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.
Flexible Bronchoscopy
Tracheomalacia
This is characterized by flaccidity of the tracheal support cartilage, which leads to tracheal collapse, especially when increased airflow is demanded. The trachea normally dilates slightly during inspiration and narrows slightly during expiration. These processes are exaggerated in tracheomalacia, leading to airway collapse on expiration. The usual symptom of tracheomalacia is expiratory stridor or laryngeal crow.
Congenital tracheomalacia
This generally goes away by 18-24 months of age. As the tracheal cartilage gets stronger and the trachea grows, noisy respirations and breathing difficulties gradually stop. However, people with tracheomalacia must be monitored closely when they have respiratory infections.
Acquired tracheomalacia
From pressure on the airway by large blood vessels
As a complication after surgical repair of a tracheoesophageal fistula or esophageal atresia
After having a breathing tube or tracheostomy for a long time
Flexible bronchoscopy
Performed when the dynamics of the larynx and the trachea need to be visualized
Position - supine, OR table turned 90-180 degrees
The patient is mask ventilated; IV will be started, DL and squirt cords with LTA (3 mL of 1% lidocaine on a jelco), pt breathing spontaneously. MD will do a flex bronc via the nose into the pharynx. The larynx is viewed while the patient breathes so that vocal cord movement can be observed. If needed, anesthesia may be deepened, and the bronchoscope advanced into the trachea (note the use of Lidocaine 1% LTA will be useful).
