Post Anesthesia Care

Post Anesthesia Unit  Specialized critical care area  Also called recovery room or PACU, (post anesthesia care unit)  Usually nurses have critical care or medical-surgical experience

 Primary goal of nursing care is to:  Maintain A,B,C’s  Thus, the environment includes special equipment:

Admission to PACU  PACU nurse receives patient and reviews information  patient’s name and age  medical diagnosis & type of surgery  general condition: airway, vital signs, BP  anesthetic used and other meds given  narcotics, muscle relaxants, paralytics  any problems in OR; e.g. hemorrhage

Post-Operative Assessment Report  Pathology encountered  Fluids given, including blood  Estimated blood loss (EBL)  Tubing, drains, catheters  Urine output  Any important historical information  allergies, or chronic illnesses

Immediate Assessment  Time patient arrived  Patency of airway, artificial airways, O2  Respirations  Pulse  Skin color, nailbeds, lips, mucous membranes (patient will be cold!!)  Neuro checks: can patient follow commands?

Immediate Assessment  Check operative site  drainage or hemorrhage  tubes that need to be unclamped and connected to drainage  Pertinent historical information  HOH, epilepsy, diabetic, allergies, drugs  Reflexes: eyelid, pharyngeal, cough  Urge to void; bladder distention

Oral Airway  Hard plastic airway used to maintain patent airway  Keeps tongue from falling back and obstructing airway  Removal: when gag reflex returns

Other Artificial Airways  Ventilators  patient may require ventilatory assistance

Vital Signs  check q 15 mins until stable; then q 30”  pulse above 110 or below 60 should be reported  BP  inform physician if BP drops more than 20 mmHg after OR, or 5-10 mmHg at each reading  Color of lips and nailbeds indicate tissue perfusion (but patients are cold)

 Temperature  usually very cold and maybe hypothermic  report fever at once

Intravenous Infusion  Most patients will have an IV  Purpose?

Neurological Assessment  Return of reflexes such as swallowing or gagging  Patient’s response to name or verbal stimuli  Level of alertness or orientation

GI Assessment  Nausea and vomiting is common after anesthesia  Assess bowel sounds  NPO until bowel sounds return  If NG inserted, check for patency

Wound-Drainage Assessment  Observe dressings and drains  Observe under patient for any pooling of bloody drainage  Record color and amount of drainage

Comfort/Pain Assessment  Assess need for analgesics  Administer as needed if ordered, or call  Assess for respiratory or cardiovascular depression  Siderails up  Provide warmth  Mouth will be dry, moistened wash cloth

Possible Behavior after General Anesthesia  Nausea and vomiting  Restlessness  Crying  Grogginess  Weakness

Complications of Post- Operative Anesthesia

Respiratory Obstruction  Signs and symptoms  restlessness  choking  noisy irregular respirations  Causes  laryngeal spasms  secretions  relaxation of tongue over epiglottis

Prevention and Treatment of Respiratory Obstruction  Clear secretions from airway  suction if necessary  Position airway properly  100% oxygen  Prepare for intubation if necessary

Circulatory Complications of Post-Operative Anesthesia  Hemorrhage  check dressings and drain tubes with vital sign checks  Post-operative hypotension  usually accompanied by increased pulse

Volume Depletion  Definition  Not enough circulating blood volume in the body  Causes  Patient fasting prior to surgery  Blood loss during surgery

Prevention of Hypovolemic Shock  Monitor fluids very closely  Blood loss measured and reported  Blood and blood substitutes available  Monitoring of vital signs continued throughout recovery

Unexpected Outcomes  Unstable vital signs  Shallow or noisy irregular respirations  Restlessness or c/o pain  Significant fall in BP  Significant bleeding  Imbalance in intake or output

Discharge from PACU  Patient is stable and recovered from anesthetic agents  Specific criteria patient must meet:  uncompromised airway  stable vital signs  oriented to time, place and person  urine output greated than 30 ml/hr  nausea/vomiting and pain under control

Discharge Criteria  Hospital use specific tool  Patient’s scores taken at intervals  Total score will indicate patient’s readiness for discharge  Note criteria used by hospital when doing recovery room rotation