continuity of care.
What is the focus of Standard 12 regarding anesthesia care?
Participate in the ongoing review and evaluation of anesthesia care to assess quality and appropriateness to improve outcomes.
What does Standard 13 require of CRNAs?
Is physically and mentally able to perform duties of the role.
What is the objective of Standard 14 in the AANA Standards?
Foster a collaborative and cooperative patient care environment
This includes interdisciplinary engagement, open communication, a culture of safety, and supportive leadership.
List some position statements related to outpatient surgery and office-based anesthesia.
- ASA Statement on Ambulatory Anesthesia and Surgery
- AANA Dental Office Sedation and Anesthesia Care
- AANA Discharge After Sedation or Anesthesia on the Day of the Procedure
- AANA Office Based Anesthesia
What are the types of sedation mentioned?
Light, moderate, deep sedation
These types refer to the levels of sedation used in anesthesia.
What does NORA stand for?
Non-Operating Room Anesthesia
NORA refers to anesthesia provided outside traditional operating rooms.
List the three steps in the NORA approach.
- The Patient
- The Procedure
- The Environment
What is a key consideration for the patient in NORA?
Thorough preanesthetic evaluation
What is essential for the procedure in NORA?
Understanding procedural demands such as positioning and equipment needs
What unique challenges does the environment present in NORA?
Limited space for anesthesia setup and staff unfamiliar with anesthesia protocols
True or False: NORA requires adherence to ASA standards.
True
What is Office Based Anesthesia (OBA)?
Anesthetic performed in an outpatient venue not accredited as an ASC or hospital
What are some advantages of Office Based Anesthesia?
- Cost containment
- Patient & surgeon convenience
- Reduced nosocomial infection risk
- Improved privacy & continuity of care
What are potential risks associated with Office Based Anesthesia?
- Increased risk of injury
- Policy, legal, and financial considerations
- Variable governmental oversight
Who is the ideal patient for Office Based Anesthesia?
ASA I or II patient
What is the most common reason for delayed discharge from Office Based Anesthesia?
Post Operative Nausea and Vomiting (PONV)
Define Monitored Anesthesia Care (MAC).
Anesthesia provided by an anesthesia professional with potential for deeper sedation than moderate sedation
What are the components of a MAC?
- Preprocedure examination & evaluation
- Continuous presence of anesthesia provider during the procedure
- Appropriate recovery & management postprocedure
What is a key goal of MAC?
Provide patient comfort & anxiolysis
What is TIVA?
Total Intravenous Anesthesia, maintained solely with IV medications
What are the advantages of TIVA?
- Less environmental pollution
- Smoother emergence
- Reduced postoperative nausea/vomiting
What is the ASA Physical Status Classification for ASA I?
Normal, completely healthy patient
What does ASA IV indicate?
End-stage disease with constant threat to life
What is the purpose of the AANA Professional Practice Manual?
To provide standards and guidelines for nurse anesthesia practice
What is the hierarchy of practice rules in anesthesia?
- Standards
- Guidelines
- Position Statements
- Practice Considerations
What is a key requirement of a MAC according to ASA?
Continuous physical or proximate presence of an anesthesia provider
Fill in the blank: The primary method of anesthesia delivery in TIVA is _______.
[IV medications]
What pharmacokinetic principle is crucial for MAC dosing?
Context-sensitive half-time
What is the primary responsibility of the AANA in relation to Nurse Anesthesia Practice?
To establish standards and guidelines for practice based on evidence and legal regulations.
What does Standard 1 of the AANA Standards for Nurse Anesthesia Practice focus on?
Patient’s Rights: Respecting the patient’s autonomy, dignity, and privacy, and supporting the patient’s needs and safety.
What is included in Standard 2 regarding Preanesthesia Patient Assessment and Evaluation?
Perform and document or verify documentation of:
* General health
* Allergies
* Medication history
* Preexisting conditions
* Anesthesia history
* Relevant diagnostic tests
What does PARQ stand for in the context of anesthesia care?
Plan Alternative Risk Questions.
What does Standard 3 require after the patient has considered anesthesia options?
To formulate a patient-specific plan for anesthesia care.
What is the focus of Standard 4 regarding Informed Consent for Anesthesia Care?
To obtain and document informed consent from the patient or legal representative in accordance with law and institutional policy.
What is the requirement of Standard 5 concerning Documentation?
To communicate anesthesia care data through legible, timely, accurate, and complete documentation.
What does Standard 6 state about Equipment?
Adhere to manufacturer’s operating instructions and perform daily anesthesia equipment checks.
What is the role of the CRNA according to Standard 7?
To implement and modify the anesthesia plan based on the patient’s response.
What does Standard 8 emphasize regarding Patient Positioning?
To collaborate with the surgical team for proper positioning and monitoring of body alignment.
What monitoring activities are required by Standard 9?
Monitor and document the patient’s physiologic condition, including blood pressure, heart rate, and respiration.
What is the purpose of Standard 10 related to Infection Control and Prevention?
To verify and adhere to infection control policies to minimize infection risks.
What does Standard 11 state about Transfer of Care?
To evaluate when to transfer care responsibility and communicate essential information for continuity.
What is the goal of Standard 12 concerning Quality Improvement Process?
To participate in ongoing review and evaluation of anesthesia care to improve outcomes.
What does Standard 13 state about Wellness?
The practitioner must be physically and mentally able to perform their duties.
What is emphasized in Standard 14 regarding a Culture of Safety?
To foster a collaborative patient care environment through interdisciplinary engagement and open communication.
What is the ASA Statement on Ambulatory Anesthesia and Surgery?
A position statement regarding outpatient surgery and anesthesia practices.
Fill in the blank: The AANA _______ Office Based Anesthesia provides guidelines for anesthesia in outpatient settings.
Dental
