A small compilation of nurse anesthesia care plans

These anesthesia care plans are meant to inspire nurse anesthesia residents when they are making their care plans. Always make sure you fully understand and "own" your care plan. Your plan must be specific for your patient and should always be with the most up-to-date information.

Arthritis

Osteoarthritis (OA) / Degenerative Joint Disease

OA is a degenerative process affecting the articular cartilage of one or more joints, most commonly the knee and hip. The spine is often involved, so be careful with neck position during intubation. Usually, it is due to wear and tear (think age or obesity)—minimal inflammatory reaction

Ankylosing Spondylitis (AS)

AS is also known as rheumatoid spondylitis and Marie-Strumpell disease. This chronic inflammatory disorder primarily affects the spine and sacroiliac joints and causes spinal vertebrae and costovertebral joint fusion

  • Chronic low back pain
  • X-ray evidence of bilateral sacroiliitis
  • Limited chest wall expansion
  • Extraskeletal limitations: iritis (inflammation of the iris), cardiac conduction defects, peripheral arthritis, fever, fatigue, weight loss, and fibrobullous disease of the apexes of the lungs

Rheumatoid Arthritis (RA)

RA is prevalent in the orthopedic population and may involve the pulmonary (pleural effusion), cardiac (pericardial thickening and effusion, conduction defects, cardiac valve fibrosis), and musculoskeletal systems (usually multiple joints, symmetrical involvement). It differs from OA because it is immune-mediated joint destruction due to inflammatory processes in the synovial membranes.

  • Cervical spine: limited neck ROM, influencing airway management
  • Temporomandibular joint (TMJ): pain and limited mouth opening (may require fiberoptic nasal intubation)
  • Larynx: possible cricoarytenoid joint arthritis (note hoarseness), requiring the use of a smaller ET tube

Advanced RA patients are at substantial risk for compression of the spinal cord with intubation due to cervical instability, and some require pre-op X-rays. RA patients may be on steroids; note for perioperative steroid treatment, be aware of thin and atrophic skin, adrenal insufficiency, and impaired immune system.

  • It primarily affects synovial tissues
  • Immune-mediated joint destruction
  • Morning stiffness around joints
  • Swelling around three or more joints
  • Subcutaneous rheumatoid nodules
  • X-ray showing erosion or bony decalcifications

Characterized by chronic pain and inflammation, which limits the degree of patient mobility.

Anesthetic considerations

  • Bleeding disorder due to aspirin, nonsteroidal anti-inflammatory drugs, and corticosteroid treatments
  • Consider PT, PTT/INR/ PLT
  • Consider the need for supplemental steroid coverage
  • Protect airway; may need fiberoptic intubation
  • Both AS and RA can mask cardiac disease as pts have low exercise tolerance due to pain and joint restrictions

Special Considerations

  • Bleeding disorder due to aspirin, nonsteroidal anti-inflammatory drugs, and corticosteroid treatments
  • Consider PT, PTT/INR/ PLT
  • Consider the need for supplemental steroid coverage
  • Protect airway; may need fiberoptic intubation
  • Both AS and RA can mask cardiac disease as pts have low exercise tolerance due to pain and joint restrictions