Anesthesiology Post Op Care

Question 1

What are the primary goals of postoperative care?

Answer 1

To prevent complications, promote healing, and return the patient to health.

Question 2

What are the phases involved in postoperative care?

Answer 2

Assessment, diagnosis, planning, intervention, and outcome evaluation.

Question 3

What factors influence the extent of postoperative care required?

Answer 3

Individual’s pre-surgical health status, type of surgery, and whether it was day surgery or in-hospital.

Question 4

What does PACU stand for?

Answer 4

Post-Anesthesia Care Unit.

Question 5

Where should the PACU ideally be located?

Answer 5

Close to the OR, Radiology, Laboratory, and other ICUs.

Question 6

What are some of the key design features of the PACU?

Answer 6

Open ward, 1 isolation bed, 1.5 PACU bed to OR bed ratio, 120 sq ft per patient, multiple outlets, suction, ventilation, and central station for staff.

Question 7

What is the nurse-to-patient ratio in the PACU?

Answer 7

1:1 care.

Question 8

What specific training should PACU nurses have?

Answer 8

Training in anesthesia emergence, airway management, ACLS, wound care, drainage catheters, and post-op bleeding.

Question 9

What equipment is essential in the PACU?

Answer 9

Pulse oximeter, ECG, NIBP, thermometer, Foley catheters, oxygen masks, laryngoscopes, Ambu bag, defibrillator, and crash cart with emergency drugs.

Question 10

Who reports the patient’s condition to the PACU upon admission?

Answer 10

The anesthesiologist.

Question 11

What information does the anesthesiologist report during PACU endorsement?

Answer 11

Patient’s condition, type of surgery performed, type of anesthesia, estimated blood loss, total fluids input, and urine output.

Question 12

What is the primary role of the PACU nurse upon patient admission?

Answer 12

To be aware of first priorities such as complications during surgery, hemodynamic stability, airway patency, vital signs, and consciousness.

Question 13

What additional assessments should be done in the PACU?

Answer 13

Check surgical site, drainage patency, body temperature, IV fluids, circulation, sensation after certain surgeries, and pain status.

Question 14

How frequently should vital signs be monitored in the PACU’s first 8 hours?

Answer 14

Every one to two hours.

Question 15

Why are respiratory exercises recommended postoperatively?

Answer 15

To prevent pneumonia by promoting lung expansion and clearing airways.

Question 16

What are the standards of care in PACU management?

Answer 16

Standards I to V, including receiving appropriate care, continuous evaluation, and discharge based on criteria.

Question 17

According to Standard I, who should receive postoperative management?

Answer 17

All patients who have received general, regional, or monitored anesthesia.

Question 18

What is the primary discharge criterion from the PACU?

Answer 18

Meeting established discharge criteria, often evaluated using the Aldrete scale.

Question 19

What areas are scored in the Aldrete scale for PACU discharge?

Answer 19

Mobility, respiratory status, circulation, consciousness, and pulse oximetry.

Question 20

How often should patients be repositioned after surgery?

Answer 20

Every 2 hours, if not contraindicated.

Question 21

What should patients be able to do 8 hours post-surgery?

Answer 21

Sit on the edge of the bed, unless contraindicated.

Question 22

What are some strategies for postoperative pain management?

Answer 22

More aggressive perioperative analgesia and multimodal analgesia.

Question 23

Which populations are considered special for postoperative pain management?

Answer 23

Elderly, renal-impaired, liver-impaired, and opioid-tolerant patients.

Question 24

What is the first-choice oral analgesic for elderly patients?

Answer 24

Paracetamol.

Question 25

What approach should be taken for administering drugs to elderly patients?

Answer 25

Start low and go slow, with frequent reevaluation.

Question 26

Why should NSAIDs be used cautiously in elderly patients?

Answer 26

Risk of GI bleeding, renal failure, and other side effects.

Question 27

What type of drug is commonly used as an adjuvant in elderly pain management?

Answer 27

Opioid-sparing agents like Dexmedetomidine and Gabapentin.

Question 28

What is a significant consideration in managing pain for renal-impaired adults?

Answer 28

Avoid NSAIDs and adjust dosages based on renal function.

Question 29

How should analgesic plans differ for Stage 3 CKD patients?

Answer 29

Avoid repeat boluses or infusions due to accumulation risk.

Question 30

What pain management strategy is appropriate for cirrhotic patients?

Answer 30

Lower doses, longer intervals, and careful titration to avoid adverse effects.

Question 31

What is an important postoperative complication for geriatric patients?

Answer 31

Postoperative delirium.

Question 32

What does the Pain Ladder Approach entail?

Answer 32

Using the safest drugs, least invasive route, and dose escalation if needed.

Question 33

Why are opioids considered for elderly postoperative pain despite risks?

Answer 33

They are effective and often necessary for severe pain control.

Question 34

How does multimodal analgesia improve postoperative pain management?

Answer 34

It allows for lower doses of multiple drugs targeting different pain pathways.

Question 35

What is the purpose of preemptive analgesia?

Answer 35

To prevent nervous system sensitization by administering analgesics before painful stimuli.

Question 36

What is the goal of preventive analgesia?

Answer 36

To reduce central sensitization by managing pain across the perioperative period.

Question 37

What is PCA?

Answer 37

Patient-controlled analgesia, allowing patients to self-administer controlled doses of analgesics.

Question 38

How does a PCA pump benefit patients?

Answer 38

It enables self-titration of pain relief, often improving patient comfort and satisfaction.

Question 39

What scale assesses sedation levels in the PACU?

Answer 39

Ramsay Sedation Scale or Riker Sedation-Agitation Scale.

Question 40

Describe Score 3 on the Ramsay Sedation Scale.

Answer 40

Patient responds to commands.

Question 41

Describe Score 4 on the Riker Sedation-Agitation Scale.

Answer 41

Calm and cooperative, obeys commands.

Question 42

Why should opioids be used with caution in liver-impaired patients?

Answer 42

They can worsen hepatic encephalopathy and carry a higher risk of adverse effects.

Question 43

What is the primary consideration for opioid-tolerant patients postoperatively?

Answer 43

To prevent withdrawal and manage pain with baseline opioid requirements.

Question 44

Why is a PCA with a background infusion beneficial post-thoracotomy?

Answer 44

It provides effective pain control and allows for earlier incentive spirometry.

Question 45

What should be avoided for patients with Stage 5 CKD on hemodialysis?

Answer 45

NSAIDs, due to the risk of adverse renal effects.

Question 46

What is the purpose of assessing Glomerular Filtration Rate (GFR)?

Answer 46

To determine kidney function and stage kidney disease for appropriate medication adjustment.

Question 47

How is opioid dosing different for opioid-tolerant patients compared to naive ones?

Answer 47

Opioid-tolerant patients may need 3 times the dose to achieve similar pain relief.

Question 48

What is the significance of the Ramsay Sedation Scale in postoperative care?

Answer 48

It helps evaluate the level of sedation to adjust care and medication accordingly.

Question 49

Why is paracetamol a preferred analgesic for renal-impaired patients?

Answer 49

It is generally safe without major renal adjustment.

Question 50

What is an adverse effect of NSAIDs in elderly postoperative patients?

Answer 50

Increased risk of gastrointestinal bleeding and renal issues.

Question 51

How often should respiratory exercises be performed postoperatively?

Answer 51

Every 2 hours to prevent pneumonia.

Question 52

Why is it essential to monitor urinary output postoperatively?

Answer 52

To assess kidney function and detect potential urinary retention.

Question 53

Why might warming devices be used in the PACU?

Answer 53

To prevent or treat hypothermia, which is common post-surgery.

Question 54

What is the Observer’s Assessment of Alertness and Sedation Scale?

Answer 54

A scale to assess alertness and sedation, scored from 1 to 5 based on responsiveness.

Question 55

What is the impact of polypharmacy in elderly postoperative patients?

Answer 55

It can increase the risk of adverse drug interactions and complications.

Question 56

What does the term 'perioperative' refer to?

Answer 56

The period around surgery, including pre, intra, and postoperative stages.

Question 57

What is the significance of the Aldrete scale?

Answer 57

It helps determine if a patient is ready for discharge from the PACU.

Question 58

What factors increase the risk of chronic postoperative pain?

Answer 58

Age, surgical procedure, anxiety level, and preexisting conditions.

Question 59

How does postoperative delirium affect elderly patients?

Answer 59

It can lead to confusion, longer recovery, and higher morbidity.

Question 60

What is the role of adjuvants in postoperative pain management?

Answer 60

They can reduce opioid requirements and help manage complex pain conditions.