Intro NAP III

1844 Horace Wells arranged to demonstrate painless dental surgery using N20 which was done at this hospital. He was not successful and was discredited as a result of this demonstration?

Mass General Hospital

According to the National Patient Safety Foundation this is defined as an unintended healthcare outcome caused by a defect in the delivery of care to a patient?

Healthcare or Medical Error

This nurse founded & directed the Barnes School of Anesthesia in St. Louis. Chaired the AANA Education Committee & established the curriculum & minimum standards for schools of nurse anesthesia. Performed anesthetic for world's first successful pneumonectomy and became the AANA President from 1940-1942?

Helen Lamb

Though rare, the sitting & prone positions can sometimes be associated with what 2 spinal cord injuries?

Hemiparesis quadriplegia

These 2 meds used in surgery are barbiturates and are known to cause amnesia?

Thiopental methohexital (Brevital)

This nerve wraps around the head of the fibula on the lateral leg and is at significant risk of injury with the lithotomy position if it is not sufficiently padded?

common peroneal nerve

The lithotomy position can cause injury to which 3 nerves? (Hint: SOC)

common peroneal nerve saphenous nerve Obturator nerve

For patients in the Lateral Decubitus Position, check the dependent eye for what 2 conditions?

compression pressure

This type of vision loss occurs when ischemia or trauma leads to infarction of the visual pathways?

cortical blindness

Position the patient to his/her comfort _________ to induction if they have a history of severe arthritis, decreased neck mobility, or neuropathy of the upper extremities?

prior

With quality improvement, the use of these 2 measures is key to truly make improvements and to be able to demonstrate that improvements are taking place?

process measures outcome measures

Corneal abrasion is especially seen when patients are in which position?

prone

This med used in surgery is considered a Isopropyl phenol and is known to cause amnesia?

propofol

In 1983, Congress passed this cost control bill which revised the means of calculating Medicare payment from cost-plus fee for service, to prospective pricing based on diagnosis related groups (DRGs); a payment system that covers all charges associated with an inpatient stay from the time of admission to discharge?

prospective payment system (PPS)

When patients are supine, use gel pads or mattresses to more evenly distribute the patient's body weight and prevent what?

reddened areas

Peripheral nerve injury is a known complication when which 2 types of anesthesia are used?

regional anesthesia general anesthesia

When patients are supine, place a pillow under the patient's knees (if the procedure allows) as ligaments of the vertebral column __________ with GA and can lead to headache and lower BP?

relax

You cannot manually bolus a patient with this drug, no IV push. This drug is meant to be given via a pump bolus or continuous infusion only?

remifentanil

According to Alice Magaw these were the 3 signs most carefully watched when administering anesthesia?

respiration color quality of the pulse

In patients receiving MAC, ______________ ________________ from sedative drugs like propofol, benzodiazepines and opioids are an important mechanism of injury?

respiratory depression

For patients in the trendelenburg position, cephalad movement of the mediastinum may result in the migration of the tip of the ETT into where?

right mainstem bronchus

For fracture table positioning, the patients trunk is supported by what 2 pieces?

sacral plate padded post

This is defined as the lack of harm; focuses on avoiding adverse events; if patient injury is avoided, then the process is safe?

safety

This nerve can be compressed in the lithotomy position by contact with the leg brace medially as it courses superficially and horizontally across the medial femoral epicondyle. This bony prominence should be padded?

saphenous nerve

Florence Henderson called for the formation of anesthesia education in where? The officers of the American Hospital Association echoed Henderson's call and by _______, the first organized programs of nurse anesthesia education in the United States started?

schools of nursing 1912

In the sitting position, the knees are usually slightly flexed for balance and to reduce stretching of which nerve?

sciatic nerve

For thyroid or parathyroid surgery, the patient can be supine in one of which 2 positions with the neck extended. A roll can be placed transversely under the scapulae to facilitate exposure of the anterior neck, and great care is taken to assure that there is no neck hyperextension?

semi-Fowler beach-chair

These 3 hamstring muscles are innervated by the sciatic nerve itself before it divides into the tibial and common peroneal nerves?

semitendinosus semimembranosus biceps femoris

Humphrey Davy taught himself many subjects including theology, philosophy, poetics, & several sciences including chemistry. He even spoke how many different languages?

seven

Inhalation agents employed to maintain general anesthesia include potent volatile agents such as the following 6 meds? (Hint: SHINED)

sevoflurane X (Ultane) desflurane (Suprane) isoflurane (Forane) halothane (Fluothane) nitrous oxide (N20) ...not nitric oxide (NO) Enflurane (Ethrane)

Before putting a patient in the prone position, check the patient's range of motion at which joint preoperatively to determine the safe degree of extension?

shoulder joint

For patients in the lithotomy position, the legs should be raised and lowered ___________________ in an effort to avoid torsion (twisting) of the spine and extension of the hip. Ask for help if need be?

simultaneously

Use of a peripheral nerve block in addition to this can improve post-op care?

single-shot spinal block

In the prone position, improper positioning can cause compression of the vena cava and subsequent engorgement of this plexus which can also result in a potential increase in blood loss?

spinal venous plexus

The seven conditions listed for billing the TEFRA act were misconstrued as what instead of billing/cost rules, & were adapted as standards of practice in the ASA Guidelines to the Ethical Practice of Anesthesiology?

standards of practice

The anesthesia provider should pad all bony prominences, as well as small pieces of equipment such as these 2 components which may exert pressure on the skin?

stopcocks intravenous lines

In 1848, under the influence of chloroform, Horace Wells threw this on 2 prostitutes in the streets of NY and was sent to NY's Tombs Prison?

sulfuric acid

Pulmonary function is actually _____________in the prone position vs supine, if you do not have increased abdominal pressure?

superior

In the supine (dorsal decubitus) position, the hands and forearms can be in one of these 2 positions to reduce external pressure on the ulnar nerve?

supinated kept in a neutral position (palm toward the body)

Nerve injuries associated with steep and reverse Trendelenburg are the same as what position?

supine

This is the most common position for surgery?

supine

Who were the ones who actually drafted nurses into anesthesia practice?

surgeons

In 1830 Henry Hill Hickman died from what?

syphilis

Patients who complain of sensory or motor dysfunction post-op should be reassured of what?

that this is frequently a temporary condition

Because Alice Magaw was so skilled with the open-drop ether technique, she became known internationally as what?

the "mother of anesthesia"

Why do some people experience lower back pain when in the lithotomy position?

the normal lordotic curvature of the lumbar spine is lost in this position

In the California case, Chalmers-Francis v Nelson, who won in that case?

the nurse anesthetist

What happened during Horace Wells nitrous oxide demonstration at Massachusetts General Hospital (MGH) in Boston, leading to the demonstration ending in failure. N2O was declared a hoax, and would remain so for another 60 years?

the patient screamed

With ulnar nerve injuries, the area of neuropathy usually affects which part of the hand?

the pinky finger and half of the ring finger

In the early nurse anesthetist days, most medical care was provided in homes by family b/c hospitals were primarily used to care for whom?

the poor & indigent (needy)

Most physicians were more eager to learn the skills & techniques of whom?

the surgeon

With obese patients, the heaviest portion of the body, and therefore the patient's center of gravity, should be opposite from what?

the weighted foot of the table

With radial nerve injuries, the area of neuropathy usually affects which part of the hand?

thumb and the first 2 fingers

The sciatic nerve divides into these 2 nerves which are the most important branches of the sciatic nerve?

tibial nerve common peroneal nerve

What was the first objective of the AANA?

to develop educational standards & technique(s) in the administration of drugs

When using MAC its important to monitor the total dose of local anesthetic used by the surgeon to avoid what?

toxicity risk

If a Foley catheter is placed in a patient in the prone position, it should hang free after positioning without ____________ on the genitalia?

traction

These are 2 recent issues in anesthesia that have been identified through empirical observation?

•Awareness of dangers of anemia during spine surgery •Hypotension in sitting position

These are 7 infrequently occurring risks of regional anesthesia that have a severe Impact?

•Bleeding •Infection •Nerve damage/paralysis •Persistent numbness/weakness •Seizures •Coma •Death

These are 3 disadvantages of TIVA?

•Blood concentrations of IV agents are not easily obtained. •Greater risk of intraoperative awareness due to underdosing compared with inhalational techniques. •TIVA techniques are more costly than inhalational techniques, depending on the combination of selected IV agents.

These are 2 positive cardiovascular effects of the Trendelenburg position?

◦↑ venous return ◦↑ central blood volume

When patients are in the lithotomy position with the legs up, these are 3 physiological effects seen on the CV system?

◦↑ venous return (minor and transient) ◦↑ Mean B/P ◦↑ CO

In the Trendelenburg position, the abdominal contents are displaced toward the diaphragm, which can result in the following 3 respiratory complications?

◦↓ FRC ◦↓ pulmonary compliance ◦higher airway pressures during mechanical ventilation

Anesthetized persons who are spontaneously breathing compared with those who are non-anesthetized have what 3 differences in their respiratory functions?

◦↓ Tidal volume ◦↓ FRC ◦↑ Closing volume

When patients are in the lithotomy position with the legs down, these are 2 physiological effects seen on the CV system?

◦↓ venous return ◦Hypotension (when cuff cycles w/ legs down)

Vertical distance between arms of an adult male is ~____ inches? Pressure difference between 2 arms in an adult male is ____ mmHg?

16 32

In 2010 Hispanics comprised _____% of the total U.S. population of 308.7 million or ~49.3 million?

16%

Nitrous oxide (N20) gas was 1st synthesized in ________ by an English chemist, author and Unitarian minister by the name of _________ ___________?

1772 Joseph Priestly

Chloroform was invented in what year?

1831

These are 6 ladies who served as nurse anesthetists to the Mayo Brothers?

1889-1893: Edith Graham 1893-1918: Alice Magaw 1904-1917: Florence Henderson 1905-1936: Mary Hines 1909-1949: Mary Shortner 1909-1950: Ann Powderly

Between 1912-1920, approximately _____ nurse anesthesia schools opened?

19

The National Association of Nurse Anesthetists (NANA) was formed in _________ , with its name changed to the American Association of Nurse Anesthetists in ________. During this time Agatha Hodgins was the AANA president?

1931 1933

In ________, the New York Society of Anesthetists formed a Certification Committee planned for written, oral, & practical examination?

1933

When was the first MD anesthesia examinations given?

1939

In ______, the American Society of Anesthetists (ASA) was 1st recognized as a specialty by the American Medical Association (AMA)?

1940

In what year did Crawford W. Long appear on the US postage stamp?

1940

In _______, the AANA implemented Accreditation of NA programs?

1954

In ______, the ASA celebrated its Golden Jubilee year; ASA's primary concerns were their economic status, continuing struggle for universal acceptance as specialists by surgeons & hospital administrators, anesthesia fees with insurance?

1955

The Crawford W. Long Museum in Jefferson, GA opened in _________ and a ribbon cutting was done in _________?

1957 2010

In ______ the Voluntary CE program was approved by AANA?

1969

What does the PDSA acronym for quality improvement stand for?

Plan Do Study Act

The Triple Aim is a combination of these 3 variables?

Population Health Experience of care Per capita cost

These are defined as evidence-based recommendations intended to optimize patient care & to assist nurse anesthetists, or other anesthesia professionals, & patients in decision-making about appropriate healthcare for specific circumstances?

Practice Guidelines

This is defined as evidence-based statements that describe the minimum requirements & responsibilities for anesthesia practice?

Practice Standards

After the successful demonstration with ether, John C. Warren told the audience in the amphitheater, "Gentlemen, this is no humbug". The amphitheater was then named what?

"Ether Dome"

This is the basic tenet (principle) of medical/health care?

"First, do no harm"

This was Alice Magaws first publication; was issued in the Northwestern Lancent in 1899 and included more than 3000 cases?

"Observations in Anesthesia"

Henry Hill Hickman wrote up his work on animal studies & sent it to one of the presidents of the Royal Society. The Lancet titled the article this and criticized his work?

"Surgical Humbug"

What is the vision of the Anesthesia Patient Safety Foundation (APSF)?

"That no patient shall be harmed by anesthesia"

In the 1930's, this new word was coined by physician anesthetists in the US to differentiate themselves from nurse anesthetists?

"anesthesiologist"

Surgeon George Crilen and his nurse anesthetist Agatha Hodgins developed a technique where nerve blocks, combined with N2O were used to attenuate (weaken) the cardiovascular shock with chloroform or ether anesthesia. They called this technique what?

"anoci-association"

When the Mayos arrived at St. Mary's Hospital, they decided that a nurse was more suited to giving anesthesia, because they were more likely to do what?

"keep their mind strictly on it"

B/c of Humphrey Davy and his public experiments, nitrous oxide became known as what?

"laughing gas"

According to Alice Magaw, the subconscious or ___________ ___________ is particularly susceptible to suggestive influence; therefore, during the administration, the anesthetist should make those suggestions that will be most pleasing to this particular subject?

"secondary self"

The ASA has also described a continuum of the depth of sedation that includes progressive levels of sedation which ranges from what?

"verbal anesthesia" to "room air generals"

How much money was William T.G Morton seeking in compensation for his patent being ignored?

$100,000

In 1950, AANA membership dues were increased to $_____, with $__ (25%) allocated to the accreditation program, where "accreditation would vouch for the fact that graduate NAs, who now occupy or who in the future would enter our field from our standard courses of training, are irreproachably equipped, educationally & clinically, to meet the professional requirements & responsibilities that are inherent in the practice of our specialty".

$20 $5

On 7/29/18, the Pamphlet prepared by the Lord brothers to investigate & substantiate the legality of Charles T. Jackson's claims to priority in the use of sulphuric ether for surgery posted online for sale for how much money?

$300

Dues for CRNAs to be part of the AANA are currently how much?

$645/year

What are the 3 elements of the fire triangle?

-Heat (Ignition Source) -Fuel -Oxidizer (Oxygen, Nitrous Oxide, Room Air)

The following 3 checklists have been identified as top patient safety strategies to prevent operative & postoperative events?

-Preoperative checklists -checklists to prevent central-line-associated bloodstream infections (CLABSI) -anesthesia checklists

KLEINMAN'S 8 Questions: -What do you call your illness? (What name does it have)? -What do you think has caused the illness? -Why and when did the illness start? -What do you think the illness does? How does it work?

-How severe is it? Will it have a short/long course? -What kind of treatment do you think the person should receive? What are the most important results you hope to receive from this treatment? -What are the chief problems the illness has caused? -What do you fear most about the illness?

These are 2 ways to avoid compartment syndrome in surgical patients in the lithotomy position?

-Maintain perfusion pressure -avoid external leg compression

These are the 4 Culturally and Linguistically Appropriate Services (CLAS) standards?

-Principal Standard -Governance, Leadership and Workforce -Communication and Language Assistance -Engagement, Continuous Improvement and Accountability

These are 3 potential causes for injury to the sciatic nerve during surgical procedures?

-Malnourished/emaciated patient supine or sitting on inadequately padded table -Leg straight in sitting position -Legs externally rotated with knees extended in lithotomy

These are 4 positioning recommendations to prevent ulnar nerve injuries during surgery?

-Supinate forearm on padded arm board -Do not flex elbows more than 90 degrees -Place sufficient padding around elbow -Draw sheet should extend above the elbow and be tucked between the patient and the mattress

Frank vs. South has 4 important points:

-Medical practice laws are designed to protect consumers, & not to benefit one profession at the expense of members of another profession -There can be overlap between the scopes of practice of different professions -Nurses have the right to administer anesthetic medications when directed by a physician -knowledge of administering anesthesia was not exclusively within the province of medicine

These are 2 way to prevent corneal abrasion when patients are in the prone position?

-Tape eyes -Protect / lube eyes

These are 4 position-related injuries that are seen within the neurological system?

-peripheral neuropathy -quadriplegia -decreased cerebral blood flow -increased intracranial pressure (ICP)

These are 4 position-related injuries that are seen within the body parts associated with the HEENT?

-postop vision loss (POVL) -corneal abrasion -facial edema -vocal cord edema

The Joint Commission defines events that do NOT require focused reporting & review to them, (meaning a list of bad things that can happen however they do not require reporting to TJC). These include the following 4 conditions?

-near miss -medication errors that do not result in death or functional loss -minor hemolysis -death or functional loss after leaving AMA

Nurse anesthesia practice may include, but is not limited to, the following 6 elements?

-performing a comprehensive history and physical; -conducting a preanesthesia evaluation; -obtaining informed consent for anesthesia; -developing and initiating a patient-specific plan of care -selecting, ordering, prescribing and administering drugs and controlled substances -selecting and inserting invasive and noninvasive monitoring modalities

*******CULTURAL DIVERSITY STARTS HERE*******

*******CULTURAL DIVERSITY STARTS HERE*******

*******START OF ANESTHETIC TECHNIQUE*******

*******START OF ANESTHETIC TECHNIQUE*******

******START OF QUALITY & PATIENT SAFETY********

******START OF QUALITY & PATIENT SAFETY********

****PATIENT POSITIONING STARTS HERE******

****PATIENT POSITIONING STARTS HERE******

***The Anesthesia approach when it comes to learning from experience has been to: •identify & describe such events as they occur, •determine how they might occur in clinical practice, •develop & test countermeasures, & •disseminate the results through technical improvements or education

***A key to learning from experience is to: •recognize a potentially preventable event, •evaluate its likelihood, & •systematically develop countermeasures to reduce the incidence

**WEEK 1 PROFESSIONALISM STARTS HERE**

**WEEK 1 PROFESSIONALISM STARTS HERE**

Steps to follow after an adverse event? *Get help *The primary caregiver(s) should continue patient care. *Designate immediately an Incident Supervisor *Close that OR for that day; do not turn off or unplug anything *Contact the care facility's administrator & risk manager & possibly also the practitioner's insurance company & attorney if indicated. *Arrange immediate comfort & support for patient &/or family. Share as much information as possible.

*Designate a Follow-up Supervisor *Document everything *Try to review formal reports submitted by the institution to the authorities (state department of health/licensing body or the National Practitioner Data Bank) both in order to know what they contain & also add your observations or commentary if indicated. *Continue involvement after the event when the patient survives

Despite being an effective anesthetic, chloroform had several disadvantages. 3 are listed?

*The quantity of chloroform required to differentiate stage 3 from stage 5 was small. *Great skill was required to administer chloroform safely, as the fatal dose was only ~30 ml. *Even if the patient survived the operation, delayed chloroform poisoning could lead to problems such as liver damage.

Since education of anesthetists was haphazard (unorganized) in 1909, Florence Henderson published a paper stating that the education of anesthesia providers fell into one of three categories? (At that time, anesthesia was not part of any curriculum of any medical or nursing school)?

-On the job training of nurses -Observation & supervision of visiting clinicians as a courtesy -Demonstrations by itinerant (traveling) representatives of manufacturer's (so basically if there was a new mask or drug coming out, these were the people who come to teach the technique of what to do)

Anesthesia providers may use one technique or a combination of techniques during surgery. The choice of anesthetic technique is based on multiple considerations, including these 4 topics?

-Patient safety -Ability of surgeon to perform the surgical procedure -Ability of anesthetist to perform the anesthetic technique -Patient satisfaction/comfort during & after procedure

These are 2 positioning recommendations to prevent injury to the radial nerve or circumflex (axillary) nerve during surgery?

-Place adequate padding between arm and pole -ensure arm is not pressed against vertical posts /pole

These are 3 positioning recommendations to prevent injury to the common peroneal nerve?

-Adequate padding between leg and stirrup -Knees flexed with minimal external rotation -Padding under the fibular head

These are 4 potential causes of ulnar nerve injuries from surgical positioning?

-Arms pronated on arm board -Arms folded across abdomen or chest with elbows flexed more than 90 degrees -Arms secured at side with inadequate padding at the elbow -Arms inadequately secured at side, elbows extend over table edge

These are 3 different components of the comprehensive surgical safety checklist and who they involve?

-Before Induction of Anesthesia (w/nurse & anesthetist) -Before Skin Incision (w/nurse, anesthetist, & surgeon) -Before Patient Leaves OR (w/nurse, anesthetist, & surgeon)

These are 3 risk factors associated with central retinal artery occlusion (CRAO) leading to vision loss after non-ophthalmic surgery? (Hint: HIC)

-Cardiopulmonary bypass (CPB) -hypotension -increased extraocular pressure

Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery includes the following 3 criteria?

-Conduct a pre-procedure verification process. -Mark the procedure site -A time-out is performed before the procedure.

When the AANA was forced to give up its accrediting functions, these were the 2 autonomous councils that were developed and were not under the oversight of the AANA?

-Council on Higher Education Accreditation (CHEA). -National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA - which certifies us for practice)

These are 6 positioning recommendations to prevent an injury to the brachial plexus?

-Do not abduct arms more than 90 degrees -Ensure arms are adequately secured -Support head to maintain neutral alignment -Place well padded shoulder brace over the acromioclavicular joint -Place roll caudal to the axilla supporting the upper part of the thorax -Abduct arms minimally

These are 2 reasons why Venous Air Embolisms more likely in the cerebral venous circulation in the sitting position?

-Dural sinuses maintain constant size; thus they do not contract when pressure ↓s -there are no valves in the cerebral venous circulation

These are 3 tools used in surgery that can be used as a form of heat or ignition source and can start a fire?

-Electrocautery -lasers -endoscopes

These are 9 conditions that increase the risk of aspiration during induction of anesthesia?

-Full stomach -Pregnancy after 12-20 weeks - symptomatic GERD -Diabetic or other gastroparesis -hiatal hernia -gastric outlet obstruction -esophageal pathology -bowel obstruction -increased intra-abdominal pressure (ascites/abd mass)

These are 3 positioning recommendations to prevent injuries to the sciatic nerve?

-Generous, soft padding under buttocks -Flex table at knees -Minimal external rotation of legs

These are 5 risk factors associated with central retinal vein occlusion that can lead to vision loss? (Hint: COSHI)

-HTN -CV disease -increased BMI -open angle glaucoma -sickle cell anemia

*Positioning basics: -Weight-bearing surfaces of the extremities and joints should be well padded. -Curvatures of the body, including the lumbar spine, should be supported. -The head should ideally remain midline without substantial extension or flexion. -The eyes are kept closed without external pressure.

-When more extreme positions cannot be avoided, their duration should be limited as much as possible. -The need for tilting the surgical table during surgery should be anticipated and the patient should be secured accordingly. -The use of safety straps and the prevention of falls from the surgical table to the floor are fundamental

These are 3 pulmonary dynamics that are seen with patients in steep trendelenburg?

-Zones 3 and 4 are poorly perfused -V/Q mismatch -Edema

These are 3 individuals that should be designated as immediate supervisors if an adverse event occurs in the OR; assumes overall direction & control of the event.?

-a senior practitioner -department leader -person running the OR schedule and assignments)

These are 3 position-related injuries that are seen within the integumentary system?

-abrasion -alopecia -decubiti

When a sentinel even occurs, the hospital must develop a plan to identify strategies to reduce future events; the plan must include the following 4 criteria?

-action to be taken -who will implement -timeline for implementation, -strategies for measuring the result & sustaining the changes

These are 4 position-related injuries that are seen within the musculoskeletal system?

-amputation -backache -compartment syndrome -rhabdomyolysis

These are 2 position-related injuries that are seen within the pulmonary system?

-atelectasis -endotracheal intubation

The brachial plexus consists of what 5 nerves? (Hint: MURAM)

-axillary -radial -ulnar -median -musculocutaneous

According to Virginia Thatcher, the reason why surgeons turned to nurses to administer anesthesia is b/c they wanted someone who would meet the following 5 criteria?

-be satisfied with a subordinate role -make anesthesia their one absorbing interest -not look at the position of the anesthetist as one that puts them in a position to watch & learn from the surgeon's technique -accept comparatively low pay -have the natural intelligence to develop a high level of skill in providing the smooth anesthesia & relaxation

These are 3 major complications associated with patient positioning? (Hint: CDC)

-compartment syndrome -corneal abrasion -digit amputation

What are 5 vent changes that should be made for patients in the steep trendelenburg position?

-decreased TV to 500-600ml -increase the PEEP -lengthen the inspiration time to (1:1.5 or 1:1; normal 1:2) -Maintain the Peak pressures <40 -Maintain plateau pressures < 30-35

The lithotomy position can affect the CV system by causing a pooling of blood in the abdomen and lower extremities and can lead to these 4 results?

-decreased central blood volume -decreased cardiac filling -decreased SV -decreased CO

These are the 2 most common causes of ischemic optic neuropathy (ION)?

-decreased perfusion -increased IOP

These are 3 motor functions of the tibial nerve?

-foot plantar flexion -foot inversion -toe flexion

Oxidizers like O2, nitrous oxide & Room air are especially important during these 3 cases b/c these gases can build up under drapes, when given in non-closed circuit?

-head -neck -upper chest (Examples: facial plastic surgery, tracheotomy)

These are 3 specific things to consider when administering neuraxial regional anesthesia?

-hypovolemia increases risk for hypotension -coagulopathy increases risk of epidural hematoma -increased ICP may cause cerebral herniation with intentional or accidental dural puncture

This condition alone accounts for 89% of POVL after prone spinal cases?

-ischemic optic neuropathy (ION)

Altogether, these 2 conditions account for 81% of postoperative visual loss (POVL)?

-ischemic optic neuropathy (ION) -central retinal artery occlusion (CRAO)

Visual loss after non-ophthalmic surgery is mainly due to these 5 causes?

-ischemic optic neuropathy (ION) -central retinal artery occlusion (CRAO) -central retinal vein occlusion -cortical blindness -glycine toxicity

These are the 2 motor functions of the femoral nerve?

-leg flexion at the hip -leg extension at the knee

These are 5 patient factors associated with ischemic optic neuropathy (ION)?

-male **pre-existing diseases: -HTN -vascular disease -obesity -diabetes

Head flexion on the neck in sitting or prone position can lead to what 3 consequences?

-midcervical flexion myelopathy with temporary or permanent quadriplegia -SC moving anteriorly, compressed against the posterior vertebral body -lengthening of the spinal cord leading to stretch

These are 2 position-related injuries that are seen within the genitourinary system?

-myoglobinuria -acute renal failure

These are 5 situations in which regional anesthesia may not be appropriate?

-preferences/experiences of the patient, anesthesia provider, or surgeon -need for immediate post-op neuro exam in the anatomic area impacted by the regional anesthetic -coagulopathy -preexisting neuro diseases (MS, neurofibromatosis) -infected/abnormal skin at the puncture site

These are 2 benefits of the Combined Spinal Epidural (CSE) Technique?

-quicker onset of analgesia (pain relief) -no motor blockade if opioids alone are placed intrathecally (in the spinal canal)

These are 9 circumstances in which a specific anesthetic technique may be safer or more effective than other techniques?

-site of surgery -coexisting diseases -patient positioning -elective vs. emergency surgery -full stomach/ GER risk (gastroesophageal reflux) -difficult airway -patient age -duration of surgery -anticipated recovery time (PACU discharge criteria)

These are 6 intraop patient factors associated with ischemic optic neuropathy (ION)?

-spinal surgery -prone -prolonged cases -large blood loss -low Hct -SBP < 100 mmHg

These 5 positions are potential causes for brachial plexus injuries?

-supine -prone -lithotomy -lateral -trendelenburg

These are 3 position-related injuries that are seen within the CV System?

-vascular occlusion -DVT -ischemic injuries

The effects of chloroform inhalation became more serious as the dose was increased. These effects were divided into the following 5 stages?

1 - Pt. became insensible but retained consciousness. 2 - Pt. entered a lethargic state in which some pain could be felt. 3 - Pt. was physically incapable & could feel no pain. 4 - Pt. exhibited strenuous breathing & complete muscle relaxation. 5 - Pt. suffered an (often fatal) paralysis of the chest muscles.

Dagmar Nelson received financial support from which supporter during her trial?

Adeline Curtis (went thru a similar issue with the CA system in 1928)

Tafford E. Oltz has been a CRNA since when? LaRayne Lunz Oltz has been a CRNA since when? In 2012, both received the AANA's Ira P. Gunn Award for Outstanding Professional Advocacy?

1970 1969

This time period was considered the turbulent decade for nurses?

1970s

In _______, mandatory CEs for nurses became effective?

1978

There were 37.4 million Hispanics in the civilian, non-institutionalized population in 2002 representing _____% of the total population?

13.3%

In _______ , the "Scope of Practice" statement was first published as part of the American Association of Nurse Anesthetists Guidelines for the Practice of the Certified Registered Nurse Anesthetist?

1980

Alice Magaw gave a review of over _____________ surgical anesthesias to the Missouri State Medical Society in 1906. She assessed each patient preop to determine the patient's needs & surgical requirements. She stressed proper technique for administering ether slowly & described many ways to hold the jaw in maintaining a good airway.She gave detailed information on induction of ether anesthesia?

14,000

In Alice Magaws 3rd publication, she issued a review of over how many surgical anesthetics?

14,000

According to the Surgical Care Improvement Project (SCIP) core measures, urinary catheters should be removed on post-op day ___ or ___, with day of surgery being day 0?

1 or 2

In Alice Magaws 2nd publication, she issued observations of how many cases from January 1, 1899 to January 1, 1900?

1,092

Asians for example grew from 10.2 million in 2000 to _______ million in 2010?

14.7

These are the 2 positions that the arms should be in when the patient is prone?

1. Should be positioned at the sides 2. Extended along the head on arm boards.

What is the normal IOP?

10-22 mmHg

Over ________ nurse anesthetists were deployed to Britain & France during WWI (1914-1918), with many serving on the front lines. This further propagated the need for more nurse anesthetists?

1000

In the ________, Physician anesthesiologists were said to have billed for services when they were not present in the hospital or even in town. Some did not come in for night or weekend cases, yet billed as if present, & supervision ratios did not exist. Even tho generic meds were coming along, hospitals were still wanting the more expensive drugs so that they could charge higher percentages?

1980s

Before ________ there was no academic degree required for admission to an NA program; you just had to be an RN (didn't require ICU experience)?

1986

In _______, a Bachelor's degree in nursing or a related degree was required for admission to NA programs?

1986

Bill Clinton, whose mother was a CRNA, was president from what time period?

1993-2001

In ______, all nurse anesthesia programs required to award at least a master's degree. Programs 2 yrs in length, so by 2000, all NA graduates had earned at least a master's degree?

1998

Never events are events that should at no time occur; the National Quality Forum (NQF) has defined ____ never events?

28

In addition to being skilled, Magaw documented & evaluated all her anesthesia procedures. Recognizing that her accomplishments would have value in the education of future anesthetists, Magaw published articles on the practice of anesthesia in how many different publications?

3

In ______, AANA adopted position statements supporting doctoral education for entry into nurse anesthesia practice by 2025. Programs 3 yrs in length, so all new enrollments by 1/1/2022 will be in doctoral programs, to graduate in 2025?

2007

According to the Surgical Care Improvement Project (SCIP) core measures surgery patients should received appropriate VTE prophylaxis within ____ hrs before & after surgery?

24

According to the Surgical Care Improvement Project (SCIP) core measures, prophylactic antibiotics should be discontinued ______ hrs after surgery end time; and _____ hrs for cardiac surgery?

24 48

In the Lateral Decubitus Position gravity alters BP by ____ mmHg for every inch?

2

To prevent spinal cord injuries during surgery avoid hyperflexion of the head and neck, allow at least ___ fingerbreadths between the sternum & mandible?

2

How can a brachial injury occur when patients are in the lateral position?

2/2 thorax pressure being exerted on the dependent shoulder and axilla

How much cricoid pressure is initially applied during rapid sequence induction of IV general anesthesia?

20 newtons or approx. 7 lbs.

According to the Surgical Care Improvement Project (SCIP) core measures ALL patients with surgery with > 60 minutes receiving neuraxial or GA should receive active warming to 36 C or warmer within ____ min. prior to or ____ min. after anesthesia end time?

30 15

Nurse Anesthetists deliver anesthetics to patients of all ages for all types of surgical cases at a rate of approximately ______ million patients per year in the United States?

32

According to the Surgical Care Improvement Project (SCIP) core measures surgery patients should have their temperature managed perioperatively with the core temp being what upon arrival to PACU?

36.0 C (96.8F)

How many stages of anesthesia depth are there?

4

The speaker, Mary DeVasher, only had ___ students in her class and her program was ____ months?

4 18

Normal ventilation is ~ ____ L/min? Normal pulmonary blood flow is ~ ____ L/min? Mathematically, the V/Q Ratio is equal to what?

4 5 0.84 (Depending on the source, V/Q ratio can be anywhere b/t 0.82 to 1.0)

If the length of the procedure is longer than ___ to ___ hrs it can place the patient at risk for position-related injuries?

4-5 hrs

TJC requires hospitals to respond to Sentinel Events within _____ days by reporting to TJC, performing RCA, & developing an action plan to identify strategies the hospital intends to implement to reduce the risk of similar events in the future?

45

In the lateral decubitus position, if the non-dependent arm is suspended on an arm holder with traction, abduction of ____ to ____ degrees should be maintained and <_____ lbs of traction applied?

45-60 10

If atlantoaxial instability exceeds ___ mm, intubation should be done with neck stabilization & awake fibreoptic intubation (FOI)?

5

There were a total of _____ nurse anesthesia schools by 1950. Middle TN School of Anesthesia (MTSA) started in 1950?

54

In most cases, peripheral nerve injuries caused from surgery usually resolve in ____ to ____ weeks, but some persist for months or years?

6-12

Must be aware of vital signs in the sitting position b/c the BP will drop as soon as the patient is raised. Be ready with IVF, vasopressors, and do not allow the MAP to fall below what level?

70 mmHg

Beecher & Todd did a study in 1954 where they tracked the outcomes of 599,548 anesthetics (almost 600k); looked at anesthesia-associated deaths in 10 centers over 4 years and identified how many deaths?

7977 deaths (almost 8k); (~1.3 deaths per 100 anesthetics)

In healthy awake patients, the ↑ in arterial Hgb O2 saturation achieved with ___ vital capacity breaths of 100% O2 over 60 seconds is similar to that achieved by breathing 100% O2 for ___ minutes at normal tidal volumes?

8 3

The goal of preoxygenation is to have the expired O2 concentration to be roughly ____%?

80%

In the sitting position, aggressively treat blood pressure values below ____% of the preoperative resting values, while maintaining a MAP > what?

80% 70 mmHg

Anesthesia Quality Institute (AQI) is the largest registry for anesthesia quality in the US and maintains ___ registries?

9

During his later years, Horace Wells closed his dental office ___ times & relocated ___ times. Claimed due to ill health, but his physician found no cause for his nonspecific complaints. Later married and had one son?

9 6

1945 the AANA gives its 1st NA certification exam to ____ women?

90

When a patient is in the prone position, the arms should not be abducted greater than ____ degrees?

90

When patients are in the prone position, if the arms are abducted more than _____ degrees it could lead to a brachial plexus injury?

90

When patients are in the supine, trendelenburg, or lithotomy positions, brachial plexus injuries can occur when: -arms are abducted > ____ degrees on the arm board? -arm falls off the table edge and is ___________ and __________ rotated? -arm is abducted and lateral flexion of the head to the __________ side?

90 abducted, externally opposite

In the sitting position, the hips should be flexed no more than ____ degrees, and the knees should be slightly flexed, to prevent stretch injury of which nerve?

90 sciatic nerve.

In 1993, a review found that ____% of medical research being published in journals was either flawed or irrelevant?

95%

According to the Surgical Care Improvement Project (SCIP) core measures, cardiac surgery should have a controlled 6am post-op serum glucose of what?

< 200 mg/dL

***In 2/2019 the APSF published a newsletter, which was originally written by World Federation of Societies of Anesthesiologists' (WFSA's), which read "whenever possible, anesthesia should be provided, led, or overseen by a physician anesthesiologist.". This did not sit well with a lot of anesthesia professionals b/c this statement was used as a weapon against the nursing anesthesia practice to limit them. The AANA had a meeting with APSF and discussed their concerns & requested to have the standards article either retracted or the specific statements removed.

APSF placed a disclaimer on the electronic newsletter which reads, "Its [the article's] content does not imply or reflect the opinion of the APSF." AANA BOD decided to withhold funding from APSF. Interestingly, we still have CRNAs on APSF Board & committees who continue to carry on the AANA's mission to contribute to patient safety

This Patient Safety-Focused Program was initiated in 1984 by ASA to review settled anesthesia lawsuits (closed malpractice claims) & improve patient safety. Closed claims reviewers are ASA member anesthesiologists, No CRNAs as reviewers or as Advisory Committee members; operates in cooperation with malpractice insurance organizations?

ASA Closed Claims Project

This ASA status is given to a normal healthy patient?

ASA I

This ASA status is given to a patient with mild systemic disease and no substantial functional limitations?

ASA II

This ASA status is given to a patient with severe systemic disease, Substantive functional limitations; One or more moderate to severe diseases?

ASA III

This ASA status is given to a patient with severe systemic disease that is a constant threat to life?

ASA IV

This ASA status is given to a moribund patient who is not expected to survive without the operation?

ASA V

This ASA status is given to a declared brain-dead patient whose organs are being removed for donor purposes?

ASA VI

This is defined as cultural modification of an individual, group, or people by adapting to or borrowing traits from another culture. A merging of cultures as a result of prolonged contact?

Acculturation

In 1928, this nurse resigned from NA practice when the California Board of Medical Examiners published a resolution alleging that nurse anesthetists were not licensed to provide anesthesia. Through an attorney, she obtained a statement from the CA Attorney General that there was no law in CA prohibiting a nurse from giving anesthesia.?

Adeline Curtis

In this QPP reimbursement track, eligible clinicians & practices participating in the this model are rewarded for taking on some risk related to their patients' outcomes. Seek to incentivize providers to lower costs, while improving care?

Advanced Alternative Payment Models (APMs)

In 1908 at Lakeside Hospital in Cleveland, OH, surgeon George Crilen asked __________ _____________ to become his anesthetist?

Agatha Hodgins

In 1912, this nurse inaugurated (initiated) the first school of nurse anesthesia at Lakeside Hospital that would become as famous for its anesthetic techniques as it would for its subsequent closure amid much political controversy? (During this time all of the nurse anesthesia schools were started in hospitals)

Agatha Hodgins

This was the first president of the AANA?

Agatha Hodgkins

In 1909, the first school for anesthetists was established by this lady at St. Vincent's Hospital in Portland, OR. This was the 1st school of anesthesia in the world and was often attended by future physician anesthetists, too?

Agnes McGee

These are 3 examples of High-Reliability Organizations?

Air traffic control systems nuclear power plants naval aircraft carriers

In 1922, Yale Medical School appointed this nurse anesthetist, to an instructor position with university rank (promoted to Assistant Professor in 1930). She authored a textbook, Principles and Practice in 1948 which was used by nurse anesthetists and medical students alike?

Alice Hunt

Edith Graham was succeeded by the most famous nurse anesthetist of all time, ___________ ____________, a graduate of Woman's Hospital in Chicago. She was said to have won more widespread notice than any Mayo figure other than the Mayo brothers?

Alice Magaw

In 1927, the 1st medical academic anesthesia department was formed in Wisconsin by what doctor?

Dr. Waters

This nurse anesthetist worked at St. Mary's/Mayo; published observations of 1092 cases on anesthesia in the The St. Paul Medical Journal; published observations drawn from an experience of 11,000 anesthesias in Transactions of the Minnesota State Medical Association; and she published A Review of of over 14,000 surgical anesthesias in the Surgery, Gynecology & Obstetrics using the open-drop ether technique without a fatality?

Alice Magaw

These are 2 modified lithotomy positions in which the hips are flexed 80-100 degrees with the lower legs parallel to the floor?

Allen stirrups Candy cane stirrups

***In 1954 the Beecher & Todd study looked at 600,000 patients to study CV dangers of curare (a paralytic), and compared outcomes between physician specialists, residents in anesthesia, & nurse anesthetists. This was an attempt to measure the quality of care b/t the diff specialties >>>>

Although there was comparably good & poor risk cases in the three groups" & "although the physician specialist anesthetizes only half as many patients as the nurse, he is charged with an equal number of deaths."

In 1930, Agatha Hodgins from Lakeside Hospital presented a paper suggesting that nurse anesthetists organize into a "coherent & acting body" at the biennial called what?

American Nurses Association (ANA)

In 1945, the American Society of Anesthetists (ASA) name was changed again to what?

American Society of Anesthesiologists (ASA)

This governing body defines Monitored Anesthesia Care (MAC) as "a specific anesthesia service in which an anesthesiologist has been requested to participate in the care of a patient undergoing a diagnostic or therapeutic procedure."?

American Society of Anesthesiologists (ASA)

This governing body defines general anesthesia as "a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation"?

American Society of Anesthesiologists (ASA)

In 1936, the New York Society of Anesthetists rose to 484 members and the name once again changed to what?

American Society of Anesthetists (ASA)

This is another common list of general anesthesia components and is referred to as the 3 A's?

Amnesia Analgesia Areflexia

The 1st school of anesthesia in St. Vincent Hospital consisted of a six-week course which included instructions in what 3 areas of study?

Anatomy & physiology of the respiratory tract Pharmacology techniques of administering anesthetics

This was the first specialty to embrace universally applicable standards; developing monitoring recommendations with the goal of reducing anesthesia-related adverse events?

Anesthesia

This Patient Safety-Focused Program was established in 1985 as an independent, nonprofit corporation; members include: anesthesiologists, CRNAs, equipment & drug manufacturers, engineers, & insurers?

Anesthesia Patient Safety Foundation (APSF)

This Patient Safety-Focused Program was established as nonprofit by ASA in 2008 to facilitate practice-based quality management through education & quality data feedback; managed by ASA & members approved by ASA; no CRNAs on Board/Committees?

Anesthesia Quality Institute (AQI)

This was the first medical specialty to champion patient safety as a specific focus?

Anesthesiology

These are 3 substances given perioperatively that all have varying degrees of immunosuppression?

Anesthetics blood products antibiotics

This nurse anesthetist received her anesthesia training in Dr. Charles Mayo's OR with Florence Henderson as her teacher. Training period was ~3 months & salary was $75/month. Surgical day began at 7am. She "talked her patients over the excitement stage" when administering ether. Said excitement stage was never a problem if she kept talking to the patient?

Ann Powderly

This nurse anesthetist, was held as a prisoner of war in the Philippines, & described dodging bombs & giving anesthesia to one casualty after another, who "needed help that only a nurse could give them."?

Annie Mealer

This is a potential cause of injury to the radial nerve or circumflex (axillary) nerve due to patient positioning during surgery?

Arm pressed against vertical positioning or retractor post or pole securing the ether screen

According to the 2010 U.S. Census, which 2 populations have grown considerably due to higher levels of immigration?

Asian populations Hispanic populations

This is a misalignment of the 1st & 2nd cervical vertebrae, may occur only with neck flexion; causes protrusion of the odontoid process (most pronounced projecting feature of the axis) into the foramen magnum during manipulation with intubation, compromises vertebral blood flow & compresses SC or brain stem?

Atlantoaxial subluxation

It's a good idea to have the this monitor when administering TIVA so you can monitor the LOC and prevent intraoperative awareness?

BIS monitor

In surgery, the sitting position is also known as what?

Beach chair position

This cultural assessment tool consists of a 44 item questionnaire and is a guide to a patient- focused, scripted dialogue b/t a provider and patient. It is different from other assessment tools in that it looks at both culture and spirituality simultaneously. These two threads are so delicately woven together in the tapestry of our sacred story and inner journey that we seldom separate them. Only in the Western industrialized world has a sacred-secular split developed?

Berg Cultural/Spiritual Assessment Tool

This best practice related to anesthesia focuses on: Errors during sterile compounding of drugs, especially high-alert medications?

Best Practice 11

This best practice related to anesthesia focuses on: Inappropriate use of fentaNYL patches to treat acute pain &/or patients who are opioid-naïve?

Best Practice 12

This best practice related to anesthesia focuses on: Lack of learning from external medication safety risks & errors?

Best Practice 14

This best practice related to anesthesia focuses on: Missing or inaccurate patient weights, & mix-ups between metric & non-metric units when measuring & documenting weight?

Best Practice 3

This best practice related to anesthesia focuses on: Inadvertent NMBA administration to patients not receiving proper ventilator assistance?

Best Practice 7

This best practice related to anesthesia focuses on: infusion-related errors when administering high-alert IV medications?

Best Practice 8

This best practice related to anesthesia focuses on: Delay in administration or improper use of antidotes, reversal agents, & rescue agents?

Best Practice 9

Margaret Boise, in collaboration with a surgeon by the name of Hugh Young, invented a gasether machine, known as what?

Boise-Young apparatus.

Humphrey Davy contributed to the discoveries of what 5 elements? (Hint: B-PICS)

Boron iodine chlorine sodium potassium

This block uses a stimulating needle and targets the ventral rami of the brachial plexus derived from the C5 -T1 nerves and is therefore suited for surgeries that involve the distal clavicle, shoulder, and upper arm. Catheter can stay in place for 3 days with this block?

Brachial plexus interscalene block

Which brachial plexus nerve roots innervate the axillary and musculocutaneous nerves?

C5-C7

Which brachial plexus nerve roots innervate the radial and median nerves?

C5-T1

Which brachial plexus nerve roots innervate the ulnar nerve?

C8-T1

When the California verdict granted nurses the right to admin anesthesia, Adeline Curtis resumed work and helped the Los Angeles nurse anesthetists to band together and form this organization? (symbolizes the importance of forming State Associations)

CA Association of Nurse Anesthetists

The Surgical Care Improvement Project (SCIP) is tracked by whom?

CMS (Center for Medicare & Medicaid Services)

President Bill Clinton's Managed Healthcare proposals allowed payments for anesthesiologists under the medical direction plan that were 120%-140% greater than for CRNAs or anesthesiologists working alone. This was a great incentive for MDAs to hire CRNAs, but was not the intent of the congress. The GAO recommended one single fee, no more than for one anesthesiologist working alone, & to be split 50% for CRNA services & 50% for anesthesiologist services. >

CRNAs accepted the single payment plan. In the final days of Clinton's tenure, HCFA ruled that CRNAs could practice without physician supervision. The very next month, the Bush administration did not implement it; rather restored the previous model. However, it did allow states to "Opt Out" of physician supervision if their state governors requested it.

This specific lithotomy position can affect the peroneal nerve. Compression of the peroneal nerve can occur when the pts leg rests against the pole while in this position. Injury is on the lateral side of the upper leg and can extend all the way down from the knee to the toes?

Candy cane Lithotomy Position

___________________ changes are the most important physiologic effects of the sitting position?

Cardiovascular

The lithotomy position is another variation of the supine position and mainly affects which 2 body systems?

Cardiovascular Respiratory

This AHU learning outcome states: The AHU graduate will be a caring professional who possesses a willingness to nurture other individuals in the context of healthcare as a ministry. Analyzes the impact of caring behaviors in healthcare. Evaluates caring behaviors of one's self and others in healthcare?

Caring

From its four core values AHU has identified the following 7 learning outcomes which forms its curricular and extracurricular endeavors?

Caring Communication Critical Thinking Ethical/Moral Professional Expertise Service to the Community Lifelong Learning

This was the first nurse to administer anesthesia, during the Civil War (1861-1865). During the Battle of Bull Run, she administered chloroform to wounded soldiers for emergency operations in the battlefield?

Catherine S. Lawrence

This is a type of epidural block that is usually done in pediatrics?

Caudal anesthesia

Edith gave anesthesia for the Mayo brothers from 1889-1893, until she married which Mayo brother in 1893; then retired?

Charles H. Mayo

This man was a Harvard Medical School graduate, taught chemistry lectures at Harvard to William T. G. Morton, introducing him to the anesthetic properties of ether. Morton, who later became a Dentist, discussed the merits of ether with this person who then advised Morton that to rub ether on the gums would produce analgesia enough to remove teeth?

Charles T. Jackson

These words are listed on the tombstone of which man: Eminent as a chemist, mineralogist, geologist, & investigator in all departments of natural science. Through his observations of the peculiar effects of sulphuric ether on the nerves of sensation & his bold deduction, there from the benign discovery of painless surgery was made. Thy godlike crime was to be kind to render with thy precepts less the sum of human wretchedness & strengthen man?

Charles T. Jackson (1805-1880); Mount Auburn Cemetery, Cambridge, MA

This is the main way to prevent digit amputation in surgical patients?

Check for digit protrusion before moving the bed

About the same time Ether was discovered in the US, this was discovered in England & was used by John Snow?

Chloroform

This anesthetic agent was a cardiovascular and respiratory depressant and was rough to administer?

Chloroform

This is the volume of lung inflated when the small airways in the dependent parts of the lung begin to collapse during expiration; the volume in the lungs at which its smallest airways, the respiratory bronchioles, collapse?

Closing volume

This is defined as the ethical responsibilities of the CRNA as a member of the profession of nurse anesthesia. Consists of principles of conduct and professional integrity that guide decision making and behavior of the CRNA?

Code of Ethics

This nurse was on an assignment when Pearl Harbor was struck, & later served in Korea & Japan. In 1963, she became the first nurse anesthetist to hold the position of Chief of the Army Nurse Corps (until 1967)?

Col. Mildred Clark

Historian Thatcher observed that what specific event revived the physician anesthetist's interest in protecting his income by eliminating competition?

Collapse of the nation's economy

These are the 4 phases of the Quality Payment Program (QPP) participation process?

Collect Data Report Data Feedback Available Payment Adjustment

In this anesthesia technique, following LOR technique to reach the epidural space, a spinal needle is then inserted through the Tuohy (epidural) needle to puncture the dura and local anesthetic with or without opioid is administered once the CSF is noted. The spinal needle (Gertie Marx) is removed first with the epidural needle still in place and a catheter is placed in the epidural space?

Combined Spinal Epidural (CSE) Technique

This AHU learning outcome states: The AHU graduate will be an effective communicator who possesses appropriate verbal, nonverbal and written skills in the practice of healthcare as a ministry. Analyzes and critiques the communication of oneself and/or others, reads and evaluates research reports within the healthcare field, designs and presents scholarly activity?

Communication

This mechanism responsible for nerve injuries occurs when a nerve is forced against a bony prominence or a hard surface Ex. Arm board or leaning on the elbow?

Compression

In a study of 33 patients with severe post-surgical neuropathies at Mayo Clinic, mostly involving the ulnar nerve and with widespread microvascular neuropathies, many responded to immunologic modulation with high doses of what?

Corticosteroids

In this category of the Merit-based Incentive Payment System (MIPS) the cost of the care you provide will be calculated by CMS based on your Medicare claims. MIPS uses cost measures to gauge the total cost of care during the year or during a hospital stay. Beginning in 2018, this performance category will count towards your MIPS final score?

Cost

This person administered diethyl ether in 1842, which was 4 years earlier than William Morton, but since he did not publicize his work, Morton was therefore given credit in the world of anesthesia. Morton is credited for the discovery of ether b/c he was the first one to publish its findings and made it known for people to give feedback?

Crawford Long

This gentleman never received full credit for discovery of ether during his life?

Crawford W. Long

In 1879, the National Eclectic Medical Association declared that this man was the official discoverer of anesthesia?

Crawford W. Long (*Remember, Long successfully used ether to remove a neck tumor but didnt publish b/c he said his practice kept him too busy)

This man was the first surgeon to use anesthesia in obstetrics and even administered ether to his wife during birth in 1845?

Crawford Williamson Long

This person applied to the University of Georgia in Athens at age 14, studied at Transylvania College in Lexington, KY under surgeon Benjamin Dudley & participated in many surgeries without anesthesia. Obtained an MD degree from an 18 month internship in NY, and took over rural medical practice in Jefferson, GA?

Crawford Williamson Long

Nursing experiences in which 2 wars allowed women to challenge male dominance in hospitals & demand cleanliness & care improvements?

Crimean War (1853-1856) Civil War (1861-1865)

This AHU learning outcome states: The AHU graduate will be a critical thinker who gathers relevant information and analyzes and uses that knowledge in practicing healthcare as a ministry. Develops solutions for complex problems, evaluates solutions for complex problems?

Critical Thinking

This component of cultural competence is defined as a deliberate, cognitive process in which healthcare providers become appreciative and sensitive to the values, beliefs, lifeways, practices and problem-solving strategies of client's cultures?

Cultural Awareness

This component of cultural competence is defined as the motivation of healthcare providers to want to engage in the process of cultural competence?

Cultural Desires

This component of cultural competence encourages practitioners to engage directly in cross-cultural interactions with clients from culturally and/or ethnically diverse backgrounds?

Cultural Encounters

This component of cultural competence is defined as a process through which an individual seeks and obtains an educational foundation regarding various world views of culture?

Cultural Knowledge

This component of cultural competence involves the ability to collect relevant cultural data regarding client's health histories?

Cultural Skills

This phenomenon occurs when a healthcare professional assumes there are no cultural differences because a particular client may look and behave much the same way the healthcare provider does?

Cultural blind spot

This is defined as the tendency to impose one's beliefs, values and pattern of behavior upon another culture?

Cultural imposition

This professional attribute of the nurse anesthetist states: The nurse anesthetist respectfully interacts with others, regardless of their culture, to achieve a shared vision. Awareness of own biases, understands and values cultural differences, communicates across customs and language barriers?

Culturally Competent

In 2000, the U.S. Dept. of Health and Human Services(HHS), Office of Minority Health (OMH), issued a set of national standards to ensure that all people entering the healthcare system receive equitable and effective treatment in a culturally and linguistically appropriate manner; what is the name of this service?

Culturally and Linguistically Appropriate Services (CLAS)

This is defined as the characteristics and knowledge of a particular group of people, defined by everything from language, religion, cuisine, social habits, music and arts?

Culture

This documents that requirements for graduation from the program have been met and establishes the unique attributes of the student compiling the material?

DNAP Student Portfolio

This nurse was a graduate of St. Mary's School in Rochester; NA for 10 years at Mayo. Surgeon (V. Hunt) invited her to work for him at St. Vincent's Hospital in LA, CA. She was a hospital employee; worked for all surgeons, but had a preference to Hunt's cases. Within months, Dr. William V. Chalmers-Francis charged Nelson with practicing medicine without a license. He sought an injunction against the hospital to bar this nurse from giving inhalation anesthesia?

Dagmar Nelson

Which scripture? But you, Daniel, shut up the words of this book until the time of the end; many shall run to and fro, and knowledge shall be increased."?

Daniel 12:4

These are 3 postural changes in hemodynamics that are seen when a patient goes from supine to standing?

Decreased venous return Decreased CO Decreased arterial BP

With this LOC, defined by the Joint Commission, the patient maintains a purposeful response after a repeated or painful stimulus; the patients ventilation may be inadequate and airway intervention may be required; and the cardiovascular function is usually maintained?

Deep sedation

What does the DMAIC acronym for quality improvement stand for?

Define Measure Analyze Improve Control

In 1964, this individual published an article and came up with 4 lung zones which explains the pressure-flow relationship b/t perfusion and ventilation in each lung zone?

Dollery West

Patients with this condition are more likely to encounter atlantoaxial subluxation; prone to developing C1-C2 fractures and since that's where the respiratory center is located, you must be careful when intubating?

Down Syndrome

________________ displacement of the diaphragm generates a negative intrathoracic pressure and allows lung expansion as gas flows inward.

Downward

During the Frank McMechan petition, this surgeon along with two other surgeons defended nurses as anesthetists, arguing that Lakeside Hospital was taking the lead & being followed by many large clinics in the US?

Dr. George Crile

In 1847, this person, a highly respected obstetrician administered the vapor of ether to a parturient (woman in labor) to relieve the pain of labor?

Dr. James Y. Simpson

This man was the first to describe the anesthetic properties of chloroform on animals; was afraid to use it on humans?

Dr. Robert Mortimer Glover

**These 2 health Economists' studied Medicare data between 1999-2005 & found, "no evidence that opting out of the oversight requirement resulted in increased inpatient deaths or complications and they recommend that CMS return to its original intention of allowing nurse anesthetists to work independently of surgeons & anesthesiologist supervision without regard to state governments to formally petition for an exemption."?

Dulisse & Cromwell

***Antitrust Case: In the Hyde v Jefferson Parish Hospital District No. 2 case: At EJP Hospital, a group of anesthesiologists held an exclusive contract with the hospital (arrangement where one firm agrees to do business with another firm, but nobody else) & worked with hospital-employed CRNAs. Dr. Hyde alleged a tying arrangement, but was denied privileges solely on the basis of the exclusive contract.

EJP won at the local level, but Hyde, backed by the ASA (whose position related that Hyde should be allowed due to superiority of his performance compared to CRNAs), took it to the U.S. Supreme Court, which also ruled in favor of EJP.

William T.G. Morton experimented with ether on himself & on small animals, and then in 1846 he painlessly removed a tooth from this man who was a Boston merchant?

Eben Frost

Anesthesia was first administered for the Mayos by which nurse?

Edith Graham

On October 16, 1846, William T.G Morton gave ether to this person during a 10 minute operation by surgeon John C. Warren. The patient indicated he felt no pain. The demonstration was a success?

Edward Gilbert Abbot

This ASA status is applied to any patient in whom an emergency operation is required; added to one of the above?

Emergency "E"

Which GA university operated the "Crawford W. Long Hospital" in Atlanta (named in his honor in 1931). Was later renamed to Emory University Hospital Midtown?

Emory University

This anesthetic agent was a cardiovascular stimulant and caused the HR to increase. Was not a respiratory depressant. Was given in small doses with room air as a vehicle, and was easy to formulate & transport, as well as to administer?

Ether

This place was where the first anesthetic case was done at Mass General Hospital. More like an amphitheater where people sat around and watched surgeries take place?

Ether Dome

This AHU learning outcome states: The AHU graduate will exhibit the characteristics of a Christian professional: treating everyone with respect and dignity in the context of healthcare as a ministry. Applies ethical/moral principles in decision making, evaluates the ethical /moral principles in healthcare practice, integrates ethical/moral principles in healthcare practice?

Ethical/Moral

How often does TJC publish National Patient Safety goals?

Every year

This professional attribute of the nurse anesthetist states: The nurse anesthetist evaluates and integrates scientific research, expert opinion, patient preferences, and other metrics to improve processes and outcomes. Exhibits intellectual curiosity, searches for relevant information, evaluates, ranks, and synthesizes best evidence, integrates scientific evidence with practice experience to improve processes and outcomes?

Evidence Based Practice

According to the Surgical Care Improvement Project (SCIP),surgical outcomes can be improved by appropriate interventions that are what?

Evidence based

What does each letter stand for in the ETHNICS Framework for cultural competence?

Explanation Treatment Healers Negotiate Intervention Collaboration Spirituality

These are 3 additional Structured Quality Improvement Programs; all 3 apply to the same basic model: Evaluate, implement, measure. These acronyms refer to commonly used blueprints for initiating & executing a quality improvement project?

FADE PDSA DMAIC

This is a process implemented before something bad happens; a resource-intensive, comprehensive analysis of a specific process, with the goal of identifying all the potential ways that it can fail; •Uses simulation, imagination, & other sources to identify potential failures; is extremely time-consuming?

Failure mode effects analysis (FMEA)

This is a type of RCA model consisting of a diagram with the ultimate problem on the end and then you think about the potential areas where problems could occur and what might happen?

Fishbone Diagram

This lady came into training at Mayo Clinic in 1904 to become an anesthetist. Once trained, she became primarily Charles Mayo's anesthetist, and Alice Magaw was then primarily William J. Mayo's anesthetist?

Florence Henderson

What does the FADE acronym for quality improvement stand for?

Focus Analyze Develop Execute-evaluate

In 1917, this physician anesthetist, petitioned the Ohio State Medical Board to close the Lakeside School for Nurse Anesthetists, proclaiming that anesthesia was strictly the practice of medicine. (Agatha Hodgins was program director). This became the first public conflict surrounding nurses administering anesthesia?

Frank McMechan

This is the volume of air in the lungs at the end of passive expiration?

Functional Residual Capacity (FRC) (Expiratory Reserve Volume + Residual Volume)

These are the 3 methods used to administer general anesthesia?

Gas IV combination of both

The combination of these 2 anesthesia techniques may ↓ intraoperative blood loss and potentially ↓ the rate of intraoperative transfusions?

General + regional anesthesia

The combination of these 2 anesthesia techniques may ↓ the rates of postoperative chronic pain?

General + regional or neuraxial

This type of anesthesia can affect the normal compensatory mechanisms that maintain cardiovascular stability?

General anesthesia

With this LOC, defined by the Joint Commission, the patient has no response even with a painful stimulus; ventilation is frequently inadequate and airway intervention is often required; and cardiovascular function may be impaired?

General anesthesia

This is the positioning recommendation to prevent injury to the pudendal nerve?

Generous padding between perineum and post

These are 2 positioning recommendations to prevent injury to the posterior tibial nerve?

Generous padding under knees Avoid use of this stirrup for prolonged procedures

Which bible verse; also considered the first anesthetic? ´V. 21: And the LORD God caused a deep sleep to fall upon Adam, and he slept; and He took one of his ribs, and closed up the flesh instead thereof. ´V. 22: And the rib, which the LORD God had taken from man, made he a woman, and brought her unto the man. ´V. 23: And Adam said, This is now bone of my bones, and flesh of my flesh; she shall be called Woman, because she was taken out of Man.

Genesis 2:21-23

This is the name of the special needle used for inserting spinal blocks?

Gertie Marx

This nurse anesthetist was a Lakeside Hospital alumni & became the AANA's 2nd President; planned 1st AANA meeting and published the 1st issue of AANA Journals in 1933. She promoted the idea of accreditation of schools & advocated for national board exam for nurse anesthesias?

Gertrude Fife

Visual loss from this cause is rare and is mainly seen in patients with L-arginine deficiency?

Glycine toxicity

This was the first anesthesia school organized in the southeastern U.S. Students were given 10 hours of pharmacology instruction & taught how to administer chloroform, ether, & N20 in combination with O2 for anesthesia?

Grady Memorial in Atlanta

_________________ factors affect the distribution of ventilation and perfusion within the lung, as well as the shape of the thoracic cavity and movement of the diaphragm and abdominal contents.

Gravitational

Perfusion follows what?

Gravity

In the 1930s, a movement arose to abolish nurse anesthesia when competition for work grew more intense. This was due in part b/c of this world wide event which lead to high unemployment and competition for work & $$$?

Great Depression

This med is an antipsychotic used in surgery and is known to cause amnesia?

Haloperidol

These 2 inhalation GA agents are not used as much?

Halothane Enflurane

The first fatality directly attributed to chloroform was of this healthy 15 year old girl who lived in the UK. Had successfully undergone diethyl ether anesthesia several months prior for removal of a toenail, received chloroform for removal of another toenail, likely died due to an overdose, aspiration of the water & brandy used to try to resuscitate her, or some combination. Death certificate states that she died from the effects of chloroform?

Hannah Greener

What was the reason Crawford Williamson Long gave as to why he didn't publish his findings of ether when it was first discovered?

He claimed that his rural practice in the antebellum South kept him too busy & too isolated to verify & publicize his discovery.

This person as an English physician & promoter of anaesthesia. Went to medical training at Edinburgh Medical School, and in 1823 he began gruesome animal experiments in anaesthesia. Made the animal insensible/unconscious by rebreathing CO2 (almost suffocating it with CO2), then performed small operations (amputate a part of the animal to see if it could feel pain under this "anaesthesia")?

Henry Hill Hickman

These are organizations or systems that operate in hazardous conditions but have nearly failure-free performance records, not simply better than average?

High-Reliability Organizations

These are 2 signs that may signal narrowing of the glottic opening from cricoarytenoid arthritis and can lead to atlantoaxial subluxation if not carefully handled. Even with smaller ETT, it may cause post-extubation airway obstruction?

Hoarseness Inspiratory stridor

1842 this person administered N20 to himself and found that it relieved his pain. He initially noticed the hypnotic and analgesic effects at a public exhibition in Hartford, Conn?

Horace Wells

This person began 2-year apprenticeship for dentistry in Boston and opened a dental practice in Hartford, CT at age 21 with his apprentice William Morton. Age 23 he published booklets advocating the use of the toothbrush?

Horace Wells

These words are listed on the tombstone of which man: "There shall be no pain", Discoverer of Anesthesia, "I awaken to glory", and "I sleep to awaken"?

Horace Wells (1815 -1848); Cedar Hill Cemetery Hartford, CT

This gentleman was an apprentice to an apothecary surgeon and his idea was to stop pain. He inhaled a gas that had been isolated by Joseph Priestly - nitrous oxide. Found that it could produce stupefaction. He was well-known for his dramatic public experiments. He encouraged visiting poets to breathe nitrous oxide & relate how it affected them. Was also known for making an arc for miners which was used for street lighting?

Humphrey Davy

When patients are in the sitting position, these 2 interventions are often required to maintain MAP?

IV fluids vasopressors

This category of the Merit-based Incentive Payment System (MIPS) is relatively new; assess how you improve your care processes, enhance patient engagement in care, & increase access to care. The inventory allows you choose the activities appropriate to your practice from categories such as, enhancing care coordination, patient & clinician shared decision-making, & expansion of practice access?

Improvement Activities

In the Lateral Decubitus position, if the patient is spontaneously breathing (usually awake), there will be ______________ ventilation of the dependent (lower/down) lung b/c the patient is able to maintain negative intrathoracic pressure?

Increased

The lithotomy position can positively affect the pulmonary system by reducing the pressure from the abdominal contents and leading to these 2 results?

Increased FRC Increased compliance

These are 3 postural changes in hemodynamics that are seen when a patient goes from standing to supine?

Increased venous return Increased CO Increased arterial BP

This is a legal requirement and must be obtained for all non-emergency procedures; at minimum, it involves the indications for the treatment in terms a layperson can understand with alternatives?

Informed consent

This is a framework developed by the IHI that describes an approach to optimizing health system performance. It is IHI's belief that new designs must be developed to simultaneously pursue three dimensions, which we call the "Triple Aim"?

Institute for Healthcare Improvement (IHI) Triple Aim

This is an international non-profit organization devoted entirely to preventing medication errors & educating the healthcare community & consumers about safe medication practices (work began in 1975); runs the only national voluntary practitioner medication error reporting program?

Institute for Safe Medication Practices (ISMP)

This agency defines a "near miss" as "An act of commission or omission that could have harmed the patient but did not cause harm as a result of chance, prevention, or mitigation" or "Any event that could have had an adverse patient consequence but did not, and was not indistinguishable from a full-fledged adverse event in all but outcome" or "An error caught before reaching the patient"?

Institute of Medicine (IOM)

This is defined as the adherence to moral and ethical principles; soundness of moral character; honesty?

Integrity

This is defined as the recognition that there is more variation within cultural groups than across cultural groups?

Intra-cultural variations

Point pressure in soft tissue may decrease local blood flow and leads to what?

Ischemia

How can stretching of the nerves to > 5% of the normal resting length leads to ischemia?

It decreases the venous and arteriole blood flow

There are many different variations of this table which is used for surgical operations that require the prone position?

Jackson Table

There is a Monument (statue) to Long located where in GA. There is also a Statue of Long unveiled in the US Capitol as one of the two statues to represent the state of GA?

Jefferson, GA

In this scripture, which occurred at the end of the crucifixion process, They filled a sponge with vinegar, and put it upon hyssop, and put it to his mouth. When Jesus had received the vinegar, he said, It is finished; and he bowed his head, and gave up the ghost (died).

John 19:29-30

In 1845 Horace Wells demonstrated the use of nitrous oxide to this surgeon, & to medical students at Massachusetts General Hospital (MGH) in Boston?

John Collins Warren

In 1853, this English obstetrician administered choloroform to Queen Victoria during the birth of Prince Leopold (the queens 8th child)?

John Snow

This man was a Surgeon-apothecary apprentice and treated cholera epidemic. Was an early epidemiologist, and identified the source of the cholera as public water pumps; had a medical apprenticeship with William Hardcastle; Didn't drink, gamble, or marry; vegetarian; drank only distilled water. In 1843 he began experimenting with ether to see its effects on respiration?

John Snow

This person was an English Unitarian minister, scientist, philosopher, & author. Discovered oxygen (O2) in 1771, isolated nitrous oxide (N2O) in 1772. Wrote about his research on gases in 1794: "I cannot help flattering myself that, in time, very great medicinal use will be made of the application of these different kind of airs..."?

Joseph Priestly

In this case, the Louisville Society of Anesthesiologists passed a resolution that only physicians could administer anesthesia. The attorney general agreed, & KY Medical Association followed with a resolution that it was unethical for a physician (surgeon) to use a non-physician anesthetist (meaning a nurse). The surgeon Frank & his nurse anesthetist Margaret Hatfield asked the State Board of Health to join them in this lawsuit?

Kentucky: Frank v. South

In this case which took place in 1917, the courts determined that a nurse administering anesthesia was not engaging in the unauthorized practice of medicine. Although the case is many years old, its finding that nurse anesthetists do not practice medicine is still relevant because it has never been overturned or contradicted by another court?

Kentucky: Frank v. South case

A number of states adopted statutes recognizing the practice of nurse anesthetists. Typically, these statutes followed the formulation of this case which provided that nurse anesthetists were to work under the "supervision" or "direction' of the physician; but, the statutes did not define supervision?

Kentucky: Frank vs South case

This med used in surgery is a PCP derivative and is known to cause amnesia?

Ketamine

This professional attribute of the nurse anesthetist states: The nurse anesthetist creates and articulates clear direction and vision to engage others to accomplish shared goals. Mentors and empowers diverse individuals and teams, demonstrates transparency, engagement, and adaptability, assesses own and team performance for quality assurance and improvement activities?

Leader

This AHU learning outcome states: The AHU graduate will be a lifelong learner who pursues excellence and the ongoing acquisition of knowledge and professional expertise. Examines growth and improvement in learning experiences, develops a personal plan for lifelong learning.?

Lifelong learning

What does each letter stand for in the L.E.A.R.N. Model for cultural competence?

Listen Explain Acknowledge Recommend Negotiate

Eventually the US physician anesthetists began to be organized and in 1905, 9 physicians from NY organized the 1st professional anesthesia society which was called what?

Long Island Society of Anesthetists

To reach the epidural space most anesthesia providers use this specific technique where they pulsate fluid a little at a time into the needle until they go thru the ligamentum flavum; when resistance is lost it means you are in the epidural space; a catheter can be threaded & left in place for up to 3 days?

Loss of resistance technique

What does the abbreviation LES mean?

Lower esophageal sphincter

This is a rare condition associated with the lithotomy position. It occurs when perfusion to an extremity is inadequate because of either restricted arterial flow (from leg elevation) or obstructed venous outflow (direct limb compression or excessive hip flexion). This results in ischemia, edema, and rhabdomyolysis from increased tissue pressure within a fascial compartment?

Lower extremity compartment syndrome

25 On one occasion an expert in the law stood up to test Jesus. "Teacher," he asked, "what must I do to inherit eternal life?" 26 "What is written in the Law?" he replied. "How do you read it?" 27 He answered, "'Love the Lord your God with all your heart and with all your soul and with all your strength and with all your mind'; and, 'Love your neighbor as yourself.'" 28 "You have answered correctly," Jesus replied. "Do this and you will live." 29 But he wanted to justify himself, so he asked Jesus, "And who is my neighbor?"

Luke Chapter 10

This type of anesthesia is more labor intensive than any other type of anesthetic b/c it requires constant readjustments regarding whats happening in the surgical field?

MAC anesthesia

What is the formula for IOP?

MAP - ocular perfusion pressure (OPP)

Johns Hopkins School of Anesthesia for Nurses, founded by this nurse, operated from 1922-1985. (DNP-NA track opens 5/2020); Started as a 6-month course of anesthesia, where nurses received a certificate?

Margaret Boise

In this scripture, which occurred earlier in the crucifixion process, Jesus was offered wine mixed with myrrh, but he did not take it. A stupefying liquor, strong narcotic, made of the sour wine of the country, mingled with bitter herbs, & mercifully administered to dull the sense of pain?

Mark 15:23

This was the 3rd US hospital built in 1811?

Massachusetts General Hospital (MGH)

In this scripture, which occurred earlier in the crucifixion process, Jesus was offered wine to drink, mixed with gall, but after tasting it, he refused to drink it b/c it was prepared with narcotics & stupefying drugs. Designed to cheer spirits & intoxicate head, to not be sensible of pain & misery; He tasted of it, in courteous recognition of the kindly purpose, but refused to drink it. He would not dull the sense of pain or cloud the clearness of his communion with his Father in that last awful hour?

Matthew 27:34

In 1889, St. Mary's Hospital, in Rochester, MN was established by the Sisters of St. Frances; later renamed what?

Mayo Clinic

The Quality Payment Program (QPP) was established under this legislation which is the new Medicare (CMS) value-based reimbursement system?

Medicare Access & CHIP Reauthorization Act of 2015 (MACRA)........... (CHIP) is the Children's Health Insurance Program

This is the process by which the meds the patient is currently taking pre-op are reviewed for any possible adverse reactions with any meds the patient might receive intraop & post-op; part of ADU NAP Care Plan process /worksheet?

Medication reconciliation

In this QPP reimbursement track, participants can potentially earn a performance-based upward payment adjustment to their Medicare Part B payments based upon their performance in 4 categories?

Merit-based Incentive Payment System (MIPS)

These are 3 Benzodiazepines used in surgery that are known to cause amnesia?

Midazolam lorazepam diazepam

This is a positioning recommendation to prevent injury to the obturator nerve?

Minimal hip flexion

This LOC, defined by the Joint Commission, involves the use of anxiolytics; the patient maintains a normal response to verbal stimulus; the patients ability to maintain the airway and spontaneous ventilation are not affected; and the cardiovascular function is not affected?

Minimal sedation

This LOC, defined by the Joint Commission, is considered conscious sedation; pt maintains a purposeful response to verbal or tactile stimulation; ventilation is adequate and the pts airway is maintained without intervention; the cardiovascular function is usually maintained?

Moderate sedation

Minimal alveolar concentration (MAC) is decreased by concurrent administration of what 2 things?

N2O (nitrous oxide) IV anesthetic agents (sedative-hypnotics or opioids).

The Beecher & Todd study also found that patients who received _________ drugs had a significantly higher perioperative morbidity rate?

NMB

This registry of the Anesthesia Quality Institute (AQI) currently captures information on ~25% of all anesthetics administered in US; is approved as a qualified registry by CMS (Center for Medicaid and Medicare Services)?

National Anesthesia Clinical Outcomes Registry (NACOR)

Which national day is celebrated March 30 each year to commemorate Crawford W. Long?

National Doctor's Day

These 2 blocks may be combined with general anesthesia to provide long-lasting postoperative analgesia (pain management) following a surgical procedure that may not be amenable to regional anesthesia alone?

Neuraxial block peripheral nerve block

This type of regional anesthesia is normally done in children and involves spinal, epidural, and caudal blocks?

Neuraxial regional anesthesia

This occurs when direct compression of neural and soft tissue leads to ischemia and tissue damage?

Neuropathy

Which state demonstrated the highest rate of minority population growth of 78 percent during the 2000 and 2010 time frame?

Nevada

In the supine (dorsal decubitus) position, the hands and forearms should NEVER be in what position?

Never pronate

In 1911 the Long Island Society of Anesthetists expanded to 23 members & was renamed to what?

New York Society of Anesthetists

AdventHealth University strives to create an educational environment that fosters the inculcation of these four core values?

Nurture Excellence Spirituality Stewardship

This is the safest gas to administer?

O2

In terms of pharmacoeconomics, this is the ultimate goal when administering anesthesia?

Obtain the best results (low toxicity, rapid awakening, absence of nausea & vomiting) at the most practical cost

Injuries to this nerve have been associated with patients in the lithotomy position if the hip is flexed beyond 90 degrees, this extreme angle should be avoided?

Obturator nerve

This man was a poet, and named William T.G Morton's ether procedure "anesthesia", & the era of modern anesthesia was officially born?

Oliver Wendell Holmes

In 1986, one of the greatest lobbying achievements not only of AANA, but the whole of nursing, occurred after a 3- year long effort. President Reagan signed into law this act and since then Medicare & Medicaid have paid directly for CRNA services, making CRNAs the first nursing specialty to be directly reimbursed?

Omnibus Budget Reconciliation Act

This category of measuring healthcare quality looks at the midpoint and end results of the clinical care process. Focuses on morbidity, mortality, infection rates, complication rates. Evaluated by combining other measures to examine the end results of care?

Outcome measure

These are the 5 components of AANA Standard 9: Monitoring, Alarms?

Oxygenation Ventilation Cardiovascular Thermoregulation Neuromuscular

These are 4 components used in surgery that can be used as a form of fuel and can start a fire?

Paper drapes fabric towels gauze sponges skin prep solutions with alcohol

According to the National Patient Safety Foundation this is defined as the prevention of healthcare errors, & the elimination or mitigation of patient injury caused by healthcare errors?

Patient Safety

This is an absolute contraindication to regional anesthesia?

Patient refusal

This was the one rule that Alice Magaw gave her patients during surgery?

Patients are not allowed to talk

TJC says reports of wrong-site surgeries are increasing; in _________________, 50% of wrong-site incidents in the 4th quarter of 2009 were wrong-site anesthesia blocks?

Pennsylvania

This is defined as the movement of blood into the lungs thru pulmonary capillaries?

Perfusion

These blocks are used for superficial operations of the extremities &/or for postop analgesia with deeper procedures; uses a stimulating needle to locate the nerve and requires the use of ultrasound guidance?

Peripheral nerve blocks

This type of regional anesthesia involves peripheral nerve blocks and bier blocks?

Peripheral regional anesthesia

Dorsiflexion (point up) of the great toe signifies which nerve is intact? Plantarflexion (point down) of the great toe signifies which nerve is intact?

Peroneal nerve Tibial nerve

These are 4 other common peripheral neuropathies?

Peroneal nerve neuropathy Brachial plexus neuropathy Femoral nerve neuropathy Sciatic nerve neuropathy

In the Lateral Decubitus Position, what should be between the knees?

Pillow/padding

*MAC values mean that for 50% of the population this is how much of the anesthetic it will take to prevent movement from a painful stimulus; usually takes more of the anesthetic for the patient to fall asleep but at minimum these are the MAC values. Ex. If using Sevo, you would crank the drug up to ~3 to allow the pt to fall asleep. For kids we usually crank it to ~5 or 6 b/c they will fight with you b/c they don't like the smell of the gas. >

Place one hand on the mask and their chin and the other hand gripping the back of the childs head to keep the mask steady so they breathe in the gas. Once asleep you can decrease the MAC. Do not be intimidated by crying babies b/c they will inhale the drug quicker. (per the professor a robin hood anesthetic is one that is given when the baby is already asleep LOL!!)

This category of measuring healthcare quality looks at the specific ways that healthcare is provided. Looks at laboratory and radiology tests, diagnostic approaches, drugs prescribed, therapeutic procedures. Evaluates against national criteria and standards for specific diagnostic categories and procedures?

Process measures

This AHU learning outcome states: The AHU graduate will demonstrate professional expertise by passing appropriate professional examinations and exhibiting proficiencies within the context of healthcare as a ministry. Examines the impact and effectiveness of the profession, supports the profession within the arena of healthcare?

Professional Expertise

This is defined as having professional character, spirit, or methods?

Professionalism

This professional attribute of the nurse anesthetist states: The nurse anesthetist advances and advocates for the nurse anesthesia specialty. Represents and advances the mission, vision, and values of the nurse anesthesia profession?

Professionally Engaged

This category of the Merit-based Incentive Payment System (MIPS) focuses on patient engagement & the electronic exchange of health information using certified electronic health record technology (CEHRT); was formerly named Advancing Care Information; participants must fulfill the required measures for a minimum of 90 days:?

Promoting Interoperability (PI)

This category of the Merit-based Incentive Payment System (MIPS) covers the quality of the care you deliver, based on performance measures created by CMS, as well as medical professional & stakeholder groups. You pick the six measures of performance that best fit your practice?

Quality

This is defined as the optimal performance of a task, which may refer to outcome, efficiency, cost, satisfaction, or some other metric of performance, in addition to avoiding injury?

Quality

For Merit-based Incentive Payment System (MIPS), performance is measured through the data clinicians report in these 4 areas?

Quality Improvement Activities Promoting Interoperability Cost

This is a customized payment approach developed by the Center for Medicare & Medicaid Services (CMS); payment program that changes the way Medicare providers are paid and provides incentives to clinicians who are providing high-quality, high-value care. In this process all anesthesia providers or groups are tracked via a provider identification number?

Quality Payment Program (QPP)

This is one of the most widely-circulated anesthesia publications in the world & is dedicated solely to safety. Issues highlighted include: anesthesia machine checkout, opioid-induced respiratory depression, residual neuromuscular blockade, postop vision loss, emergency manual & checklist use?

Quarterly newsletter of the Anesthesia Patient Safety Foundation (APSF)

To help prevent atlantoaxial subluxation, flexion & extension X-rays should be obtained on all patients with this condition if it is severe enough to require steroids or methotrexate?

RA (rheumatoid arthritis)

The ideal anesthetic meets these 4 topic points?

Rapid recovery avoid post-op side effects low cost provides optimal turnover times.

This code of ethics states: As an independently licensed professional, the CRNA is responsible & accountable for judgments made & actions taken in his or her professional practice. Educates the SRNA regarding the ethical responsibilities of the profession, is honest in all professional interactions to avoid any form of deception, treats all others, in a culturally sensitive manner & without prejudice, bias, or harassment?

Responsibility as a Professional

This code of ethics states: The CRNA, regardless of practice arrangement or practice setting, maintains ethical business practices in dealing with patients, colleagues, institutions, corporations, & others. Establishes & performs contractual obligations consistent with this Code of Ethics; is honest in all business practices?

Responsibility in Business Practices

This code of ethics states: The CRNA protects the integrity of the research process & the reporting & publication of findings. Conducts research projects according to accepted ethical research & reporting standards established by law, institutional policy, & the Institutional Review Board (IRB). Protects the rights & wellbeing, Respects the autonomy & dignity of all human research participants, promotes selecting human participants in such a way that all populations have equal access to the potential benefit & risks of the research?

Responsibility in Research

This code of ethics states: The CRNA respects the patient's moral and legal rights, and supports the patient's safety, physical & psychological comfort, & well-being. The CRNA collaborates with the patient & the healthcare team to provide compassionate, holistic, patient-centered anesthesia, pain management, & related care. The CRNA:

Responsibility to Patient

This code of ethics states: The CRNA collaborates with members of the health professions & others to improve the public health, including access to healthcare & anesthesia, pain management, & related care?

Responsibility to Society

This code of ethics states: The CRNA may endorse products & services only when personally satisfied with the product's or service's safety, effectiveness, and quality; Only uses the CRNA credential when endorsing products or services that are related to CRNA professional practice or expertise?

Responsibility when Endorsing Products & Services

This is a structured process for identifying the causal or contributing factors underlying adverse events or critical incidents; utilizes a multidisciplinary group to evaluate every step of the process that resulted in the event; attention focused on system processes, not individual provider behavior?

Root cause analysis (RCA)

This communication tool is used when patient care is transferred to another provider ("handoffs")?

SBAR Communication Tool

This broadly defines the professional roles, functions, & responsibilities for anesthesia practice?

Scope of practice

This med is an anticholinergic used in surgery and is known to cause amnesia?

Scopolamine

This is defined as any unanticipated event in a healthcare setting resulting in death or serious physical or psychological injury to a patient or patients, not related to the natural course of the patient's illness?

Sentinel Event

This AHU learning outcome states: The AHU graduate will be one who fulfills their social, civic and environmental responsibilities in their involvement of healthcare as a ministry. Engages with civic entities, evaluates service opportunities completed through self-reflection and peer evaluations?

Service to the Community

What are the MAC values of the following agents? •Sevoflurane (Ultane) •Isoflurane (Forane) •Desflurane (Suprane) •Nitrous oxide (N2O) •Halothane (Fluothane) •Enflurane (Ethrane)

Sevoflurane - 1.85 Isoflurane - 1.15 Desflurane - 6.0 Nitrous oxide - 104 Halothane - 0.76 Enflurane - 1.63 (**These are equal to 1 MAC value)

In 1799, this person administered N20 for dental analgesia?

Sir Humphry Davy

This man was a Scottish obstetrician and early advocate of the use of midwives in hospitals. Improved the design of OB forceps which became known as the "Simpson's Forceps". Also designed the Air Tractor which is the earliest known vacuum extractor to assist with childbirth. Was the first physician to demonstrate anesthetic properties of chloroform on humans during an experiment with friends in 1847?

Sir James Young Simpson

Catholic Church records document that the earliest nurse to specialize in anesthesia was this lady who studied at St. Vincent's Hospital in Erie, PA in 1877. More nurse nuns were then trained?

Sister Mary Bernard

This professional attribute of the nurse anesthetist states: The nurse anesthetist uses knowledge, experience, and perception to identify critical elements to make a decision. Applies critical thought, experiences, and best evidence to each unique situation, seeks additional resources as necessary to inform decision-making prior to taking action, manages emotions, demonstrates accountability for decisions?

Situationally Aware

This is a positioning recommendation to prevent injury to the Suprascapular Nerve?

Stabilize patient in lateral position

Which stage of Chloroform was recommended for most surgical procedures?

Stage 3

This stage of anesthesia depth is considered the analgesia stage; patient is conscious and rational, with decreased perception of pain?

Stage I

This stage of anesthesia depth is considered the delirium stage; patient is unconscious, body responds reflexively, irregular breathing pattern with breath holding?

Stage II

This stage of anesthesia depth is considered the surgical anesthesia stage; there are increasing degrees of muscle relaxation, patient is unable to protect the airway?

Stage III

This stage of anesthesia depth is considered the medullary depression stage and there is depression of the cardiovascular and respiratory centers?

Stage IV

This AANA Standard states: Verify & adhere to infection control policies & procedures as established within the practice setting to minimize the risk of infection to patients, the CRNA, & other healthcare providers.

Standard 10: Infection Control & Prevention

This AANA Standard states: Evaluate the patient's status & determine when it is appropriate to transfer the responsibility of care to another qualified healthcare provider. Communicate the patient's condition & essential information for continuity of care?

Standard 11: Transfer of Care

This AANA Standard states: •Participate in the ongoing review & evaluation of anesthesia care to assess quality & appropriateness to improve outcomes?

Standard 12: Quality Improvement Process

This AANA Standard states: The CRNA is physically & mentally able to perform duties of the role?

Standard 13: Wellness

This AANA Standard states: Foster a collaborative & cooperative patient care environment through interdisciplinary engagement, open communication, a culture of safety, & supportive leadership?

Standard 14: A Culture of Safety

This AANA Standard states: Respect the patient's autonomy, dignity, & privacy, & support the patient's needs & safety?

Standard 1: Patient's Rights

This AANA Standard states: Perform & document or verify documentation of a preanesthesia evaluation of the patient's general health, allergies, medication history, preexisting conditions, anesthesia history, & any relevant diagnostic tests. Perform & document or verify documentation of an anesthesia-focused physical assessment to form the anesthesia plan of care?

Standard 2: Preanesthesia Patient Assessment and Evaluation

This AANA Standard states: After the patient has had the opportunity to consider anesthesia care options & address his or her concerns, formulate a patient-specific plan for anesthesia care. When indicated, the anesthesia care plan can be formulated with members of the healthcare team & the patient's legal representative (e.g., healthcare proxy, surrogate)?

Standard 3: Plan for Anesthesia Care

This AANA standard states: After the patient has had the opportunity to consider the anesthesia care options and address his or her concerns, formulate a patient-specific plan for anesthesia care. When indicated, the anesthesia care plan can be formulated with members of the healthcare team and the patients legal representative (ex. healthcare proxy, legal representative)?

Standard 3: Plan for Anesthesia Care

This AANA Standard states: Obtain & document or verify documentation that the patient or legal representative (e.g., healthcare proxy, surrogate) has given informed consent for planned anesthesia care or related services in accordance with law, accreditation standards, & institutional policy?

Standard 4: Informed Consent for Anesthesia Care and Related Services

This AANA Standard states: Communicate anesthesia care data & activities through legible, timely, accurate, & complete documentation in the patient's healthcare record?

Standard 5: Documentation

This AANA Standard states: Adhere to manufacturer's operating instructions & other safety precautions to complete a daily anesthesia equipment check. Verify function of anesthesia equipment prior to each anesthetic. Operate equipment to minimize the risk of fire, explosion, electrical shock, & equipment malfunction?

Standard 6: Equipment

This AANA Standard states: Implement &, if needed, modify the anesthesia plan of care by continuously assessing the patient's response to the anesthetic & surgical or procedural intervention. The CRNA provides anesthesia care until the responsibility has been accepted by another anesthesia professional?

Standard 7: Anesthesia Plan Implementation & Management

This AANA Standard states: Implement, and if needed, modify the anesthesia plan of care by continuously assessing the pts response to the anesthetic and surgical intervention. The CRNA provides anesthesia care until the responsibility has been accepted by another anesthesia professional; so basically If the regional anesthesia you started with stopped working switch to general anesthesia (put the pt to sleep)?

Standard 7: Anesthesia Plan Implementation and Management

This AANA Standard states: Collaborate with the surgical or procedure team to position, assess, & monitor proper body alignment. Use protective measures to maintain perfusion & protect pressure points & nerve plexus?

Standard 8: Patient Positioning

This AANA Standard states: Monitor, evaluate, & document the patient's physiologic condition as appropriate for the procedure & anesthetic technique. When a physiological monitoring device is used, variable pitch & threshold alarms are turned on & audible. Document blood pressure, heart rate, & respiration at least every five minutes for all anesthetics?

Standard 9: Monitoring, Alarms

This AANA Standard states: Collaborate with the surgical or procedure team to position, assess, and monitor proper body alignment. Use protective measures to maintain perfusion and protect pressure points and nerve plexus...Is actually a new standard that was introduced due to recent injuries involving the nerve plexus?

Standard VIII - Patient positioning

This mechanism responsible for nerve injuries occurs when nerves have a long course across many structures?

Stretch

This refers to the presence or absence of specific organizational features that are considered to be integral to the provision of high-quality care?

Structure

This category of measuring healthcare quality deals with how the organization is set up. Ex. Not all physicians or providers have to be board certified in order to practice. But the organization can set up measures that require board certification. Looks at licensure, compliance with health and safety codes, medical staff appointments, and board certifications. Evaluates the environment in which services are provided, whether it is adequate or not?

Structure measures

These are 2 positioning recommendations to prevent injury to the saphenous nerve?

Sufficient padding between legs and vertical bar Sufficient padding between stirrup and leg

According to Alice Magaw, ________________ is a great aid in producing a comfortable narcosis. The anesthetist must be able to inspire confidence in the patient, & a great deal depends on the manner of approach?

Suggestion

For patients in the lateral position, they are usually rolled semi-prone onto the dependent arm with shoulder circumduction; this position is a potential cause for injury to which nerve?

Suprascapular Nerve

Patients should be informed about the risk of POVL by which 2 providers?

Surgeon anesthesia provider

In the 1980s, who began to complain to private insurers & Medicare about the lack of presence of physician anesthesiologists & their billing practices?

Surgeons

This agency is interested in improving surgical care by significantly reducing surgical complications; provided incentives for public reporting of hospital performance on evidence-based process measures (abx in timely manner; continuation of preop beta-blockers into periop period)?

Surgical Care Improvement Project (SCIP)

This model states that most accidents result from multiple, smaller errors in environments with serious underlying system flaws. Errors made by individuals result in disastrous consequences due to flawed systems - the holes in the cheese. Not the fault of just one person but a problem can occur when all of the problems leading up to the adverse event align?

Swiss Cheese Model of Medical Errors

These are 7 methods used to detect a Venous Air Embolisms?

TEE ETCO2 PA pressures ETN2 BP Pulse oximetry Esophageal stethoscope

When GA is administered via IV form its called what?

TIVA (total intravenous anesthesia)

The official Do Not Use list - for abbreviations: •U (units) --- write "units" •IU (international units) --- write "International Units" •QD, qd (every day) --- write "daily" •QOD, qod (every other day) --- write "every other day" •Trailing zero (X.0) --- write "X mg" •Lack of leading zero (.X mg) --- write "0.X mg" •MS, MSO4, MgSO4 --- write "morphine/magnesium sulfate"

TJC review for possible future inclusion: •> (greater than), < (less than) --- write "greater/less than" •Abbreviations for drug names -- write drug names in full •Apothecary units (grains, ounces, etc.) -- use metric units •@ --- write "at" •cc --- mL is preferred •µg --- write "mcg" or "micrograms"

This act was designed to control costs. It limited the number of cases an anesthesiologist could supervise concurrently to four (4), & in each of these, the anesthesiologist had to demonstrate seven (7) activities they must fulfill in each of the cases they supervised?

Tax Equity & Fiscal Responsibility Act (TEFRA)

This professional attribute of the nurse anesthetist states: The nurse anesthetist fosters an environment that encourages successful learning and understanding of information for patients and others. Assesses learning styles and preferences of the learner, communicates knowledge and assesses learner's understanding, evaluates learning to provide feedback?

Teacher

Between 2000 and 2010, these 5 states experienced a phenomena called "majority-minority" in which more than 50 percent of the population was part of a minority group?

Texas California District of Columbia Hawaii New Mexico

This act which was implemented during the Obama presidency (2009-2016), is the center of much ongoing political debate during the Trump presidency (2016-2020)?

The Affordable Care Act

Root cause analysis (RCA) is mandated by whom for its accredited hospitals whenever a Sentinel Event occurs (one of several prespecified types of adverse events, that exposes a dangerous gap in care & signals need for immediate investigation & response)?

The Joint Commission (TJC)

This is the organization that manages the National Certification Examination (NCE) for nurse anesthetists?

The National Board of Certification & Recertification for Nurse Anesthetists (NBCRNA)

This was a major impetus (driving force) for the development of anesthesia techniques with short-acting agents like TIVA?

The drive for cost containment in cardiac surgery

What was the result of the Kentucky: Frank v. South case?

They initially lost but then won on an appeal

What was the danger in developing these 2 autonomous councils separate from the AANA?

These processes provided an opportunity for physicians to attempt to control CRNA education.

FYI: PCV is a protective lung mode. We usually always start with a pt in a vol control mode to see how well they tolerate. Delivers a set volume with each breath, if the pts lungs are non-compliant, in order for the vent to deliver the set vol, the pressure in the lungs must increase.

This leads to very high peak pressures and can cause barotrauma. If we switch the patient to a pressure control mode then you can control the pressures but the volumes will vary.

T or F: A 2013 systematic review showed that in a broad range of surgical procedures, use of local infiltration or peripheral nerve block in addition to general anesthesia improve postoperative pain scores and decreased opiate consumption?

True

T or F: A patient safety event does not actually have to effect the patient. A near miss is a patient safety event but where the patient was not harmed?

True

This is a potential cause of injury to the pudendal nerve during surgery?

Traction of legs against the perineal post or orthopedic fracture table

This mechanism responsible for nerve injuries may be due to surgical maneuvers or trauma?

Transection

These are the 3 primary mechanisms responsible for nerve injuries during surgery?

Transection Compression Stretch

These 3 positions are considered variations of the Supine Position?

Trendelenburg Lithotomy Sitting (Beach chair)

T or F: 1/1995 - 12/2009: TJC reviewed 6600 sentinel events (68% died); Among most frequently reported sentinel events: Wrong-site surgery, operative/postop complications, medication errors, & unintended retention of a foreign body?

True

T or F: 2 central themes arose in the 1900s surrounding nurse anesthesia: The first is the central question of, "Are nurses who deliver anesthesia engaging in the practice of medicine?" would recur in attempts to eliminate nurse anesthetists and thus followed many legal battles?

True

T or F: 2 times to play the position of a quarterback in the OR. When putting a patient in prone positioning, and when putting a baby to sleep. You count to 3 then flip w/the team. Your job is to secure the head at all times. Patients must be anesthetized and intubated on the stretcher bed before you place them on the surgical bed in the prone position?

True

T or F: 4 vital capacity breaths over 30 seconds also ↑s arterial oxygenation, BUT the time until Hgb desaturation is shorter than in patients breathing O2 for 3 minutes or taking 8 deep breaths?

True

T or F: Ether anesthesia was considered safer than Chloroform, due to the side effects they each produced?

True

T or F: A second theme seen in the fight for justice amongst nursing anesthesia was the allegiance formed between surgeons, hospitals, & nurse anesthetists throughout the court cases. Back then, the surgeons and hospital administrators were the main friends and supporters of nurse anesthetists?

True

T or F: According to the Surgical Care Improvement Project (SCIP) core measures, surgery patients on β-blockers before admission received a β-blocker during the perioperative period?

True

T or F: All IV anesthetic agents cause a dose-dependent decrease in EEG amplitude and frequency, ultimately producing burst suppression and electrical silence at high doses. The higher the dose of the narcotic, the EEG line flattens (electrical silence) and indicates less brain activity. You want to avoid this?

True

T or F: Always show your hand and be upfront with patients about the possibility of needing to put them to sleep with general anesthesia if the initial anesthetic wears off?

True

T or F: An example of antitrust laws: 1988 case of Oltz v. St. Peters Community Hospital. Husband and wife CRNAs (Oltz) held independent privileges in a hospital, then had privileges terminated due to the hospital giving an exclusive contract to an anesthesiologist group. Case lasted >12 years, but court ruled in favor of Oltz. The final monetary settlement was not disclosed; however, Oltz was awarded $1.6 million just in attorney fees?

True

T or F: Anesthesia is not the exclusive practice of nursing or medicine, but falls within the scope of practice of both professions?

True

T or F: Anesthesia providers and practices are required to have measurements that they report on to show that things are improving. These measures are available for reporting to the National Anesthesia Clinical Outcomes Registry (NACOR) for INTERNAL improvement only (not to CMS)?

True

T or F: Anesthesiologists wanted to control ALL of anesthesia education. They were unable to control nurse anesthesia education, but introduced a new model in 1969, the physician assistant model (Anesthesiologist Assistants) which they could control. However, dialog between the ASA & AANA slowly began to enhance understanding of each group, but would be tested severely?

True

T or F: Antitrust violations, governmental & non- governmental regulations of healthcare facilities, control over accreditation of educational programs, & clinical privileging are but a few examples of where nurse anesthetists' autonomy has been challenged?

True

T or F: Anxiety is lower in patients seen by the anesthesia provider prior to surgery, compared to those receiving only premedication; Ok to premedicate patients before taking them to the OR if they are anxious but do not overdo it. Give a little to make them comfortable?

True

T or F: As a responsibility to the patient, the CRNA must introduces self, using name, a term representing the CRNA credential, & role. Verifies that students have introduced themselves or been introduced to the patient, & the patient has consented to student participation in anesthesia, pain management, & related care?

True

T or F: Before IV induction of general anesthesia, consider giving a sedative/anxiolytic in the pre-op holding area or on the way to the OR?

True

T or F: Before Queen Victoria (head of the church) was given chloroform, women were not allowed to have pain relievers b/c they were to follow the biblical advice which stated that "in sorrow shall thou bring forth children"; thus, having anesthesia for childbirth was an anathema. But, if the Queen, who was also considered as head of the church, could have anesthesia for childbirth, others could, too?

True

T or F: Before going prone, disconnect as many monitors and lines as is safe (place pulse ox on arm nearest OR table)(Place lines in your hand when turning). Disconnect ETT immediately prior to prone positioning and reconnect first. (Place soft bite block in mouth, foam cradle on face and position properly first. Head neutral through transfer). This is optional but you can put a mirror under the patient to see the eyes and face etc.?

True

T or F: By identifying "bright spot" institutions that have better outcomes in healthcare quality, the corresponding best practices can be identified & disseminated?

True

T or F: CMS is required by law to implement a quality payment incentive program, referred to as the Quality Payment Program (QPP), which rewards value & outcomes in one of two ways: Merit-based Incentive Payment System (MIPS) & Advanced Alternative Payment Models (APMs)?

True

T or F: CRNAs have an ethical obligation to deliver care to minimize risk of infection for their patients or themselves. Syringes & needles are single-use items that must only be used once. These guidelines were written in accordance with best practices to enhance patient safety & minimize healthcare costs?

True

T or F: CRNAs practice in urban and suburban locations, and are the primary anesthesia professionals providing care to the U.S. Military, rural, and medically underserved populations. As APRNs, CRNAs advocate for the removal of scope of practice barriers to increase patient access to high-quality, comprehensive care?

True

T or F: CRNAs provide acute, chronic and interventional pain management services, as well as critical care and resuscitation services; order and evaluate diagnostic tests; request consultations; and perform point-of-care testing?

True

T or F: Certain variations of the lithotomy position can also cause respiratory complications that can worsen when steep Trendelenburg is added which can decrease FRC. High lithotomy shifts abdominal viscera cephalad (towards the head), limits diaphragmatic movement, ↓ compliance and VT?

True

T or F: Charles T. Jackson hired the Lord brothers as his attorney's b/c he felt that he needed to be compensated for discovering the anesthetic effects of ether. Jackson stated that he was the "head behind the hands" meaning he believed that he was the idea man and he wanted recognition for the discovery of ether since he was the one who told Morton to rub ether on the gums?

True

T or F: In the sitting position, low venous pressure in the operative field creates a gradient for air entry into the venous system, similar to the risk of venous air entry during central line placement?

True

T or F: Charles T. Jackson recommended to Morton that ether could be rubbed in the gums and people would not feel pain. In reality, as the ether was rubbed on the gums the patients would also inhale the ether and that was how the analgesia occurred. Not from the local anesthetic effects?

True

T or F: Checklists have been validated as an effective tool in improving patient safety in both inpatient & ambulatory surgery settings?

True

T or F: Christ was offered these pain killers so that he would feel the pain but the brain would not recognize it and he wouldn't care about the pain. The meds were refused b/c he did not want to have his mind blocked or anything to stop his connection with the father. B/c dulling the brain would interrupt his connection with the Father. He only tasted the meds out of courtesy b/c the people were trying to help him but he did not drink it?

True

T or F: Compensatory mechanisms such as ↑HR in response to ↓BP are blunted by general anesthesia, rendering CO and B/P more susceptible to gravitational forces?

True

T or F: Contrary to popular belief, it was very difficult to chloroform a patient to the extent of stage 3 and a skilled anesthetist could take 5 minutes to render a patient suitable for surgery?

True

T or F: Controlled PPV favors the upper lungs in the lateral decubitus position b/c it is more compliant than the lower lung. Neuromuscular blockages enhance this effect by allowing the abdominal contents to rise up further against the dependent hemidiaphragm and impede ventilation of the lower lung. Using a rigid bean bag to maintain the patient in this position further restricts movement of the dependent hemithorax?

True

T or F: Crawford Williamson Long finally reported his findings to the Medical College of GA in 1849, after learning that others were staking ether claims?

True

T or F: Crawford Williamson Long had a hospital for OB which was mainly for slaves where they could come if they had issues having their babies?

True

T or F: Crawford Williamson Long poured sulfuric ether on a towel & had James Venable inhale. The patient felt no pain under the surgeon's knife; thus, Long became the first man to use ether for the purpose of anesthesia?

True

T or F: Cricoid pressure is provided by an assistant exerting downward pressure the thumb and index finger on the cricoid cartilage (~5-kg pressure) to occlude the compliant esophagus; cartilaginous cricothyroid ring is displaced posteriorly and the esophagus is thus compressed (occluded) against the underlying cervical vertebrae?

True

T or F: Dagmar Nelson continued to work with Dr. Hunt, who remained a staunch (loyal) defender. In 1943: Dr. Hunt was tragically murdered → Nelson left St. Vincent's and went to another hospital?

True

T or F: Damage from the saphenous nerve can occur from the front of the inner thigh all the way down the leg?

True

T or F: Depending on the level of sedation required, a regional technique may allow surgical anesthesia with complete preservation of upper airway reflexes, even in the patient at risk for aspiration of gastric contents; but regional anesthesia cannot provide surgical analgesia for all procedures?

True

T or F: Despite the higher costs of short-acting drugs used for TIVA, it was found that large economic benefits resulted from earlier extubation, decreased ICU stays, early ambulation and earlier hospital discharges; so even tho these drugs cost more up front, they are beneficial b/c they reduce the overall cost of the hospital stay. Patients do better with recovery when they are at home?

True

T or F: Despite the negative PR campaigns by physicians against NAs, surgeons, & often the anesthesiologists themselves, were not dissuaded from trusting the nurse anesthetists, prompting the AANA to promote the specialty to nurses who had not been frightened away, & AANA began collecting safety data?

True

T or F: Discrepancies of 5-20 mmHg have been found between direct & indirect pressure measurements in the same arm when patients are in the Lateral Decubitus Position?

True

T or F: Doctors Mayo sent their nurse anesthetists on "study" trips to other medical centers, with pleasure & relaxation, as well as study. They also accompanied surgeons to state medical meetings. The anesthetists were invited to spend weekends with Mayo families on boats. If surgery schedule finished early in day, anesthetists went to clinic & worked the remainder of day (x-ray, surgical records office)?

True

T or F: Dr. Riveras capstone project: "A Retrospective Chart Review Evaluating the Effects of Tranexamic Acid on Postoperative Hemoglobin Levels and the Need for Transfusion After Primary Total Hip Arthroplasty, Total Knee Arthroplasty, and Revision Procedures"

True

T or F: Due to the petition from Frank McMechan, Lakeside Hospital was forced to discontinue the anesthesia school following the Medical Board's resolution to withhold all recognition of the Lakeside Hospital as an acceptable Training School for Nurses pending a "hearing". Nursing graduate recognition was withheld until Lakeside ceased to educate nurses to become anesthetists?

True

T or F: During Jesus's crucifixion,traditional efforts to control his pain included alkaloids of opium & mandragora & other herbs, as well as magic & hypnotism. Christ was offered a rudimentary pain killer at multiple points during his crucifixion?

True

T or F: During the Chalmers-Francis v Nelson case, the AANA filed its 1st amicus brief (legal document) for Nelson's case. Dr. Chalmers-Francis filed for a mistrial → failed. In 1936, Dr. Chalmers-Francis appealed to CA Supreme Court and was denied?

True

T or F: Early on in her career, Alice Magaw used towels saturated with ether or chloroform, nearly suffocating the patients. Magaw was introduced to the open-drop ether by a visiting German surgeon. It was a means of gradually introducing the irritating ether vapor into the respiratory tract & titrating to the level of anesthesia?

True

T or F: Early on, Ether was usually administered by a disinterested medical student, nurse, orderly, or some other individual, none of whom had any formal instruction in anesthesia?

True

T or F: Examples of quality & safety - use of ultrasound to place central lines -> Safety improvement - ↓s of incidence of carotid puncture, Quality improvement - ↓s insertion time (& number of misses)......pin indexing on gas cylinders adds safety, but doesn't really change quality?

True

T or F: External pressure on a nerve could compromise its perfusion, disrupt its cellular integrity, and eventually lead to edema, ischemia, and necrosis. Unfortunately, some peripheral nerve injury is not preventable?

True

T or F: FMEA analysis reserved for large-volume, high-risk processes, for which the risk of catastrophic failure is clear?

True

T or F: Famous statement by Alice Magaw as to why she favored ether over chloroform: "Ether kills slowly, giving plenty of warning, but with chloroform there is not even time to say good-bye."

True

T or F: Field of anesthesiology has systematically improved patient safety, over time. Anesthesia is specifically identified as, "an area in which very impressive improvements in safety have been made."?

True

T or F: For a spinal block, once you see the drip of CSF you know you're in the spinal canal and can introduce the anesthetic. A spinal block is a one shot deal meaning you cannot thread a catheter and hook it up to a pump as seen with epidurals; usually lasts about 2-3 hrs?

True

T or F: For fracture table positioning, each leg is in an independent traction, can abduct/adduct legs independently. Use a shower curtain style drape to cover the patient?

True

T or F: For fracture table positioning, if doing a rt. Hip repair, the right arm must be brought across the chest. Everything must be cleared from the surgical side?

True

T or F: For patients in the Lateral Decubitus Position, disconnect the circuit from patient when moving them. Reconfirm appropriate ETT/airway position after position change from supine to lateral?

True

T or F: For patients in the Lateral Decubitus Position, if the cuff is placed on the dependent arm the BP will be higher b/c the patient is lying on top of the cuff?

True

T or F: For patients in the lithotomy position, the foot of the table is often removed/lowered for procedures. If arms are tucked at sides, hands and fingers may be injured or amputated when the foot section is raised/replaced. Safe position of the hands should always be confirmed prior to moving, removing, or replacing the foot of the table?

True

T or F: For patients who do complain of post-op neurologic dysfunction, they should be referred for neurological evaluation and physiological testing, such as nerve conduction and electromyographic studies?

True

T or F: From 1995-2009 wrong-site surgery was the most frequently reported sentinel event (13.5%) to The Joint Commission?

True

T or F: GA state legislature proposed a constitutional amendment to create Long County; which was ratified (approved) on 11/2/1920?

True

T or F: Halothane can also be used in the US but its not used as often; mainly used in other countries?

True

T or F: IV regional anesthesia (ex. bier block) is more cost-effective than general anesthesia or brachial plexus block?

True

T or F: If a process is changed to produce better patient satisfaction or shorter length of stay, it may represent higher quality but not necessarily better safety; it is ideal to improve both safety & quality?

True

T or F: If an adverse event occurs in the OR, when documenting, be sure to put strictly objective narrative entries in the medical record & incident report; Possibly make additional detailed (including subjective impressions or value judgments) personal notes for later use created specifically while sitting with an attorney?

True

T or F: If it appears likely that an equipment failure (anesthesia machine ventilator, bubble detector on a rapid infuser, or whatever) contributed to an accident, it may be indicated to conduct an inspection session involving the real-time participation of representatives of the involved practitioners, the equipment manufacturers, the equipment maintenance personnel, facility administration, & involved insurance companies?

True

T or F: If the CRNA has a moral, religious, or ethical conflict related to the patient's healthcare decisions or plan for care, the CRNA may, without judgment or bias, transfer care to an appropriately credentialed anesthesia provider willing to perform the procedure?

True

T or F: If the analgesic requirements for the planned procedure can be met with local or topical anesthesia, or if the planned procedure is not associated with pain (e.g., diagnostic radiology procedure such as magnetic resonance imaging), MAC may be the most appropriate choice?

True

T or F: If you feel as if the patients airway will be manipulated or compromised during the procedure affecting ventilation, oxygenation, or if the level of consciousness requires immobility, analgesia, or anxiolysis then you need to do a general anesthesia?

True

T or F: Implications: If closing volume encroaches (intrudes) on FRC, airway closure may occur during normal expiration and decrease ventilation to areas distal to the closure, worsening the ventilation /perfusion relationship (V/Q)?

True

T or F: In 1800, Humphrey Davy wrote, "as nitrous oxide in its extensive operation, appears to be capable of destroying physical pain, it may probably be used during surgical operations in which no great effusion of blood takes place". Sadly, he never followed up on his own supposition, & the discovery of modern anesthesia was still more than 40 years away?

True

T or F: In 1911 in New York, Dr. Charles Mayo had an attack of cholecystitis & needed surgery. Dr. William Mayo took Florence Henderson with him to provide anesthesia. The Chicago North Western Railroad provided a private car for Dr. W. Mayo & Miss Henderson?

True

Nurse anesthetists, like other professionals, are subject to these laws, which regulate the conduct of businesses, called "competition laws". Federal laws that forbid businesses from monopolizing (taking over) a market?

antitrust laws.

T or F: In 1935: Committee on Education of the Society sent questionnaire regarding the teaching of anesthesia to 87 medical schools in US & Canada → 75 replied; 57 listed anesthesia instruction by a physician as a separate course by nurses, as part of surgery or pharmacology, & 7 with no instruction at all?

True

T or F: In 1936, Alice Magaws articles were cited as evidence in a California civil suit that supported the contention that when administering anesthetics, nurses do not illegally practice medicine?

True

T or F: In 2018, The Anesthesia Quality Institute (AQI) National Anesthesia Clinical Outcomes Registry (NACOR) removed certain measures from the registry that no longer required reporting b/c they were rejected by CMS due to high performance rate & lack of variability for improvement?

True

T or F: In Hartford, CT, Horace Wells attended a public demonstration of nitrous oxide's stupefying effect (one of the "airs" recommended by Davy in 1800). Wells noted that the person who inhaled N20 cut his leg. The man said he felt no pain. Wells decided this could be used for dental extractions?

True

T or F: In June 2013, the AANA Board of Directors approved revisions to the Scope of Nurse Anesthesia Practice?

True

T or F: In World War I (1913-1918), army nurses played a significant role (up to 3,524 by war's end), but the number of nurse anesthetists is unknown, because at that time, they were part of the general nursing staff?

True

T or F: In normal health, the closing volume is less than the FRC and accounts for the residual volume (RV) of the lung at the end of expiration?

True

T or F: In order for a fire to start, each element of the fire triangle (heat, fuel, oxygen) must be present?

True

T or F: In the 1970s, the AANA was forced to relinquish accrediting & certification functions. The AANA had a lot of different professional bodies all working within the same building yet under the control of the AANA. There were claims that it was a conflict of interest for them to do that so the government had them relinquish (give up) the accrediting functions?

True

T or F: In the 1980's, the economic growth slowed & inflation rose; however, medicine "seemed to pass from stubborn shortages to irrepressible (uncontrollable) excesses". Healthcare expenditures grew between 1970 & 1980 from $69 billion to $240 billion, & reimbursement practices for hospitals & doctors were designed to encourage higher costs?

True

T or F: In the Bahn v. NME Hospitals case a hospital replaced Bhan, CRNA, with an anesthesiologist. Bhan sued. The defense argued that Bhan, as a nurse & nurse anesthetist, did not, in the eyes of the law, compare with a physician because of differences in licensure. Bhan lost the antitrust battle, not due to defense, b/c there were other hospitals in the area where Bhan could practice?

True

T or F: In the Chalmers-Francis v Nelson case, at trial, Judge Alan B. Campbell ruled that Nelson & the hospital were NOT in violation of the CA Medical Practice Act, because NAs never acted independently & were under the supervision of the physician at all times?

True

T or F: In the Dagmar Nelson case, Nelson, a NA accused of practicing medicine, won at each level of the California civil court system. The CA Supreme Court ruled again that the functioning of the NA under supervision & in the direct presence of a surgeon or the surgeon's assistants was the common practice in operating rooms; therefore, the NA was not diagnosing & treating within the meaning of the medical practice act?

True

T or F: In the Kentucky vs. South case, the Appellate judge said, state licensure was meant to protect consumers, not to benefit professionals in one profession over another. The Court determined that a nurse administering anesthesia was not engaging in the unauthorized practice of medicine. Its finding that NAs do not practice medicine is still relevant because it has never been overturned or contradicted by another court.?

True

T or F: In the Lateral Decubitus Position, an axillary roll should be placed underneath the patient just caudal to the axilla (a couple finger breadths below the axilla) not in the axilla itself. The axillary roll prevents compression injury to the dependent brachial plexus and dependent axillary vascular structures?

True

T or F: In the Lateral Decubitus Position, the dependent arm is placed in front of the patient on a padded arm board. The nondependent arm is often supported over folded bedding or suspended with an armrest or foam cradle. Neither arm should be abducted more than 90 degrees in order to prevent injury to the brachial plexus from the humeral head!? (see slide 40)

True

T or F: In the Quality Payment Program (QPP) all data from all the cases that year are collected and put into a system and the data is sent to a centralized location the following year. Payments are adjusted 2 years after the Performance Period?

True

T or F: In the Root cause analysis model, you continuously ask yourself "why" to continue to dig deeper to get to the root of the problem and identify what factors were involved?

True

T or F: In the Swiss Cheese Model of Medical Errors its important to identify potential gaps in the healthcare system and come up with measures to fill the gaps?

True

T or F: In the early days, mortality from ether admin was mainly due to aspiration of gastric contents, asphyxiation due to respiratory obstruction, or unrecognized events such as low BP or cardiac arrhythmias (no clinical monitoring). Also, in the mid-1800's, the concept of antisepsis hadn't been extended to surgery, and post-op infections were common?

True

T or F: In the era of early nurse anesthetists, women practicing nursing outside religious orders (being a nun) were seen as socially and morally corrupt?

True

T or F: In the lateral decubitus position, V/Q matching is preserved during spontaneous ventilation. The dependent (lower) lung receives more perfusion than does the upper lung due to gravitational influences on blood flow distribution in the pulmonary circulation; and the dependent lung also receives more ventilation b/c contraction of the dependent hemidiaphragm is more efficient since the patient maintains the natural negative inspiratory force that drives breathing?

True

T or F: In the supine (dorsal decubitus) position, when the arms are adducted, they are usually held alongside the body with a "draw sheet" that passes under the body and over the arm and is then tucked directly under the torso (not the mattress) to ensure that the arm remains properly placed next to the body. Never tucked under buttocks?

True

T or F: In the trendelenburg position, Brachial plexus injury can occur when shoulder supports (eg, shoulder braces or bean bags) are placed at the base of the neck, where they may compress the roots of the brachial plexus. Use rigid supports with caution!!!?

True

T or F: It is also possible that some perioperative neuropathies may have no relationship to intraop positioning or management of physiologic factors?

True

T or F: Large component of anesthesia safety has been derived from a history of empiric observation & experience b/c mechanisms by which most anesthetics exert their effects haven't been completely understood (& still aren't), and many intraop states (muscle relaxation, one-lung ventilation, cardiopulmonary bypass) aren't found in normal human activity?

True

T or F: MAC anesthesia is more cost effective compared to GA or regional anesthesia?

True

T or F: MAC anesthesia uses the same standard of care as any other procedure such as monitors to measure SaO2, ECG, & BP; uses supplemental O2 via NC, mask; ETCO2 trending is also required per standard V; level of sedation may progress rapidly, go beyond consciousness, & lead to an "unplanned" GA?

True

T or F: MAC values differ for each of the commonly used inhalational agents and are influenced by patient age and coexisting diseases or conditions?

True

T or F: Massachusetts General Hospital (MGH) in Boston was known for having a surgical suite that had an amphitheater type structure where the residents, medical students and other observers could come sit and watch what the surgeon did. No one really paid attention to the anesthesia world at this time?

True

T or F: Monitored Anesthesia Care (MAC) is not to be confused with Minimum alveolar concentration also abbreviated as MAC?

True

T or F: Most anesthetists perform better with techniques with which they are more experienced; so, while in NAP, take advantage of every opportunity to learn as many different anesthetic techniques as possible, to enable you to be as flexible as possible in various settings?

True

T or F: Never events includes an intraop death in a ASA class I patient, death/disability from irretrievable loss of an irreplaceable biologic specimen, & death from electric shock?

True

T or F: Nitrous oxide and Ketamine are also known to cause analgesia?

True

T or F: No sooner was Morton's discovery made public (published in the 1846 issue of Medical Examiner after he used ether to extract a tooth from Eben Frost), than Crawford Long of Georgia, Horace Wells, & Charles Jackson vied (competed) for credit as the first to discover anesthesia?

True

T or F: Observations of harmful events have led to ↓s in anesthesia-related mortality rates, with current estimates ranging from 1:250,000 for healthy patients to 1:1500 for patients with complex medical problems?

True

T or F: On the National Certification Examination (NCE), the General Principles of Anesthesia section consists of 30% of the test and focuses on ethical considerations, Legal issues, and Safety and wellness such as substance abuse (impairment, disorder, and other considerations), and issues surrounding patient safety. Also includes Enhanced recovery after surgery (ERAS) protocols?

True

T or F: One exception to the Lateral Decubitus Position in which you may want to put the patient on the same side as the operative side is (for ex.) if the patient is getting the left hip done you should place the spinal block on the left side and then place the patient on that side. The idea is to get more of the drug on the left side and make it more numb than the right side so that the patient is more comfortable?

True

T or F: One modification to the AQI-NACOR registry, made in 2018 for 2019, was the use of Neuraxial Techniques &/or Peripheral Nerve Blocks for Total Knee Arthroplasty (TKA). The measure description was updated to state: •% of patients, regardless of age, that undergo primary TKA for whom neuraxial anesthesia &/or a peripheral nerve block is performed?

True

T or F: Operating room table weight limits should be strictly observed; they differ substantially with regard to normal and reverse positioning?

True

T or F: Out of greed or resentment, those associating with Charles T. Jackson in these 3 discoveries denied his contributions & claimed the honor of discovery for themselves. To bolster their arguments, each published defenses of their claims that disparaged (belittle) & denigrated Jackson's & blackened his name. For that, Jackson was not given credit for either discovery. Not uncommon for one specialist in a field to denigrate or belittle another specialist in the same field?

True

T or F: Over the 8-year history of SCIP (2006-2014), performance on nearly all process measures included in the project improved, BUT outcomes (whether surgical site infections or mortality) failed to improve. So they were collecting all this data about processes but nothing improved. The goal of the agency was to reduce surgical complications by 25% by 2010, but this did not happen?

True

T or F: Pain from the sciatic nerve runs from gluteus (buttocks), down the legs, and can travel as far as the feet and toes?

True

T or F: Patient safety during a surgical technique refers to the fact that there are few circumstances in which a specific anesthetic technique may be safer or more efficacious than another technique?

True

T or F: Patients in Reverse Trendelenburg must be prevented from slipping off the table. The use of a footboard is preferable to the overzealous (excessive) tightening of the table strap?

True

T or F: Philosophical differences b/t mainstream nursing and nurse anesthetists arose b/c many nurses felt as if nurse anesthetists were practicing medicine and this eventually prompted the nurse anesthetists to remain separate from the American Nurses Association (ANA)?

True

T or F: Positioning injuries during surgery remain a significant source of perioperative morbidity. Optimal surgical positions frequently result in undesirable physiologic changes which primarily include the cardiovascular, respiratory and nervous system as well as soft tissue injury?

True

T or F: Postoperative vision loss (POVL) can occur in one or both eyes and ranges from decreased visual acuity to blindness?

True

T or F: Practice guidelines are not a substitute for the clinical judgment of the CRNA or other anesthesia professional, & do not establish legally enforceable requirements or responsibilities?

True

T or F: Professional attributes of the nurse anesthetist are the non-clinical knowledge, skills, attitudes, & judgments that are fundamental for success?

True

T or F: Provider practices are supposed to report when bad things happen to registries & submit their data so they can be studied and investigated?

True

T or F: Recent data suggests that perioperative inflammatory responses play an important role in the development of peripheral, and potentially central neuropathies. inflammatory responses may be dramatically altered post-op and microvascular neuropathy may be a previously unrecognized cause of peripheral neuropathy?

True

T or F: Regarding the philosophical differences b/t nurses and nurse anesthetists, a corner was turned when nurse anesthesia gained the ability to be reimbursed privately and independently thru Medicare. This was the first branch of nursing to do that and this led to other branches of nursing escalating and enhancing their own education so there was a re-approachment and coming back together of nursing and nurse anesthesia?

True

T or F: Risk assessment is hampered by individual patient variability; Some assessment of risk is important to inform patients during the consent process?

True

T or F: Sentinel events are called "sentinel" because they signal the need for immediate investigation & response?

True

T or F: Sir James Young Simpson & friends sat in his dining room in the evenings to try new chemicals to see if they had any anaesthetic effect. In 1847 they inhaled chloroform, which gave them cheer & humour > collapsed > then regained consciousness in morning?

True

T or F: Size of the needle is significantly bigger for an epidural than a spinal block?

True

T or F: Some places may use separate rooms for induction of anesthesia adjacent to OR?

True

T or F: Sometimes inhalation techniques are more expensive than TIVA techniques esp if the pt experiences PONV and is given IVF & additional meds like Zofran which prolongs their hospital stay b/c they cannot go home vomiting. They will have to be observed for an additional 24hrs?

True

T or F: Structural measures are usually easy to measure, BUT the link between structure & improved outcomes is often difficult to discern; its difficult to prove that the structure is what improved the outcomes?

True

T or F: Surgeons travelled from across the US to learn from the Mayos, & they also were impressed with the skill of the nurses giving anesthesia. By 1/1/1893, 655 surgeries had been performed at St. Mary's with a 98.3% success rate. Edith's sister, Dinah Graham, was also a nurse & likely gave anesthesia?

True

T or F: The 1826 article by Henry Hill Hickman was titled Surgical Humbug but back then the word humbug meant deception, so what the Lancet felt about this experiment was that it was deception, not factual at all?

True

T or F: The 1960's were transitional for everyone in health care. In the USA, which had relied upon employer-based health insurance since WWII, coverage to the elderly & poor was extended through Medicare & Medicaid in 1965. This led to the need for more providers?

True

T or F: The AANA Standards for Nurse Anesthesia Practice provide a foundation for CRNAs in all practice settings. The CRNA must document modifications to these standards in the patient's healthcare record, along with the reason for the modification. When integrating new technologies or skills into practice, the CRNA will obtain any necessary education & evidence competency?

True

T or F: The Crile-sponsored bill, approved by the Ohio Legislature to legalize the administration of anesthesia by nurse anesthetists, contained an amendment which stated that nothing within the bill "shall be construed to apply to, or prohibit in any way, the administration of anesthesia by a registered nurse under the direction of, and in the immediate presence of a licensed physician." Physician supervision, first mentioned here (1917), would recur many times in the future?

True

T or F: The Culturally and Linguistically Appropriate Services (CLAS) principle standard states: Provide effective, equitable, understandable and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy and other communication needs?

True

T or F: The Frank McMechan "hearing" resulted in the withdrawal of the edict by the Medical Board. The Lakeside School reopened in 1917 with more applications; 141 nurses & 31 physicians, than previously. Lakeside hospital closed and reopened within the same year?

True

T or F: The Lakeside school of nursing which was started by Agatha Hodgins was actually targeting nurses but there were still some physicians that came to receive training as well?

True

T or F: The Lateral Decubitus Position will cause a V/Q mismatch b/c the dependent lung will have decreased ventilation but increased perfusion?

True

T or F: The Merit-based Incentive Payment System (MIPS) performance Year runs from 1/1 to 12/31 each year. Program participants must report data collected during one calendar year by March 31 of the following calendar year?

True

T or F: The National Certification Examination (NCE) Handbook for nurse anesthetists is published on the NBCRNA website, and it contains the current NCE content outline?

True

T or F: The National Coordinating Council for Medication Error Reporting & Prevention (NCCMERP) defines a "medication error" as any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer; the NCCMERP urges medication error researchers, software developers, & institutions to use this standard definition to identify errors.?

True

T or F: The O2 knob is always shaped differently and is always located last in the chain of gases. This is done for safety so that anesthesia providers can react quickly in emergency situations without having to take your eyes off of the patient?

True

T or F: The Q in V/Q mismatch stands for quotient and signifies the perfusion of the ratio?

True

T or F: The Quality Payment Program (QPP) rewards physicians & clinicians for giving better care based on health outcomes, not just more care (numbers of services)?

True

T or F: The actual incidence of wrong-site surgery estimated to be 1:15,000 to 1:112,000?

True

T or F: The anesthesia apparatus evolved over time as agents evolved. They went from saturating a towel with the agent → to a mask covered with gauze → to an "anesthesia machine" with an oxygen supply directing oxygen over liquid in a jar attached to the machine, → to rudimentary vaporizers → to modern-day heated vaporizers?

True

T or F: The anesthesia provider must be prepared to convert to general anesthesia if it becomes apparent that appropriate analgesia and immobility cannot be achieved by other means?

True

T or F: The anesthesia provider must have the ability to implement a range of anesthetic plans and be prepared to address unexpected events that may necessitate a sudden change in plan?

True

T or F: The anesthetic risks associated with MAC anesthesia are not necessarily different from general or regional anesthesia?

True

T or F: The appellate court ruling that gave Bhan & CRNAs standing to sue anesthesiologists as competitors set a significant precedent for the profession?

True

T or F: The article published by the World Federation of Societies of Anesthesiologists' (WFSA's) encourages those countries who currently use the term "anesthetist" to denote "anesthesiologist" to adopt the universal categorization of the terminology of "anesthesiologist"?

True

T or F: The courts tested whether or not surgeons, under "respondeat superior"/ "Captain of the Ship" were liable for the actions of nurse anesthetists. Surgeons have not been held liable in a court of law for any negligence of nurse anesthetists. Courts have apportioned (divided) liability, whether to the surgeon, anesthesiologist, &/or nurse anesthetist.

True

T or F: The focus of the ASA Closed Claims Project is on rare & serious sentinel events; initially, most claims were due to unrecognized esophageal intubation or other reasons for inadequate oxygenation -> recognized that listening to chest may not be a reliable indicator of detecting esophageal intubation -> requirement for pulse oximetry & capnography as standard monitors with GA?

True

T or F: The goal of the ASA Closed Claims Project is to identify major safety concerns, patterns of injury & strategies for prevention for anesthesiologists working in pain management, ORs, labor, remote locations, & critical care?

True

T or F: The lithotomy position is a potential cause for injury to the peroneal nerve when the fibular neck rests against the vertical bar of the lithotomy stirrup or when the knees are extended and the legs are externally rotated?

True

T or F: The major drawback to the RCA process is that its retrospective in nature so it means that something bad already happened and our goal is for bad things not to happen?

True

T or F: The objectives of general anesthesia can be achieved with a combination of drugs (depends on procedure, patient); inhalation agents with or without N2O (can cause dose-dependent cardiac depression); IV agents; Muscle relaxants (MUST be given in the presence of adequate anesthetic (or risk intraoperative awareness), so before you paralyze a patient make sure they are adequately sedated

True

T or F: The practice of anesthesia is a recognized nursing and medical specialty unified by the same standard of care?

True

T or F: The purpose if preoxygenation is to replace nitrogen (denitrogenation) in the lungs (more specifically, Functional Residual Capacity (FRC), which is about 2500 mL of 21% O2) with 100% O2; it increases the margin of safety during apnea that may accompany induction of GA?

True

T or F: The purpose of the Culturally and Linguistically Appropriate Services (CLAS) is to provide a common understanding and consistent definitions of culturally and linguistically appropriate services in healthcare. The ultimate goal of these services is to bridge the gap or help in the elimination of racial and ethnic health disparities and to improve the overall health of all Americans?

True

T or F: The term MAC is not part of the description of the sedation continuum, as the LOC may change during a procedure & progress to an "unplanned" general anesthetic. The preoperative evaluation, monitoring, and other anesthesia care standards apply equally to the patient receiving MAC.?

True

T or F: The tooth extraction done on Eben Frost was published and & Henry Jacob Bigelow, a surgeon from Massachusetts General Hospital (MGH), talked with John Collins Warren, & Morton was invited to demonstrate the use of ether at MGH. Remember, John Collins was the same surgeon who demonstrated the use of N2O with Horace Wells in which the patient screamed but now he was willing to give anesthesia another try?

True

T or F: The use of checklists may assist in reducing the number of errors that occur in the surgical/ procedural setting; Non-medical, high reliability organizations (HROs) (e.g., aviation, military operations & engineering) have successfully implemented checklists to reduce their error rates?

True

T or F: The verdicts in the Frank vs. South case rested on the fact that nurse anesthesia had become customary in many areas & included Alice Magaw's 35 year old publication. (Evidence-based practice!)?

True

T or F: There are no valves between the central venous & epidural venous systems, so when the head is flexed in the sitting or prone positions, it allows direct transmission of ↑ed abdominal or intrathoracic pressure to the vertebral venous system. This leads to congestion in the veins draining the SC, & ↓ed BP, leads to ↓ed SC perfusion?

True

T or F: There are ~100 surgical fires/year, with 20 serious injuries & 2 patient deaths?

True

T or F: There is a lower risk for postdural puncture headache seen with epidural anesthesia but only if you don't puncture the dura?

True

T or F: Throughout his professional career, Crawford W. Long was strongly convinced of his calling to serve humanity. He said that his profession was a "ministry from God" and that his "highest ambition was to do good & leave the world better by his labors."

True

T or F: To avoid nerve injuries to the upper arm, when possible, avoid BP cuffs below the antecubital fossa?

True

T or F: Today, most CRNAs & physician anesthesiologists continue to work well together, considering that much of what they each do connotes direct competition between two very distinct provider groups. There are >50,000 CRNAs.

True

T or F: Up until the discovery of oxygen (O2) in 1771, and isolated nitrous oxide (N2O) in 1772 by Joseph Priestly, people were not aware what they were breathing?

True

T or F: Verifying an air leak around the ETT or visualizing the larynx before extubation may be prudent (wise) in those w/swelling while in the T-burg position. May be wise to deflate the cuff of the ETT first to verify that gas is able to move around the tube. Absence of a cuff leak suggests the presence of airway edema, increasing the risks of post-extubation stridor and reintubation?

True

T or F: We actually do like for patients to take a few deep breaths when admin anesthesia b/c we want to replace the room air that's in the lungs with a mixture of O2 and the anesthetic gas b/c this makes the induction of anesthesia more effective. In the current practice this is one thing that we disagree with Alice Magaw on?

True

T or F: When an adverse event occurs during surgery, in the very unusual circumstance that the anesthesia provider becomes ill or disabled or is so shocked by the realization of the accident that s/he cannot function, s/he should devote full attention to direct clinical care rather than to the necessary organizational & administrative considerations?

True

T or F: When an adverse event occurs in the OR it is important to access any memory in any monitor or device used (especially the vital signs stored in many OR patient monitors) & print this out or photograph the screen(s) if there is no printing capacity; sequester all involved equipment & supplies (& the trash & needle buckets) & then: Alter nothing (no cleaning, no disassembly, no repair); Discard nothing, and Lock away all of the above?

True

T or F: When detecting a Venous Air Embolism, the monitoring Sensitivity of the TEE & doppler are most sensitive, followed by ETN2, ETCO2, & PAP?

True

T or F: When patients are in the sitting position, its important to avoid flexion or profound lateral rotation of the neck?

True

T or F: When patients are supine, avoid head rotation away from the abducted arm b/c this can stretch the brachial plexus between the clavicle and first rib; also avoid shoulder compression b/c vertical compression on the shoulder can injure the brachial plexus (as seen on slide 26 of the patient positioning ppt)?

True

T or F: When transitioning a patient to the prone position, make sure all lines and tubes are very well secured to prevent dislodgement during turning and to prevent tube migration during the case. Watch the sides of the OR table, IVs and pulse ox?

True

T or F: When using MAC with moderate or deep sedation an anesthesia provider is requested or required to provide anesthetic services, which includes preoperative evaluation, care during the procedure, & management after the procedure?

True

T or F: Whether monitoring standards &/or new technologies were responsible for perceived reduction in adverse events, willingness of anesthesia providers, as a group, to adopt practice standards is key?

True

T or F: While the preparation and expertise exists to care for patients in the operating room, there has been a need to develop cultural skill sets due to the influx of individuals from diverse cultural backgrounds in this country?

True

T or F: William T.G Morton patented ether #4848 in November 1846, but he refused to tell nature of the compound. Medical community condemned the patent as unjust so no effort was made to enforce the patent and the drug was used anyways. Morton applied to Congress for compensation in the amount of $100,000. Appealed 4 times and each one failed?

True

T or F: With a cooperative patient, regional anesthesia may ensure the appropriate immobility and analgesia required for surgery, without exposing the patient to the risks of general anesthesia?

True

T or F: With obese patients be careful when reversing the axis (support swivel) on the operating room table. The operating room table can tilt and tip over if sufficient weight is placed away from the base?

True

T or F: With the anesthesia devices today, you cannot administer NO2 past a certain point without O2 being automatically started, and as you increase the NO2 flow it automatically increase the O2 flow to ensure that you do not give a hypoxic gas mixture to the patient?

True

T or F: Words by Alice Magaw: One must be quick to notice the temperament, & decide which mode of suggestion will be the most effective in the particular case: the abrupt, crude & very firm, or the reasonable, sensible, & natural. The later mode is far the best in the majority of cases?

True

T or F: Words of Alice Magaw: Patients should be prepared for each stage of the anesthesia with an explanation of just how the anesthetic is expected to affect him; 'talk him to sleep', with the addition of as little ether as possible?

True

T or F: Words of Alice Magaw: We have one rule; patients are not allowed to talk, as by talking or counting, patients are more apt to become noisy & boisterous. Never bid a patient to "breathe deep," for in so doing, a feeling of suffocation is sure to follow, & the patient is also apt to struggle?

True

T or F: in the sitting position, the arms and feet should be supported and padded and the shoulders should be even or very mildly elevated in order to avoid stretch injury between the neck and shoulders?

True

T or F? When patients are prone, if the arms are positioned with hands up, the ulnar nerve at the elbow should be padded or free. The brachial plexus may be stretched when the neck is rotated; the limits of the patient's ability to rotate the head should be determined preoperatively?

True

T or F: When used in combination with a sedative-hypnotic or opioid & neuromonitoring is necessary, TIVA agents have less effect on motor evoked potentials than potent volatile inhalational agents or N2O. Motor evoked potentials (MEP's) are very sensitive to inhalation agents, while somatosensory evoked potentials (SSEP's) are moderately affected?

True *Somatosensory evoked potentials (SSEPs) are brain and spinal cord responses elicited by sensory stimulation, mainly electrical stimulation of a peripheral nerve. *Motor evoked potentials (MEPs) are electrical signals elicited by stimulation of the muscles or motor pathways

This is the name of the special needle used for inserting epidural catheters?

Tuohy needle

In the sitting position, this nerve may be compressed at the elbow and should be padded?

Ulnar nerve

What is the most common peripheral nerve injury seen with surgery?

Ulnar neuropathy

Dr. Rivera completed his DNP degree at ____________ ______________ in Jackson, TN in May 2016?

Union University

Which extremities are more at risk of peripheral nerve injuries in the prone position?

Upper extremities

This is one method used to decrease the cost of volatile agents?

Use low fresh-gas flows (< 2 L/min) during maintenance

This is defined as the ratio of alveolar ventilation to the amount of blood that perfuses the alveoli?

Ventilation / Perfusion Ratio (V/Q)

Nurse anesthetist Agatha Hodgins served with surgeon George Crile in France during which world war?

WWI

Antibiotics weren't introduced until which world war?

WWII

_________ held back the implementation of standards for nursing anesthesia, but by 1945, a standard curriculum was developed as part of the "Essentials of an Acceptable School of Anesthesiology for Graduate Registered Nurses."?

WWII

During which world war did nurse anesthetists start to distinguish themselves from other general nurses?

WWII (1939-1945)

In 2005 Dr. Rivera graduated from ___________ ______________ in St. Louis, MO?

Webster University

This professional attribute of the nurse anesthetist states: The nurse anesthetist makes lifestyle choices that promote the positive and healthy balance of personal and professional environments.Seeks appropriate help or support, demonstrates adaptability and resiliency, develops and uses appropriate coping skills?

Well

When moving to a prone position, the anesthesia provider controls the head and airway, and is therefore responsible to coordinate the move. You are in charge! What is the one exception to this rule?

When patient is in rigid head pins (in this case, neuro is in charge)

This person noticed the effect of diethyl ether during "ether frolics" in which ether was breathed for its liberating effects?

William Morton

This is termed as a person who compounded mixtures together to make a product?

apothecary surgeon

These words are listed on the tombstone of which man: -Inventor and Revealer of Anaesthetic Inhalation; -BEFORE WHOM in all time, Surgery Was Agony. -BY WHOM Pain in Surgery was averted and annulled. -SINCE WHOM Science has control of pain.?

William T. G. Morton (1819-1868); Mount Auburn Cemetery, Cambridge, MA

This gentleman studied at the Baltimore College of Dental Surgery, graduated & became apprentice to Horace Wells in Hartford, CT. Entered Harvard Medical School & attended chemistry lectures by Dr. Charles T. Jackson, who introduced him to the anesthetic properties of ether?

William T.G. Morton

These were the first 3 surgeons at St. Mary's Hospital: (1865-1939).

William W. Mayo (father) William J. Mayo (son) Charles H. Mayo (son)

This organization views anesthesia as a medical practice, because of its complexity and potentially hazardous nature; and an anesthesiologist is a "graduate of a medical school who has completed a nationally recognized specialist anesthesia training program?

World Federation of Societies of Anesthesiologists' (WFSA's)

This agency defines a "near miss" as "An error that has the potential to cause an adverse event (patient harm) but fails to do so because of chance or because it is intercepted"?

World Health Organization (WHO)

This involves all surgical procedures performed on the wrong patient, wrong body part, wrong side of the body, or the wrong level of a correctly identified anatomic site?

Wrong-site surgery

These are 4 populations that tend to have higher incidences of PONV with inhaled anesthetic agents?

Young healthy non-smokers females

This lung zone of Wests model, represents alveolar dead space because the region is ventilated but not perfused. Exists in a very small portion of the lung around the apex, but the use of PEEP or high airway pressures during mechanical ventilation can create or expand this zone. PA > Ppa > Ppv (pressure in alveoli > pressure in pulm artery > pressure in pulm vein)?

Zone 1

This lung zone of Wests model, is considered the "Waterfall" zone; variable relationship b/t vascular and alveolar pressure. A point is described where arterial pressure exceeds alveolar pressure. Depending on the pts position it may consist of dead space; ventilation but no perfusion; may be false readings. Ppa > PA > Ppv (pressure in pulm artery > pressure in alveoli > pressure in pulm vein)?

Zone 2 (As we move down the lung zone, the blood flow in the pulm artery steadily increases which is similar to a waterfall)

This lung zone of Wests model is the dependent portion of the lung, where both pulmonary arterial and venous pressures exceed alveolar pressure. This zone represents continuous blood flow, and it is here where the tip of a PA catheter should lie b/c there's no obstruction of blood flow. Ppa > Ppv > PA (pressure in pulm artery > pressure in pulm vein > pressure in alveoli)?

Zone 3

This lung zone of Wests model is in the most dependent portions of the lung, wherein extravascular pressure from mechanical compression or interstitial fluid compresses the vessels and occludes their flow. Ppa > PISF > Ppv > PA (pressure in pulm artery > pressure in interstitial fluid > pressure in pulm vein > pressure in alveoli)?

Zone 4

An ____________________ is someone studying under someone else to become what that person is?

apprentice

After successful intubation with GA, turn on the vent and assess the following 4 settings?

a.Assess ventilator settings (Vt & RR) b.Assess delta Vt on anesthesia machine (< 200 ml is OK) c.Assess circuit bag for inflation and deflation d.Assess for continuous EtCO2 waveform

In the classic supine position, one or both arms can be _____________ or ______________ alongside the patient?

abducted adducted

In the sitting position the patient's head and also the operative field are located where?

above the level of the heart

Within the lungs, pulmonary blood flow is uneven due to the effect of gravity, decreasing linearly from base to apex. -Zone 1, perfusion is ______________? -Zone 2, perfusion is ______________? -Zone 3 and 4, perfusion is ____________?

absent sporadic constant

If shoulder supports are used to assist patients while in the trendelenburg position, supports should be placed laterally, at the __________________ joint, to avoid direct nerve compression?

acromioclavicular

For fracture table positioning, the arm on the operative side should be brought where?

across chest, resting (padded), secured across abdomen

What is the motor function of the obturator nerve?

adduction of the thigh

This professional attribute of the nurse anesthetist states: The nurse anesthetist works with others to develop shared solutions; Articulates thoughts and ideas clearly, regulates emotions, shows respect for other team member's positions and ideas, implements innovative problem solving strategies?

collaborative

What is the goal of patient positioning?

allow for optimal surgical access while minimizing potential risk to the patient

When transitioning a patient to the prone position, the arm over which the patient rolls should be where to prevent injury?

along the patient's side

When supine, reposition the patient's head during prolonged procedures as ___________ may occur due to prolonged pressure (gel donuts may be a better choice in long procedures)?

alopecia

V & Q must be matched at the __________________ level for gas exchange to occur?

alveolocapillary

Anesthesia needs to have these 3 components in order to have an optimal surgery?

amnesia - absence or abolition of awareness/memory analgesia - absence or abolition of pain areflexia - absence or abolition of movement

A systematic review found no major difference in maternal benefit or fetal risks b/t the epidural and CSE technique but there was an increased rate of these 2 effects with the CSE technique?

analgesia (pain relief) onset maternal pruritus (itching) for ~ 30 mins to 1 hr

This is defined as the absence or abolition of sensation?

anesthesia

Physicians were not interested in making anesthesia a full-time practice, because of these 3 reasons?

anesthesia was subordinate to surgery anesthesia had a much lower professional status anesthesia had a lower income potential

Every surgical position carries a degree of risk that is increased once an __________________is administered.

anesthetic

Even if the patient had a preoperative visit & assessment in advance (maybe a few weeks before the surgery), the final assessment is the responsibility of whom and should be done the day of the surgery?

anesthetist providing anesthesia

Care must be taken to prevent patients in steep head-down positions from slipping cephalad (head first) on the surgical table. These are 5 techniques used to restrain the patient from sliding?

anti-skid bedding knee flexion shoulder braces beanbag cradling padded cross-torso straps

These are 3 complications of Venous Air Embolisms?

arrhythmias acute pulmonary hypertension circulatory collapse

The induction of ether in the early days was compared to what, & patients struggled so much they had to be held down?

asphyxiation

Any position that limits the movement of the diaphragm, chest wall, or abdomen may cause an increase in these 2 conditions?

atelectasis intrapulmonary shunt

Ideally, patients are placed in a surgical position that they can tolerate when what?

awake

When in the prone position, EKG patches should be placed on the patient's ________ not in areas of pressure (ex. under shoulders)?

back

These are 3 securing devices that can be used for patients in the lateral decubitus position to prevent them from falling or tilting forward to backward?

beanbag peg board bedding rolls

For fracture table positioning, when do you anesthetize the patient?

before you place them in the final surgical position

Type of IV regional anesthesia used for procedures lasting 20-90 mins; usually used for upper (hand & wrist) & lower extremities; lower can sometimes be problematic 2/2 size of the leg & volume of local anesthetic needed in adults; usually done for carpal tunnel sx and requires a 2nd IV?

bier block

For patients in the Lateral Decubitus Position, make sure the head remains in a neutral position without lateral rotation to protect what? (Grab blankets and foam cradle to help position head)

brachial plexus

In the classic supine (dorsal decubitus) position, arm abduction should be limited to less than 90 degrees in order to prevent injury to this nerve group which can occur from the head of the humerus pushing into the axilla?

brachial plexus

In the sitting position, which nerve plexus is at risk for stretch if the arms are inadequately supported?

brachial plexus

In the prone position, these 3 body parts should be correctly positioned to avoid compression and padded as appropriate?

breasts iliac crests genitalia (*Breasts should be on the inside of the chest rolls)

Chloroform is now regarded as a possible cause of what?

cancer

In the sitting position, the ultimate effect on oxygenation depends on this which tends to fall, and may negate the beneficial effects of improved respiratory function?

cardiac output

In the prone position severe head rotation can also obstruct these 3 major vessels and has rarely led to cerebral infarction?

carotid artery vertebral artery jugular veins

How can the lateral position cause damage to the common peroneal nerve?

causes undue pressure on downside leg

In the sitting position, correct B/P is needed for appropriate _________ ____________. Remember that gravity alters BP by 2 mmHg for every inch?

cerebral perfusion

In the sitting position, hypocapnia associated with mechanical ventilation results in this which may further reduce cerebral perfusion?

cerebral vasoconstriction

In the prone position, lateral rotation of the head and neck can stretch the roots of the ___________ ___________ and the neurovascular bundle at the head of the ____________ and can compress the nerves and vessels between the clavicle and _________ rib?

cervical plexus humerus first

In 1848, Horace Wells left his wife and son and moved to NY City, began self-experimenting with ether & chloroform, and became addicted to which one?

chloroform

Alice Magaw also tried using these 4 anesthetic agents but favored ether?

chloroform N2O (nitrous oxide) scopolamine morphine

When patients are prone, firm rolls or bolsters that extend from the __________to the ________ __________should be placed laterally, to minimize pressure on the abdomen and thorax and the associated physiologic changes?

clavicle iliac crests

This is identified as a set of congruent behaviors, attitudes and policies that come together in a system, agency or among professionals which enables that system, agency or those professionals to work effectively in a cross-cultural situation?

cultural competence

Opioids have the potential to cause what 3 physiologic changes?

decrease heart rate decrease CO decrease B/P

In the sitting position, venous pooling in the lower extremities, along with the vasodilation and myocardial depression that accompany general anesthesia, can produce the following 4 physiological effects?

decrease in preload decrease in SV decrease in MAP decrease in cerebral perfusion pressure (CPP)

Administration of neuromuscular blocking agents contributes to ____________ venous return d/t the loss of normal muscle tone?

decreased

In the Lateral Decubitus position, if the pt is mechanically ventilated, there is ______________ ventilation of the dependent lung b/c the pt loses the natural respiratory drive and muscle tone of the diaphragm. Abdominal contents shift down & cephalad → lower hemidiaphragm moves upward?

decreased

Administration of anesthetic medications leads to myocardial depression and vasodilation resulting in what 2 physiologic changes?

decreased BP decreased CO

Administration of anesthetic medications leads to blood pooling in the dependent body areas which also leads to what 2 physiologic changes?

decreased preload decreased SV

In the prone position, the hemodynamics are actually well maintained, however, if the patient is improperly positioned and pressure is placed on the abdomen, this can lead to the following 4 physiological effects?

decreased venous return decreased SV decreased CO/CI decreased B/P

For patients in the Lateral Decubitus Position, the pulse oximeter or arterial line should be placed on/in which arm to detect compression of the axillary neurovascular bundle/axillary artery?

dependent arm (down-side)

In the awake patient that is spontaneously breathing, contraction of which 2 muscles causes expansion of the thoracic cavity in both the anterior-posterior and lateral posterior directions?

diaphragm intercostal muscles

Any position in which the arms are tucked can lead to this complication?

digit amputation

Motor and sensory function perioperatively should always be what?

documented

The supine position is also called what?

dorsal decubitus

How is the lithotomy position a potential cause for injury to the posterior tibial nerve?

due to the "knee crutch" stirrups supporting posterior aspect of knees

Florence Henderson was interested in the _____________of anesthetists. In 1909, she published an article in the American Journal of Nursing, discussing the drawbacks of having anesthesia administered by interns, the reasons surgeons were turning to nurses, & some factors nurse anesthetists must bear in mind while administering anesthesia?

education

The scope of nurse anesthesia practice is determined by the following 4 factors?

education experience state and federal law facility policy

In the trendelenburg position, the stomach also lies above the glottis, therefore this is often preferred to protect the airway from aspiration of gastric contents related to reflux and to reduce atelectasis?

endotracheal intubation

When general anesthesia is required in the prone position, these are 5 things that should all be obtained in the supine position first while the patient is still on a gurney. (Bring the anesthesia machine closer so that it can reach the patient)?

endotracheal intubation temp probe insertion IV access Foley catheter invasive hemodynamic access

On March 30, 1842, Crawford Williamson Long successfully removed a small tumor from the neck of James Venable under the influence of what med?

ether

This med used in surgery is considered a Non-benzo imidazole and is known to cause amnesia?

etomidate

For patients in reverse Trendelenburg, invasive arterial blood pressure monitoring should be calibrated (zeroed) at the level of what in order to optimize cerebral perfusion?

external auditory meatus (ear canal)

In the sitting position, transducers for arterial lines should be leveled where?

external auditory meatus (ear canal)

PONV can become a major problem the more you use which inhaled anesthetic agent?

nitrous oxide

Prolonged head-down positioning can result in swelling of these 4 structures with an increased potential for postoperative upper airway obstruction (especially with administration of IVFs)? (Hint: F-TLC)

face conjunctiva larynx tongue

Interestingly enough, Alice Magaws articles reported the use of the open-drop ether technique in over 14,000 anesthetics without a single ___________ and for that, many surgeons & hospitals from around the world sent nurses to Mayo to be trained by Alice Magaw?

fatality

In 1935, Agatha Hodgins noted "the strongest objection of physicians was against those nurse anesthetists who were working on a what?

fee for service basis (A method in which doctors and other health care providers are paid for each service performed)

Sciatic nerve runs from what nerve roots?

from L4-5 thru S1-S3

How can the lithotomy position can cause injury to the obturator nerve?

from excessive flexion of the thigh at the hip (bending the thigh inwards)

Sir James Young Simpson used chloroform as a ____________anesthetic. This induced the loss of consciousness necessary for painless surgery. Chloroform was non-flammable & relatively rapid at producing anesthesia?

general

This type of anesthesia is required in any instance in which the patient loses consciousness, as defined by the inability to respond purposefully?

general anesthesia

Nurses' roles expanded after the ________theory of disease was understood & the need to prevent infection was accepted; roles then required knowledge & science application?

germ

What happens to the spinal cord when it is stretched?

gets thinner

As federal expenditures rose in the 1970s, the _____________ exerted greater oversight of health services, & new criteria were developed for accreditation?

government

William T.G. Morton discussed the merits (qualities) of ether with Jackson who then advised that to rub ether on the ______ would produce analgesia enough to remove teeth?

gums

The clinical use of chloroform decreased & was eventually eliminated with the discovery of increasingly safer general inhalation anesthetics such as these 6 agents?

halothane (Fluothane) enflurane (Ethrane) methoxyflurnae (Penthrane) isoflurane (Forane) sevoflurane (Ultane) desflurane (Suprane)

In the classic supine position these 3 body landmarks all retain neutrality?

head neck spine

In the sitting position, the patient's head must be adequately fixed. This can be done via these 3 maneuvers?

head strap tape rigid fixation

This is defined as a predetermined, well-defined, evidence-based set of steps that should be completed during a designated medical clinical encounter or medical procedure?

health care checklist

In 1829, Humphrey Davy died of what?

heart failure

In 1844 horace Wells used nitrous oxide (N20) on whom, & had a colleague extract a tooth, painlessly! He declared, "It is the greatest discovery ever made. I didn't feel it so much as a prick of a pin!". Wells went on to perform a series of extractions without pain.?

himself

The Fracture Table Positioning is mainly used for what body part?

hips

Success rate of peripheral nerve blocks depends on what?

how often the anesthetist uses the technique

The Institute of Medicine stated that medical errors are most often due to___________ _______________, with the largest number of errors occurring in high-intensity settings (i.e., ICUs, ERs, and ORs)?

human fallibility

Patients in reverse Trendelenburg, particularly those patients who are hypovolemic, are at risk for ___________________ due to decreased venous return?

hypotension

For patients in the Lateral Decubitus Position, the B/P cuff should be placed on which arm; b/c this arm should have the lower pressure. This minimizes risk of unrecognized hypotension.

non-dependent arm (up-side)

In the lateral decubitus position the patient lies on which side?

nonoperative side

Anesthesia is the practice of nursing when performed by ________ ___________ and the practice of medicine when performed by _____________. There is no defining line between the professions?

nurse anesthetists physicians

The first formal training programs in anesthesia were begun by whom?

nurses

Blood tends to pool where when patients are prone?

in the extremities

What is the most common cause of peripheral nerve injuries during surgery?

incorrect patient positioning

In the sitting position, FRC and lung compliance _____________, compared with supine, lateral and prone positions, as the abdominal contents fall away from the diaphragm?

increase

In the Lateral Decubitus position, if the patient is mechanically ventilated (asleep/paralyzed), there will be ______________ ventilation of the non-dependent (upper) lung due to a caudal shift of the upper hemidiaphragm causing unrestricted lung excursion?

increased

When the patients head is flexed at the neck in the sitting or prone position, this injury is usually seen post-op?

increased vertebral venous pressure

The risk of peripheral nerve injury should be discussed during what? (especially when patients are to be placed in non-supine positions).

informed consent

With a spinal block, the local anesthetic is injected where?

into the CSF

With an epidural, the local anesthesia is injected where?

into the epidural space ("potential" space)

Where can the obturator nerve be felt?

on the inner thigh

For fracture table positioning, use padded arm support on the side that is ____________ the operation?

opposite

Compression & stretch on the spinal cord can lead to what?

ischemia

This is defined as ischemia to a portion of the optic nerve?

ischemic optic neuropathy (ION)

This is the most significant obstacle to anesthesia quality?

knowledge of patient outcomes

When Horace Wells was arrested in NY, as the chloroform wore off his mind started to clear he asked the guards to escort him to house to get his shaving kit. Went back to the jail and committed suicide in his cell by slitting his ________ __________ __________ with a razor, after inhaling an analgesic dose of chloroform?

left femoral artery

What is the main motor function of the sciatic nerve?

leg flexion at the knee

Patients should be positioned with the head at or above what level in the prone position, to avoid venous congestion of the face; may have to move the bed to a slight reverse trendelenburg to achieve this?

level of the heart

Compartment syndrome is especially seen when patients are placed in which position?

lithotomy

This is the most important factor in determining if regional anesthesia is appropriate?

location of the surgical incision.

When patients are in the trendelenburg position, if the shoulder braces are placed too ___________ or __________ it could lead to a brachial plexus injury?

medial lateral

To this day, the American Society of Anesthesiologists (ASA) insists that anesthesia is the practice of what?

medicine

Before the start of the inhalation induction process, this is given orally during the pre-op setting to ↑ patient cooperation?

midazolam

If a Venous Air Embolism is detected while a patient is in the sitting position, what type of murmur may also be heard?

millwheel murmur

Dosing of inhalation agents used for GA is determined by potency, which is reported using this value which refers to the concentration of an inhaled agent in the alveoli that is required to prevent movement in response to a surgical stimulus in 50 percent of patients?

minimal alveolar concentration (MAC)

How is the dependent leg positioned when patients are in the Lateral Decubitus Position?

must be somewhat flexed

With general anesthesia, there is a high risk of urinary retention when _______________ are used (esp seen in the elderly) and can prolong the hospital stay?

narcotics

When the patient is prone, the arms should not be overextended, to avoid stretching or compressing what structure?

neurovascular bundles in the axilla

Ether & Chloroform administered through inhalation remained the only anesthetics in common use for some 20 years until this was again reintroduced as a dental agent in the 1860's?

nitrous oxide

In the supination position, the radius and ulna bones are what? In the pronation position, the radius bone does what?

parallel rotates over the ulna bone

The anesthetic choice should be tailored to what 2 things?

patient's medical condition the needs of the surgical procedure

Early attempts to improve anesthesia quality focused on this rather than outcomes?

periop process

Prolonged ischemia on a nerve leads to what?

permanent neural damage

During WWI, discussions began about the need for professional ______________ anesthetists?

physician

When administering ether in the early days, morbidity & mortality were encountered as a result of what?

poor anesthetic techniques

An ↑ in this can adversely affect post-op outcomes, because it correlates with ↑ed post-op analgesic requirements & prolonged recovery & hospital stay; it also impairs retention of information?

preop anxiety

The decision-making process regarding anesthetic technique begins with what?

preoperative evaluation

This is termed as the administration of 100% O2 via face mask immediately before induction of general anesthesia (GA)?

preoxygenation (denitrogenation)

This is always required before IV or inhalation induction with general anesthesia?

preoxygenation with 100% O2

For patients in the Lateral Decubitus Position, check the dependent ear to avoid what 2 things?

pressure folding

When supine, heels should be elevated off the mattress to prevent what?

pressure sores

In the supine (dorsal decubitus) position, the legs should be what?

uncrossed

When you transition a patient to the prone position, make sure that all lines, IVs, monitors are reconnected ___________the breathing circuit and reconfirm breath sounds after position change?

under

According to the Surgical Care Improvement Project (SCIP) core measures, prophylactic antibiotic should be received within 1 hr before the surgical incision, but the exception is seen with these 2 meds which are administered within 2 hrs?

vancomycin fluoroquinolones

The most significant complication from the sitting position is risk of a what?

venous air embolism

When patients are in the prone position, if the operative site is higher than heart, there is an increased likelihood for what?

venous air embolus

Gas exchange depends largely on the matching of what 2 components?

ventilation perfusion

In 1937, 4 hospitals were approved for anesthesia residency, 17 in 1938; and 49 in 1945. What was the greatest impetus (stimulus) to the increased number of residencies?

veterans returning after WWII

New data also suggests that __________ have been associated with central and peripheral neuropathies that develop perioperatively?

viruses

In the prone position, perfusion of the arms should be monitored via what 4 methods?

visual inspection palpation of pulses noninvasive BP cuff continuous pulse ox

When was chloroform brought to popularity in England?

when Queen Victoria was administered chloroform by John Snow for the birth of Prince Leopold in 1853.

How is atlantoaxial subluxation diagnosed?

with X-rays

These are 8 infrequently occurring risks of general anesthesia that have a severe Impact?

•Awareness •Visual loss •Aspiration •Organ failure •Malignant hyperthermia •Drug reactions •Failure to wake up/recover •Death

According to the Camphina-Bacotes Model the process of cultural competence in the delivery of healthcare services consists of these 5 major components? (Hint: ASKED)

§Cultural Awareness §Cultural Knowledge §Cultural Skills §Cultural Encounters §Cultural Desires

Where are hispanics from? §Argentina §Bolivia §Chile §Colombia §Costa Rica §Cuba §Dominican Republic §Ecuador §El Salvador

§Guatemala §Honduras §Mexico §Nicaragua §Panama§Paraguay §Peru §Puerto Rico §Spain §Uruguay §Venezuela

These are 4 cultural assessment tools used to guide healthcare providers in developing cultural competence? (Hint: BELK)

§L.E.A.R.N. Model §ETHNIC Framework §KLEINMAN'S 8 Questions §BERG Cultural/Spiritual Assessment Tools

Charles T. Jackson was a key figure in these 3 notable discoveries in US before 1850?

´Discovery of surgical anesthesia (Morton) ´Discovery of electromagnetic telegraph (Morse) ´Commercial exploitation of copper in Michigan

The dispute over who discovered anesthesia quickly escalated into a battle, complete with character assassination, lies, & endless recrimination waged before the press. Became very bitter, and what were the fates of 3 of the men. To this day, followers of each of these men continue to assert credit to their respective "discoverer"?

´Wells committed suicide, ´Morton died in poverty of apoplectic seizures & CVA, ´Jackson spent the last several years of his life in an insane asylum where he died

At the end of WWII in 1945, these were 3 reasons why MDs providing anesthesia proliferated from 285 in 1940 to 1,231 in 1949?

´a) Increased complexity of anesthetics ´b) Military structure that encouraged specialization ´c) GI bill that supported medical residencies

The Advanced Alternative Payment Model (APM) can apply to these 3 primary buckets?

•A specific clinical condition •A care episode •A patient population

These are a list of 9 registries for reporting adverse events that work with CRNA groups?

•ABG QCDR •Advance QCDR •AQI NACOR (examples in textbook & next slides) •AQR QCDR •Blue Nine QCDR •MEDNAX QCDR •MiraMed •Ortho[m]atrix •SCG Health

These are 2 NSAIDS used in surgery that are known to cause analgesia?

•Acetaminophen •Ketorolac

These are 5 areas involved in the Before Skin Incision component of the comprehensive checklist?

•All team members introduced themselves by name & role •Confirm patient's name, procedure, & where incision will be •Antibiotic prophylaxis given within last 60 minutes •Anticipated critical events •Essential imaging displayed

These are 4 objectives as to why we use general anesthesia?

•Amnesia •Analgesia •Skeletal muscle relaxation •Control of sympathetic nervous system responses evoked by noxious stimuli, if needed

If all else is equal, patient satisfaction may become the principal determinant in anesthetic technique selection; these are 6 things to consider for patient satisfaction?

•Analgesia •PONV •Anxiety (avoiding being awake) •Urinary retention •myalgia •pruritus

These are 3 Patient Safety-Focused Programs that were formed & exist to encourage safety?

•Anesthesia Patient Safety Foundation (APSF) •ASA Closed Claims Project •Anesthesia Quality Institute (AQI)

Who coordinates and directs the patient positioning in the OR?

•Anesthesia providers

Steps in routine/standard IV induction of GA: •All monitors applied (BP, Pulse Ox, EKG, Nerve stimulator), Assess VS, Equipment check, Suction on •100% O2 (preoxygenate); O2 flowmeters @ 6-8 Lpm, open APL valve •Admin IV Lidocaine &/or Opioid (blunts airway reflexes) •Admin IV anesthetic induction agent (propofol, etomidate, ketamine) > rapid onset of unconsciousness

•Assess effect of induction agent (talk to patient; eyelash reflex absent, tape eyes closed) •Verify mask ventilation ability (give 1 -2 breaths; must see chest rise •Check baseline TOF; admin muscle relaxant; Roc 0.6mg/kg (case/patient dependent) •Continue to Mask/LMA ventilate until loss of TOF (Check TOF, if no twitches, proceed)

These are 5 ways to minimize postural hypotension?

•Avoid abrupt or extreme position changes •Reverse position if VS deteriorate •Keep patient well hydrated •Have drugs available to counteract reaction •Vasopressors, such as neo or ephedrine

These are 2 ways to improve medication safety by avoiding abbreviations & unnecessary decimal points?

•Avoid decimal points with trailing zeroes (1.0 vs 1 vs 10) •Must use a zero before a decimal point (0.2 vs .2 vs 2)

If the patient is properly positioned in the prone position, it can have these 3 positive pulmonary effects?

◦increased FRC ◦increased compliance ◦increased oxygenation

These are 4 advantages of inhaled anesthetic agents?

•Bronchodilation •Dose-dependent decrease in skeletal and smooth muscle tone •Decreased cerebral metabolic rate (CMR) •Increased cerebral blood flow (CBF)

Inhalation induction process or GA: •Oral midazolam preoperatively to ↑ patient cooperation •Use Sevoflurane (with or without N2O) •Have the patient breathe Sevoflurane 6-8% with 3 L O2 & 7 L N2O through the face mask (preferably with a good seal) •Loss of consciousness usually occurs within 1 minute

•Can usually insert an LMA within 2 minutes (if LMA indicated) •A muscle relaxant can be given to facilitate tracheal intubation (if ETT) •If patient begins to have airway obstruction or begins to desaturate, turn off the N2O & administer 100% O2

These are 5 steps that are done in preparation for surgery?

•Check anesthesia machine, monitors, equipment •Prepare equipment & drugs •Preparation of patient in pre-op holding area •Transport to OR for induction of anesthesia (some regional blocks are placed in holding area) •In OR, TIME OUT before induction - check patient ID/allergies & reconfirm surgery, etc.

According to the National Patient Safety Foundation, these are 3 different types of errors?

•Commission (doing the wrong thing) •Omission (not doing the right thing) •Execution (doing the right thing incorrectly)

Steps in IV rapid sequence induction (RSI) of GA: •All monitors applied (BP, Pulse Ox, EKG, Nerve stimulator), Assess VS, Equipment check, Suction on •100% O2 (preoxygenate); O2 flowmeters @ 6-8 Lpm, open APL valve •Admin IV Lidocaine &/or Opioid (blunts airway reflexes) •Consider defasciculating dose of a ND-NMB (i.e. rocuronium 5mg or 0.5ml)

•Cricoid pressure applied by assistant, til ETT place verified; start with 20N •Admin IV anesthetic induction agent (propofol, etomidate, ketamine) > rapid onset of unconsciousness •Assess effect of induction agent (talk to patient; eyelash reflex absent) •Administer rapid acting muscle relaxant immediately after Propofol (Succinylcholine 1-2mg/kg or Rocuronium 1.2mg/kg)

A sentinel event is a patient safety event that reaches a patient and results in any of the following 3 conditions?

•Death •Permanent harm •Severe temporary harm & intervention required to sustain life

These are a list of never events in which if these occur, CMS will not pay the hospital for the added cost of the extra care incurred as a result: •Foreign object left in patient after surgery •Surgery on wrong patient •Surgery on wrong body part •Wrong surgery on a patient

•Death/disability associated with intravascular air embolism •Death/disability associated with incompatible blood •Death/disability associated with hypoglycemia •Death/disability associated with a fall within a facility •Death/disability associated with electric shock •Death/disability associated with a burn incurred within facility

These are 2 types of muscle relaxants that are known to cause areflexia?

•Depolarizing NMBs •Non-depolarizing NMBs

The Anesthetist is ultimately responsible for these 3 important steps?

•Determining patient's medical status •Developing plan of anesthesia care ("Care Plan") •Reviewing proposed plan with patient (or responsible adult)

These are 6 disadvantages of inhaled anesthetic agents?

•Dose-dependent suppression of airway reflexes •Respiratory depression •Myocardial depression •Vasodilation leading to hypotension •Increased risk of PONV •Potential to induce malignant hyperthermia (MH) in susceptible individuals.

These are High-Alert Medications in Acute Care Settings that are more likely to be seen in anesthesia?

•EPINEPHrine •Epoprostenol (Flolan), IV •Insulin (esp. U-500) •Magnesium sulfate inj. •Nitroprusside sodium inj. •Oxytocin, IV •Potassium chloride for inj. Concentrate •Potassium phosphates inj. •Vasopressin, IV

These are 4 ways to prevent fires in the surgical setting?

•Effective communication between all periop team members •Prep solutions completely dried prior to surgical draping •Lasers & endoscopes turned off or standby when not in use •When possibility that O2 may come in contact with electrocautery, O2 should be used at lowest concentration possible

These are 4 major advantages of using TIVA?

•Favored when patient is high risk for PONV •Contributes to postoperative analgesia •Less effect on motor evoked potentials •Dose-dependent decrease in EEG amplitude & frequency

These are the 3 main types of anesthesia?

•General Anesthesia •Regional Anesthesia •Monitored Anesthesia Care (MAC)

These are 8 National Patient safety goals published by TJC for 2019?

•Goal 1 - Patient Identification •Goal 2 - Improve Communication •Goal 3 - Medication Safety •Goal 6 - Clinical Alarm Safety •Goal 7 - Health Care-Associated Infections •Goal 9 - Reduce Falls •Goal 14 - Pressure Ulcers •Goal 15 - Risk Assessment

These are 5 sentinel events that immediately trigger a root cause analysis (RCA)?

•Hemolytic transfusion reaction •Invasive procedure on the wrong patient, wrong site, or wrong procedure •Prolonged fluoroscopy > 1500 rads (radiation absorbed dose units) •Fire, flame, or unanticipated smoke, heat, or flashes during an episode of patient care •Any intrapartum maternal death or severe morbidity

These are 4 main components of general anesthesia?

•Immobility •Amnesia •Analgesia •Lack of patient harm

What are the 3 goals of the "Triple Aim"?

•Improving the patient experience of care (including quality and satisfaction); •Improving the health of populations; •Reducing the per capita cost of health care.

These are 6 conditions that may ↑ the risk of aspiration during surgery?

•Incompetent lower esophageal sphincter w/reflux •Hiatal hernia •Diabetes mellitus •Gastric motility disorders •Intra-abdominal masses (including pregnancy) •Bowel obstruction

These are 5 regional blocks that are known to cause analgesia and areflexia? (Hint: PIA-FA)

•Interscalene •Axillary •Femoral •Popliteal •Ankle

The following 9 positioning devices are risk factors associated with position-related injuries?

◦Table straps ◦Leg holders & stirrups ◦Axillary roll ◦Bolsters ◦Fracture table post ◦Shoulder braces ◦Positioning frames ◦Headrests ◦Ether screen

These are 3 Human-anesthesia machine interfaces that were designed to reduce inadvertent errors?

•Knobs shaped differently for oxygen vs. air & nitrous oxide •Consistent location of oxygen knob (O2 always last) •Potential for dangerous delivery of hypoxic gas mixtures is prevented by "linking" oxygen flow to nitrous oxide flow, so oxygen is always present

These are 4 advantages of epidural anesthesia (a type of neuraxial regional anesthesia)?

•Lower risk for postdural puncture headache •Less systemic hypotension •Ability to prolong or extend the anesthetic through an indwelling catheter •May use epidural catheter to provide postop analgesia

These are 3 advantages of peripheral nerve blocks?

•Maintenance of consciousness during surgery may be possible •Continued presence of protective upper airway reflexes possible •Possibility for isolated anesthetic effect attractive in patients with COPD, severe cardiac impairment, inadequate renal function, etc.

These are the 2 reimbursement tracks for Quality Payment Program (QPP)?

•Merit-based Incentive Payment System (MIPS) •Advanced Alternative Payment Models (APMs)

All patients should be identified using 2 independent identifiers which can includes the following; must be checked every time a patient is to undergo a diagnostic test, procedure, or receive medication?

•Name •Date of birth •Medical record number

These are 5 areas involved in the Before Patient Leaves the OR component of the comprehensive checklist?

•Name of procedure •Instrument, sponge, & needle counts •Specimen labeling •Any equipment problems to be addressed •Key concerns for recovery & management of patient

Regional anesthesia includes these 2 additional subtypes?

•Neuraxial regional anesthesia •Peripheral regional anesthesia

Safe Injection Guidelines for Needle & Syringe Use: •Never administer medications from the same syringe to multiple patients, even if the needle is changed. •Never reuse a needle, or needleless access device even on the same patient. •Never refill a syringe once it has been used, even for the same patient

•Never use infusion or IV administration sets on more than one patient. •Never reuse a syringe or needle to withdraw medication from a multidose vial (MDV). •Never reenter a single-dose medication vial, ampoule or IV infusion bag. (•Do not reenter a single-use medication vial, even for the same patient.)

These are 2 disadvantages to regional anesthesia?

•Occasional failure to produce adequate sensory levels •Hypotension that may accompany the peripheral SNS blockade, especially with hypovolemia

These are 4 ways to improve medication safety when labeling syringes?

•Only draw up meds immediately prior to patient use •Label with drug name, concentration, time drawn up •Color-coded labels for different classes of meds •Should NOT pre-label empty syringes

These are 8 ideal anesthetic components?

•Optimal patient safety & satisfaction •Excellent operating conditions for the surgeon •Rapid recovery •Avoidance of postoperative side effects •Low in cost •Allow early transfer or discharge from PACU •Optimize postoperative pain control •Permit optimal OR efficiency (turnover times)

These are 6 frequently occurring risks of general anesthesia that have a minimal Impact?

•Oral or dental damage •Sore throat •Hoarseness •Postoperative nausea/vomiting •Drowsiness/confusion •Urinary retention

These are 7 areas involved in the Before Induction of Anesthesia component of the comprehensive checklist?

•Patient confirmed identity, site, procedure, consent •Operative site marked •Anesthesia machine & medication check complete •Pulse oximeter on & functioning •Allergies •Difficult airway or aspiration risk •Risk of > 500 mL blood loss (7 mL/kg in children)

Which 2 patient populations do we use inhalation induction on as compared to the IV induction agents used on adults?

•Pediatric patients without an IV •pts with difficult airway management

What is the most common physiologic consequence of positioning?

•Postural hypotension

These are the main 3 steps of the universal protocol?

•Preop verification of the patient (which uses 2 identifiers), the procedure, & the site/side or vertebral level & involves at least 2 healthcare providers (1 of whom is the surgeon) •Site marking of operative site by surgeon, with his/her initials or "yes" with patient involvement •"Time-out" right before starting procedure

These are 3 primary categories for measuring healthcare quality?

•Process measures •Structure measures •Outcome measures

These are 3 frequently occurring risks of regional anesthesia that have a minimal Impact?

•Prolonged numbness/weakness • Postdural puncture headache • Failure of technique

These are 6 drugs used for TIVA?

•Propofol •Fentanyl •Remifentanil •Dexmedetomidine (Precedex) •Ketamine •Lidocaine

•Examples of structural elements considered to correlate with quality care include the following 5 areas?

•Ready availability of diagnostic radiologic testing •Having physicians on call for emergencies •Electronic medical record •Mandating a dedicated intensivist for all CC units •Hospital rules governing: nurse-patient ratios, timely availability of OB anesthesia specialists, protocol for hand hygiene

These are 4 main points to document in the pre-op anesthesia note?

•Relevant findings •ASA classification •Anesthetic technique planned (& GA backup, if plan is other than GA) •Statement noting that the patient understands & accepts the plan & accompanying risks

General anesthesia may be used in the following 3 circumstances?

•Requirement for systemic neuromuscular blockade •Requirement of a secured airway •Preference of the patient, anesthesia provider or surgeon

The Institute for Safe Medication Practices (ISMP) has had multiple accomplishments in the following 4 areas?

•Safe medication standards •Drug packaging & labeling •Tools & resources for the healthcare community •Public policy efforts

Steps in routine/standard IV induction of GA (cont'd) •Increase cricoid pressure to 40N (Tape eyes) •NO Mask ventilation •Intubation with ETT (when airway reflexes lost & MR effective; proper depth of ETT is 21-23cm; (need for ETT is case/patient dependent) •Assess ETT placement: (chest rise, condensation in ETT, +EtCO2, auscultate BBS), open APL •Release cricoid pressure

•Secure ETT •Turn on ventilator (Push volume control/auto flow button on anesthesia machine) •Decrease O2 flow to 2 Lpm •Begin inhalation agent •Re-check VS

Steps in routine/standard IV induction of GA (cont'd) •Intubation with ETT when airway reflexes lost & MR effective; proper depth of ETT is 21-23cm; (need for ETT is case/patient dependent) •Assess ETT placement: (chest rise, condensation in ETT, +EtCO2, auscultate BBS), open APL

•Secure ETT •Turn on ventilator (Push volume control/auto flow button on the anesthesia machine) •Decrease O2 flow to 2 Lpm •Begin inhalation agent •Re-check VS

These are 3 volatile anesthetics that are known to cause amnesia and analgesia? (Hint: DIS)

•Sevoflurane (Ultane) •Desflurane (Suprane) •Isoflurane (Forane)

What does SBAR stand for?

•Situation - Identify patient & problem or the change in patient's condition •Background -Relevant background info specific to situation •Assessment -Offer analysis of problem or convey more extensive data about patient, such as changes from prior assessments •Recommendation -What provider believes would help resolve situation, or what is desired response

These are 3 neuraxial blocks that are known to cause analgesia, and areflexia?

•Spinal/SAB •Epidural •CSE

These are 3 anticipated critical events associated with the Before Skin Incision component of the comprehensive checklist?

•Surgeon: critical or non-routine steps; case duration; anticipated blood loss •Anesthetist: any patient-specific concerns •Nurses: Sterility confirmed; any equipment issues or concerns

These are 4 advantages of spinal anesthesia (a type of neuraxial regional anesthesia)?

•Takes less time to perform •Rapid onset •Better-quality sensory & motor anesthesia •Associated with less pain during surgery

These are 3 patient or procedural characteristics that are not appropriate for MAC anesthesia?

•Uncooperative •Patient Refusal •Surgical pain not amenable (susceptible, responsive) to local or topical anesthesia...pain is not controlled with these meds

These are 2 disadvantages of peripheral nerve blocks?

•Unpredictable attainment of adequate sensory & motor anesthesia •Patient must be cooperative

These are 5 evidences of a patent upper airway after induction with general anesthesia; these methods are effective with spontaneous, assisted, or controlled ventilation?

•Upper part of chest expands & reservoir bag partially empties during inspiration •Reservoir bag refills during exhalation •Capnography reveals cyclic waveforms ↓ing to zero during inhalation & a plateau peak (> 20 mmHg) during exhalation ("sustained") •Pulse oximeter continues to read > 95% •Bilateral breath sounds present

Process of administering a bier block: •"Extra" IV to the hand on the operative extremity •Double cuff tourniquet on upper arm (lift arm, drain blood) •Exsanguination of extremity •Inflation of tourniquet >>>>

•Verification of NO peripheral pulses •Injection of PF local anesthetic (0.5% Lidocaine, ~40mL) *Once the tourniquet is released, blood flow returns along with sensation of pain.

The choice to use general anesthesia includes planning for which 4 areas of care?

•induction of anesthesia •airway management •maintenance of anesthesia •postoperative care

These are the 3 most important factors to decide when choosing an appropriate anesthetic technique?

•type of surgical procedure •the patient's coexisting diseases •patient preferences

How does the trendelenburg position affect intracranial pressure?

↑ ICP

The trendelenburg position can negatively affect the intraocular pressure and can lead to the following 2 complications?

↑ IOP vision loss

In obese patients, frequently the torso is positioned over the open side of the table for what 2 reasons?

◦ improve surgical access ◦permit use of equipment such as the C-arm x-ray devices.

The following 8 preexisting pathophysiologies are risk factors associated with position-related injuries?

◦Anemia ◦Diabetes mellitus ◦Peripheral vascular disease ◦HTN ◦Liver disease ◦Peripheral neuropathies ◦Alcoholism ◦Limited joint mobility ◦Smoking

These are 2 CV physiological effects seen in patients in the Lateral Decubitus Position?

◦CO unchanged unless venous return is obstructed (Ex kidney rest) ◦BP may decrease d/t decreased vascular resistance

These are 2 pulmonary physiological effects seen in patients in the Lateral Decubitus Position?

◦Decreased volume of dependent (lower/down) lung 2/2 compression/↓ space ◦Increased perfusion of dependent (lower/down) lung 2/2 gravity

These are 2 ways in which the lithotomy position can cause injury to the saphenous nerve?

◦Foot suspended outside vertical bar, leg rests on bar ◦Excessive pressure on medial aspect of leg from "knee crutch" stirrups

The following 3 anesthetic techniques are risk factors associated with position-related injuries?

◦General anesthesia ◦Hypotensive techniques ◦Neuromuscular blockade

If the patient is improperly positioned in the prone position, it can lead to this negative physiological respiratory effect?

◦Increased work of breathing

Patient positioning is a group activity that requires which 4 factors? (Hint: KTTC)

◦Knowledge ◦Team work ◦Timing ◦Coordination

The following 3 body habitus (builds) are risk factors associated with position-related injuries?

◦Obesity ◦ Malnutrition/Underweight ◦Bulky musculature

For patients in the Lateral Decubitus Position, these are 4 signs of adequate circulation to the dependent arm?

◦Palpable pulse ◦Visual inspection ◦Free-flowing IV infusion ◦Pulse oximeter waveform