physical assessment q1 Flashcards
who is credited with first use with diethyl ether anesthetic in 1842
Crawford Long-first use of diethyl ether in surgery for removal of small cyst
horace wells charles jackson
and what does william morton have to do with it?
experimented with ether and nitrous oxide but it was william morton who used it for surgery 1846
William Morton
Letheon-added red dye to ether, tried to get it patented
chloroform first usage for relief of labor pain
James Simpson
Harvey Cushing
founder neurosurgery-patient died was told it was not his fault, continued with studies but never forgot
John Snow
queen Victoria for delivery of children-chlorophorm
Catherine Lawrence
provided anesthesia during Civil War skillfull nurse is as important as skillfull MD
Who is earliest known NA
Sr. Mary Bernard, Erie PA St. Vincents
Sr. Mary Erhart
Administered anesthesia for 42 years in maui
Who known as the “mother of anesthesia”-by Dr.Charles Mayo,
Mayo Clinic
published report of 14000 cases with out a death
Alice Macaw
who is credited with forming AANA, first president of AANA, started with 47 members also first to introduce gas anesthesia(but dr. crile took credit) she mixed Nitrous Oxide with O2 during cases, first organized educational programs to teach anesthesia
Agatha Hodgins
Alice Weinberg
chief NA for Jewish hospital in Phila. PA in 1950, choose by Dr. Teller(chief surgeon) for her pugnacity
Alice Hunt
appointed to faculty of yale medical school
authored anesthesia principles and practices in 1949
Helen Lamb
Barnes Hospital in St. Louis
first successful pneumonectomy in 1929 (credit went to Dr. Evart Graham)
Gertrude Fife
2nd AANA president
Started Board Exams
Who performs accreditation of NA schools
COA-formed in in 1975 took over for AANA
AANA began process in 1952, recognized by government in 1955
CCNA
charged with protecting and serving public ensuring NA providers are qualified and standards are ensured for providing safe NA service
council of public interest
monitor concerns in public safety, quality care, risk management, and practitioner wellness for prospective of public interest
Phyllis Roberts
Student of Gertrude Fife
sole anesthesia provider, educator in rural hospital
regional anesthesia author
TEFRA
7 standards that supervising anesthesiologists must meet to obtain medical reimbursement direction of CRNAs
What are 7 requirements of TEFRA
1) pre anesthesia evaluation
2) prescribe anesthesia plan
3) personally participate in induction and emergence and other demanding procedures
4) monitor course of case at frequent intervals
5) remain physically available for emergencies
6) provide post anesthesia care
7) refrain from personally performing anesthesia procedure when performing medical direction
OPT out
a governor of a state can request from medicare that there is no supervision for CRNAs in their state
when a govenor sends this request, they must provide documentation and evidence for need, if approved state says there is no supervision requirements
What are requirements for becoming a CRNA
1) current and unrestricted state license as RN
2) graduate from COA accredited NA program
3) completion of passing score NBCRNA Board exam
AANA core values
quality professionalism, compassion, collaboration, wellness, diversity
AANA motto
safe and effective anesthesia care
AANA mission statement
advancing patient safety, practice, excellence, member profession
What is most common NA malpractice insurance claim
damage to teeth, gums, or dental prosthetics, central incisors are most effected
Judicial Branch
Federal and state set up common laws and statues, review laws
Legislative Branch
medicare A and B TEFRA, TJC, national practitioner bank congress sets up statutory laws
3 types of torts
intentional-assault battery, abuse, imprisonment bodily or emotional harm
strict liability-product liability torts
unintentional-negligance, malpractice person or organization through breach of duty causes damage to another
executive law federal and state
Department of health and human services department of education department of justice state-state boards of RN example-accredit schools help to define and enforce practice state-you must know what you can do in a particular state
Difference between Criminal and Civil law
criminal-protect society from harm
civil-concerned with private rights and remedies
Examples of Criminal Law
fraudulent filing of insurance or medicare claims, falsely billing for procedures, falsifying who did case, practice without licensure
employs unlicensed person, misuse of controlled substances
proximate cause
as part of negligence case, plaintiff must prove that actions of defendant caused damage suffered but also that there was proximate cause=forseeable damages that could have been prevented and it took place anyways
what is burden of proof
up to prosecution-must prove something happened
what does res ipsa loquitur
“the thing speaks for itself”
what is occurrence policy
covers you indefinitely for duration of time that you had the policy
what is claims made policy
covers you until you stop cover-if you stop working there you are not covered unless you buy a tail
what does respondent superior mean
let the master answer employer is responsible for actions of employed, if employee is negligent, then employer may be also sued
Preoperative anesthesia assessment
under standard 1 of AANA standards of practice, if you do not do this you are negligent
what is PAC clinic
pre anesthesia assessment clinic obtain med history exam what meds to take lab tests NPO status complete pre op diagnostic coordination with other relevant MD should be done at least 1 wk prior to surgery
thyromandibular distance
distance of tip of thyroid cartilage to tip of chin
Sniffing position
external meatus of ear with sternum, brings laryngeal axis in you direction
What effect do chronic Seizure meds have on MAC
induce CYP enzymes, need higher doses of meds, induction agents
Predictors of pulmonary complications
Surgical site-thoracic, aortic, upper airway, neck, neurosurgery, risk increases as surgical site approaches diaphragm, surgeries over 2 or 3 hours, PPV (altered respiratory cycle) V/Q mismatch
What does STOP BANG stand for
S-snoring T-tired Observed apnea during sleep p-blood pressure b-BMI Age-greater then 50 N-neck circumference G-male gender high risk greater then 3-have on 24 hour pulse ox order
METS
METS1-bad activity tolerance
4OK walk up stairs
10 physically fit
Aortic Stenosis
greatest risk for non-cardiac surgery MI
cardiac considerations, BP and HR
maintain BP within 20 % of baseline, HR is major component of myocardial o2 demand, avoid shivering as it increases O2 consumption
beta blockers
must be given pre op if patient is on one, prevents preoperative ischemia
sellick manuver
down right and up, 10 lbs of pressure RSI
Mendelson syndrome
chemical pneumonitis
aspiration gastric volume greater then 25 ml.
pH less than 2.5
particulate aspirate>clear aspirate
fasting guidelines
no chewing gum after midnight clear liquids 2 hours before surgery breast milk 4 hours before surgery non human milk, infant formula 6 hours meds with a sip of water 150 ml of H20 up to one hour
diabetic med rules peroperatively
hold oral med morning of surgery
take 1/2 insulin
check BS upon arrival, frequently during surgery
total joints check BG whether diabetic or not
thyroid cases
use beta blockers to reduce peripheral conversion of t4 to t3 such as propanerol
controls SNS
renal disease avoid
benzodiazapines
liver disease
altered med metabolism
musculoskeletal disease
MH
cocaine use
avoid beta blockers because you will further decrease coronary flow
ca channel blockers used to manage HTN, tachycardia
avoid ephedrine
recuronium
most common cause of introperative allergic reaction
shellfish allergy
avoid contrast dye
atypical pseudocholinesterase
post op vent support needed until SUX metabolizes
ASA classifcation 1
healthy, no medical issues-healthy kids
ASA 2
mild to moderate systemic disturbances, well managed DM, HTN, etc.
ASA 3 severe systemic disease limits activity
severe systemic disease that limits activity, poorly controlled HTN, diabetes
class 4 ASA
severe systemic disease that is constantly life threatening-ICU patients
Class 5 ASA
If they don’t get surgery, they will die
Class 6 ASA
brain dead, organ harvest
E after ASA
emergency surgery required
failure to obtain consent
battery
anesthesia consult note
date, time, planned procedure, description of extraordinary circumstances, allergies, meds, labs, disease processes, ASA status
SOAP
Suction Oxygen Airway PPV, pharmacy Monitors, mediations
general anesthesia
any instance when patient loses consciousness as defined by ability to respond purposefully, patient loses ability to protect their airway
regional anesthesia
spinal, epidural, subarachnoid, intrathecal, peripheral nerve blocks
MAC
monitored anesthesia care, should respond if stimulated, should maintain, airway reflexes, should protect their own airway, sedation may progress rapidly into general
3 standards of AANA
preoperative assessment (history, pt interview) informed consent constructing a patient specific anesthesia care plan(basics about types of anesthesia)
august bear
first spinal anesthesia
exemplary damages-punative
monetary awards, draw public attention to negligence of defendant
mititgation
minimize impact action make a mess, clean it up
safe device act of 1190
fda reporting of a med or device malfunction
direct verdict
one party has not proved their case as a matter of law
replivin
lawsuit to recover goods by intake from another
HIPAA
right to view medical records, confidential unless court ruling against a parent
indemnification
clause that can appear in employment contract to sue employee if damages are caused by actions of employee
duties of executive director of AANA
maintaining minutes of AANA meetings policy formation representing AANA to other organization does not vote on matters overseeing board clinical standard of guideline participates in activities
