Advanced Health Assessment, day 1 - Leersnyder Flashcards
(37 cards)
“Mother of anesthesia” as deemed by Dr. Charles Mayo at St. Mary’s Hospital in Minnesota
Alice Magaw, delivered more than 14,000 anesthetics without a single complication
First nurse anesthetist at St. Vincent’s in Erie, PA
Sister Mary Bernard
ASA 1
Healthy
ASA 2
Mild Systemic Disease
ASA 3
Activity-limiting disease
ASA 4
Constant threat to life - CHF, renal failure
ASA 5
Not expected to survive 24 hours
ASA 6
Donor
ASA ____ E
“E” indicates emergency surgery
Organizations involved in the practice of nurse anesthesia
ASA, AANA, school, hospital, board exam, state and federal government, state nursing association
standards of care - preop assessment and eval
standard 1
standard of care obtaining and documenting informed consent
standard 2
standard for formulating a patient specific plan of anesthesia care
standard 3
six steps for preop assessment per ASA taskforce 2002
- interview patient
- physical exam
- order tests
- review tests
- ASA
- make plan and obtain consent
ASA basic standards for pre-anesthesia 2010
- review record
- interview and exam
- order and review tests
- order preop meds
- receive consent
- document in chart
Joint Commission H and P
within 30 days, also requires surgical reassessment to be documented within 24 hours
CMS H and P requirements
completed or updated within past 7 days
six elements of effective communication
Professional Empathy Language, lay Touch, personal Eye contact Eye level
7 steps of physical exam
airway heart breath vitals height/weight neuro mobility/disability
METS assessment - metabolic equivalent of task
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
3-3-2
3-3-2 rule
3 finger mouth opening
3 finger hyoid to chin
2 finger hyoid to floor of mandible (jaw)
lemon
lemon look externally eval 3-3-2 rules mallampati obstruction neck mobility
components of airway exam
- upper incisors
- teeth condition
- relation of maxilla to mandible
- ability to extend mandible anterior to maxilla >3cm
- tongues size and mobility
- uvula
- facial hair
- thyromental distance
- big fat neck
- ROM of head and neck
stop bang
stop bang snore tired observed apnea pressure (blood pressure) BMI age neck circumference gender