PACU Care Complications Flashcards
At what temperature when patient is considered hypothermic (PACU care complications)?
Temp < 36 C
What are complications associated with hypothermia?
Shivering
Impaired wound healing/ surgical infection site
Myocardial ischemia
Coagulopathy
What is the treatment for hypothermia?
Warming measures checked Q15 minutes
What are the risk factors for PONV (PACU care complications)?
Female +1
Nonsmoker +1
PONV Hx +1
Postoperative opioids +1
What is the difference between Reglan and Zofran (PACU care complications)?
!Reglan - MOA is increasing gastric emptying
!Reglan contraindicated patient’s with Parkinsons because it blocks dopamine receptors
!Zofran - given after chemotherapy or surgery
Zofran - 5-HT3 receptor antagonists, MOA blocking the action of serotonin, a natural substance that may cause nausea and vomiting
Who are at risk for unintended intra-operative awareness complication (PACU care complications)?
History of drug or alcohol abuse
Extreme anxiety
Previous episode of awareness
For pt w/ ASA status > 3 consider lighter anesthesia
What is emergence delirium (PACU care complications)?
Dissociative state of consciousness demonstrated by responsive/ non-responsive agitation that may last 10-45 minutes
Anxiety and Agitation
What is the treatment for emergence delirium (PACU care complications)?
Keep safe
!Always rule out hypoxemia
PACU Care Complications
What are the causes of upper airway obstruction?
tongue relaxation most common cause, d/t not fully recovered from opioid or sedative medications or whoresidual neuromuscular blocking agents.
Other causes - airway edema, airway injury, hemorrhage, obstructive sleep apnea, or preexisting neurologic or muscular weakness
PACU Care Complications
What are treatments of upper airway obstruction?
verbal or tactile stimulation
airway repositioning with chin lift or jaw thrust
placement of oral or nasopharyngeal airway adjunct
application of positive pressure with a bag-valve-mask device
If above are ineffective: oral or nasal placement endotracheal tube, or emergency cricothyroidotomy or tracheostomy
Position patient side-lying with head down to facilitate drainage
What are the signs of airway obstruction (PACU care complications)?
Snoring or stridor
Use of accessory muscles
Paradoxical respirations
Dyspnea
Somnolence
Hypoventilation
Hypoxia
Sleep apnea
What is laryngospasm (PACU care complications)?
Flow of air is blocked into and out of the lung by spasm of the larynx
It may be partial (possibly with stridor souds) or complete (absence of sound).
Risk factors include excess secretions, vomitus, blood, coughing, artificial airway placement
What are the signs and symptoms of laryngospasm (PACU care complications)?
Dyspnea
Hypoxia
Hypoventilation
Absence of breath sounds
Hypercarbia
High pitch crowing sounds
What are possible interventions for laryngospasm (PACU care complications)?
Hyperextend neck
Reduce stimuli
Administer humidified O2
Positive pressure ventilation w/ BVM
Administer succinylcholine
Administer steroids/ Lidocaine IV
How does succinylcholine help in laryngospasm (PACU care complications)?
Relax laryngeal muscles
How does steroids/ lidocaine IV help in laryngospasm (PACU care complications)?
Decrease airway irritation - racenic epinephrine
PACU Care Complications
What is noncardiogenic pulmonary edema?
Noncardiogenic pulmonary edema = negative pressure pulmonary edema
d/t upper airway obstruction, laryngospasm, naloxone bolus, incomplete reversal of neuromuscular blockade, or a significant period of hypoxia
PACU Care Complications
What are the signs and symptoms of noncardiogenic pulmonary edema?
hypoxemia
cough
failure to maintain oxygen saturation levels
tachypnea
frothy sputum
Treatment includes O2 administration, patent airway, CPAP, mechanical ventilation with PEEP if unable to maintaint patent airway
PACU Care Complications
What type of diseases predispose patients to pulmonary embolism?
obese or immobility
pelvic or long bone procedures
history of congestive heart failure
congenital heart disease
malignant disease.
Signs and symptoms include
tachypnea
pleuritic chest pain
hemoptysis
breathlessness
sense of impending doom
What is bronchospasm (PACU care complications)?
Constriction of bronchial smooth muscles
What are the signs and symptoms of bronchospasm (PACU care complications)?
Dyspnea
Wheezing
Use of accessory muscles
Tachypnea
Decrease O2 saturation
What are the risk factors of bronchospasm (PACU care complications)?
Asthma
COPD
Chronic bronchitis
Aspiration
What is the intervention for bronchospasm (PACU care complications)
Reduce airway irritability
What is hypoxemia (PACU care complications)?
D/t respiratory depressant effect of anesthetic agent resulting to shallow breathing. This is more prevalent in patient s/p upper abdominal surgery.
What are the signs/ symptoms of hypoxemia (PACU care complications)?
Decrease SPO2
What is the intervention for hypoxemia (PACU care complications )?
Administer O2
Deep breathing
What are the causes of dilutional hyponatremia in TURP syndrome (PACU care complications)?
Absorption of irrigating solutions
!Leads to water intoxication
What are the s/s of dilutional hyponatremia (PACU care complications)?
Confusion
Nausea
Bradycardia
Seizure
Coma
What are the characteristics of compartment syndrome (PACU care complications)?
5 P’s
Pallor
Paresthesia
Paralysis
Pulselessness
Pressure
What are the s/s of compartment syndrome (PACU care complications)?
intense pain unrelieved by conventional methods (hallmark)
paresthesia
sharp pain on passive stretching of middle finger/toe of affected extremity
progressive symptoms include decreased strength, decreased sensation (numbness and tingling), and decreased capillary refilling; peripheral pulses are not generally compromised.
Immediate intervention includes elevation of the extremity, application of ice, and release of restrictive dressings.
The most significant sign is pain out of proportion with injury or surge
What is the late sign for MH (PACU care complications)?
Fever
What BP medication can not be given to MH (PACU care complications)?
!No calcium channel blockers for MH
PACU Care Complications
What is the difference between symptoms of MH and Thyrotoxic Crisis?
Thyroid storm or thyrotoxic crisis can occur after surgical manipulation of a hyperactive thyroid. S/S may initially include fever and tachycardia, and later agitation, disorientation, hypertension, tachycardia, and heart failure proceeding to shock, hyperthermia.
Malignant hyperthermia more typically appears intraoperatively with a rise in end-tidal CO 2 , rigidity, elevated creatinine kinase, or lactic acidosis, whereas thyroid storm more typically appears postoperatively and with hypokalemia.
Tx bb, iodine, vasopressors, fluidt, O2, salicylates, steroids, cooling
What is citrate toxicity in blood transfusion (PACU care complications)?
Per NIH, citrate toxicity occurs when citrate in transfused blood begins to bind calcium in the patient’s body. However, clinically significant hypocalcemia does not usually occur unless the rate of transfusion exceeds one unit every five minutes or so.
What is the treatment for Disseminated Intravascular Coagulation (PACU care complications)?
Fresh frozen Plasma when bleeding is present or anticipated
What medication to treat Von Willebrand Disease (coagulation/ bleeding d/o)?
DDVAP - prevents breakdown of clotting factors
What are the side effects of scopolamine (PACU care complications)?
!Disorientation
!Hallucinations
Sedation
Dry mouth
Visual disturbance
Dysphoria
Confusion
What are signs and symptoms of epidural hematoma as complication of epidural anesthesia?
Lower back pain
Motor changes
Bowel/ bladder dysfunction (urine incontinence / NOT retention)
What are signs and symptoms of epidural hematoma as complication of epidural anesthesia?
Lower back pain
Motor changes
Bowel/ bladder dysfunction (urine incontinence / NOT retention)
