Nursing Commons^™

Development Of Clinical Practice Guidelines For Incorporating Paravertebral Blockade For Thoracic Surgery Adult Patients, India Hutchison

Doctor of Nursing Practice Scholarly Projects

Thoracic surgery is considered one of the most painful surgical procedures due to its severity and the duration of the procedure. Pain is detrimental to the patient experience, and poor patient satisfaction results in revenue loss for hospitals. Maintaining adequate pain control after surgery is crucial in preventing pulmonary complications such as atelectasis and respiratory failure that prolong patient recovery. It is the responsibility of the anesthesia provider to ensure adequate pain control throughout the perioperative experience. Although current evidence-based data shows that regional anesthesia provides superior thoracic postoperative pain control, the current practice continues to be the utilization of …

Implementation Of Guidelines For Preprocedural Ultrasound In Neuraxial Placement For Obstetric Patients With Scoliosis, Luther Nyirenda

Doctor of Nursing Practice Scholarly Projects

Neuraxial anesthesia including epidural, spinal, and combined spinal-epidural, is used with 65% of parturients in the United States for the management of pain and discomfort. Conventional landmark palpation has been the mainstay technique for neuraxial anesthesia, but unfamiliar spinal anatomy can lead to incomplete blockade or an increased incidence of complications. Scoliosis causes lateral curvature and rotation of the spine leading to arthritis and soft tissue changes that can present obscure anatomical landmarks, cause difficulty in needle passage, and result in inadequacy of local anesthetic efficacy. The literature illustrates that preprocedural ultrasound is recommended for needle placement in parturients with …

Development Of An Evidence-Based Crna Preceptor Training Program, Emmanuel Mensah

Doctor of Nursing Practice Scholarly Projects

A preceptor is an experienced clinician who is expected to facilitate a student's learning experience. Preceptorship is the relationship between a staff nurse and student, focusing on the development of clinical skills and knowledge. Initially introduced by Florence Nightingale in the 1800s, the concept was quickly adopted by nurse anesthetists and is a staple of the anesthesia practice today. As it stands, many Certified Registered Nurse Anesthetists (CRNA) preceptors do not receive formal training in their role, which may lead to a decrease in teaching ability and confidence to face broad teaching-learning issues. A lack of preparation hinders preceptor outcomes …

Preprocedural Ultrasound For Labor Neuraxial Anesthesia: Evidence-Based Practice Recommendations, Nicholas Anderson

Doctor of Nursing Practice Scholarly Projects

Central neuraxial blockade (CNB) is the most widely used method of anesthesia provided to laboring patients and includes epidural, spinal, combined spinal-epidural, and caudal techniques. Studies have shown that using preprocedural ultrasound is a safe and effective tool to facilitate the placement of neuraxial needles, especially in patients with predicted difficulty. With the prevalence of obesity increasing, laboring patients with predicted difficulty of neuraxial needle placement is increasing as well. In addition, the traditional method of palpation and visualization of anatomical landmarks to place neuraxial needles can produce inaccurate results due to inconsistencies between patients. Use of preprocedural ultrasound to …

An Evidence-Based Strategy For The Use Of Simulation To Assess Situation Awareness In Applicants To Nurse Anesthesia Programs, Angela Lee

Doctor of Nursing Practice Scholarly Projects

Medical errors are considered one of the top causes of patient death. Closed claims analysis reveals an estimated 50% of claims are associated with preventable events by the anesthesia provider. Errors in anesthesia leading to critical incidents are associated with errors in situation awareness (SA). Identification of human factor variables, such as SA, provides an analysis of observable behavior and intuition necessary to guide crisis management, maintain clinical performance, and mitigate errors in patient safety. The human factor components of human error and SA play critical roles in patient safety and overall clinical anesthesia practice. The viability of simulation assessment …

Development And Implementation Of An Evidence Based Practice Guideline Related To The Management Of Adult Angioedema, Megan Przybysz

Doctor of Nursing Practice Scholarly Projects

Angioedema (AE) is a potentially life-threatening medical condition that occurs with a higher frequency than medical providers may expect, with the emergency department (ED) serving as the usual first point of medical contact for patients. Any hesitation in recognizing AE or inconsideration of the disease process in differential diagnoses may lead to a dangerous delay of care. Due to the potential rapid progression of airway obstruction in AE, inexperienced providers should not attempt intubation, instead deferring to providers experienced in alternative airway techniques (i.e., anesthesia providers). The primary goal of this project is to develop an evidencebased practice guideline for …

Final Scholarly Project: Clinical Guidelines For The Perioperative Management Of Patients With Opioid Use Disorder Requiring Anesthesia, Jessica Kayla Joos

Doctor of Nursing Practice Scholarly Projects

Opioids have highly addictive properties that allow for high levels of misuse. Since the early 1990s, the misuse and deaths rates related to narcotics have steadily risen in the United States. Efforts to identify individuals using opioids prior to surgery have proven difficult. The number of patients misusing opioids and reporting for surgery can only be estimated due to under-reporting related to fear and self-stigma. With 50 million surgeries in the U.S. annually and 3.32 million people misusing opioids monthly, the chances of a patient with Opioid Use Disorder (OUD) presenting for anesthesia are exceptionally high. Moreover, patients who rate …

Implementation And Evaluation Of A Structured Mentorship Program, Cary Bedinghaus, Caroline Hillman

Doctor of Nursing Practice Scholarly Projects

The project addresses mentorship in a graduate nursing anesthesia program. The goal is to improve the existing mentorship program and to implement a durable and consistent system that gathers and responds to feedback from the students. Two literature reviews form the underpinnings of the structure and evaluation components of the project. Three structural components were identified in the review as highly effective in multiple studies of diverse mentorship programs. The first component is establishing an effective dyad matching scheme. The second component is establishing clear goals. The third component is maintaining the relationship and achieving goals through frequent and consistent …

Implementation Of Evidence Based Practices To Reduce Postoperative Sore Throat, Anthony Brusadin

Doctor of Nursing Practice Scholarly Projects

An estimated 15 million endotracheal tube (ETT) intubations occur annually in the United States. In addition to pain and nausea, one of the leading complaints by patients after intubation is a sore throat. Postoperative sore throat (POST) is caused by increased pressure on the trachea from the ETT during intubation and after the ETT cuff has been inflated. To prevent the occurrences of POST many options were explored, including cuff material, shape, filling media, and ETT tube size. Through research one of the ways to reduce POST is by monitoring the cuff pressure of the ETT against the tracheal. Typically, …

Breastfeeding After Maternal Anesthesia: A Guideline Development, Megan Berens

Doctor of Nursing Practice Scholarly Projects

Postoperative breastfeeding recommendations for lactating mothers by anesthesia providers are inconsistent and often inaccurate. Inappropriate recommendations have led to withholding of breastmilk to the infant, unnecessary disposal of breastmilk, surgical delay, exposure of an infant to high levels of drugs in breastmilk, and early cessation of breastfeeding. The purpose of the scholarly project was to develop a set of evidenced-based practice guideline recommendations and a proposed implementation plan for anesthesia providers to use in support of breastfeeding mothers who recover from surgery. Many studies in the literature indicate that there are inconsistencies in postoperative breastfeeding recommendations by anesthesia providers. When …

Development And Implementation Of An Ultrasound-Guided Peripheral Intravenous Catheter Insertion Training Program For Student Registered Nurse Anesthetists, Nicholas Colangelo, Zachary Wise

Doctor of Nursing Practice Scholarly Projects

The American Association of Nurse Anesthetists (AANA) has defined the scope of nurse anesthesia practice to include services in acute, chronic, and interventional pain management, as well as the use of ultrasound (U/S) and other diagnostic technologies. However, there are no standard curriculum requirements in place that mandate graduate programs to educate student nurse anesthetists in U/S-related modalities. In addition to the AANA, the use of U/S in nurse anesthesia practice has recently been adopted by The Council on Accreditation of Nurse Anesthesia Educational Programs (COA), which characterizes U/S use by its clinical impact on the reduction in complications, increased …

Development And Implementation Of An Evidence-Based Practice Guideline Regarding Cricoid Pressure, William Carson Ii

Doctor of Nursing Practice Scholarly Projects

Cricoid pressure (CP) has been a standard of practice since the 1960s. The purpose is to reduce aspiration of gastric content into the lungs in high-risk patients undergoing induction of general anesthesia. Aspiration has been identified as the most common cause of airway-related mortality for patients undergoing general anesthesia. The cause of airway-related mortality can be correlated to the application of CP. Incorrect application of CP may lead to adverse clinical events and outcomes. It has been demonstrated that when administering CP in a simulation-based environment, providers are applying pressure to the incorrect anatomical location and/or applying the incorrect amount …

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 …

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, …

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 …

Parkinson's Disease And Anesthesia, Anthony Brusadin

Nursing Student Class Projects (Formerly MSN)

Parkinson’s disease is one of the most common neurodegenerative disorders in the world and is rapidly growing. With the global population living longer there will be more people that develop Parkinson’s like the average person’s life expectancy increases. With no cure and only treatment and management of the symptoms, it is important for research to continue to find better treatment options and potentially a cure. In the world of anesthesia patients with Parkinson’s are more difficult to manage with sedation medication because of the lower dopamine levels the patient has. It is important to stay updated on how to prepare …

Type I And Type Ii Diabetes Mellitus: Pathophysiology And Nursing Anesthesia Considerations, Megan Przybysz

Nursing Student Class Projects (Formerly MSN)

Diabetes Mellitus is prevalent across the globe, affecting more than 400 million people worldwide (Ogurtsova, 2017). Due to the high incidence of those affected, all healthcare providers will be responsible for the care of a diabetic patient, making it imperative that providers have a working knowledge of the pathophysiology of diabetes. This poster discusses the pathophysiology of type I and type II diabetes mellitus, as well as diabetes signs and symptoms and diagnostic criteria. There is also an examination of comorbidities associated with diabetes and how the pathophysiology of diabetes assists in the development of conditions such as autonomic neuropathy, …

Malignant Hyperthermia, Nicholas Colangelo

Nursing Student Class Projects (Formerly MSN)

Malignant hyperthermia is a rare manifestation of a genetic mutation involving the ryanodine receptors. This mutation causes a sustained intracellular calcium release that is triggered by certain anesthetics such as depolarizing neuromuscular blockers and volatile gases. The extended release of calcium functions as a dangerous catalyst for hyper-metabolism that will lead to rapid death if unrecognized and untreated. Current treatment involves the drug dantrolene in tandem with symptomatic management in the intensive care setting. Symptomatic treatment may likely involve rapid cooling, fluid resuscitation, electrolyte management, and mechanical ventilation until symptoms resolve. A literature review of malignant hyperthermia is of vital …

Understanding Covid-19, William Carson Ii

Nursing Student Class Projects (Formerly MSN)

The SARS-CoV-2 outbreak has changed the lives of many. To combat the disease referred to as COVID- 19, anesthesia providers must be educated on specific topics. Understanding of a brief history of previous strands of the disease details the need for measures to reduce healthcare providers exposure. As patients present to the operating room (OR), viral and antibody testing combined provides identification and prognosis of the disease with infected patients who can transmit the disease. Anesthesia providers encounter transmission entry points frequently increasing possibility of exposure. The disease process of COVID-19 can lead to progression of complications necessitating interventions from …

Malignant Hyperthermia, Courtney Stevenson

Nursing Student Class Projects (Formerly MSN)

Malignant Hyperthermia (MH) is a rare but life-threatening medical emergency. It is a skeletal muscle disorder that leads to a hypermetabolic reaction. It occurs in response to the administration of inhaled anesthetics and depolarizing muscle relaxants.

Opiate Addiction And Considerations For Anesthesia, James Saltanovitz

Nursing Student Class Projects (Formerly MSN)

Opiate addiction and awareness are problems and should be of interest to our society, particularly those working in healthcare. This poster provides statistics that provide the reader with information of the depth of the problem in the United States. The poster presents information for the reader to better understand opiate addiction’s pathophysiology, signs, and symptoms. For anesthesia providers there are many different evaluations that can be made to make sure that us at risk or opiate dependent patients are safe while under anesthesia. The poster presents many alternative options to help prevent patients’ from feeling pain, while also keeping them …

Pheochromocytoma, Cody Plapp

Nursing Student Class Projects (Formerly MSN)

• Pheochromocytoma presents with unusual symptomology and can remain difficult to diagnose. Early detection is paramount along with pre-surgical pharmacological intervention for best outcomes. Decrease manipulation of tumor to avoid additional secretion of catecholamine (Chung et al., 2018). From an anesthesia perspective, pheochromocytomas in patients presents a severe risk to the preservation of life pre, intra, and post-operatively. It remains necessary to prevent hemodynamic instability and to prevent administration of drugs which may elicit hemodynamic instability, since prolonged hemodynamic instability may lead to loss of life or chronic disability (Sonntagbauer et al., 2018).

Poster: Malignant Hyperthermia Preparedness For Labor And Delivery Nurses, Patricia Rabinowitz

Doctor of Nursing Practice Scholarly Projects

Malignant Hyperthermia (MH) is a rare, inherited disorder of skeletal muscle triggered by general anesthesia in susceptible individuals. Although MH can occur later in the anesthetic course as well as post-operatively, it most frequently occurs shortly after induction of general anesthesia.

Operating room (OR) nurses receive extensive training in MH crisis management. On labor and delivery (L&D) units, neuraxial (spinal and epidural) blocks are the safest and most commonly used anesthetics during pregnancy. General anesthesia is utilized only when the life of the mother or infant is in jeopardy or when a neuraxial block is not possible. Under these circumstances, …

Malignant Hyperthermia, Alexandra Mcguire

Nursing Student Class Projects (Formerly MSN)

Malignant Hyperthermia (MH) is a rare but life-threatening, genetic condition that can manifest when a patient is exposed to certain inhalation agents used in anesthesia as well as the depolarizing muscle relaxant succinylcholine (Rosenberg, Pollock, Schiemann, Bulger, & Stowell, 2015, p. 1). MH can develop during or after a surgical procedure and if left untreated, can cause major organ system damage and death (Seifert, Wahr, Pace, Cochrane, & Bagnola, 2014, p. 189). Creating awareness of this rare genetic condition allows for quicker interventions in reversing MH.

Post-Operative Nausea And Vomiting In Adults, Kristina Ann Vasnaik

Nursing Student Class Projects (Formerly MSN)

The purpose of this evidence-based poster is to discuss post-operative nausea and vomiting in the adult population undergoing surgery. Post-operative nausea and vomiting is a common concern for patients and providers, a common complication of surgery, and leading cause of unexpected hospital admission of ambulatory care patients. Post-operative nausea and vomiting also increases healthcare costs and causes decreased patient satisfaction as it creates additional discomfort for the surgical patient. The goal of this poster is to discuss common pathophysiology and significance of post-operative nausea and vomiting, signs and symptoms, risk factors for developing post-operative nausea and vomiting, pre-operative/intra-operative/post-operative treatment strategies, …

Malignant Hyperthermia, Ashley Casimir Vasnaik

Nursing Student Class Projects (Formerly MSN)

The Certified Registered Nurse Anesthetist (CRNA), as well as other anesthesia providers and support staff interact with a variety of patients on a day to day basis. These patients come to the hospital to seek help for their medical and surgical ailments. As every patient is different, they can also have a variety of health-related issues, many of which can also impact their anesthetic plan. One of the most difficult issues and or emergent situations that can impact everyone in the operating room is an exacerbation of Malignant Hyperthermia (MH), whether it is anticipated or unanticipated. The task of preventing …