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.

Spinal Neuraxial Block

Indications

Procedures below the umbilical

  • Such as hernia repairs, gynecological and urologic, and lower extremity surgeries

C-Sections

Patients with congestive heart failure, except those with stenotic valvular heart disease or hypertrophic cardiomyopathy, which is contraindicated

Contraindications

Patient refusal

Infection at site

Coagulation defects

Sepsis

Neurologic disease, particularly involving the spinal cord, such as myelitis

Intracranial hypertension

Severe spinal or spinal cord deformity

Spinal cord tumor

Stenotic heart valve lesions

Severe hypertrophic cardiomyopathy

Lack of anesthesiologist experience

Placement

Preload the patient with a minimum of 1 L fluids to prevent hypotension pre-placement

The distal termination of the spinal cord varies from about the level of the 3rd lumbar vertebrae (L3) in infants to the lower border of L1 in adults

Prepare patient, obtain consent, and do BP supine before sitting pt up to have a baseline

L3-L4/L4-L5/L5-S1

Use T4 - top of iliac crest as a guideline for L4 - L4-L5 space, and palpate for spinal processes

Have pt round back as mad cat

They can be sitting/lateral decubitus/prone

Wash off the area three times with iodine - let dry

Insert wheal with lidocaine and then go deeper (5 mL of 1% lidocaine = 10 mg/mL) using a 25g needle

22g Quincke needle with bevel lateral

  • Prevents shearing of tissue and reduces the risk of post-dural punctual headache

The needle will pass through the supraspinous and interspinous ligament, ligamentum flavum (first pop), and Dura (second pop). At this point, remove the stylet; clear CSF should flow

Attach the syringe with medication (0.75% bupivacaine x 2 mL (15 mg), can add Astramorph (0.1-0.5mg) or fentanyl (up to 25 mcg) for pain management post-op)

Aspirate while holding the syringe and supporting hand on the back of the patient to ensure correct placement. When mixing in medication, you'll see a swirl of fluid. Inject into the subarachnoid space. Remove the syringe and needle in a smooth motion.

Monitor vital signs for possible intravascular injection (ST changes)

Place patient supine

Monitor the level of spinal

  • The sympathetic level is two above the sensory level, and the motor is two below
  • Check sensory with pinprick/alcohol pad for sympathetic block (temperature)

Baricity

Hyperbaric

Moves dependently with positioning

Sitting promotes saddle block

Lateral position eliminates the effect of spine curvature

Contains glucose

Hypobaric

Prone procedures

Hip procedures with affected site up, so pt does not have to lie on fracture

Contains sterile water

Isobaric

Remains in place