Week 9: PARU Flashcards
What is the post anaesthesia recovery unit?
Well defined unit which provides continuous, individual, critical assessment, care and treatment for post operative patients emerging from GA, spinal, regional or local sedation anaesthesia
What are the minimum training requirements for PARU?
Airway management ALS Caring for acute surgical wounds Caring for a variety of drainage catheters Knowledge of anaesthesia pharmacology Acute pain management
What are the nurse-to-patient ratios in the PARU?
1: 1 for: first 15 minutes following GA, unconscious and intubated, unstable, paed
1: 2 for: 1 conscious, stable and uncomplicated + 1 conscious, moderate complications such as pain relief
1: 3 for: conscious, stable and uncomplicated
1: 6 for: conscious, stable and uncomlicated, and being considered for discharge (DSU stage 2 or 3)
What are the minimum time frames for keeping patients in PARU?
3 sets of conscious, stable obs
What are the requirements for transferring a patient from the OT to PARU?
Anaesthetist, nurse, wardsperson
Safe monitoring, OHS
O2: prongs/mask/ETT/LMA, Ambibag with mask
O2, suction, ventilation: O2 cylinder which works as twinvac, has enough O2 left for transfer
Supine or lateral
Observe for complications
What information do you need to know from the anaesthetist during PARU handover?
Clinical obs and monitoring Pain relief Complication: PONV, blood loss Respiratory therapy Discharge expectations Ongoing care: post-op orders, medications written up, devices Procedure ID: name, age, etc Medical/surgical/anaesthetic history Stays until A-G assessment complete
What information do you need to know from the scrub/scout nurse during PARU handover?
Patient ID Procedure Drips, drains and dressings Specific patient care, such as skin integrity Documentation X-rays Extras: teeth, glasses, clothing
What needs to be done during the PARU A-G assessment?
Airways: patent and unobstructed
Breathing: look, listen and feel for breathing
Circulation: colour, sats, BP, pulse
Drips, drains, dressings and drugs. Consciousness
Exposure: temperature
Fluid orders
Glucose if needed
When do PARU patients needs to be ECG monitored?
Cardiac history
Large blood loss
Hypothermic
Intraop arrhythmia
What are possible PARU patient complications?
CNS: unconsciousness Respiratory: hypoxia, obstruction Cardio: hypotension, hypertension, arrhythmia Fluid: hypovolemia, hypervolemia Temp: hypothemia Pain PONV
What are the causes of delayed emergence and how is it managed?
Residual anaesthesia (most common) Hypothermia Endocrine: diabetes, muscular dystrophy/MS, hepatic/renal disease
Systematic assessment: Pre-op status Intra-op events Ventilation Response to stimulation Cardio status Neuro status
How do you assess airway/breathing in PARU?
Look: Effective resps Symmetrical chest Breathing normal, shallow, laboured Deep breahting Sats
Listen:
Noisy
Wheezing
Silent
Feel:
Chest movement
Expired air
What are the causes and treatment of airway obstruction?
Tongue in posterior pharynx (most common)
Foreign body
Inadequate relaxant reversal
Residual anaesthesia
Verbal/physical stimulation Jaw support: chin tilt, jaw thrust Artificial airway Crico-therapy Tracheostomy Suction secretions Pharmacological intervention
What are the causes of postop hypertension?
CNS stimulation: pain, urinary retention
Fluid overload
How does TURP syndrome affect a post-op patient?
Symptoms: dizziness, headache, nausea, SOB, confusion, restless, increased BP, decreased HR, cyanosis, cardiac arrest
Uptake of irrigation fluids through venous networks of prostate bed (vascular)
Average absorption 20mL/min
Circulatory overload, blood volume increase, BP increase, pulmonary and cerebral oedema
Sodium transfers into interstitial space –> hyponatremia –> water intoxication and altered CNS function
PO or CHF
What does a hypotensive patient with pain indicate?
Not in pain
Haemorrhaging as well
What is the treatment for post-op hyertension?
Diagnose cause and treat
Pain: check chart, ask patient
Fluid: check chart, urine output
Pharmacological treatment: pain control, beta blockers, metoprolol
How do you manage IPH?
Anticipate: surgery >1hr, exposed position, frail/elderly or obese
Baseline temp
Actively rewarm
Administer O2: shivering –> increase O2 demand –> hypoxaemia, lactic acidosis, hypercarbia
What are the risk factors for PONV?
Type of surgery: gynaecology
Anaesthesia: GA
Female
Lifestyle: non-smoker
History: previous negative anaesthetic experience, vision and hearing issues, balance issues
Extended fasting –> dehydration –> hypotension –> PONV
What are the causes of post-op oliguria and how is it managed?
Hypovolemia
Surgical trauma to ureters
Impaired renal function
Mechanical blocking of catheter
Assess catheter patency
Fluid bolus
Lasix
How can you ensure post-op comfort?
Quiet calm environment Repositioning Hot/cold packs Elevate affected limb Pressure area care Breathing
What is the PARU discharge criteria?
Awake with muscle strength Patent airway Good resp function Stable obs Patent tubes, catheters, IVs Post-op orders Condition of surgical site Comfort/anxiety Documentation Minimum 3 stable conscious obs If pre-existing conditions preclude meeting criteria, must be assessed by MO Unable to fulfill criteria: remain in PARU, transferred to critical care area for observation and management
What is included in the discharge handover?
Patient ID Surgical procedure Anaesthetic Medical history Condition/progress Medications Drips, drains and dressings Post-op orders
