Test 1: NORA Standards of Care - TIPS Flashcards
What is the 1st AANA standard of care?
Patient rights: autonomy, privacy, safety
What is the 2nd AANA standard of care?
Pre-anesthesia assessment/eval
- K+, EKG, coags
- Heart and lung functions (METS)
What is 1 MET?
The amount of oxygen consumed while sitting at rest and is equal to
(3.5 ml O2 per kg body weight per min)
What is a leisurely walk in METS?
2.5
What is a brisk walk in METS?
5
What is a poor MET score?
<5
What is a fair MET score?
5-8
What is a good MET score?
9-11
What is an excellent MET score?
Greater than 12
What is the 3rd AANA standard of care?
Patient specific plan
What is the 4th AANA standard of care?
Informed consent
What is the 5th AANA standard of care?
Documentation: accurate, timely, legible
What is the 6th AANA standard of care?
Equipment: verify funcionality
What is the 7th AANA standard of care?
Plan/modification of plan
- CRNA provides care until the responsibility has been accepted by another anesthesia professional
What is the 8th AANA standard of care?
Patient positioning
What is the 9th AANA standard of care?
Monitoring/Alarms
(audible!)
- Don’t turn off alarms. It is recorded within the machine’s hard drive
What is the 10th AANA standard of care?
Infection control policies
- One syringe, one needle, one patient, one time
What is the 11th AANA standard of care?
Transfer of care
- GA needs appropriate recovery
What are the 5 points included under the Modified Aldrete Scoring System?
- Respirations
- Oxygen Saturation
- Consciousness
- Circulation
- Activity
What are the 5 points included under the Postanesthesia Discharge Scoring System?
- Vital signs
- Surgical Bleeding
- Activity and mental status
- Intake and output
- Pain/nausea/vomiting
When using post anesthesia recovery scoring, what score qualifies patient for phase 1 PACU?
Less than 5
When using post anesthesia recovery scoring, what score is needed to discharge the patient to phase 2 PACU
More than 5
When using post anesthesia recovery scoring, what score is needed to discharge the patient from phase 2 (to the floor/home)
More than 9
What does phase 1 PACU mean?
1 PACU nurse to 2 patients
What does phase 2 PACU mean?
1 PACU nurse to 4-6 patients
How is the post anesthesia recovery scored?
- Five categories each scored form 0-2
How does conscious sedation differ from general anesthesia in terms of responsiveness?
Conscious sedation: Purposeful response to verbal or tactile stimulation
General anesthesia: Un-arousable
How does conscious sedation differ from general anesthesia in terms of Airway?
Conscious sedation: No intervention required
General anesthesia: Intervention often required
How does conscious sedation differ from general anesthesia in terms of Spontaneous ventilation?
Conscious sedation: Adequate
General anesthesia: Frequently inadequate
How does conscious sedation differ from general anesthesia in terms of Cardiovascular Function?
Conscious sedation: Usually maintained
General anesthesia: May be impaired
What are the levels of sedation?
- minimal
- moderate
- deep
Patient factors requiring anesthesia?
- Anxiety
- cerebral palsy
- Seizure disorders
- pain
- acute trauma
- increased intracranial pressure
- significant comorbidities
- extreme ages
- Drug/alcohol
- Emergent or routine procedures outside the OR
When treating cerebral aneurysms, what is the typical type of anesthetic?
GETA
- Volatiles
- Propofol gtt
- Precedex
What are some equipments that may be needed during cerebral aneurysm treatment?
Large bore IV
A-line
Possible complications of cerebral aneurysm coiling?
- Rupture/dissection
- Contrast hypersensitivity, anaphylaxis
- Groin hematoma
What is triple H therapy?
- Hypertension
- Hypervolemia
- Hemodilution
Triple H therapy is used to treat cerebral vasospasm
What is the formula for Cerebral perfusion pressure? (CPP)
MAP - ICP = CPP
How does increased CO2 affect cerebral vessels?
Vasodilation
What type of anesthetic is recommended for AAA repair?
GETA
- Large bore IV/A-line
- Heparin, frequent ACT’s, protamine
- Foley catheter
- Controlled mild hypotension
Possible complications of AAA repiar?
- Rupture/dissection
- Contrast sensitivity, anaphylaxis
What is the protamine dosage for heparin reversal?
1 mg of protamine per 100 units of heparin
Max dose of protamine sulfate
50 mg
Give this amount SLOWLY to prevent hypotension. Protamine releases histamine.
What does TIPS stand for
Transjugular intrahepatic portosystemic shunt
Possible comorbidities with TIPS procedures
- Recent GI bleed
- Hepatic encephalopathy
- Ascites
- Pleural effusion
- Alcoholic cardiomyopathy
- Coagulopathy
- Decreased protein binding
Anesthesia considerations with TIPS
- GETA recommended
- RSI (ascites)
- Large bore IV
- Arterial line
- Volume replacement (Albumin and PRBC’s)
- Consider what drugs are metabolized by the liver
- Provider radiation protection
Three factors in radiation exposure
- Time
- Distance
- Shielding
What is the most important factor that limits radiation exposure?
Distance (probably)
Inverse square law (Double distance = quarters radiation dosage)
