PACU & Complications (Cornelius) Exam II Flashcards
According to Standard 1, all patients who have received general anesthesia, regional anesthesia, or __________ shall receive appropriate postanesthesia management.
A. Epidural anesthesia
B. Spinal anesthesia
C. Monitored anesthesia care
D. Sedation only
C. Monitored anesthesia care
Slide 4
Which of the following are requirements according to Standard 2? (Select 3)
A. The patient must be accompanied by a knowledgeable anesthesia care team member.
B. The patient’s condition must be continually evaluated during transport to the PACU.
C. The patient can be transported without evaluating if stable.
D. The patient should receive support appropriate to their condition during transport.
E. A physician is responsible for the discharge of the patient from the postanesthesia care unit
A. The patient must be accompanied by a knowledgeable anesthesia care team member.
B. The patient’s condition must be continually evaluated during transport to the PACU.
D. The patient should receive support appropriate to their condition during transport.
C- For instance, if you have somebody who’s going back to the ICU, you probably are going to keep them on the cardiac monitor and check their blood pressure, pulse, oxygen sort of thing
On the other hand, most of our PACU patients will be be off all mechanical monitors and be more dependent on our observation skills.
Slide 4
According to Standard 3, upon arrival to the PACU, the patient shall be re-evaluated and a __________ provided to the responsible PACU RN by the member of the anesthesia care team.
A. Written report
B. Verbal report
C. Email report
D. Brief report
B. Verbal report
Slide 5
Standard 4 states that the patient’s condition shall be evaluated __________ in the PACU.
A. Occasionally
B. Once
C. Continually
D. Sporadically
C. Continually
Slide 5
Standard 5 specifies that a __________ is responsible for the discharge of the patient from the postanesthesia care unit.
A. Nurse
B. Hospitalist
C. CRNA
D. Physician
E. Charge RN
F. Respiratory Therapist
G. PACU Secretary
H. Patient’s family member
D. Physician
This can be a anesthesiologist or surgeon
Slide 5
In 1920, several __________ were opened in the United States as a response to recognizing the need for closer monitoring of post-surgical patients.
A. Intensive Care Units
B. Operating Rooms
C. Postanesthesia Care Units
D. Outpatient Surgery Centers
C. Postanesthesia Care Units (PACUs)
Slide 6
After __________, the number of PACUs increased as the military recognized the critical time period for patients following surgery.
A. The Great Depression
B. World War I
C. The Vietnam War
D. World War II
D. World War II
Slide 6
A study in 1947 showed that over an 11-year period, approximately __________ of deaths in the first 24 hours following surgery were preventable.
A. 30%
B. 50%
C. 70%
D. 90%
B. 50%
Slide 6
In 1949, PACU care became a __________ of care for postoperative patients.
A. New recommendation
B. Standard
C. Suggestion
D. Temporary solution
B. Standard
Slide 6
Which of the following staff members are NOT commonly found in a PACU?
A. Interventional radiologist
B. Respiratory therapists
C. Anesthesia personnel
D. Intensivists or hospitalists
E. Specially trained nurses
A. Interventional radiologist
Slide 7
In some PACUs, __________ or __________ are responsible for overseeing the care of patients if they are admitted to the hospital after surgery.
A. Nurses, nurse practitioners
B. Respiratory therapists, anesthesiologists
C. Intensivists, hospitalists
D. Surgeons, anesthesiologists
C. Intensivists, hospitalists
Slide 7
A __________ therapist may be assigned to float through the PACU to assist with specific needs such as ventilators or airway management.
A. Physical
B. Occupational
C. Respiratory
D. Speech
C. Respiratory
Slide 7
Postoperative care of patients in PACU includes:
A) Monitoring of oxygenation, ventilation, and circulation
B) Only monitoring oxygen levels
C) Monitoring ventilation and oxygenation
D) Monitoring of oxygen and ventilation
A) Monitoring of oxygenation, ventilation, and circulation (HR and BP)
Cornholio - Maybe it’s not common practice to transport patients on oxygen, but you’ve got to take them half mile.
Probably want to make sure you have oxygen. Do I need to take an Ambu bag with every patient? Probably not if I’m going across the hallway, but if I’m going a long way, it’s another story. Think about emergency medications and complications you can kind of encounter in between.
Slide 8
Which of the following actions should be taken upon a patient’s arrival in the PACU? Select 3
A) Assess airway patency
B) Assess respiratory rate
C) Connect the patient to monitors
D) Administer a diuretic
E) Taking the patient’s weight
A) Assess airway patency
B) Assess respiratory rate & Saturation %
C) Connect the patient to monitors
Slide 9
When assessing a patient on arrival to the PACU, which of the following is NOT required to be evaluated?
A) Mental status
B) Pain level
C) Oxygen saturation
D) PERRLA
D) Heart rate
E) Presence of PONV
D) PERRLA
Slide 9
The following factors should be considered in the treatment of hypoxemia in the PACU:
Select 3
A) Sedation
B) Patient’s mental status
C) Advanced age
D) Room air
E) Endentulous
A) Sedation
C) Advanced age (>60)
D) Room air
Also assess for respiratory rate and obesity
Slide 9
True or False
One of the biggest things we really worry about after anesthesia is hypovolemia.
FALSE
Corndog - *One of the biggest things we really worry about after anesthesia is hypoxemia. Are they older patients, people that are sedated that still have it in circulation. Do we have them on oxygen? Do they need oxygen? Is the oxygen adequate?
You will see that it’s part of your best efforts to monitor the patient and care for him that things will change between point A and point B. A patient that was 100% in the room may now suddenly be 50-60%, even though they’re still breathing…Having those monitors on quickly is pretty valuable.
Slide 9
What actions should the CRNA take upon the patient’s arrival to the PACU? Select 3
A) Reassess the patient
B) Connect the patient to monitors
C) Administer postoperative antibiotics
D) Provide a report to the PACU RN
A) Reassess the patient
B) Connect the patient to monitors
D) Provide a report to the PACU RN
Slide 10
What factors should you consider when giving a report to the PACU RN?
Select 2
A) Type of anesthetic used
B) Every medication and dose administered during surgery
C) Diabetes or hypertension
D) The exact time each medication was administered
A) Type of anesthetic used
C) Diabetes or hypertension
Slide 10
After monitors are placed on the patient in the PACU, the PACU RN assesses the patient and there are ________ separate phases of recovery.
A) 1
B) 2
C) 3
D) 4
B) 2
Slide 10
True or False
The admissions report needs to be specific, organized, and completed only when you have the full attention of the receiving RN.
TRUE
C - So no matter what you do, as far as report, try and make it organized, if you just hop around, it’s very hard for people to kind of follow your train of thoughts.
We all run into people with ADD that only listen for about 5 or 10 seconds.
So if they stop paying attention, start doing something else, sometimes I’ll just stop talking and wait. Sometimes I stare at them.
Sometimes I’ll ask are they listening?
Especially if I’m going to give something kind of important.
Slide 11
What does the acronym SBAR stand for in the context of patient handoff?
A) Situation, Background, Assessment, Recommendation
B) Summary, Background, Assessment, Report
C) Situation, Brief, Assessment, Response
D) Summary, Brief, Analysis, Recommendation
A) Situation, Background, Assessment, Recommendation
Slide 12
Which of the following is most important to communicate during a PACU handoff?
A) Every medication administered during surgery
B) Surgical duration and complications
C) Anesthetic events and complications
D) The name of the anesthesiologist and medications
C) Anesthetic events and complications
Slide 12
When should the CRNA ask if the PACU nurse has any questions about the handoff?
A) At the beginning of the report
B) After confirming patient allergies
C) At the end of the report
D) Before discussing the patient’s anesthesia history
C) At the end of the report
C - …and then at the end make sure that they don’t have any questions.
Slide 12