Post-operative Care Flashcards
PACU
post-anesthetic Care Unit
the place for immediate recovery for post-op pts.
suitable for general, regional, and local anesthesia pts.
what is included in a verbal report before going to PACU?
The anesthesiologist/perioperative nurse give report to the PACU nurse.
general info:
- pt name
- age
- anesthesiologist name
- surgeon name
- surgical procedure
pt hx:
- indication for surgery
- medical hx, allergies, medicationis
intraoperative management: - anesthetic meds received - other meds given pre op - blood loss - fluid replacement totals and urine output
intraoperative course:
- unexpected anesthetic events or reactions
- unexpected surgical events
- VS and monitoring
- intraop lab results
airway
assess the post op pt’s airway patency.
do they need their chin lifted?
Do they need an oral or nasal airway?
do they need an endotracheal tube?
breathing
RR and quality
auscultate the lungs
pulse Ox
O2 therapy needed?
hypoxia: below 80 PaO2
circulation
assess by monitoring ECG rate and rhythm. BP should be compared with baseline BP. temp CWMS cap refill peripheral pulses
what is the initial neurological assessment? (PACU)
Includes LOC, orientation, sensory/motor functions, PERRLA.
what is the first sense to return from anesthesia?
hearing
what is the urinary system assessment (PACU)?
Focuses on intake, output, and fluid balance.
note all IV lines, irrigation solutions, infusions, catheters, drains..etc
nausea/vomiting should be treated with antiemetics
assessing the surgical site (PACU)
note the condition of the dressings, colour and amount of drainage, from incision site.
pain at the incision site?
what are the priorities of the PACU?
respiratory functions circulatory functions pain temperature surgical site pt response to reversal of anesthetic
what are potential alterations in resp function in PACU?
airway obstruction!
Caused by tongue falling back or thick secretions.
hypoxemia! this is a PaO2 less than 80 (ABGs)
hypoventilation d/t sedation from anesthesia
tx) assess patency, depth, and rate of breathing.
if unconsciouness, put into recovery
if conscious, put in supine with HOB up
common alteration of resp function in surgical unit?
- atelectesis- partial or complete collapse of the lung d/t deflated alveoli
- pneumonia
prevent: early mobilization, DB+C, incentive spirometer
what are potential cardiovascular alterations in PACU?
HYPOTENSION! most commonly caused by unreplaced fluid loss in the OR or post-op hemorrhage.
TX: administer O2 to perfuse organs. give IV fluids, appropriate meds.
HYPERTENSION
caused by SNS stimulation because of pain, anxiety, bladder distension, etc.
TX: analgesia, rewarming, appropriate drug intervention
dysrhythmias
what are potential cardiovascular alterations in the surgical unit?
fluid and electrolyte imbalances related to stress of surgery.
fluid retention during post op day 2-5
ADH release + renin-angiotensin-aldosterone system
stress response increases clotting and platelet production–> risk of DVT
treat with low-molecular weight heparin.
Monitor Ins and Outs.
monitor electrolytes.
potential neuro complications in PACU/
- Emergence delirium- wakes up from anesthesia in an agitated state
- agitation
- disorientated state of mind
- thrashing and shouting
- *rule out hypoxia**
2. delayed awakening
3. most common cause of post op agitation-> hypoxemia
