PACU

Question 1

Phase 1

Answer 1

Immediate intensive care level recovery
Patient emergence & awakening
Continues until standard discharge criteria met

Question 2

Phase 2

Answer 2

Less intensive care
Ensures patient ready for discharge
Fast-tracking directly to phase 2 care (outpatients)

Question 3

Transport to PACU

Answer 3

Patent, stable airway
Adequate ventilation & oxygenation
Hemodynamic stability
Transport w/ supplemental O2

Question 4

AANA Standard 11

Answer 4

Transfer of care

Question 5

Hand-off Report

Answer 5

Patient name, age, allergies, cognitive assess
Diagnosis, surgical procedure, surgeon
Pre-anesthesia assessment, VS, med/surg history, medications
Anesthesia technique, course, complications, agents used, intraop fluids
Preop lab values
Medications - last admin, next due, dosage (antibiotics, antiemetics, narcotics)
PACU orders

Question 6

Delayed Emergence

Answer 6

Failure to regain consciousness 30-60min after general anesthesia discontinued

Question 7

Delayed Emergence Causes

Answer 7

Most commonly d/t residual drug effects
Narcan, flumazenil, NMB reversal agent

• Hypothermia
• Hypoxia
• Hypercarbia
• Metabolic disturbances
• Periop CVA

Question 8

PONV Risk Factors

Answer 8

Young
Female
Non-smoker
Body habitus
Motion sickness or PONV history

Surgery - laparoscopy, GYN, eye, ENT, breast, neurosurgery
Postop - hypotension or pain

Question 9

Antiemetic Classes

Answer 9

Dopamine
5-HT3 (serotonin) antagonists
Antihistamine
Anticholinergic

Question 10

Chemoreceptor Trigger Zone

Answer 10

Vomiting center

Area postrema in dorsomedial medulla oblongata

Question 11

Delirium Risk Factors

Answer 11

Medications
Pain
Hypoxemia
Electrolyte abnormalities
Malnutrition
Dehydration
Environmental change

Question 12

Hypothermia & Shivering

Answer 12

Impaired immune system
↑infection incidence
↑blood loss & transfusion requirements
↑CO ↑MVO2
↓drug metabolism
↑O2 consumption ↑CO2 production

Question 13

Postop Shivering Treatment

Answer 13

Demerol (Meperidine) 12.5mg IV

Question 14

Respiratory Complications

Answer 14

Airway obstruction
Bronchospasm
Laryngospasm
Pulmonary edema
Pulmonary embolism
Aspiration
Hypoventilation → hypoxemia

Question 15

Hemodynamic Complications

Answer 15

Hypertension
Cardiac dysrhythmias
Fluid & electrolyte abnormalities

Question 16

Neurological Complications

Answer 16

Peripheral nerve injuries
Postdural puncture headaches
Transient focal deficits
POVL

Question 17

PACU Discharge Criteria

Answer 17

Minimum 20-30min observation after last PO narcotic
Easily arousable
A&O x4 or return to baseline
Maintains & protects airway
Stable VS x15-30min
No obvious surgical complications