Nurse Anesthesia Department

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    Neuromuscular Disorders & Anesthetic Implications
    ( 2014) Kujanek, KIm ; Kursch, Amber ; Pekarek, Hilary
    Describe the basic pathophysiology, diagnosis, treatment, and anesthetic implications of 24 neuromuscular disorders. Increase the anesthesia provider’s awareness and knowledge of neuromuscular diseases. Present the most recent data related to neuromuscular diseases thereby allowing the opportunity for anesthesia providers to treat patients with current, evidence based research findings.
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    Nurse Anesthesia Clinical Mentorship Program
    ( 2014) Staten, Amber ; Baptista, Danielle
    Project: Implementation of a Clinical Mentorship Program. Problem: Transition from registered nurse to student registered nurse (SRNA) is extremely challenging; Struggling SRNAs facing inconsistencies in clinical setting; Difficult to establish foundation in anesthesia when paired with different providers each day. Intended Project Outcomes: Provide excellent clinical experience; Build confidence and support struggling SRNAs; Enhance basic concepts and skills necessary for safe anesthesia care.
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    Specialty Rotation: Pediatric Cardiac Anesthesia
    ( 2014) Gurr, Brian ; Noth, Russell
    Our project sought to increase the knowledge of student nurse anesthetists at the Adventist University of Health Sciences on pediatric cardiac anesthesia by creating a learning module and administering a pre and post module test. Scores when then compared to evaluate module effectiveness. In addition, a pediatric cardiac clinical rotation was established.
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    The Lumbar and Sacral Plexus and Their Role in Anesthesia
    ( 2014) Bolin, Niki ; Whitcomb, Emily
    In the Fall Semester of 2012, the Nurse Anesthesia Class of 2014 was introduced for the first time peripheral nerve blocks (PNBs) of the lower extremity. Although lots of time was dedicated to the PNB procedures and ultrasound technique, the class spent several hours self-studying the anatomy and physiology. This included reviewing approximately six to seven chapters in the Hadzic Regional Anesthesia Textbook. In efforts to aid in this described problem, the authors of this capstone project created a learning module that was presented to the Class of 2015. This module, which included an extensive literature review and PowerPoint presentation about regional anesthesia of the lumbar and sacral plexus including the anatomy, technique, complications, and clinical importance, was introduced to the Class of 2015 during their third semester on November 11, 2013. To evaluate the success of this capstone project, a 19 question pre and post-test was administered to 22 students. In addition, the same test was administered 12 weeks later to help determine recall on this topic. The results demonstrated that test scores increased with each subsequent administration from an approximate mean score of 56.1% to 77.5%. Following the completion of the pre-test, post-test 1, and post-test 2, a statistical analysis was completed in efforts to determine significant outcomes. A One-Way Analysis of Variance (ANOVA) showed a statistical significance of p < 0.05 at a p-value of 0.009. This led to an additional statistical analysis using a post hoc multiple comparison. Even though the mean scores increased with each subsequent test, post hoc comparisons indicated that a significant difference could only be found between mean scores of Pre-test and Post-Test 2 (p = .002). This result proved to be an interesting finding. There could be several factors responsible for the improved mean test scores. Students had 12 weeks between the presentation and post-test 2. During this time, students received an additional exposure to the material through an ultrasound-simulation lab, completion of assigned reading, and examination preparation. In addition, some students may have received exposure to lower extremity PNBs during their clinical rotations. These could all contribute to the limitations of the statistical analysis. The literature review completed for this capstone demonstrated the importance of lower extremity PNBs to anesthesia providers and the importance of classroom exposure to the anatomy and physiology of these nerve blocks. The goal of this capstone project was to aid in the classroom portion of SRNA’s education on lower extremity PNBs. The Likert Scale survey, administered by the authors of this project and with anonymously reported results, indicated students at ADU believes that the information presented is essential in their mastery of this material and that this material should continue to be presented in subsequent years.
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    Educating Student Registered Nurse Anesthetists (SRNAs) on Diagnosing and Managing Preoperative Thyroid Storm Using a Simulation Scenario
    ( 2014) Ashrov, Aziz ; Mulandi, Victoria
    Thyroid storm is one of the most highly ranked endocrine emergencies and is an extreme presentation of thyrotoxicosis. Although intraoperative thyroid storm incidence is a rare event in hyperthyroid patients (10%), it accounts for high mortality rate of up to75% due to cardiac failure, shock, thromboembolic complications, and multi-organ failure. Timely recognition and the management of TS is vital for the anesthesia provider in ensuring patient safety and prevention of fatal outcomes.
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    Management of Three Uncommon but Potentially Detrimental Anesthesia Emergencies; Amniotic Fluid Embolism, Local Anesthetic Toxicity and Intraoperative Myocardial Infarction
    ( 2014) Bringas, Sara ; Maina, Naomi ; Reid, Claston
    The operating room (OR) is usually a very controlled environment. There are rituals and routines that are characteristic of the OR and often makes for a predictable day. However, surgical intricacies may lead to rapid patient deterioration. As anesthesia providers the onus is upon us to identify and rectify the problem and restore equilibration. The focus of the capstone project to be undertaken by Naomi Maina, Sarah Bringas and Claston Reid is to provide a systematic approach to identifying common and not so common operating room emergencies and also present algorithms for the treatment of such emergencies. The importance of this project cannot be over stated. It is a known fact that judgment, memory and tactile response are significantly impaired during acutely stressful situations. And therefore this project seeks to give the anesthesia provider, especially the new provider some of the basic tools needed to deal with OR emergencies.
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    Care Planning Process for Specialty Rotations
    ( 2014) Berrios, Jane ; Chance, Elena ; Kim, Yuni
    Transitioning into a specialty rotation with minimal didactic opportunity in these areas can not only be difficult for the student nurse anesthetist, it can also cause variations of anxiousness. Having a basic understanding of the specialty rotation can be provided through preparation by developing a care plan, as well as learning how to utilize and implement the care plan. This offers the SRNA a tool to allow for an efficient transition that alleviates the anxiousness that usually occurs when starting these rotations. Research was executed regarding the benefits and barriers to utilizing and implementing the care planning process and compiling data to construct the care plans for the specialty rotations. A lecture was presented to the junior SRNAs and an anonymous pre and post likert scale questionnaire was employed to evaluate the effectiveness of the lecture. This examined the level of anxiousness for each rotation presented prior to and after the presentation. Collaboration with a statistician was exercised to identify significant findings regarding the questionnaire results. The anticipated outcomes were not achieved and unexpected results were obtained. With the exception of two items (item 1 and item 6), there were no statistically significant results in the remaining items. This could be due to the fact that the neutral category was not clearly defined and its allocation in the negative category may have skewed the significance of the results. Lack of time for the presentation and a poor evaluation tool were identified as prime areas that were likely to contribute.
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    Advancement of the Nursing Honor Society and Development of Sigma Theta Tau Internatioinal Chapter at Adventist University of Health Sciences
    ( 2015) Tucker, Ffion ; Silas, Blessy
    The Honor Society of Nursing, Sigma Theta Tau International (STTI), was founded by six nurses from Indiana School of Nursing, Indiana, in 1922. The purpose or mission of the STTI is to assist the learning, knowledge and professional advancement of nurses devoted to making a difference in global healthcare. The Adventist University of Health Sciences (ADU) established the Nursing Honor Society (NHS) in 2013 and is in the process of becoming a chapter of STTI. The ADU honor society has already completed the first two phases of STTI chapter development and is now operating in the third phase. The process of establishing an STTI chapter at ADU was started in 2012 by two nurse anesthesia students from the class of 2013 and was followed by another student from the class of 2014 who helped the chapter to proceed into the third phase. The goal of this project was to advance this chapter to its next phase and recruit needed members (50) to apply for the STTI chapter. This project needed to be done in order to help promote the NHS and to build membership so that the goal of achieving STTI status can come to fruition. This was necessary so that the mission of ADU and the STTI to build healthcare and advance nursing professional excellence can continue to be met, not only in the Florida Hospital community and its environs, but also globally. Advancing the ADU NHS to STTI chapter would be a great achievement and would provide for inter professional collaboration on an international level. This project has implications for nurse anesthesia practice in that membership by the nurse anesthesia students will deepen the roots of education by providing continuing education in the form of conferences, meetings, and online or in journal articles, and encourages growth by improving the leadership skills. These organizations will help nurses learn the refined values and priorities that are not learned from the classroom. It is of vital importance to help cultivate in these nursing professionals, soon to be CRNA’s, the drive to always strive for excellence and to align themselves with certain organizations that can help to facilitate this growth and development. This growth and development of leadership skills along with the continued drive for excellence by these student nurse anesthetists can also transcend into the work place and affect anesthesia practice.
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    Understanding the Concept of Regional Analgesia/Anesthesia and Its Implications on Nursing Care
    ( 2015) Phan, Shirley ; Saint-Sauveur, Odevelyne
    To present evidence-based clinical guidelines for the assessment and management of women undergoing regional analgesia/anesthesia during labor and delivery. To assess nursing student’s knowledge related to the concept of regional analgesia/anesthesia for pain management of the women in labor. To offer information about the concept of regional analgesia/anesthesia directed at reinforcing a provider’s understanding of their role and responsibilities in the care of the laboring patient before, during, and after the administration regional analgesia/anesthesia.
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    Top 9 Herbal Hazards in Anesthesia
    ( 2015) Geyer, Sara ; Osorio, Edgar
    Herbs are products made from plants used to treat disease or improve quality of life. Herbal supplements have been used for centuries, but their use in western and eastern societies is increasing. Herbal products have intrinsic pharmacological activity and side effects that when combined with medications can have severe adverse effects. It is estimated that as much as 20% of the population in the United States consumes herbal supplements, and 70% of those taking herbal supplements fail to tell their physicians (Ruiz & Maldonado, 2014). With the increasing use of herbal supplements and patients’ failure to mention them to providers, there is a definite need to ask patients pre-operatively for their use of supplements to prevent potential adverse events. Due to the lack of research, the American Society of Anesthesiologists has determined that there is insufficient data to provide exact dosage recommendations for individual herbs; therefore, we have reviewed the literature to examine the safety, pharmacodynamics, and pharmacokinetics of the top nine herbs most frequently seen among patients.
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    Safe Syringe and Needle Use
    ( 2015) Russu, Demis ; Wade, Robert
    It is the moral duty of anesthetists to provide excellent patient care, while virtually eliminating any hazardous risks. Education is a key component to positive results. An extensive literature review was conducted regarding proper infection control practices among anesthesia providers focusing on safe syringe and needle use. Unfortunately, the findings demonstrate the need for further education on this subject as unsafe practices violating the AANA’s standard IX continues to occur. In addition, the education gap between student nurse anesthetist and proper infection control practices was analyzed. The analyzed data demonstrated that there was a significant increase in average scores from pre to post-test evaluations. This suggests that the educational material, which was presented in between pre and post-test evaluations, is a positive tool to increase the knowledge base regarding safe syringe and needle use among SRNA cohorts. Literature containing conflicting evidence concerning the use of single–dose vials for multiple patients does exist. Additionally, it challenges the accuracy of the present infection control guidelines and regulations. Furthermore, it analyzes and describes flaws with the studies used to develop the guidelines and regulations that are currently used as standard of practice. This can further add to the level of confusion to practitioners that practice anesthesia based on evidence. Nevertheless, it is clear that in order to prevent infection and its transmission all healthcare providers must not breach hand hygiene, sterile preparation, or barrier precautions.
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    Assessment and Management of the Opioid Tolerant Patient During the Perioperative Period
    ( 2015) Rauch, Karla ; Bautista, Claire
    Currently, management of chronic pain patients in a perioperative setting continues to be a challenge for every anesthesia provider. The challenges faced include opioid-induced hyperalgesia, patient satisfaction with their pain control, prevention of long-term disability, and issues of delayed mobilization due to uncontrolled pain. These challenges may occur due to under medication or lack of balanced analgesia techniques. Conversely, overmedication can lead to postoperative respiratory insufficiency with prolonged ventilator dependence and associated complications increasing length of hospital stay. These challenges are complicated for experienced providers; therefore, student registered nurse anesthetists (SRNAs) beginning their clinical rotations will find managing these patients an even greater challenge. The goal of this project was to provide tools for use in the care of patients with chronic pain. Tools that were provided included introducing the new SRNA to an in-depth preoperative pain assessment, a thorough understanding of the pathophysiology of acute and chronic pain development, dosing and regimens of analgesic adjuncts to be utilized concomitantly with opioids, and the use of equi-analgesic opioid dosing to plan appropriate interventions to improve the future health of their patients. Case scenarios were discussed to emphasize multimodal analgesia techniques to reduce the negative side effects of a pure opioid analgesia technique.
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    Thromboelastography (TEG) and Rotational Thromboelastometry (ROTEM)
    ( 2015) Morales, Jesus ; Vu, Chau
    Review coagulation cascade Review cell-based model of coagulation Limitations of conventional tests History of TEG and ROTEM Current research Differences between TEG and ROTEM ROTEM parameters and analysis Cardiac and liver case management Limitations of TEG and ROTEM
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    Clinical Uses and Limitations of the FloTrac Monitoring System
    ( 2016) Simpson, Adam ; Morris, Jonathan
    Background: The Edwards Lifesciences FloTrac Monitoring System can be utilized in the operating room to improve patient outcomes with the use of continuous measurement of hemodynamics. Those measurements can be used to help determine a patient’s fluid status or cardiac function. Student registered nurse anesthetists often have a lack of understanding and familiarity with FloTrac. The aim of this study was to educate those SRNAs with a PowerPoint presentation and increase their ability to utilize FloTrac. Methods: After informed consent was obtained, a convenience sample of 23 SRNAs at Adventist University of Health Sciences were given a 10-question test. A PowerPoint was then presented to the participants. At the conclusion of the PowerPoint, the SRNAs were given the same 10-question test. The tests were graded, and those numbers were then analyzed. Results: The mean score of the pretest was 3.8696, while the posttest was 8.4348. The standard deviation of the pretest was 1.86607 and the posttest was 1.07982. The obtained t value was -9.991, which is associated with a p < 0.05. This is considered statistically significant. Conclusions: The statistics show that the SRNAs demonstrated a significant increase in their knowledge and understanding of FloTrac. The participants may now have the understanding and confidence needed to appropriately utilize FloTrac in the clinical setting. Hopefully, this will lead to an increase is patient safety.
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    Mechanical Assist Devices for Heart Failure Education
    ( 2016) Mattison, Kenneth A ; Thomas, Tamara
    An educational deficit has been noted among Certified Registered Nurse Anesthetists (CRNAs) of varying backgrounds at a prominent hospital in Central Florida. This is also compounded by a minimal number of available research studies and educational text book materials. The educational lecture provided addressed the need for additional knowledge available to fourth semester Student Registered Nurse Anesthetists (SRNAs). This lecture is also available for utilization by current CRNAs at the previously noted hospital. A convenience sample of 21 SRNAs was utilized. Informed consent and anonymity within the education evaluation process was of paramount concern. No personal data was collected. A pretest and a posttest were provided on a voluntary basis and evaluated for the difference between the two test scores. After completion of the lecture and evaluation, a paired t test was used to compare the results for statistical significance. A p value of < 0.05 was observed, establishing statistical significance. Results obtained concluded that in almost all cases the mean test score significantly increased from the pretest to the posttest. The lecture was made available for future review. The hope is that with increased knowledge, patient safety may be enhanced.
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    Development of an Orientation Resource for JLR New Hires
    ( 2016) McGuire, Kelly Ann ; McNutt, Lindsey Kathleen
    JLR Medical Group had an ineffective orientation process for new hire Certified Registered Nurse Anesthetists (CRNA) and Anesthesiologists. Concern was expressed about the lack of information provided to new JLR employees. Added to the stress of the transition to a new employer, new hires complained of daily confusion regarding site-specific locations, policies, procedures, and expectations. To address JLR’s orientation process, information was obtained from JLR’s current employees regarding their orientation needs. One hundred percent of the respondents strongly agreed that facility access codes and facility maps would have been helpful to the beginning of their employment with JLR. Ninety percent of the respondents strongly agreed that specific site tips and mentors would have been helpful. Eighty percent of respondents strongly agreed that access to print required forms prior to the first day on-site would have been helpful. Site visits were then performed to collect data regarding site maps, directions, door codes, contact information, and other site-specific tips. The most accessible method to deliver this information was identified. Through collaboration with JLR’s information technology department, this information was organized in a standard fashion and made accessible to all employees in a web-based format. One hundred percent of respondents who had utilized the information strongly agreed that facility access codes, facility maps, required forms, specific site tips, and CRNA privileges were helpful to the start of their employment. The implications for nursing practice are that there can be a reduction in new employee stress, employee turnover, and improvement in employee satisfaction with an effective orientation resource.
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    Prevention of Postoperative Visual Loss
    ( 2016) Marble, Tim ; Camille, Felix
    Anesthesia providers have the responsibility of providing safe and competent care to patients that entrust them with their lives. It is expected that all potential hazards be minimized during that time. Such expectation can be met utilizing a plethora of current research evidence available at the disposal of every provider. After conducting a thorough literature review on the incidence of Postoperative Visual Loss (POVL), it is understood that though rare, such a complication can be devastating as it can result in permanent injuries to the victim’s visual system. The knowledge base of a convenience sample size of 39 Student Registered Nurse Anesthetists (SRNAs) at Adventist University of Health Sciences (ADU) on preventative measures of POVL was assessed. The intent of this capstone is to educate the current SRNAs at Adventist University of Health Sciences (ADU) regarding POVL. The ultimate goal is to increase vigilance among current ADU SRNAs when caring for those susceptible to developing POVL, which may subsequently decrease its incidence. A simple t-test difference was conducted. It determined the correlation between the pre and post-tests. The results suggested a significant increase in the knowledge base amongst the SRNAs following a thorough PowerPoint presentation. Education via a POVL PowerPoint presentation is a great positive tool to assess ways in which SRNAs stay informed on current evidence based anesthesia care. The results of the presentation demonstrated an increase in posttest scores and therefore a better understanding of POVL among the sample chosen.
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    Understanding the Concept of Geriatric Anesthesia and Its Implication in Clinical Practice: A Learning Module for Student Registered Nurse Anesthetists
    ( 2016) Rolfsen Simpson, Kim ; Uchegbu, Oluchi B.
    Increase in longevity of the geriatric population, and increase in number of the group has led to an increased frequency of requirement for anesthesia management. A thorough understanding of the physiological changes associated with aging, the effect of aging on various body systems, the intricate medication management, and dosing as it relates to anesthesia practice all become very important. A thorough knowledge of the healthcare implications concerning the geriatric population would be an important tool for the Senior Registered Nurse Anesthetists (SRNA). The purpose of the project was to provide additional learning opportunities to Student Registered Nurse Anesthesia in clinical rotation as an addition to their knowledge base of adult anesthesia care. Grounded knowledge of the care of the geriatric involves a thorough understanding of all aspects of care for this population. The presentation of this learning module involved use of current anesthesia textbooks and journal articles on geriatric anesthesia, as well as the use of visual and audio aids to educate underclassmen. Focusing on the physiology and pathophysiology changes with aging. Understanding of the pharmacological problems associated with aging, the implication of inhalation anesthesia, and local anesthesia on aging were addressed by using current anesthesia literatures and journal articles. A pretest tool was used to evaluate the knowledge base of the SRNAs. A post-test was used to re-evaluate the knowledge base post presentation. Upon review of the pre-test and post-test statistical analysis it was identified that the educational module was instrumental in increasing the knowledge base of the SRNAs who participated in the study.
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    Trauma Setup
    ( 2016) Brown, Natalie ; Wagner, Maria
    Trauma is the leading cause of death for people under 44 years of age and a leading cause of death worldwide making it a massive public health problem (Tobin et al, 2013). As anesthesia providers, we must be equipped to manage trauma cases, as this public health epidemic does not seem to be ending. A good trauma setup is crucial in order to maintain order in the midst of chaos. In order to prevent missing a step in the trauma setup, checklists have proven to be useful. They have been proven to decrease patient morbidity and mortality by assuring a checks and balance system. This capstone project identified the importance of a trauma setup checklist geared toward the anesthesia provider to prevent missing critical steps in the trauma setting.
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    Anesthesia Requirements for Redheads
    ( 2016) Classon, Nathan
    As the melanocortin-1 receptor gene was not discovered until 1995, only anecdotal observation supported that redheads had an increased anesthetic requirement. Utilizing relatively recent research, this project aimed to enhance the knowledge regarding the anesthetic requirements for redheads among student registered nurse anesthetists (SRNAs). Interestingly, there was a decided perspectival shift in the opinion of literature reviewed between 2004 and 2015. Earlier studies were supportive of an increased anesthetic requirement of redheads, while more recent studies discouraged such an approach. It is possible that the later studies relied on self-reported hair phenotype, rather than analysis of genetic makeup of the MC1R genotype. Given this, it is plausible that there is a significant difference in the anesthetic requirements of redheads, depending on whether they are homozygous, heterozygous, or compound heterozygous. Therefore, current literature was reviewed, synthesized, and presented simultaneously to two cohorts of SRNAs at Adventist University (ADU). The project’s efficacy was determined by comparing the scores of an identical pre- and post-test.