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.

Nasolabial Flap Procedure

Preoperative Diagnosis

Possible basal cell carcinoma of the nose – pts may have had a previous biopsy before the procedure

Basal cell carcinoma of the nose is excised and repaired with a nasolabial rotation skin flap – see picture for an explanation of the procedure

Nasolabial flap = flap from the grove between the nose and the lip, where the donor scar hides in the line between the nose and the corner of the mouth

Preoperative Considerations

EBL

Minimal

Surgical Time

1-2 hrs

Antibiotics

Per surgeon

Position

Supine, HOB may be elevated

Anesthetic considerations

Respiratory

Decreased FRC and HR

Increased venous return, leading to increased preload and CO

Increased intraabdominal pressure.

Zone 3 (a-v-A) in the dorsal portion of the lungs

CNS

Blood/cerebrospinal fluid drainage is gravity dependent, valve less; when supine = increased ICP, which decreases cerebral perfusion pressure (CPP= MAP-ICP/or CVP)

An elevated head will promote drainage

Preoperative

Monitors: pulse ox, ECG, NIBP, temp, Bair hugger,

Induction and Intraoperative

Preoxygenation

GETA - limited access to airway – need GA with possible oral Ray ETT

The table turned to the surgeon 90-180 degrees

Complications

Hematoma

Facial paralysis

Unsatisfactory aesthetic result