physical assessment q1

Question 1

who is credited with first use with diethyl ether anesthetic in 1842

Answer 1

Crawford Long-first use of diethyl ether in surgery for removal of small cyst

Question 2

horace wells charles jackson

and what does william morton have to do with it?

Answer 2

experimented with ether and nitrous oxide but it was william morton who used it for surgery 1846

Question 3

William Morton

Answer 3

Letheon-added red dye to ether, tried to get it patented

Question 4

chloroform first usage for relief of labor pain

Answer 4

James Simpson

Question 5

Harvey Cushing

Answer 5

founder neurosurgery-patient died was told it was not his fault, continued with studies but never forgot

Question 6

John Snow

Answer 6

queen Victoria for delivery of children-chlorophorm

Question 7

Catherine Lawrence

Answer 7

provided anesthesia during Civil War skillfull nurse is as important as skillfull MD

Question 8

Who is earliest known NA

Answer 8

Sr. Mary Bernard, Erie PA St. Vincents

Question 9

Sr. Mary Erhart

Answer 9

Administered anesthesia for 42 years in maui

Question 10

Who known as the “mother of anesthesia”-by Dr.Charles Mayo,
Mayo Clinic
published report of 14000 cases with out a death

Answer 10

Alice Macaw

Question 11

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

Answer 11

Agatha Hodgins

Question 12

Alice Weinberg

Answer 12

chief NA for Jewish hospital in Phila. PA in 1950, choose by Dr. Teller(chief surgeon) for her pugnacity

Question 13

Alice Hunt

Answer 13

appointed to faculty of yale medical school

authored anesthesia principles and practices in 1949

Question 14

Helen Lamb

Answer 14

Barnes Hospital in St. Louis

first successful pneumonectomy in 1929 (credit went to Dr. Evart Graham)

Question 15

Gertrude Fife

Answer 15

2nd AANA president

Started Board Exams

Question 16

Who performs accreditation of NA schools

Answer 16

COA-formed in in 1975 took over for AANA

AANA began process in 1952, recognized by government in 1955

Question 17

CCNA

Answer 17

charged with protecting and serving public ensuring NA providers are qualified and standards are ensured for providing safe NA service

Question 18

council of public interest

Answer 18

monitor concerns in public safety, quality care, risk management, and practitioner wellness for prospective of public interest

Question 19

Phyllis Roberts

Answer 19

Student of Gertrude Fife
sole anesthesia provider, educator in rural hospital
regional anesthesia author

Question 20

TEFRA

Answer 20

7 standards that supervising anesthesiologists must meet to obtain medical reimbursement direction of CRNAs

Question 21

What are 7 requirements of TEFRA

Answer 21

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

Question 22

OPT out

Answer 22

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

Question 23

What are requirements for becoming a CRNA

Answer 23

1) current and unrestricted state license as RN
2) graduate from COA accredited NA program
3) completion of passing score NBCRNA Board exam

Question 24

AANA core values

Answer 24

quality professionalism, compassion, collaboration, wellness, diversity

Question 25

AANA motto

Answer 25

safe and effective anesthesia care

Question 26

AANA mission statement

Answer 26

advancing patient safety, practice, excellence, member profession

Question 27

What is most common NA malpractice insurance claim

Answer 27

damage to teeth, gums, or dental prosthetics, central incisors are most effected

Question 28

Judicial Branch

Answer 28

Federal and state set up common laws and statues, review laws

Question 29

Legislative Branch

Answer 29

medicare A and B TEFRA, TJC, national practitioner bank congress sets up statutory laws

Question 30

3 types of torts

Answer 30

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

Question 31

executive law federal and state

Answer 31

``` 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 ```

Question 32

Difference between Criminal and Civil law

Answer 32

criminal-protect society from harm | civil-concerned with private rights and remedies

Question 33

Examples of Criminal Law

Answer 33

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

Question 34

proximate cause

Answer 34

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

Question 35

what is burden of proof

Answer 35

up to prosecution-must prove something happened

Question 36

what does res ipsa loquitur

Answer 36

"the thing speaks for itself"

Question 37

what is occurrence policy

Answer 37

covers you indefinitely for duration of time that you had the policy

Question 38

what is claims made policy

Answer 38

covers you until you stop cover-if you stop working there you are not covered unless you buy a tail

Question 39

what does respondent superior mean

Answer 39

let the master answer employer is responsible for actions of employed, if employee is negligent, then employer may be also sued

Question 40

Preoperative anesthesia assessment

Answer 40

under standard 1 of AANA standards of practice, if you do not do this you are negligent

Question 41

what is PAC clinic

Answer 41

``` 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 ```

Question 42

thyromandibular distance

Answer 42

distance of tip of thyroid cartilage to tip of chin

Question 43

Sniffing position

Answer 43

external meatus of ear with sternum, brings laryngeal axis in you direction

Question 44

What effect do chronic Seizure meds have on MAC

Answer 44

induce CYP enzymes, need higher doses of meds, induction agents

Question 45

Predictors of pulmonary complications

Answer 45

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

Question 46

What does STOP BANG stand for

Answer 46

``` 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 ```

Question 47

METS

Answer 47

METS1-bad activity tolerance 4OK walk up stairs 10 physically fit

Question 48

Aortic Stenosis

Answer 48

greatest risk for non-cardiac surgery MI

Question 49

cardiac considerations, BP and HR

Answer 49

maintain BP within 20 % of baseline, HR is major component of myocardial o2 demand, avoid shivering as it increases O2 consumption

Question 50

beta blockers

Answer 50

must be given pre op if patient is on one, prevents preoperative ischemia

Question 51

sellick manuver

Answer 51

down right and up, 10 lbs of pressure RSI

Question 52

Mendelson syndrome

Answer 52

chemical pneumonitis aspiration gastric volume greater then 25 ml. pH less than 2.5 particulate aspirate>clear aspirate

Question 53

fasting guidelines

Answer 53

``` 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 ```

Question 54

diabetic med rules peroperatively

Answer 54

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

Question 55

thyroid cases

Answer 55

use beta blockers to reduce peripheral conversion of t4 to t3 such as propanerol controls SNS

Question 56

renal disease avoid

Answer 56

benzodiazapines

Question 57

liver disease

Answer 57

altered med metabolism

Question 58

musculoskeletal disease

Answer 58

MH

Question 59

cocaine use

Answer 59

avoid beta blockers because you will further decrease coronary flow ca channel blockers used to manage HTN, tachycardia avoid ephedrine

Question 60

recuronium

Answer 60

most common cause of introperative allergic reaction

Question 61

shellfish allergy

Answer 61

avoid contrast dye

Question 62

atypical pseudocholinesterase

Answer 62

post op vent support needed until SUX metabolizes

Question 63

ASA classifcation 1

Answer 63

healthy, no medical issues-healthy kids

Question 64

ASA 2

Answer 64

mild to moderate systemic disturbances, well managed DM, HTN, etc.

Question 65

ASA 3 severe systemic disease limits activity

Answer 65

severe systemic disease that limits activity, poorly controlled HTN, diabetes

Question 66

class 4 ASA

Answer 66

severe systemic disease that is constantly life threatening-ICU patients

Question 67

Class 5 ASA

Answer 67

If they don't get surgery, they will die

Question 68

Class 6 ASA

Answer 68

brain dead, organ harvest

Question 69

E after ASA

Answer 69

emergency surgery required

Question 70

failure to obtain consent

Answer 70

battery

Question 71

anesthesia consult note

Answer 71

date, time, planned procedure, description of extraordinary circumstances, allergies, meds, labs, disease processes, ASA status

Question 72

SOAP

Answer 72

``` Suction Oxygen Airway PPV, pharmacy Monitors, mediations ```

Question 73

general anesthesia

Answer 73

any instance when patient loses consciousness as defined by ability to respond purposefully, patient loses ability to protect their airway

Question 74

regional anesthesia

Answer 74

spinal, epidural, subarachnoid, intrathecal, peripheral nerve blocks

Question 75

MAC

Answer 75

monitored anesthesia care, should respond if stimulated, should maintain, airway reflexes, should protect their own airway, sedation may progress rapidly into general

Question 76

3 standards of AANA

Answer 76

``` preoperative assessment (history, pt interview) informed consent constructing a patient specific anesthesia care plan(basics about types of anesthesia) ```

Question 77

august bear

Answer 77

first spinal anesthesia

Question 78

exemplary damages-punative

Answer 78

monetary awards, draw public attention to negligence of defendant

Question 79

mititgation

Answer 79

minimize impact action make a mess, clean it up

Question 80

safe device act of 1190

Answer 80

fda reporting of a med or device malfunction

Question 81

direct verdict

Answer 81

one party has not proved their case as a matter of law

Question 82

replivin

Answer 82

lawsuit to recover goods by intake from another

Question 83

HIPAA

Answer 83

right to view medical records, confidential unless court ruling against a parent

Question 84

indemnification

Answer 84

clause that can appear in employment contract to sue employee if damages are caused by actions of employee

Question 85

duties of executive director of AANA

Answer 85

``` 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 ```