CRNA

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Outline

Overview

  1. Who is the Certified Registered Nurse Anesthetist (CRNA)?
    1. Advanced practice RN
      1. Provide care before, during, after surgery
        1. Assess patient preoperatively
        2. Administers anesthesia
          1. Surgery
          2. Procedures
        3. Maintains airway
          1. Intubation
          2. Laryngeal mask airway
        4. Monitors
          1. Vital signs
          2. Oxygenation
          3. Perfusion
        5. Provide postoperative care
      2. Trauma stabilization
      3. Critical care interventions
    2. Autonomous role
      1. Overseen by anesthesiologist
      2. In some states
        1. Work without anesthesiologist
    3. Highest paid advanced practice nurse
      1. Competitive field
      2. Growing profession

Nursing Points

General

  1. Where does the CRNA work?
    1. Medical/surgical hospitals
      1. Labor and delivery
      2. Emergency
      3. Surgery
    2. Outpatient surgery centers
    3. Office settings
      1. Dental
      2. Plastics
    4. Pain management facilities
    5. U.S. military facilities

Assessment

  1. Steps to become a CRNA
    1. Earn a bachelor’s degree
      1. Excel in this program!
    2. Obtain state licensure
    3. Gain experience
      1. Acute care setting
        1. At least one year
        2. Preferably 2 plus years
    4. Earn a doctorate or master’s degree in anesthesia
      1. Many programs available
      2. Intense program
        1. 24-36 months
          1. Classwork
          2. Clinical hours
        2. Student cannot typically work
      3. Graduate
        1. Pass boards!

Nursing Concepts

  1. Clinical judgement
  2. Oxygenation
  3. Patient-centered care
  4. Pharmacology

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Transcript

Hey guys!  Today I am going to talk to you about the CRNA or Certified Registered Nurse Anesthetist including what they do and how to get to the status!

So who exactly is the CRNA?  Well guys this is an advanced practice RN who has received specialized training to provide care to patients before, during, and after surgery which predominately includes understanding pharmacology of anesthesia medications to appropriately and safely administer anesthesia.  Anesthesia in simple terms is a combination of medications given to a patient so they have a loss of sensation and also awareness so they are able to tolerate a necessary procedure.


With the administration of anesthesia, the CRNA will also maintain the patient’s airway because with anesthesia they will no longer be able to do this on their own.  Maintaining the airway can mean inserting an endotracheal tube or laryngeal mask airway. While under anesthesia the CRNA will very closely monitor the patient to be sure their vital signs are adequate for perfusion and oxygenation.  The CRNA will also provide care postoperatively until handoff takes place to the postoperative care unit. Often times this means providing pain relief to the patient immediately following surgery.

The role of the CRNA tends to be quite autonomous meaning they are making decisions regarding medications to administer during surgery or a procedure on their own.  In some states CRNA’s work without an anesthesiologist present. In the facility where I work there are anesthesiologists available but the CRNA, on their own will provide anesthesia for inducation and intubation.  If an anesthesiologist is needed they are available but not unless they are called for. The CRNA does however work closely with the surgical staff and surgeon during a procedure. This is definitely a very important but high stress advanced practice nursing role which makes sense that it is one of the highest paid advanced practice nursing roles.  The good thing for those who are interested is this role is still growing but it definitely is competitive!

So where does the CRNA work?  Well, I’m sure you are all aware of the typical surgical setting in hospitals like in the OR, ER, and labor and delivery but it is also common to find CRNA’s in the outpatient surgery centers.  You may even see CRNA’s in the office setting like dental offices where procedures are performed or plastic surgery offices. Pain management facilities are a growing practice that often has CRNA’s on staff to provide anesthesia for quick procedures.  U.S. Military facilities will also have CRNA’s available.

So how can you become a CRNA?  Well if you don’t already have a BSN that will be your first step!  And guys I won’t sugar coat it getting into anesthesia school is super competitive and this starts with have excellent grades in your undergraduate program!  After that education is completed you will take your boards to gain state nursing licensure. You will want to gain experience in the acute care setting preferably the critical care unit but I have heard of some programs accepting ER experience so definitely look into this.  Most programs are asking for at least a year but the more years you have the better! After you’ve gained adequate experience you will want to apply to a program, some are master’s level but some are turning to the doctorate level either way this program lasts between 24 to 36 months.  In these months you will complete classroom education and then clinical hours. Guys keep in mind that most programs do not allow you to work nor would you want to! Finally after completing the program you will graduate and take and pass the boards! Now you are ready to administer anesthesia!

Ok, guys lets review!  The CRNA is an advanced practice RN who provides care before, during, and after surgery with the administration of anesthesia, they maintain airways and monitors patients in an autonomous role.  CRNA’s can work in the hospital setting, outpatient surgery centers, office settings, and pain management facilities. The steps to becoming a CRNA are completing a BSN program, gain state licensure, complete acute care experience, complete a doctorate or master’s nursing program in anesthesia and of course passing boards!

So what nursing concepts can we apply to the CRNA role?  Well clinical judgement most definitely as this is a very autonomous role in which appropriate decision-making is essential in providing patient-centered care.  Pharmacology is definitely appropriate as CRNA’s must understand how different medications work to produce analgesia and amnesia in surgical patients.

We love you guys! Go out and be your best self today! And as always, Happy Nursing!

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pharmacology

Concepts Covered:

  • Test Taking Strategies
  • Medication Administration
  • Adult
  • Emergency Care of the Cardiac Patient
  • Intraoperative Nursing
  • Microbiology
  • Cardiac Disorders
  • Anxiety Disorders
  • Depressive Disorders
  • Vascular Disorders
  • Nervous System
  • Upper GI Disorders
  • Central Nervous System Disorders – Brain
  • Gastrointestinal Disorders
  • Immunological Disorders
  • Fundamentals of Emergency Nursing
  • Dosage Calculations
  • Understanding Society
  • Circulatory System
  • Concepts of Pharmacology
  • Studying
  • Hematologic Disorders
  • Newborn Care
  • Adulthood Growth and Development
  • Disorders of Pancreas
  • Respiratory Disorders
  • Postoperative Nursing
  • Pregnancy Risks
  • Neurological
  • Postpartum Complications
  • Substance Abuse Disorders
  • Noninfectious Respiratory Disorder
  • Bipolar Disorders
  • Peripheral Nervous System Disorders
  • Learning Pharmacology
  • Psychotic Disorders
  • Prenatal Concepts
  • Tissues and Glands
  • Labor Complications
  • Labor and Delivery
  • Personality Disorders
  • Cardiovascular Disorders
  • Integumentary Disorders
  • Emergency Care of the Respiratory Patient
  • Oncology Disorders
  • Liver & Gallbladder Disorders
  • Lower GI Disorders
  • Disorders of the Thyroid & Parathyroid Glands
  • Urinary Disorders
  • Disorders of the Posterior Pituitary Gland
  • Multisystem

Study Plan Lessons

12 Points to Answering Pharmacology Questions
6 Rights of Medication Administration
ACLS (Advanced cardiac life support) Drugs
Adenosine (Adenocard) Nursing Considerations
Amiodarone (Pacerone) Nursing Considerations
Anesthetic Agents
Anti-Infective – Antifungals
Anti-Platelet Aggregate
Antianxiety Meds
Antidepressants
Atenolol (Tenormin) Nursing Considerations
Atropine (Atropen) Nursing Considerations
Barbiturates
Bariatric: IV Insertion
Basics of Calculations
Benztropine (Cogentin) Nursing Considerations
Bisacodyl (Dulcolax) Nursing Considerations
Buspirone (Buspar) Nursing Considerations
Carbidopa-Levodopa (Sinemet) Nursing Considerations
Cefdinir (Omnicef) Nursing Considerations
Celecoxib (Celebrex) Nursing Considerations
Codeine (Paveral) Nursing Considerations
Combative: IV Insertion
Complex Calculations (Dosage Calculations/Med Math)
Cyclosporine (Sandimmune) Nursing Considerations
Dark Skin: IV Insertion
Dimensional Analysis Nursing (Dosage Calculations/Med Math)
Diphenoxylate-Atropine (Lomotil) Nursing Considerations
Drawing Blood from the IV
Drawing Up Meds
Drug Interactions Nursing Mnemonic (These Drugs Can Interact)
Epoetin Alfa
Eye Prophylaxis for Newborn
Fentanyl (Duragesic) Nursing Considerations
Geriatric: IV Insertion
Giving Medication Through An IV Set Port
Glipizide (Glucotrol) Nursing Considerations
Guaifenesin (Mucinex) Nursing Considerations
Hanging an IV Piggyback
How to Remove (discontinue) an IV
How to Secure an IV (chevron, transparent dressing)
Hydralazine
Hydrocodone-Acetaminophen (Vicodin, Lortab) Nursing Considerations
Hydromorphone (Dilaudid) Nursing Considerations
IM Injections
Injectable Medications
Insulin
Insulin – Long Acting (Lantus) Nursing Considerations
Insulin – Mixtures (70/30)
Insulin Drips
Insulin Mixing
Interactive Pharmacology Practice
Interactive Practice Drip Calculations
IV Catheter Selection (gauge, color)
IV Complications (infiltration, phlebitis, hematoma, extravasation, air embolism)
IV Drip Administration & Safety Checks
IV Drip Therapy – Medications Used for Drips
IV Infusions (Solutions)
IV Insertion Angle
IV Insertion Course Introduction
IV Placement Start To Finish (How to Start an IV)
IV Pump Management
IV Push Medications
Ketorolac (Toradol) Nursing Considerations
Labeling (Medications, Solutions, Containers) for Certified Perioperative Nurse (CNOR)
Lidocaine (Xylocaine) Nursing Considerations
Magnesium Sulfate
Magnesium Sulfate in Pregnancy
Maintenance of the IV
Mannitol (Osmitrol) Nursing Considerations
MAOIs
Medication Errors
Medication Reconciliation Review for Certified Perioperative Nurse (CNOR)
Medications in Ampules
Meds for Postpartum Hemorrhage (PPH)
Meperidine (Demerol) Nursing Considerations
Methadone (Methadose) Nursing Considerations
Methylergonovine (Methergine) Nursing Considerations
Metoclopramide (Reglan) Nursing Considerations
Montelukast (Singulair) Nursing Considerations
Mood Stabilizers
Nalbuphine (Nubain) Nursing Considerations
Needle Safety
Neostigmine (Prostigmin) Nursing Considerations
NG Tube Med Administration (Nasogastric)
NG Tube Medication Administration
Nitro Compounds
NRSNG Live | The S.O.C.K Method for Mastering Nursing Pharmacology and Never Forgetting a Medication Again
Nystatin (Mycostatin) Nursing Considerations
OB Pharm and What Drugs You HAVE to Know – Live Tutoring Archive
Olanzapine (Zyprexa) Nursing Considerations
Opioid Analgesics in Pregnancy
Oral Medications
Oxycodone (OxyContin) Nursing Considerations
Pain Management for the Older Adult – Live Tutoring Archive
Pain Management Meds – Live Tutoring Archive
Parasympathomimetics (Cholinergics) Nursing Considerations
Patient Controlled Analgesia (PCA)
Pediatric Dosage Calculations
Pentobarbital (Nembutal) Nursing Considerations
Pharmacodynamics
Pharmacokinetics
Pharmacokinetics Nursing Mnemonic (ADME)
Pharmacology Course Introduction
Phenobarbital (Luminal) Nursing Considerations
Phytonadione (Vitamin K) for Newborn
Pill Crushing & Cutting
Positioning
Procainamide (Pronestyl) Nursing Considerations
Propofol (Diprivan) Nursing Considerations
Quetiapine (Seroquel) Nursing Considerations
Ranitidine (Zantac) Nursing Considerations
Rh Immune Globulin in Pregnancy
Sedatives-Hypnotics
Sedatives-Hypnotics
Selecting THE vein
Spiking & Priming IV Bags
Starting an IV
Streptokinase (Streptase) Nursing Considerations
Struggling with Dimensional Analysis? – Live Tutoring Archive
SubQ Injections
Supplies Needed
Tattoos IV Insertion
TCAs
The SOCK Method – C
The SOCK Method – K
The SOCK Method – O
The SOCK Method – Overview
The SOCK Method – S
The SOCK Method of Pharmacology 1 – Live Tutoring Archive
The SOCK Method of Pharmacology 2 – Live Tutoring Archive
The SOCK Method of Pharmacology 3 – Live Tutoring Archive
Tips & Tricks
Tips & Advice for Newborns (Neonatal IV Insertion)
Tips & Advice for Pediatric IV
Understanding All The IV Set Ports
Using Aseptic Technique
Verapamil (Calan) Nursing Considerations
Anti-Infective – Aminoglycosides
Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)
Eye Prophylaxis for Newborn
Eye Prophylaxis for Newborn (Erythromycin)
Lung Surfactant
Lung Surfactant for Newborns
Magnesium Sulfate
Magnesium Sulfate
Magnesium Sulfate in Pregnancy
Meds for Postpartum Hemorrhage (PPH)
Meds for PPH (postpartum hemorrhage)
Opioid Analgesics in Pregnancy
Phytonadione (Vitamin K)
Phytonadione (Vitamin K) for Newborn
Prostaglandins
Prostaglandins in Pregnancy
Rh Immune Globulin (Rhogam)
Rh Immune Globulin in Pregnancy
Tocolytics
Tocolytics
Uterine Stimulants (Oxytocin, Pitocin)
Uterine Stimulants (Oxytocin, Pitocin) Nursing Considerations
Atypical Antipsychotics
Benzodiazepines
MAOIs
SSRIs
TCAs
Anti-Infective – Penicillins and Cephalosporins
Cardiac Glycosides
Corticosteroids
NSAIDs
Opioid Analgesics
Sympathomimetics (Alpha (Clonodine) & Beta (Albuterol) Agonists)
AV Blocks Dysrhythmias for Progressive Care Certified Nurse (PCCN)
Cardiopulmonary Arrest
Hypertension (Uncontrolled) and Hypertensive Crisis for Progressive Care Certified Nurse (PCCN)
Rapid Sequence Intubation
ACE (angiotensin-converting enzyme) Inhibitors
Acute Coronary Syndromes (MI-ST and Non ST, Unstable Angina) for Progressive Care Certified Nurse (PCCN)
Anemia for Progressive Care Certified Nurse (PCCN)
Anesthetic Agents
Anesthetic Agents
Angiotensin Receptor Blockers
Antidiabetic Agents
Antineoplastics
AV Blocks Dysrhythmias for Progressive Care Certified Nurse (PCCN)
Calcium Channel Blockers
Coronary Artery Disease Concept Map
CRNA
Epoetin Alfa
Histamine 1 Receptor Blockers
Histamine 2 Receptor Blockers
HMG-CoA Reductase Inhibitors (Statins)
Hydralazine
Hypertension (Uncontrolled) and Hypertensive Crisis for Progressive Care Certified Nurse (PCCN)
Hypoglycemia for Progressive Care Certified Nurse (PCCN)
Insulin
Ischemic Bowel for Progressive Care Certified Nurse (PCCN)
Migraines
Nitro Compounds
Nursing Care and Pathophysiology for Hashimoto’s Thyroiditis
Parasympatholytics (Anticholinergics) Nursing Considerations
Proton Pump Inhibitors
Tension and Cluster Headaches
Vascular Disease for Progressive Care Certified Nurse (PCCN)
Vasopressin
Toxic Ingestion, Inhalation, Overdose for Progressive Care Certified Nurse (PCCN)