Medicine and Health Sciences Commons^™

Regional Anesthesia In Outpatient Total Joint Arthroplasty, Laci Caesar

MSN Capstone Projects

Within the past five years, outpatient total joint arthroplasties have increased three-fold due to the change in insurance companies’ reimbursement plans. After continuous literature research collection, support for spinal anesthesia was higher than compared to general anesthesia (GA) for outpatient total joint arthroplasty procedures. Healthy patient who receives regional anesthesia showed decreased post-operative pain, increased rehabilitation, and, most of all, a decrease in facility stays (Macfarlane et al., 2009). This has allowed healthy patients who meet physician, anesthesia, and facility requirements to transition from hospitals to ambulatory surgery centers for total joint replacement procedures. With this new transition comes change …

An Evidence-Based Teaching Plan To Increase Awareness Of Certified Registered Nurse Anesthetists To Patient Safety Threats Due To Provider Fatigue And To Offer Effective Strategies To Mitigate Fatigue, Tieneasha Hines, Lisa Alexander

DNP Scholarly Projects

The mental, physical, and emotional effects of stress and fatigue pose significant patient safety risks resulting from impaired concentration, coordination, and overall productivity in certified registered nurse anesthetists. Fatigue is commonly experienced by nurse anesthetists. Fatigue is an occupational hazard that affects not only nurse anesthetists but also patients, colleagues, and other healthcare stakeholders. Certified registered nurse anesthetists are most affected by fatigue due to the prolonged duration of extensive patient monitoring during surgical and complex medical procedures. Due to their central role in ensuring patient safety and comfort during surgery and other procedures requiring anesthesia, certified registered nurse anesthetists …

Objective Structured Clinical Evaluation For Volume Control And Pressure Control Ventilator Modes, Brian Bailey, Anthony Newsom

Doctoral Projects

The purpose of this doctoral project was to create a tool to teach student registered nurse anesthetists (SRNAs) in The University of Sothern Mississippi’s (USM’s) anesthesia program about pressure control and volume control ventilator modes, and how to use them. To accomplish this goal an Objective Structured Clinical Examination (OSCE) was developed. The framework used for creating this OSCE was Kolb's Theory. Kolb's Theory uses a four-stage learning cycle in which the learner encounters a new experience, reflects on the observations of said new experience, conceptualizes or modifies a concept based on this experience, and then applies their idea to …

Quality Of Care Improvement: A Process To Standardize Handoff Communication Between Anesthesia Providers And Post-Anesthesia Care Unit Nurses, Maria Chernyak, Courtney Posten

DNP Scholarly Projects

Introduction: Transition of care is the process in which sending provider teams and receiving provider teams release the care of the patient from one provider team to the next utilizing a communication process. Review of the literature has identified several different protocols in place to systematize communication among providers, however, there is no standardized instrument or process that encompasses the post-anesthesia transfer of care process. Our project goal is to develop a standardized evidence-based handoff communication instrument to be utilized during the transition of care process between anesthesia care teams to the post-anesthesia care (PACU) teams to improve quality of …

Anesthetic Considerations For Patients With Aortic Stenosis, Owen Diehl

Nursing Student Class Projects (Formerly MSN)

Aortic Stenosis places surgical patients at greater risk for adverse events during surgery. Due to the pathological process of Aortic Stenosis, the left ventricle must generate high systolic pressures to ensure adequate cardiac output. These increased pressures result in left ventricular hypertrophy, placing the patient at greater risk for myocardial ischemia. For induction of anesthesia, it is imperative to maintain hemodynamic stability as this is where problems arise. Five research articles were reviewed to determine how to administer anesthesia to these patients safely. Additional sources were gathered for a background on the pathophysiology of aortic stenosis. The research articles reviewed …

Myasthenia Gravis, Rebecca Wheeler

Nursing Student Class Projects (Formerly MSN)

Myasthenia gravis (MG), a neuromuscular and autoimmune disorder, is not completely understood by clinicians and scientists. The primary cause is thought to be anti-Acetylcholine receptor antibodies that attack the neuromuscular junction, causing destruction of post-synaptic junctional folds and blockade of the receptor. This causes frequent weakness and fatigability of voluntary muscles, making activities of daily living difficult for those living with MG. Although it is not an incredibly prevalent disease, the incidence is increasing in the United States due to better testing and diagnosis. Treatments are available, including cholinesterase inhibitors that raise the concentration of Acetylcholine at the neuromuscular junction …

Perioperative Management Of The Patient With Obesity, Trevor Mack

Nursing Student Class Projects (Formerly MSN)

Abstract

Obesity has become a problem worldwide during the past few decades. The prevalence of obesity worldwide has led to an increase in the number of obese surgical patients to whom perioperative care needs to be delivered. Hence, surgeons and nurse anesthetists will care for an increasing number of obese patients in the foreseeable future and should be prepared to provide optimal management for these individuals. This poster considers preparing for and managing the obese surgical patient by explaining underlying pathophysiology, implications of nursing care, perioperative considerations, diagnosis, and various treatments. This review provides updated evidence regarding perioperative management for …

Evidence-Based Trigger Videos Related To Distractions And Safety Threats To Anesthesia Care In The Operating Room, Alexandra Kendall, Dominique Sturdivant, Lynne Miller

DNP Scholarly Projects

Intraoperative distractions are considered exceedingly detrimental to the quality of anesthesia care. Distractions in the operating room (OR) cause an array of negative effects for healthcare providers and can represent major patient safety risks. At this time, there is no formal training for anesthesia providers targeting the impact of distractions or educating providers about the risks to their patients.

The primary aim of this project was to develop four trigger videos that will be utilized in future research to increase anesthesia providers’ awareness of the threats to patient care and quality of care that result from disruptions secondary to distractions. …

Pathophysiology Of Pulmonary Hypertension, Kayla Thomsen

Nursing Student Class Projects (Formerly MSN)

Abstract

Understanding the pathophysiology behind various diseases is essential for nursing, especially those in advanced practice roles such as nurse anesthetists. Pulmonary hypertension (PH), characterized by vasoconstriction, vascular remodeling, and thrombosis, has a complex physiological process and a vast compilation of patient considerations (Sarkar & Desai, 2018). PH affects up to fifty million people worldwide, with 1-year survival rates of 90.4% and 5-year survival rate of 65.4%, further solidifying the importance of understanding the disease for quick diagnosis and treatment (Bandyopadhyay et al., 2021). Diagnosis of PH is often delayed, with some patients experiencing symptoms up to two years before …

Electronic - Cigarettes And Anesthesia Implications, Duane Robinson

Nursing Student Class Projects (Formerly MSN)

Electronic cigarettes (ECs) became available in the United States in 2007. They were originally marketed as a safer alternative to smoking (Arndt et al., 2020). The number of users has exceeded 14M people in the U.S. (Bulat et al., 2022). ECs are not as regulated as tobacco cigarettes. The levels of nicotine in the e-liquid vary significantly and the Federal Drug Administration (FDA) does not regulate the non-nicotine ingredients in e-liquid (Krishna et al., 2020). The vapor from ECs contains heavy metals, volatile hydrocarbons, and over 70 carcinogenic substances. Lung damage from EC use has created a new respiratory ailment, …

Identifying Elderly Patients At High Risk For Post-Operative Cognitive Dysfunction: A Clinical Perspective, Kelly Glas

Doctor of Nursing Practice Final Manuscripts

Background: The U.S. Census Bureau projects the number of Americans age 65 years and older will more than double between 2010 and 2050. The geriatric patient population will likely require the use of surgical services at a higher rate than ever before. To best care for the elderly undergoing procedures with anesthesia, it is imperative to follow the most up to date evidence to avoid post-operative complications, and more specifically post-operative cognitive dysfunction.

Purpose: The purpose of this DNP evidence-based practice project is to identify patients that are at high risk for post-operative cognitive dysfunction prior to undergoing anesthesia. Post-operative …

Remifentanil Patient Controlled Analgesia Use In Laboring Women: A Feasibility And Acceptability Study, Joshua Carr

Dissertations

Background/Purpose: Interest in remifentanil patient controlled analgesia (RPCA) as a treatment for labor pain has increased due to its unique pharmacodynamics and effectiveness on pain control among parturients. Despite its promise, RPCA remains infrequently used in the US. The purpose of this study was to 1) examine the implementation and acceptability of a new RPCA protocol in the labor and delivery ward of a mid-sized hospital, and 2) identify the attitudes and beliefs of healthcare workers in a real-world clinical setting.

Theoretical/Conceptual Framework: The holistic nature of Comfort Theory can account for the proposed mechanisms contributing to the …

Quality Improvement: Education And Implementation Of Proper Narcotic Handling Practices By Nurse Anesthetists, Shelby Stevenson, Anne Hendershott, Alexis Asprah

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Medication errors are estimated to occur once in every 150-300 surgeries (Wahr et al., 2017, p. 36). Unsafe injection practices can lead to increased morbidity and mortality, diminish the overall quality of life for patients, and contribute to substantial increases in healthcare costs. A large majority of unsafe injection practices are caused by a lack of education or mistaken beliefs regarding safe injection practices. Educational reinforcement of safe narcotic handling techniques has significant potential to increase the appropriate use of narcotic syringes among nurse anesthesia providers. The long-standing impact of this project could lead to a reduced number of ‘never …

Best Practice In The Perioperative Anesthetic Management Of Infants With Gastroschisis, Emily R. Lester

Doctor of Nursing Practice Projects

Gastroschisis, a severe abdominal wall defect, occurs in approximately 1 in every 2,000 fetuses. Despite care advancements, gastroschisis is associated with significant morbidity and mortality including prolonged time to tolerance of enteral feeds, prolonged ventilator support, and increased intensive care unit length of stay and hospital costs. A recent practice change in the care of infants with gastroschisis at a tertiary care facility in central Illinois lead to the request for an integrative review of the available literature and subsequent development of a comprehensive guideline discussing best-practice perioperative recommendations pertinent to the care of infants with gastroschisis. Through review of …

Development Of Evidence-Based Rubrics And Instructional Videos For Anesthesia Induction Sequences, James P. Canny, Nathan M. Carroll

Doctor of Nursing Practice Projects

Safe and effective induction of anesthesia is a vital component of any anesthesia provider’s skill set. Although both typical sequence and rapid sequence induction are common procedures, much variance in technique exists among providers. Clear, standardized rubrics are an important element in teaching these skills. The purpose of this project was to update the typical and rapid sequence induction rubrics for the Southern Illinois University Edwardsville Nurse Anesthesia Program with the current best practice recommendations. To utilize and reinforce observational learning, instructional videos were also created to accompany the updated rubrics. These materials were presented to the student registered nurse …

Esmolol Compared To Fentanyl On Hemodynamic Effects: A Scoping Review, Anna Mccleskey Bsn, Rn, Srna, Landon Mcdonald Msn, Rn, Cnl, Tim Moore Bsn, Rn, Srna, Jamie Pitcock Bsn, Rn, Srna, Dwayne Accardo Dnp, Crna, Aprn

Doctor of Nursing Practice Projects

Purpose The purpose of this DNP project is to compare the efficacy of esmolol to fentanyl in attenuation the hemodynamic response associated with direct laryngoscopy.

Specific Aims Compare the effects of esmolol to fentanyl on patient heart rate during laryngoscopy. Compare the effects of esmolol to fentanyl on patient mean arterial pressure during laryngoscopy.

Perioperative Protocol To Prevent Emergence Delirium In Patients With Post-Traumatic Stress Disorder, Audrianna Bustos, Roxanne Sambuca

DNP Scholarly Projects

Introduction: Ten percent of adults will experience post-traumatic stress disorder (PTSD) at some point during their lifetime, 50% of which remain untreated and undiagnosed. Perioperative management of the patient with PTSD may create significant challenges for the anesthesia provider. Patients with PTSD are more likely to experience emergence delirium (ED), which poses a significant safety threat to patients and staff. Screening for PTSD is routine in the veteran population but has not yet translated into common practice. To our knowledge, no protocol currently exists for anesthetic management of patients with PTSD. Routine screening for PTSD in the preoperative period and …

Malignant Hyperthermia, Brennon Pinion

Nursing Student Class Projects (Formerly MSN)

Malignant Hyperthermia is a rare but potentially fatal disorder that is triggered by the use of certain anesthetic medications. It is caused by a mutation in specific proteins in skeletal muscle that causes prolonged contraction, leading to a hypermetabolic state. This condition can have deadly effects like kidney failure, hemodynamic instability, and cardiac arrest. It is normally discovered during surgery and must be treated right away. The discovery of the treatment of Malignant Hyperthermia has dramatically decreased the fatality of the disorder, but treatment must be given immediately. For patients who develop Malignant Hyperthermia to have the highest chance of …

Substance Use Disorder In The Crna, Bridget Hayes

Nursing Student Class Projects (Formerly MSN)

Substance use disorder (SUD) affects the anesthesia community disproportionally as compared to the general public (Rupprecht, 2022). It is estimated that SUD will affect 10%-15% of all anesthesia providers at some point in their careers (Rupprecht, 2022). One way that SUD affects the human body is the alteration of microRNAs, which are small segments of RNA that exist to regulate gene expression (Gowen et al., 2020). This poster will discuss how miRNAs change in the SUD-affected individual, anesthesia-specific risk factors, and signs and symptoms to identify when this disorder has affected someone else. Resources for help are available from the …

A Quality Improvement Initiative For Intraoperative Low Dose Ketamine Utilization In Thoracotomy, Jason Wampler

Graduate Theses, Dissertations, and Problem Reports

The challenge of postoperative pain control following a thoracotomy is well noted among anesthesia providers. The intraoperative utilization of low-dose ketamine in several patient populations, including those undergoing a thoracotomy, has been deemed a viable intervention in the multi-modal analgesia plan at not only reducing postoperative pain scores for patients, but also reducing opioid consumption. This quality improvement project sought to increase provider awareness of this intervention among anesthesia providers in a community hospital with a goal to influence a practice change. This was completed using a pre-post design centered around an educational in-service, with an additional 60-day follow-up survey …