PACU?

Question 1

What is perianesthesia nursing ?

Answer 1

Care of a pt before and after admin of anesthesia

Collaborative relationship

Nurse and anesthesia responsible for hand off
- Continuity of care

Question 2

What is ASPAN?

Answer 2

American society of perianesthesia nurses

Establish standards for perianesthesia nurses

Question 3

Who sets PACU standards?

Answer 3

American society of anesthesiologists

• recovery from anesthesia gases
• specialized equipment
• advancement of sx procedures

Question 4

PACU nurse skills?

Answer 4

Critical care experience
Competent regarding age specific care - cardiac, resp
Knowledge of general, regional, local
Holds PCLS, PALS

Question 5

Stages of surgical experience

Answer 5

Decides on sx
Pre op 
OR
PACU
Pt returns home

Question 6

Benefits of eras?

Answer 6

Improve surgical outcomes and decrease cost

Question 7

Examples of eras protocols?

Answer 7

Strength exercises
Improved nutritional status
Pre op education
Smoking cessation

Multidisciplinary, pt/fam centered

Question 8

What is ASA classification based on?

Answer 8

Perioperative risk

• systemic disease
• physiological dysfunction
• anatomic abnormalities

Question 9

ASA 1

Answer 9

Normal 
Healthy pt
No smoking
Minimal ETOH
Normal BMI

Question 10

ASA 2?

Answer 10

Mild/controlled systemic disease
Smoker
Social drinker 
Pregnancy 
BMI > 40

Question 11

ASA 3?

Answer 11

Severe/poorly controlled systemic disease 
BMI < 40
Alcohol dependence
Pacemaker
Dialysis 
Recent cardiac hx (MI, CVA, stents)

Question 12

ASA 4?

Answer 12

Severe systemic disease that is a constant threat to life
Ongoing ischemia
Valve dysfunction
Shock, sepsis

Question 13

ASA 5?

Answer 13

Patient not expected to survive without surgery 
Massive trauma 
AAA
Intracranial bleed
Ischemic bowel

Question 14

ASA 6?

Answer 14

Declared brain dead pt going for organ donations

Question 15

Levels of care in PACU?

Answer 15

Phase 1 - constant vigilance and life sustaining care

Phase 2 - focuses on in home care

Phase 3 - extended, continued observation

Question 16

Factors affecting levels of care in PACU?

Answer 16

Type and length of surgery
Type of anesthesia
Anticipated post anesthesia requirements
Comorbid conditions

Question 17

Phase 1 PACU

Answer 17

General/regional
Life sustaining needs are highest priority
Constant observation
airway, LOC, VS

Prep to transition to phase 2

Question 18

Phase 1

1:1 ratio

Answer 18

Maintains until critical elements are met
Unstable airway
Hemodynamically unstable

Question 19

Phase 1

1:2 ratio

Answer 19

One unconscious, stable pt without artificial airway (8yrs and older)
One conscious stable pt free of complications
2 conscious stable pts free of complications

(2 pt 1 nurse)

Question 20

Phase 1

2:1 ratio

Answer 20

2 nurses

One critical unstable complicated pt

Question 21

Discharge from phase 1

Answer 21

Meet criteria 
Example: aldrete scale post anesthesia scoring system 
- resp
- activity
- circulation
- consciousness 
- O2 sat

Max score 10

Question 22

Phase 2

Answer 22

Step down recovery

Pt being admitted to unit will bypass stage

Pt may be fast tracked into phase 2

Encouraged to eat, drink and walk

Family allowed

D/C by WC, no driving
- follow P&P

Question 23

What is main focus of phase 2?

Answer 23

Pt and fam education
Last opportunity before d/c
- use teach back method

Question 24

Phase 3?

Answer 24

Extended care
Waiting for inpatient bed or discharge arrangements

Part of PACU

Ratio can be 1:3-5 pt

Question 25

Blended levels of PACU?

Answer 25

All levels in same location

• staffing reasons
• workflow
• continuity

Phases = level of care not locations