Post-Op/PACU

Question 1

Where?

Answer 1

Near OR

Question 2

Goal?

Answer 2

Patient Safety during recovery and identifying problems with anesthesia. Required: SBAR report from anesthesia nurse to PACU nurse (includes med status and emotional status and blood loss and urine O and fluids given and unexpected events and monitor trends)

Question 3

Time in PACU begins with?

Answer 3

Assessment.

Question 4

Priority with assessment!?

Answer 4

-Airway! Trumpet…respiratory? auscultation? circulations? BP? O2? Cap refill? Sepsis, shock. Dry warm skin is good. -Surgical site… drains? dressing? Patent?
-GUIs… Dec. in urine output and watching Is and Os
Listen to bowel sounds.
-PERRLA
-Pain?? Internal bleeding
-SAFETY (siderails)

Question 5

Respiratory Issues

Answer 5

Obstructions
Hypoxemia
Atelectasis (not big enough breaths)
Aspiration (head tilt chin lift or sit patient up)
Bronchospasm (slow resp rate and 
Hypoventilation

Question 6

Respiratory Problems

Answer 6

Head tilt chin lift
Spirometer
Sit up
Deep breathing
Ambulation

Question 7

Cardiovascular Problems

Answer 7

Hypotension (d/t blood loss)
Hypertension (fluid overload or pain)
Resp = Cardio issues
Dysrhythmias
VTE
Syncope 

-So, monitor vitals, look for trends, is bp decreasing or increasing, air irregularities, thready, check drains, check incision, skin, monitor Is&Os, hgb, hmct…indicate bleed. AMBULATION slowly

Question 8

VTE

Answer 8

Caused by putting in an IV.
(mult pokes irritates vein…)
Superficial ones require simple fixes…warm compresses.
Damage endothelial produces platelet aggregation

Signs: Unilateral VTE. Neg. DDimer= NO clot.

@ Risk
Menopausal
Smokers.

Prevention: pump feet, AMBULATION, into chair for meals, less punctures, stop smoking, hydration! If SOB or tachypnea, call 911 (PE)

Question 9

Neurologic

Answer 9

Delirium? Hypoxic? Alcohol withdrawal.

Assess:
LOC, PEERLA,
Rule out hypoxemia, sleep deprivation, relaxation

Causes: fever, hypothermia, temp changes, pain/discomfort/blankets

Question 10

Eliminate hypothermia

Answer 10

eliminate risk for hypoxemia

Question 11

GI

Answer 11

Nausea/vomiting, gas, distention?
Opioids,
Ileus-deadly
Constipation-adequate fluid intake but only fluid and IV and even NG tube to suction…
Post-op ileus- paralysis of intestines…
AMBULATE
Diet issues.

Question 12

Discharge

Answer 12

LOC normal
vomiting?
pain?
airway?
dressings clean?

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