NASC CRNFA flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

ASA physical status IV

A patient with severe systemic disease that is a constant threat to life, such as sepsis, acute MI, or respiratory failure. Denoted with E if emergency surgery.

Revised Cardiac Risk Index

Six predictors of perioperative cardiac events: ischemic heart disease, heart failure, cerebrovascular disease, insulin-dependent diabetes, creatinine >2.0, and high-risk surgery.

NPO clear liquid interval

Two hours is the minimum fasting interval for clear liquids before elective anesthesia, according to ASA guidelines, to reduce aspiration risk.

Antibiotic prophylaxis window

Administer prophylactic antibiotics within 60 minutes before incision; 120 minutes for vancomycin or fluoroquinolones. Redose every 4 hours or with large blood loss.

Surgical hand scrub

A 3-5 minute antimicrobial scrub or alcohol-based rub per manufacturer instructions. Keep hands above elbows and dry completely before gowning.

Surgical count timing

Sponge, needle, and instrument counts occur at setup, before closure of a body cavity, and at skin closure. Any discrepancy requires an intraoperative radiograph.

Closed gloving technique

A gloving method where the sterile gown cuff covers the bare hand while the glove is applied, preserving sterility better than open gloving.

Jackson-Pratt drain

A closed-suction drain with a perforated tip and bulb reservoir. It provides active drainage and reduces retrograde contamination compared with passive drains.

Spaulding classification

Classifies equipment as critical (sterilization), semicritical (high-level disinfection), or noncritical (low-level disinfection) based on contact with sterile tissue or mucous membranes.

Steam sterilization parameters

121°C at 15 psi for 15-20 minutes, or 132°C at 27 psi for 4 minutes. Monitor with Geobacillus stearothermophilus biological indicators.

Ethylene oxide sterilization

A low-temperature sterilization method at 37-63°C for 4-6 hours. Uses Bacillus atrophaeus biological indicators and requires aeration to remove toxic residuals.

Sterile field margin

The 1-inch border around a sterile drape is considered contaminated. Items below waist level or outside the field are nonsterile.

Minimum alveolar concentration

The alveolar concentration at which 50% of patients do not respond to surgical stimulus. MAC values: sevoflurane 2.0%, isoflurane 1.15%, desflurane 6.0%.

Malignant hyperthermia treatment

Dantrolene 2.5 mg/kg IV, hyperventilation with 100% oxygen, active cooling, and sodium bicarbonate for acidosis. Triggered by volatile agents and succinylcholine.

Lidocaine maximum dose

4.5 mg/kg without epinephrine and 7 mg/kg with epinephrine. Toxicity presents with perioral numbness, tinnitus, seizures, then cardiac arrest.

Neostigmine reversal dose

0.04-0.07 mg/kg IV, paired with glycopyrrolate 0.2 mg to prevent bradycardia. Reverses nondepolarizing neuromuscular blockade.

Hesselbach triangle boundaries

Inferior epigastric vessels laterally, rectus abdominis medially, and inguinal ligament inferiorly. Direct hernias protrude through this region.

Femoral triangle contents

From lateral to medial: femoral nerve, artery, vein, and lymphatics (NAVEL). Boundaries are the inguinal ligament, sartorius, and adductor longus.

Calot triangle

Bounded by the cystic duct, common hepatic duct, and inferior liver surface. Contains the cystic artery and is the dissection target during cholecystectomy.

Abdominal wall layers

Skin, subcutaneous fat, Scarpa fascia, external oblique, internal oblique, transversus abdominis, transversalis fascia, preperitoneal fat, and peritoneum.

Lithotomy positioning limits

Hip flexion should stay under 90° and abduction under 45° to limit femoral and peroneal nerve injury. Use candy-cane stirrups and confirm symmetry.

Axillary roll placement

Place the roll 2 cm caudal to the axilla in the lateral decubitus position to protect the brachial plexus. Pad the dependent ear, shoulder, and hip.

Tourniquet pressure limits

Inflate to 100 mmHg above systolic for the arm and 150-250 mmHg for the leg. Limit inflation to 2-2.5 hours and document times.

Fire triangle in the OR

Requires an oxidizer (oxygen or nitrous oxide), an ignition source (electrocautery or laser), and fuel (drapes, hair, alcohol prep). Let alcohol prep dry fully.

Aldrete discharge score

A PACU discharge score of 9 or higher based on activity, respiration, circulation, consciousness, and oxygen saturation.

Postoperative fever timeline

Within 24 hours: atelectasis. 24-72 hours: pneumonia or UTI. 3-5 days: surgical site infection. 5-7 days: abscess or leak. After 7 days: drug fever or DVT.

Anastomotic leak signs

Tachycardia, fever, ileus, abdominal pain, and rising WBC count. CT with contrast or re-exploration is diagnostic and therapeutic.

Apfel PONV score

Four predictors: female sex, nonsmoker, history of postoperative nausea and vomiting, and postoperative opioid use. Each adds roughly 20% risk.

CRNFA scope of practice

First assistant duties include wound closure, hemostasis, and tissue handling under direct surgeon supervision. The CRNFA does not perform the primary procedure.

Scope of practice authority

Defined by state nurse practice act, facility credentialing, and professional certification, not by employer preference alone.

Never event disclosure

Wrong-site surgery, retained foreign bodies, and similar never events require immediate disclosure to the patient and family, plus institutional reporting.

RN delegation accountability

RNs may delegate tasks to unlicensed assistive personnel only when within the delegate's training, and the RN retains accountability for the outcome.