Anesthetics


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anesthetics Euthanisia

In recent years, Euthanasia has become a very heated debate. It is a Greek word that means "easy death" but the controversy surrounding it is just the opposite. Whether the issue is refusing prolonged life mechanically, assisting suicide, or active euthanasia, we eventually confront our socity's fears toward death itself. Above others, our culture breeds fear and dread of aging and dying. It is not easy for most of the western world to see death as an inevitable part of life. However, the issues that surround euthanasia are not only about death, they are about ones liberty, right to privacy and control over his or her own body. So, the question remains: Who has the right?

Under current U.S. law, there are clear distinctions between the two types of euthanasia. One group of actions taken to bring about the death of a dying patient -withdrawal of life support, referred to by some as passive euthanasia- has been specifically upheld by the courts as a legal right of a patient to request and a legal act for a doctor to perform. A second group of actions taken to bring about the death of a dying patient -physician-assisted death, referred to by some as active euthanasia- is specifically prohibited by laws in most states banning "mercy killing" and is condemned by the American Medical Association. Although it is not a crime to be present when a person takes his or her life, it is a crime to take direct action intentionally designed to help facilitate death--no matter how justifiable and compassionate the circumstances may be.1 With active euthanasia, it is the doctor who administers the lethal drug dose. Since it is tantamount to homicide, the few U.S. doctors who perform it have been brought to trial but none of them have ever been convicted and imprisoned.

Modern interest in euthanasia in the United States began in 1870, when a commentator, Samuel Williams, proposed to the Birmingham Speculative Club that euthanasia be permitted "in all cases of hopeless and painful illness" to bring about "a quick and painless death." The word "painless" is important: the idea of euthanasia began gaining ground in modern times not because of new technologies for agonizingly prolonging life but because of the discovery of new drugs, such as morphine and various anesthetics for the relief of pain, that could also painlessly induce death. Over the next three decades Williams's proposal was reprinted in popular magazines and books, discussed in the pages of prominent literary and political journals, and debated at the meetings of American medical societies and nonmedical professional associations. The debate culminated in 1906, after the Ohio legislature took up "An Act Concerning Administration of Drugs etc. to Mortally Injured and Diseased Persons", which was a bill to legalize euthanasia. After being debated for months, the Ohio legislature overwhelmingly rejected the bill, effectively ending that chapter of the euthanasia debate. 2

Euthanasia reemerged in the 1970's, when in 1976 California was the first state to legalize a patient's right to refuse life-prolonged treatment. The Legislature passed the Natural Death Act, which allows for living wills, an advance directive to a doctor requesting the withholding or withdrawing of life sustaining treatment.3 Today, all states have some form of living will legislation. In addition, the individual who wishes to have such a will, may also designate a family member or friend as a proxy to make the decisions for him or her, should he or she be unable to make the decisions himself or herself. Some states also require the individual to sign a power of attorney to do so.4

In 1976, the New Jersey Supreme Court decided the parents of Karen Ann Quinlan won the right to remove her from a ventilator because she was in a persistent vegetative state. The justices unanimously ruled that this act was necessary to respect Quinlan's right to privacy.5 Some medical ethicists warned then that the ruling was the beginning of a trend--the slippery slope--which could lead to decisions to end a person's life being made by third parties not only on the basis of medical condition but also on such considerations as age, economic status, or even ethnicity.6

In 1990, the Supreme Court case, Cruzan v. Missouri, ... more

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Nursing

The nursing field extends many opportunities to be a very important part of the health care team.  Nursing involves direct patient contact and varied skills and abilities.  A nurse has a unique opportunity to ensure that they care for a patient's comforts and needs, and can make a difference in every patient's life. Various challenging opportunities are available under the broad category of nursing.
A wide range of career opportunities is open to registered nurses.  Many nurses choose to specialize once within the field of nursing. One specialized field that nurses can go into is nurse anesthesia.  As anesthesia specialists, certified registered nurse anesthetists administer more than 65% of the twenty-six million anesthetics given to patients each year.  They have licensed and certified registered nurse anesthetists in all fifty states.  To become a nurse anesthetist, it is necessary to first become a registered nurse.
There are four ways to become a registered nurse.  It is possible through a two-year community college, earning an associate's degree in nursing, or through a three-year hospital based nursing school, earning a diploma.  Other possible ways include a four-year university program, resulting in a Bachelor's of Science degree in nursing, or the B.S.N., as it is commonly called. For those who have a bachelor's degree in another subject, there is a generic master's degree in nursing, a two or a three-year program beyond the bachelor's degree.  In the future, the B.S.N. is being considered the minimum qualification for a satisfying career.  The two-year associate's degree and the hospital-based diploma programs are rapidly closing around the country, and student nurses are being encouraged to enroll in four-year universities.
 Nursing education includes classroom instruction and supervised clinical experience in hospitals and other health facilities.  Students take courses in anatomy, physiology, microbiology, chemistry, nutrition, psychology, and other behavioral sciences, and nursing.  Corse work also includes liberal arts' classes.  Hospital departments provide supervised clinical experience in pediatrics, psychiatry, maternity, and surgery. Several programs include clinical experience in nursing homes, public health departments, home health agencies, and ambulatory clinics.
The nurse anesthetist is an essential part of the surgical team.  They are highly skilled and highly educated specialists who, under the direction of a physician, administer anesthetics to patients for all types of surgery.  The nurse anesthetist prepares for a medical procedure by setting up assigned operating rooms with necessary equipment and supplies, meeting with assigned patients, and by completing necessary preoperative procedures.  Preoperative procedures may include administering medication, hooking up the patient's IV, and connecting the patient to a life support system.  When the patient goes into the operating room for their surgery, the CRNA administers either a general or local anesthetic to the patient.  They also practice in the obstetrics department, with psychiatric patients, in the respiratory therapy department, the emergency room and in dental offices.  Attention to vital signs and changes in the patient's condition is one important function of the nurse anesthetist.  This is a field in which the nurse-patient relationship is critically important.  The CRNA has to apply physiologic and psychologic principles with sensitivity while also employing technical skills and theoretical knowledge.
The nurse anesthesia programs range from twenty-four to thirty-six months in length and encompass an academic and clinical practicum on a college degree level.  The classroom curriculum emphasizes anatomy, physiology, pathophysilolgy, biochemistry, chemistry, physics, and pharmacology as they relate to anesthesia.    All programs must offer a Master of Science degree or higher beginning in 1998. All programs require a four-year college degree in science or nursing, and at least one year of acute car nursing experience before entry.  Schools usually define acute care as intensive care, coronary care, and emergency/trauma care.  Once a student has completed their educational work, the nurse is eligible to take a national certification examination and become a certified registered nurse anesthetist. Laws also require continuing education every two years for recertification.    
Nurse Anesthetists work with physicians, nurses, and other health care professionals in well-lighted, air-conditioned, and surgically clean surroundings.  They wear a surgical gown, cap, and mask while administering the anesthetics.  Nurse anesthetists may need to lift, move, and position patients receiving anesthetics.  While they are administering the anesthetic, they may stand or sit in one position for long ... more

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