CRNAMom, a CRNA Blog

Preparing for Surgery

2017-01-02T21:07:00.001-08:00

(For You and Family)

Surgery requires a lot of planning, especially if you have a family to feed. There are different ways of organizing your downtime while you recover and recuperate.

For instance, you can have family and friends sign up at a free website called mealtrain.com. You select the dates that you need and your family and friends will bring the food and drinks to you and your family. You can add Meal Train (Plus) if you need childcare, dog walks, rides, etc., and for the usual items...

Some groceries or items to pick up before surgery include:

chicken broth
teas
extra strength tylenol, ibuprofen
thermometer
blood pressure cuff
heating pad
ice pack
pastas
saline/graham crackers
rice
Gatorade, ginger ale, or 7up (soft drink)

Be sure to schedule your payments for paying your bills via on-line banking in case you are the financial planner of the family. For example, the mortgage or rent, electricity, water, garbage, phone, and cable are all important bills to schedule payments for before a surgery or procedure.

Rides before an elective procedure need to be arranged, unless you expect that you will not be given any anesthesia. If you take a cab, Uber, or Lyft, etc., you still need a person to accompany you. Most hospitals or same day surgeries will not perform your surgery until you have indicated a designated (responsible) person to take you home.

What is a CRNA?

2014-04-09T13:41:00.000-07:00

Cancer Surgeon (middle), flanked by 2 CRNAs

Certified Registered Nurse Anesthetists (CRNAs) have been around for over a hundred years. We are advanced practice nurses who deliver safe anesthesia, whether it be general, regional, local, or monitored anesthesia care.

There is no significant difference as to who can deliver a safer anesthesia, whether it be a Medical Doctor of Anesthesiology (an 'MDA'), or a CRNA.

How Does One Become a CRNA?

CRNAs have a Bachelor’s degree in Nursing and have varying years of ICU experiences. Most CRNAs also complete a 2.5 year or 3 year Masters program from an accredited program. There are over 50 programs in the U.S. After completion of the Masters of Nurse Anesthesia program, the individual needs to take a state national CRNA board. CRNAs can work independently or side by side with Anesthesiologists, depending on the state regulation. Visit our CRNA Degree page for more detailed information on becoming a CRNA.

What we believe sets us apart from our colleagues is that we address each patient with an emphasis on human touch, along with our anesthesia knowledge.

Where Do You Find CRNAs?

CRNAs work in University hospitals, Health Maintenance Organizations (HMOs), private practices in metropolitan areas, as well as in rural settings. Usually CRNAs are supervised by MDAs in a 3:1 ratio (CRNA to MDA) depending on the hospital's protocols.

Why CRNAs?

CRNAs are more cost effective than MDAs, since they do not have the same salaries and insurance requirements as MDAs. The concept of CRNAs is similar to the concept of Nurse Practitioners.

CRNAs also help with lowering medical costs by relieving Residents of Anesthesiology at the end of the day. Residents of Anesthesiology or 'doctors in training in anesthesiology' are required to have a maximum limit of 60 hours per week. Beyond 60 hours per week would be considered unsafe practice.

CRNA Degree

2014-04-09T13:30:00.000-07:00

Become a CRNA

To become a CRNA, you will need to do the following:

1. Completion of a Bachelor of Science in Nursing at a 4 year university.

2. As a BSN graduate, work in an intensive care unit (ICU) for 1-2 years. The more years of experience, the more confidence you will have with your patient’s care.
CRNA programs prefer ICU experience above emergency room and recovery room experiences because the ICU setting mimics the operating room environment, i.e., monitors, medications, the patient’s acuity (degree of sickness).

3. Shadow a CRNA in the operating room setting to make sure this is a career that you really want to pursue. CRNA programs are very expensive in general so you don't want to make an expensive mistake.

4. Read about the different CRNA programs at www.aana.com. This site offers over 50 different CRNA programs across the U.S.

5. Plan to take the Graduate Record Examination (GRE). If you are not a good test taker, you can take a review course like the Kaplan Test Review at www.kaptest.com.

6. Apply to your top choice of CRNA schools. Here is a listing of schools by state in the US.

7. Have your ICU manager and ICU doctors write good letters of recommendation for your school applications.

8. The directors of CRNA schools are interested in the applicant as a whole, not just the grade point average (GPA). They want to know why you want to become a CRNA. Do you have any extracurricular activities or committees that you are involved in at work? This may show more of a commitment to your medical profession.

9. There are hundreds of applicants each year and most of these programs only accept 10 to 20 students per year. Since most people apply to more than one program, you may be on the waiting list. If you happen to be on the waiting list, find out where you stand on this list.

10. If you are flexible with your choice of CRNA programs, then this allows for more possibilities for admissions, especially if your state only has one program.

List of the Types of Surgeries That You Are Likely to Participate In:

-Gastrointestinal surgeries for colon and rectal cancer, ulcerative colitis, and Crohn's Disease

-Endoscopy and colonoscopy for screening of cancers, diagnosis of symptoms for upper and lower parts of the digestive systems

-Breast surgery for cancer or for patients who carry the breast cancer gene - (lumpectomy - partial breast removal or mastectomy - full) with or without lymph node biopsy or dissection

-Breast reconstruction for the cancer patient

-Plastic surgery-breast reduction or breast augmentation

-Dental surgery-multiple teeth extractions

-Melanoma surgery or skin care surgery

-Prostate cancer surgery-robotic laparoscopic prostatectomy with or without lymph nodes

-Genitourinary surgery, kidney or renal cell cancer surgery

-Endocrine surgery-thyroid or parathyroid surgery

-Spinal surgery

-Brain surgery

-Orthopedic surgey

-Heart surgery/heart valve replacement

-Heart catheter lab for cardiac arrhythmia

-Lung surgery – lung cancers i.e., Mesothelioma

-Radiology procedures for placement of stomach feeding tubes, kidney tubes

-C-sections and vaginal delivery for women in labor-epidural or spinal placement

Disclosure

2014-04-08T18:30:00.000-07:00

Disclosure before surgery

CRNAs or anesthesia providers need to know if you are a patient with increased risk of postoperative nausea and vomiting (PONV). Especially if you have mentioned this risk to your anesthesia provider. Most patients rate that “PONV is a worse feeling after surgery than pain”.

Generally, if you are a female from ages 18-50, have a previous history of general anesthesia and PONV, and/or a history of motion sickness, and are a non-smoker then you are at risk of PONV after surgery. Surgeries that increase PONV are, gynecology (GYN), breast surgery, sinus surgery, ear, nose, and throat (ENT), and gastrointestinal (GI).

As CRNAs we have different medications in the preoperative area that can be given to patients before starting surgery, such as Emend (pill form) and scopolamine patch. Emend is used for patients with a history of chemotherapy and nausea. The Scopolamine patch is also used for patients with sea or motion sickness.

Other measures like Propofol infusions are used intraoperatively as an antiemetic. This can be used at a high dose solely and no volatile agents used.

Both Decadron and Zofran can be used as anti-nausea drugs as well.

If I know I have a patient who is at high risk for PONV, I may use all drugs like Emend, scopolamine, Decadron, Propofol, and Zofran.

Other measures to prevent PONV are to use less narcotics, and give Tylenol IV and NSAIDs like Toradol IV, if not contradicted by the surgeon.

Before Surgery

2014-04-08T16:30:00.000-07:00

Before Surgery Checklist

1) What to Expect Before Surgery:

-Nothing to eat or drink after midnight; sometimes surgery is moved up due to a cancellation of another surgery, or the surgeon is running ahead of schedule.

-Advise patients to drink lots of clear fluids the night before surgery to prevent dehydration. This allows the pre-op nurses to find good intravenous (IV) access on the morning of surgery.

-Stop herbal medications two weeks before the anticipated surgery. Many herbs like ginseng, garlic, feverfew, and ginkgo biloba can increase bleeding.

-Bowel preparation if needed (enema)

2) Coping Mechanisms for the Patient Before Surgery:

-Exercise to prepare the heart and body

-Mediation and/or yoga

-Weight control or weight loss to reduce the risk of the procedure

-Smoking cessation

-Community outreach => example: church or parish prayer groups

-Family support

What About the Day of Surgery?

3) The CRNA's Surgery Preparation Checklist:

-Laboratory tests ie: complete blood work, chemistry panel, PTT, INR

-Stress test or EKG for patients that have increased heart risk

-Is the surgery a come and go surgery, i.e., same day surgery?

-Will it require several days as an inpatient?

-How much time will it require for recovery?

-Meal preparation for the patient postoperatively

-Family support

-Social services needed (if long term care is required)

Day of Surgery

2014-04-08T12:30:00.000-07:00

Day of Surgery Checklist

1) What to Expect as a Patient on the Day of Surgery:

-No jewelry and no body piercing - all must be removed.

-Remove all clothing, including underwear.

-Leave all valuables at home.

-Bring ID and insurance card for registration at the hospital.

-Take only medications that are required by the anesthesia provider; Example: Beta blockers.

-Remove dentures, contact lenses.

-Disclose of any cuts, bruises, loose teeth, etc.

-Check your hospital badge for the correct spelling of your name and date of birth.

-No food on the day of surgery decreases the patient’s risk of aspiration or pneumonia.

No exceptions!

-No breakfast or coffee with cream. Protein is like curd in the stomach.

-No gum chewing or hard candy on the day of surgery. This increases gastric secretions.

2) Questions the CRNA Will Ask You:

-Any allergies to any medications or latex?

-Any family history of anesthetic complications? i.e., Malignant hyperthermia,

prolonged sedation from general anesthesia.

After Surgery

2014-04-08T12:00:00.000-07:00

Staying upright after surgery

Don’t forget to pull out the recliner when it comes to eyes, neck, head, sinus, breast, chest, and abdominal surgery. Most of the time, surgeons will ask you to sleep upright after surgery for 24-72 hours to decrease swelling by being in the upright position of a recliner.

It may be difficult to get out of bed from a flat position because of the area of the incision. Being in a flat position without a recliner may also cause tension at the incisional site, and therefore cause the incision to reopen, which may necessitate a return for emergency surgery. Not good.

Instead of a recliner you can also use a futon. Although for some it might be too low to move in and out of a futon.

So other options would be to rent from a furniture store such as Cort Furniture Rental, or to buy a used one from a thrift store like Goodwill, or from the Salvation Army. You can have the used recliner professionally sanitized and covered before using it.

If your budget allows for some splurge, you can find recliners that offer massage and even heat therapy. It would be like going to a spa without leaving your home!

Always think twice before you throw away or donate your recliner. As we age, we might need it for sitting up to take a break from resting all day in bed, coming home from being hospitalized, or for rehabilitation for a long-term recovery from a recent surgery or ailment. It can also help to prevent pneumonia, atelectasis(partial or complete collapse of the lung) and muscle atrophy.

Weight Loss

2014-04-07T07:36:00.000-07:00

Weight loss before surgery

Weight loss before an elective surgery may be necessary for some obese patients. This should be discussed with your surgeon.

Generally, patients who have a high basal metabolic index (BMI) greater than 35% have greater risks for complications like heart attacks, strokes, deep vein thrombosis, obstructive sleep apnea, and prolonged sedation or wake up, because the anesthetic agents like Desflurane and Propofol used in surgery get absorbed in the fatty tissues.

Depending on the length of surgery, these patients may require a night in the intensive care unit after surgery with a breathing tube, remain sedated, and may require additional time on the ventilator.

Frequent monitoring of vital signs and continuous oximetry monitoring are important for monitoring for airway obstruction or signs of undiagnosed or diagnosed sleep apnea.

Sometimes patients who undergo long surgeries and anesthesia have to remain intubated and sedated in the ICU until the next morning. Weaning measures have to be started the next morning or a few days later until the patient is awake and stable enough to breathe on their own.

How about some easy, healthy meals that can be prepared from just one main food item. Visit our easy meals page. Or find out how to eat right for your type.

Eat Right

2014-04-07T06:00:00.000-07:00

Eat right for your type

Ever noticed how some people that you know will tell you that they cannot eat certain foods, since they may have trouble digesting them, or simply that it makes them feel tired or even fat?

Well, a colleague of mine who works in the operating room with me recently reminded me of the 'eat right for your type' diet, by Dr. Peter J. D'Adamo, and that perhaps we should give it a try.

If you are not familiar with this diet, let me explain a little bit about it. Doctor D'Adamo, whose website and diet books are actually based on follow-up work that he did after his dad's initial research into the science, explains how we humans today process the foods that we eat.

The concept is that our blood types, of which there are 4 (type 'O', type 'A', 'B', and 'AB'), reflect our internal chemistry, which actually can determine the way we absorb nutrients. A lot of the pre-disposition that we have today for processing nutrients is in our individual genetic blood types, which tendencies we have inherited from thousands of years of our ancestor's evolution.

For example, the oldest blood type, 'O', (think hunter-gatherer), can surprisingly eat most all meats, but is intolerant to wheat and other grains. Blood type 'O' requires a high protein, low carbohydrate diet.

My husband is type 'O', his ancestors are from Western Europe, and he has tried the diet (not really a diet, it's what we would call a modest lifestyle change). After 3 weeks I can already see that he has lost his 'wheat belly', and tells me he does not have hunger pangs or sugar crashes anymore. Mainly, he has had to cut out peanuts, peanut butter, all things wheat, and hard cheeses, which he loves. But he feels great! (By the way, he can eat other nuts, brown rice, mozzarella and goat and feta cheeses so you can see there are options).

Well, we still have a way to go before we are completely sold on this, but let me just say that 1) It's easy to get the genetic concept of why you can only eat what you or your ancestors are 'used to' and 2) So far it does not feel like a diet or punishment since we have been eating pretty much the things that we like, we just have to be willing to eliminate a few things and replace them with others.

More updates to come...CRNAMom

Recipes

2014-04-06T22:40:00.000-07:00

CRNAMom Chicken Adobo

A variation of the traditional Filipino dish. This recipe is easy to prepare, and is lower in salt and fat. You can also make it and eat it over a few days time if kept refrigerated, since this type of dish retains its flavor and freshness very well.

Ingredients:

half cup of low sodium soy sauce

half cup white vinegar

5 cloves of garlic - chopped

3 bay leaves

pinch of black pepper

1.5 to 2 pounds of chicken breasts (cubed), thighs, drumsticks (legs), de-skinned

1.5 pounds of red potatoes, cut into quarters or halves

2 tablespoons of olive oil

1 tablespoon of ketchup

sprig of rosemary

Instructions:

Simmer the garlic and olive oil in a stock pot or deep pan until slightly browned (caramelized). Then add the chicken, vinegar, soy sauce, bay leaves, ketchup and let cook for 30 minutes on low heat (slow cooking the adobo creates the best results, if you have time). Then add the potatoes, rosemary and black pepper to season the dish, and cook for another 30 minutes on low heat. Remove and serve over brown rice (optional).

How about some easy, healthy meals that can be prepared from just one main food item. Visit our easy meals page.

Easy Meals

2014-04-05T07:11:00.000-07:00

'Stretch the Chicken'

Easy Meals - 'Stretching the Chicken' - Chicken Recipes

There are many ways to use and reuse a rotisserie chicken from the supermarket.

This will lower your stress level since you will have many meals that can be yielded from just one chicken. In turn these meals should turn out to be quite healthy, and can be a part of your pre and post-surgery health and fitness regimen.

What you can do:

1) Buy a whole rotisserie chicken from the supermarket, and eat the chicken for one meal, leaving some amount of meat still on the chicken.

2) After the meal, don’t throw the carcass away, but use it for chicken noodle soup:

a) Add 2 quarts of water in a stock pot.

b) Add the remaining chicken carcass. Boil until the meat softens and comes off. This may take 30-40 mins. Allow it to cool.

c) Carefully remove the bones, meat, and fat from the pot, leaving the chicken broth. Save the meat, you can discard the bones and fat at this point.

d) In a separate pot, boil spaghetti or macaroni pasta per the directions on the box.

e) After cooking the pasta, add it to the already made boiled chicken broth. Season to your desired taste by adding sea salt and/or pepper.

3) **You can freeze the chicken broth made above for future use in case you need it after surgery.

4) If you had several pieces of chicken meat leftover you can use it to make stir-fried meals, chicken tacos, or use it to make a salad with the chicken meat tossed on top of the salad.

There are ready made organic salads that are triple pre-washed in the refrigerator section of your local supermarket. There are also pre-washed packaged vegetables for stir-fried vegetables. You can combine these with the chicken meat in whatever way you choose. Enjoy and get healthy!

chicken tacos with salsa, lettuce, quinoa, whole wheat wrap

How about checking out CRNAMom's Healthy Chicken Adobo!