Phase 1 | Phase 2 | Phase 3

PHASE 1 Lecture Programs

Phase I Lecture Program Objective

• Briefly describe the central, peripheral and autonomic nervous system with emphasis on anesthesia relevant points.
• Identify factors that impact on cerebral metabolism with emphasis on inhaled and intravenous anesthetics.
• Develop an anesthetic plan for patient having supratentorial or infratentorial surgical procedures.
• Identify anesthetic considerations and management of patient with intracranial vascular lesion.
• Develop an anesthetic plan for patients with extracranial vascular lesion.
• List critical anesthetic considerations for patient with spinal cord injury and develop a plan for management.    
• Discuss briefly the heart, blood, and vessels with emphasis on physiologic and anatomic areas important to the CRNA.
• Define hypertension and identify two classes; develop an anesthetic plan for the hypertensive patient.
• Identify two major goals for anesthetic management of the patient with CAD; describe preoperative evaluation and intraoperative management for the patient with ischemic heart disease.
• Identify hemodynamic goals (preload, after load, heart rate, rhythm, contractility) for the patient with valvular heart disease.
• List 9 common congenital heart defects and discuss ideal physiological goals for each.
• Develop an anesthetic plan for the patient having major vascular surgery.
• Briefly discuss respiratory physiology with emphasis on points critical to anesthesia care.
• Develop an anesthetic plan for patients with respiratory obstructive disease.
• Develop an anesthetic plan for patients with respiratory restrictive disease.
• Briefly identify renal physiological concepts pertinent to the anesthetic management of patients.
• Describe the pathophysiology and classes of acute renal failure; develop a plan for prevention or RX.
• List and discuss pathological changes in patients with ESRD; develop an anesthetic plan for this group with emphasis on altered sensitivity to drugs used in anesthesia.
• Describe TURP syndrome; list and describe anesthetic considerations for patient undergoing TURP, ECSW Lithotripsy, or renal transplant.
• Briefly discuss endocrine physiology pertinent to the anesthetic management of patients.
• List and describe anesthetic considerations for patients with pituitary disease.
• List and discuss anesthetic management of patients having thyroid or parathyroid surgery.
• List and discuss anesthetic considerations for patients with disease of the adrenal gland.
• Discuss the pathophysiology and medical management of the  of the diabetic, develop an anesthetic plan for the patient with diabetes mellitus.
• Develop an anesthetic plan for the patient having vaginal or c-section delivery.
• List five common OB complications and develop a plan [a prevention or management]
• Describe the ABCD’s of fetal resuscitation.
• Compare pediatric and adult anatomy and physiology.
• List and discuss major challenges in pediatric anesthesia.
• Develop a care plan for the premature infant.
• Identify indications for and describe anesthetic techniques for spinal or epidural anesthesia; List advantages and disadvantages of major regional blocks.
• Discuss anesthetics and complications associated with common peripheral nerve blocks.
• Develop an anesthetic plan for the patient having laparoscopic/robotic surgery
• Identify insertion sites, techniques, and major complications of CVP monitoring.
• Identify insertion sites, technique, and major complications of PAP monitoring.
• Discuss advantages, disadvantages, and limitations of transesophageal echocardiography (TEE)
• Discuss use of pulse oximetry/capnography.
• Discuss gas laws and identify their importance in anesthesia practice.
• Identify cases in which evoked potential maybe helpful; describe limitations of somatosensory evoked potentials.
• Identify sites of monitoring the myoneural junction; discuss goals of neuromuscular monitoring and compare various monitored sites as to onset and recovery of block.
• Describe anesthetic considerations for patients with cardiac assist devices (pacemakers/AICD’s).
• Discuss anesthetic considerations for patients With A History Of Congestive Heart failure.
• Describe ways to monitor fluid and electrolyte balance; identify signs and symptoms, prevention or treatment of common electrolytes disorders.
• Interpret alterations in acid-base balance with emphasis on respiratory or metabolic alkalosis or respiratory or metabolic acidosis; develop a plan to treat acid-base disturbance.
• Identify two commonly used ECG levels intraoperatively; describe ECG changes seen during common atrial or ventricular arrhythmia
• List several techniques used to identify the difficult intubation; describe steps to be taken in the “can’t intubate, can’t ventilate” scenario.
• Define pharmacokinetics and pharmacodynamics; Describe drug receptor interaction and drug antagonism.
• Identify primary factors controlling uptake, distribution, and elimination of anesthetics; define MAC and list factors that increase or decrease MAC.
• Compare three commonly used inhaled anesthetics; describe inhalation agent’s influence on organ and systems.
• Discuss mechanism of action, pharmacological characteristics, side effects and use of commonly used barbiturate and non-barbiturate IV induction agents.
• Describe mechanism of action, classes, pharmacokinetic and pharmacodynamic characteristics of local anesthetics; discuss toxicity of local anesthetics.
• Discuss pharmacological characteristics of naturally occurring and synthetic
  opioids and describe the role they play in modern anesthesia practice.
• Discuss mechanism of action of opioid antagonist and list complications associated with their use.
• Classify neuromuscular blocking drugs according to mechanism of action, structure, and length of action.
• List and discuss common and uncommon side effects associated with the use of succinylcholine; list side effects associated with the use of nondepolarizing neuromuscular agents.
• Discuss use if anticholinesterases and anticholinergics in pharmacological reversal of neuromuscular blocking drugs.
• Discuss mechanism of action of catecholamines (synthetic and naturally occurring and noncatecholamines; describe use and identify complications associated with their use.
• Describe the mechanism of action of alpha and beta adrenergic antagonist; list nonselective and selective beta blockers and define their role in the perioperative period.
• Describe the mechanism of action if direst acting vasodilator; compare nitroglycerine with Nipride in terms of pharmacological characteristics, indications, side effects.
• Discuss mechanism of action of calcium channel antagonist; identify indications for use and describe side effects of each drug.
• List 4 classes of antiarrhythmics commonly used perioperatively in terms of ion channel receptor action, indications for use and side effects.
• List the mechanism of action of heparin, LMWH, Coumadin, ASA, NSAIDS, Herbals; develop a plan for complete a partial reversal of anticoagulant therapy before and elective or emergency surgery.
• Discuss mechanism of action, indications, and clinical use of commonly used bronchodilators.
• List 3 Anticholinergics; define mechanism of action and compare pharmacological properties of each.
• Describe the mechanism of action of anticholinesterases compare pharmacological properties of the drugs used un anesthesia.
• Compare pharmacological of first generation and never insulin preparations; describe mechanism of actions of traditional and newer oral hypoglycemic.
• Identify antibiotics commonly administered intraoperatively; discuss pharmacological actions, side effects, anesthetic implications.
• Discuss pharmacological actions of commonly used 5 HT3 antagonists for prevention or RX of PONV; compare pharmacological properties of 3 5HT3 antagonists
• Discuss pharmacological action, indications, and side effects of commonly used antihypertensive.
• Define the physiologic role of histamine in health and disease; discuss pharmacological properties of H1 and H2 antagonist.
• Define the role of serotonin in health and disease; discuss pharmacological actions of serotonin agonist and antagonist.
• Describe mechanisms of action of 5 classes of diuretics; discuss the perioperative use of Mannitol and Lasix.
• List common drug interactions of importance in anesthesia safety.
• Define anaphylactic and antiphylaetoid reactions; discuss signs, symptoms, and RX of drug reactions.
• Discuss AANA standards and describe how they are used in legal cases.
• Discuss safety precautions to reduce electrical hazards in the OR.
• List 3 elements in triad of fire; describe JCAHCO and ECRI recommendations for reducing surgical fires.
• Describe the etiology of AIDS; develop a plan in the patient with HIV to protect patient and personnel.
• Describe the role of preoperative evaluation and testing in anesthesia safety.
• Identify general precautions for intraoperative positioning.
• List and discuss precaution to reduce positional nerve injury during surgery.
• Identify all airway management devices for use in the difficult airway.
• Describe and discuss ASA recommendations for the “can’t intubate, can’t ventilate” scenario.
• Discuss physiological changes associated with obesity.
• Develop an anesthetic plan for management of the obese with emphasis on airway management.
• Develop an anesthetic plan for the patient having thoracic anesthesia including preoperative preparation and postoperative care.
• List indicators for one lung anesthesia and describe physiological changes associated with one lung anesthesia.
• Develop an anesthesia plan for the patient having thoracic one-lung anesthesia.
• List and describe common test of coagulation.
• Identify the etiology of bleeding disorders and develop a plan to prevent intraoperative bleeding.
• Describe physiologic changes of aging; develop an anesthetic plan for the geriatric patient.
• Develop a plan for the anesthetic management of the burn patient.
• Develop a plan for the evaluation of the trauma patient; discuss recommendation for anesthetic management.
• Develop an anesthetic plan for then patient having surgery on the ear, nose, and throat. (ENT)
• Develop a plan for having ophthalmic procedures.
• Define evidence based anesthesia practice.
• Demonstrate use of evidenced based practice in P4P.
• Describe anesthetic considerations for anesthesia in remote locations.
• Describe the role of pulmonary function tests in the surgical patient.
• Discuss intraoperative awareness and the describe methods of monitoring anesthetic depth (BIS).

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Phase II Requirements
In addition to completing Phase I, the applicant must successfully complete an independent self study examination. All questions are taken from the Nurse Anesthesia textbook. Study questions are answered and returned for grading and a passing score of 80% or higher is required.

Phase II Content

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Phase III Requirements
In addition to completing Phase I and II requirements, the applicant needing 300 CE credits must successfully complete Phase III. This phase consists of problem solving and evidenced based anesthesia practice and is evaluated by graded case studies in a variety of areas. A passing score of 80% or higher is needed to successfully complete phase III. In addition, a final requirement for phase III will be successful completion (80% or higher) of a multiple choice examination that serves as a practice examination for the certification examination.

Phase III Case Study Content