14. Clinical Objectives- Specialty rotations in Cardiovascular and Obstetric Anesthesia

Student-Faculty Handbook

University of Detroit Mercy Graduate Program of Nurse Anesthesiology

Reviewed Aug 2001, Feb 2002, Mar 2003, Aug 2003, Jan 2004, Mar 2005, Apr 2006, Aug 2007

Clinical Objectives

Open Heart Experience

At the completion of the clinical rotation, the student will demonstrate competence in caring for the patient undergoing cardiac surgery as evidenced by the ability to:

  1. Assemble appropriate monitoring equipment, I.V. fluids, drugs, etc. for open-heart procedures.
  2. Formulate a sound anesthetic care plan based on patient's preoperative history, (e.g., cardiac cath report, lab data, cardiac history, drug history, EKG, etc.) and discuss proposed plan with MDA/CRNA.
  3. Demonstrate the correct technique for testing peripheral circulation to the hand, (i.e., Allen's test); and demonstrate skillful catheterization of the radial artery.
  4. Demonstrate sound knowledge of the correct dosage, mechanism of action and duration of action of frequently used vasopressors, inotropic drugs, antiarrhythmics and vasodilators (e.g. Dopamine, Dobutamine, Lidocaine, Nitroprusside, CaCl, Isuprel, Pronestyl, Epinephrine, Neosynephrine).
  5. Demonstrate solid knowledge of common anesthetic agents utilized for cardiac surgery (e.g. volatile agents, narcotic technique) and how they effect patients' cardiovascular state.
  6. Provide a smooth, stable anesthetic induction for patients with compromised cardiovascular function.
  7. Utilize correct principles of patient positioning for open-heart procedures.
  8. Recognize normal wave patterns and normal vascular pressures (eg. RVP, PAP, PCWP,etc.) from Swan Ganz catheter recordings.
  9. Interpret and correlate Swan-Ganz data to patient's intraoperative cardiovascular condition (e.g. hydration, inotropic state, peripheral vascular resistance).
  10. Perform skillful insertion of internal jugular catheter after demonstrating knowledge of the anatomy involved, potential complications and proper insertion techniques.
  11. Differentiate the cardiovascular dynamics associated with C.A.D. and valvular heart disease and select an anesthetic technique accordingly.
  12. Utilize appropriate monitored parameters (e.g. BP. PAP, CVP, U/O, length of procedure, blood loss) to determine the need for fluid and blood replacement.
  13. Relate correct dosages, mechanisms of actions and duration of action of Heparin and Protamine; and recognize when these drugs are to be administered during the open heart procedure.
  14. Demonstrate knowledge of activated clotting time and adjust protamine administration accordingly.
  15. Maintain effective interaction with entire open heart team.
  16. Utilize all available monitoring devices (e.g. esophageal/precordial stethoscope, EKG, arterial pressure recording) to provide a safe transport of patient to ICU, PAR.
  17. Relay thorough and accurate report of patient's intraoperative course (e.g. crystalloid and blood replacement, U/O, general cardiovascular status, intra-operative complications) to the nurse providing post-anesthetic care.

Clinical Obstetrical Rotation Objectives

Students may encounter obstetric cases at several sites including Genesys, St. Joseph Mercy Oakland, Sinai-Grace Hospital, and other sites.

General Objectives

  1. The nurse anesthesia student will provide safe and specialized anesthetic care for healthy and high-risk obstetrical patients using various anesthetic techniques.

Specific Objectives:

  1. Identifies high risk obstetrical patients.
  2. Plans anesthetic care based upon the patient's obstetric and pre-obstetric history.
  3. Administers sedation, as directed, utilizing sound pharmacologic and anesthetic principles.
  4. Prepares and assembles equipment and medications for possible emergency cases requiring a rapid sequence induction.
  5. Administers regional anesthesia to an obstetrical patient under the direct supervision of an anesthetist or anesthesiologist.
  6. Monitors the obstetrical patient who has received a regional anesthetic utilizing appropriate principles of obstetric care.
  7. Discusses potential complications of epidural and spinal anesthetics related to the obstetrical patient.
  8. Demonstrates skill in positioning the patient utilizing left uterine displacement.
  9. Observes and actively participates in the care of normal newborn infants (i.e. DeLee suction, auscultate breath sounds, tactile stimulation)
  10. Assesses newborn infants and assigns Apgar scores based on their observations.
  11. Assesses and actively participates in the resuscitation of depressed/high risk newborn infants.
  12. Appropriately administers anesthetic care to obstetrical patients during emergency situations (placenta previa, preeclampsia, abruptio placenta, amniotic fluid embolism, etc.)
  13. Actively participates in the post-partum pain management of the obstetric patient.
  14. Discuss and educate the parturient on options available for labor pain management.

Return to Table of Contents.