Anesthesia Management Assistance for Certified Perioperative Nurse (CNOR)
Included In This Lesson
Outline
Anesthesia Management Assistance
Guidelines:
- Induction is critical time, RN should be immediately available and present
- Masking before intervention
- Masking is king
- Preoxygenate!
- Failed intubation = do something different
- Consider floorwalker consult early
- Laryngospasm
- Paralyze, pos pressure, consider trach
- Do not allow surgeon to manipulate during induction, waitfor TOTS
- Assist with spinal placement
- Assess damage during intubation
Considerations:
- Intubation terrible time for BP cuff
- Snap connector if needed
- Pulse ox most critical
- Pulse increases with intubation
- Know location of airway gear
- KB on back table
- Quiet during emergence, “stage 2”
- Assess during surgery for anesthesia response
- Insufflation pressure
- Vent setting: pressure vs volume
- MAC/twilight: be aware of patient
- “Oops”
- RSI if indicated, NPO violation common
- Know current tube size!“Need one smaller”
- ETco2 #1 indicator for tube placement
- Beware mainstem
- Check cuff pressure! 20-30 mmhg
Nurse’s role:
- Expose chest
- Hold what told to hold
- ET tube, attach syringe, pre fill syringe with <10cc, hold in ready state
- When placed, hold with hand touching face pinch at teeth
- Call assistance
- IV maintenance
- Third hand common
- Bagging or mask pressure vice versa
- Cannot administer on their behalf for test
- Test equipment
- Glyde scope, video laryngoscope
- Backup o2
- Cric pressure
- Don’t let go until told!
- Feedback “i feel it”
- Safely ‘restrain’ for emergence if indicated
- PTSD common
Pitfalls:
- Waiting too long for code
- Not masking!!
- “I checked it this morning” FALSE
- Scrub tech clanging gear = spasm
- Emergence fight
- Wrong medication label
- Flush clamped
- Gas left on
- Long emergence period
Examples:
- Induction, mask, intubation failed (mask again, regain o2, consider changes)
- Anesthesia places tube then turns for tap (grab tube, hold atteeth and hand braced to
face) - LMA placed (listen for leaks, preemptively pull next size)
- Masking easy yet declining o2 (masking stomach likely)
Linchpins (Key Points):
- The RN has a critical role in anesthesia management that often appears small until needed. Be ready when needed
Transcript
References
- Association of periOperative Registered Nurses. (2022). Guidelines for Perioperative Practice (2022 ed.).
NCLEX
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
- Neurological
- Nervous System
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
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- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
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- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
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- Intraoperative Nursing
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- Infectious Respiratory Disorder
- Depressive Disorders
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- Peripheral Nervous System Disorders
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- Newborn Care
- Basics of Mathematics
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- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
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- Postpartum Care
- Basic
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- Bipolar Disorders
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- Basics of Human Biology
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- Prioritization
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- Writing
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- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
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- Childhood Growth and Development
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- Concepts of Pharmacology
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- Developmental Theories
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- Growth & Development
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- Med Term Basic
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- Learning Pharmacology
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- State of Consciousness
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