Post anesthesia care Flashcards
What are ERAS (enhanced recovery after surgery) protocols?
a prescribed program that patients are to follow after participating in education that is specific to the surgery.
Why are ERAS used?
These protocols have been shown to be beneficial to the patient, improve surgical outcomes, and decrease costs.
When do patients and their providers follow the ERAS protocols?
- prior to surgery
- The day of surgery
- during surgery
- after surgery
What are example of ERAS protocols?
- strengthening exercises
- improving nutritional status
- additional prep education
- smoking cessation
What is ASA 1 for physical status?
a normal healthy patient
What is ASA 2 for physical status?
a patient with mild systemic disease
What is ASA 3 for physical status?
a patient with severe systemic disease
What is ASA 4 for physical status?
a patient with severe systemic disease that is a constant threat to life
What is ASA 5 for physical status?
a moribund patient who is not expected to survive without the operation
What is ASA 6 for physical status?
a declared brain-dead patient whose organs are being removed for donor purposes
What is the ASA used for?
to determine perioperative risk. NOT to determine what anesthesia to use
What are the 3 phases of PACU care?
- Phase 1
- Phase 2
- Phase 3
What are the phases of PACU care used to describe? not describe?
are levels of care, not physical location.
What are factors that determine the level of patient care in the PACU?
- type of surgery
- length of surgery
- type of anesthesia
- comorbid conditions
- anticipated post-anesthesia requirements
What is post anesthesia phase 1?
the post anesthesia phase 1 requires constant vigilance and life-sustaining care
What is post anesthesia phase 2?
a period of care that focuses on in-home care
What is post anesthesia extended care?
care for the patient requiring continued observation or intervention.
What is the nurses role PACU phase 1?
- patient assessment and care implementation int he immediate post anesthesia period
- preparations for the patient’s transition to the phase II care, the ICU, an inpatient setting, or extended care
What kind of experience does a PACU nurse typically have?
critical care experience or ED experience
What kind of certifications does a PACU nurse typically have?
ACLS and PALS
What must the PACU nurse have knowledge of?
will have knowledge of the care necessary for the patient who has received general, regional, and/or local anesthesia
What two other pieces of knowledge is required for the PACU RN?
- age-specific care knowledge
2. how to care for a patient requiring cardiac and respiratory support
What is constantly required by the PACU RN?
constant assessment of the post patient is required to ascertain changes in the patient’s condition and respond appropriately to those changes
What is a key component of the handover report?
completing urgent tasks before doing handoff
Describe the phase II staffing and patient acuity?
- 1:3 for patients older than 8 years
2. 1:2 for patients 8 years of age and younger
What are examples of education you might find in Phase II PACU?
- how to empty the drain reservoir
- coughing and deep breathing exercises
- how to take the prescribed pain medication
What ASA classification would a patient with a BMI of 40 and type 1 diabetes be?
ASA 3; diabetes is a systemic disease that limits activity but is not incapacitating
What is part of the initial assessment for the PACU RN in phase 1? Not what?
airway, breathing, and circulation. NOT pain
What is phase II often the last opportunity for?
for the nurse to provide education to the patient and their family/support group
What is the best kind of education method in phase II patient and family education?
teach-back method
Why teach-back method the best?
reinforces what the patient knows and understands
What does the teach-back method involve?
asking your patient to teach you what you have just explained
What does the teach-back method reinforce?
the ability to correctly perform prescribed activities
Why is it important for the nurse to identify if the patient can correctly perform prescribed activities?
because If the patient misunderstands how to perform an activity, the nurse can provide further education.
What does medication reconciliation help ensure?
that the patient understands what medication they have been prescribed and why
What are 5 nursing actions during medication reconciliation?
- Compare the list to those listed in the preoperative phase.
- Provide direction on how, when, and why to take the medications.
- Discuss adverse effects of each medication.
- Review the written instructions with the patient and/or caregiver.
- Ask the patient/caregiver if they have any questions.
What is Phase II also known as?
step down
True or false; a patient may bypass phase I PACU and transfer directly to phase II
true
What is it called when a patient bypasses phase I PACU and transfers directly to phase II?
fast tracking
What is implemented between patient care providers during fast tracking? why?
hand off communication tool; to help ensure continuity of care and patient safety
Why is the patient follow-up phone call an important element of post anesthesia care?
most surgical complications occur within 48 hours of the procedure
What is discussed in the postoperative phone call? 3 things
- Postoperative instructions are reviewed and reinforced.
- Questions are answered.
- Reminders are provided concerning follow-up appointments.
Who was the first nurse to suggest that a postanesthesia unit be created?
florence nightingale
What is capnography?
The monitoring of the concentration or partial pressure of carbon dioxide (CO2) in respiratory gases (ie, end-tidal CO2 [ETCO2]). Its main use is as a monitoring tool during anesthesia.
define aldrete scale
anesthesia care unit to either the postsurgical ward or to the second stage recovery area.
What is the specialty organization for RNs working in preanesthesia, postanesthesia, pain management, and ambulatory surgery centers?
ASPAN; American society of perianesthesia nurses
What is ASPAN responsible for?
for defining and establishing the scope of perianesthesia nursing and supports nurses through advocacy, research, and clinical education.
define extended care unit/phase III?
is utilized when additional observation is required before a patient goes home, when waiting for an inpatient bed, or when waiting for the patient’s support system.
define post anesthesia phase I?
This occurs immediately following surgery. Basic life-sustaining needs are the highest priority. Constant observation is required during this phase.
define post anesthesia phase II?
This is a transition period between PACU care and discharge to extended care, home, or another facility. If the patient is being admitted to a unit, they will likely bypass Phase II.
What is a system developed by the American Society of Anesthesiologists (ASA) that provides uniform guidelines for the evaluation of the severity of systemic diseases, physiologic dysfunction, and anatomic abnormalities?
ASA physical status classification
