KUMC NURSE ANESTHESIA EDUCATION
ANESTHESIA CARE PLAN
Clinical Practicum NURA 801
Student:
Instructor:
Age
Gender
None
Allergies / Reactions:
Date:
Weight (kg)
Height
ASA
Mallampati Score
Surgical Procedure:
Previous Anesthetics/Complications
EKG / Chest X-ray:
Labs:
Current
medications
Co-existing
diseases
Drug
classification
Etiology
Dosage
Peak
action
Symptoms
Elimination
half life
Anesthesia interactions/Considerations
Anesthetic considerations
Anesthesia Plan
Choose One: MAC
Airway: ETT (size)
oral / nasal
LMA (size)
Induction drugs / dosage:
Muscle relaxant / dosage:
Narcotic / dosage:
Inhalation agent:
Antiemetic / dosage:
Antibiotic / dosage:
Ventilator settings:
Choose One: Mask
Anesthesia Care Plan Part II -- CALCULATION WORKSHEET
Fluid Balance and Body Weight Calculations:
Ideal body weight (IBW) = 105 lb + 6 lb for each inch > 5 feet for males
= 100 lb + 5 lb for each inch > 5 feet for females
Ideal body weight (IBW) =
kg
Obese Calculated Weight / Adjusted Body Weight (ABW) =
kg
0.3 (actual weight - ideal weight) + ideal weight = adjusted body weight
Maintenance fluid:
First 10 kg: 4 ml/kg/hr
Second 10 kg: add 2ml/kg/hr
>20 kg: add 1ml/kg/hr
Maintenance fluid =
ml/hr
NPO deficit =
ml (hourly maintenance x number of NPO hours)
3rd space loss – please choose one: none
3rd Space loss =
ml
Estimated blood volume
ml
Neonates: Preterm 95 ml/kg, term 85 ml/kg; infants 80 ml/kg;
Adult Male 75 ml/kg, Adult female 65 ml/kg
Allowable blood loss
Starting HCT
ml = (HCT start - HCT allow) x EBV / HCT start
Allowable HCT
1st hour
2nd hour
3rd hour
4th hour
NPO
Maintenance
3rd space
EBL
Total
Pediatrics
Endotracheal tube size (mm)
Choose One: cuffed
Children older than 2 yrs (age/4 + 4 = ETT); generally children < 10 yrs old get uncuffed ETT
Length of ETT insertion (oral)
cm
(under 1 yr: 6 + wt (kg); over 2 yrs: 12 + age/2)
Reservoir bag (circuit) size
(newborn 0.5 L; 1-3 yrs 1.0 L; 3-5 yrs 2.0 L; >5 yrs 3.0 L)
Care Plan Resources (APA format):
Document1