POSTOPERATIVE Flashcards
What is the goal PACU (5)
1 maintain client safety 2 adequate body system 3 alleviate pain 4 prevent post complications 5 identify actual and potential problems
vital roles of nursing (5)
1 support ventilation & perfusion 2 maintain fluid and electrolyte balance 3 promoting comfort 4 reducing infection 5 promoting safety
immediate assessment includes (3)
1 proper positioning to promote airway
patency
2 supporting vital physiologic functions
3 immediate assessment
what do the nurse need to check for airway
patency, presence of tubes and respiratory assistance device
what do the nurse need to check for breathing
RR and depth, presence of bilateral breath sounds, stridor, wheezes, hoarseness or decreased breath sounds
what do the nurse need to check for circulation
pulse, BP, skin color, O2 sat
signs of inadequate oxygenation (5)
1 delayed capillary 2 weak peripheral pulses 3 decreased O2 saturation 4 restlessness 5 flushed
what do you do in phase 1 of post anesthesia care
1 immediate post anesthesia period
2 ECG and more intense monitoring
what do you do in phase 2 of post anesthesia care
1 ambulatory
2 fast tracking
what is extended observation
extended care
what is blended levels of care
various of levels offered in same environment
nursing care in PACU
1 assess respiratory status 2 assess circulation 3 assess neurologic status 4 monitor wound 5 reduce N&V
what should high risk client use to detect respiratory depression
the client use transcutaneous CO2 and end tidal CO2
what should the nurse assess for neurologic status of patient
1 level of consciousness
2 orientation
3 sensory and motor status
4 size, equality, and reactivity of pupils
what should the nurse assess for the body temperature
1 peripheral pulse
2 capillary refill
3 skin condition