Case Study

The orthopedic surgeon has seen Mrs. Parks and agrees that she needs a hip arthroplasty. As promised, you sit down with Mrs. Parks and her family to discuss her fears about the surgery, as well as what you learned at the Risks of Anesthesia inservice. She's most afraid of waking up during surgery, and asks you what the chances are of it happening again. Your response: Intraoperative awareness occurs in one-fifth of one percent of surgeries.

Mrs. Parks' daughter says that she recently learned about BIS monitors in a nursing class. She wants to know how useful they are in preventing intraoperative awareness. Your response: They may be useful, but research has shown them to be less than 100% effective.

Mrs. Parks asks if she has to have general anesthesia for her hip surgery, or if there is another option. Your response: Regional anesthesia may be a possibility, and the anesthesiologist or nurse anesthetist will discuss the options with her before surgery.

Certified Registered Nurse Anesthetists and Anesthesiologists

Age and affect a patient's response to anesthesia.

Anesthesiologists and Certified Registered Nurse Anesthetists (CRNA) are the only health care providers who administer anesthesia. Anesthesiologists are physicians who are board-certified in anesthesiology. Education for anesthesiologists involves an undergraduate degree, four years of medical school, and four years of residency. In addition, many spend a further year in a specialty fellowship, such as cardiac anesthesia, pain management, pediatric anesthesia, or critical care.

CRNAs are registered nurses who have graduated from a baccalaureate nursing (or other appropriate) program, along with an additional two- or three-year master's degree from an accredited nurse anesthetist program. To become certified, the nurse must pass the national certification exam. In larger cities, CRNAs usually work under the supervision of anesthesiologists; the level of autonomy given to them varies by institution. CRNAs tend to have the most opportunity for autonomy in more rural areas. According to the American Association of Nurse Anesthetists, CRNAs are the only anesthesia providers in two-thirds of rural hospitals in the U.S.

Case Study

When you come in for work at 7 a.m. the next day, Mrs. Parks is being wheeled down the hall for surgery, with her husband and daughter by her side. They all thank you for your help yesterday, and Mrs. Parks says that she has a wonderful anesthesiologist who told her all about the anesthesia options. He listened to her fears about waking up during surgery, and said that regional anesthesia might be a better option anyway because of her other risk factors for general anesthesia.

Mrs. Parks returns to the floor at noon after discharge from the postanesthesia care unit, and you volunteer to care for her again. She tolerated the surgery and regional anesthesia well. She's alert, and says it was odd to be awake during her surgery, but it wasn't scary this time because she could tell the anesthesiologist if anything was wrong.

You notice that Mrs. Parks is shivering while getting settled in bed. The postanesthesia care unit discharged her to the floor with oxygen at 2 liters/minute by nasal cannula and an IV of 0.9 normal saline at 50 cc/hour, to be continued until 5 p.m. She also has a patient-controlled analgesia (PCA) pump with morphine. She has a Foley catheter draining clear yellow urine and an abduction pillow to maintain her hip prosthesis in correct alignment. Your five postoperative care priorities:

You continue to care for Mrs. Parks during her uneventful recovery. She'll be discharged to a nursing home for a few weeks of rehabilitation before going home, and she's eager to continue learning how to take better care of herself. Her husband and daughter are supportive of her, and grateful to you for all your help during Mrs. Parks' hospital stay. You discharge her to the nursing home, feeling proud of a job well done!

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