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.
Interscalene Block
Indications
Shoulder or upper arm surgery
|
Plexus |
Nerves/Muscles |
Side effects |
|
R - Roots |
Median |
CNS |
|
T - Trunks |
Radial |
Cardiac |
|
D - Divisions |
Ulnar |
|
|
C - Cords |
Musculocutaneous |
|
|
B - Branches/Nerves |
Axillary |
Equipment
Sterile prep
Nerve stimulator
Connector, Electrode
2x 20 mL syringe with LA
3-way stopcock
5 mL Syringe with 1% lidocaine
22-gauge 50 mm insulated stimulating needle
If using bupivacaine 0.5%
- 3 mg/kg, max 175mg (cardiotoxicity)
- Onset 30 min, duration 4-6 hrs
Ropivacaine (Naropin) 0.2% or 0.5%
- 3 mg/kg, max 200 mg
Position
HOB 30 degrees, head to either right/left side
Identify external jugular vein
Identify the anterior and middle scalene muscles at the level of the trunks at the C6 level
Have pt sniff - creates grove, which is the brachial plexus
Procedure
Prep - wheel with 1% lidocaine
Puncture skin with bevel, then insert 22g blunt stimulating needle
Current 1.5 milliamp - deltoid, triceps, forearm, biceps muscles
Phrenic nerve = diaphragm movement
- The phrenic nerve lies anterior to the brachial plexus, so the needle is redirected posteriorly
2 cm depth (brachial plexus)
Stimulate at 0.2 milliamp; if difficulty, have pt turn head until ear touching the bed
- Causes stretching of nerve=closer to skin
0.2-0.4 milliamp correct placement
Aspirate/inject 5 mL at a time
Monitor for systemic effects (ringing in ears/metallic taste)
- Horner's Syndrome: Enophthalmos, Ptosis, Miosis, Anhidrosis, Heterochromia
Note
Contraindicated in pt with impaired lung status
C3, C4, and C5 keep the diaphragm alive, and these are usually blocked with this technique
Do NOT block bilaterally - they may not breathe