Assessments and nursing interventions for Post Anaesthetic Care Unit (PACU)
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SAMPLE ANSWER
Assessments and nursing interventions for Post Anaesthetic Care Unit (PACU)
- Identify the assessments performed. Were these assessments adequately prioritized?
The post-operative care must be adequately planned to make the client’s recovery process fast. After the patient identification is positive, the second step is physical assessment (Parekh Et al.,2013). This includes recording patient Heart Rate, respiration rate, temperature SpO2, and Blood pressure. Other processes include examining patient’s oxygen requirements, Urine output, IV fluids, Blood loss, Analgesia, surgical wound assessment and presence of drains. The RR, HR, SpO2 should be done continuously until the patient is ready for transfer to inpatient ward (Barnes Et al., 2013).
From the video, the assessments performed were prioritized. Once the nurse received and formally identified the patient from operating room, she performed full body assessments, starting with the airway, to ensure that it is patent. Oxygen is a very important aspect of the body metabolic functions; its deficiency leads to serious complications or even death. An artificial airway must remain in place until the patient can breathe easily (Milby Et al., 2014).
The nurse monitored the oxygen saturation levels via pulse oximetry. If the difficulty in coughing is prolonged, the nurse is supposed to suction the accumulated secretions. The patient in the video seemed to have small in difficulty in breathing. In this case, it is also important to encourage the patient to take deep breath and cough every 2 hours as this will help boost oxygen saturation levels in the lungs (Price Et al., 2011). The patient lung’s was auscultated.
In terms of the circulatory system, the nurse assessed the patient any indication of internal or even external bleeding and there was none. She did this assessing the patient’s skin color and condition. The patient ECG readings were closely monitored. The patient indicated that she was hypothermic; therefore, the nurse provided a heated blanket (Bittner, Eikermann & Schmidt, 2012).
The patient positioning is also very important during PACU (Demirel Et al., 2014). The nurse positioned the patient with head flat. Evidence based practice indicates that this positioning prevents hypotension (Price Et al., 2011). For unconscious and/ or unresponsive patients, they should be positioned on their side to reduce risk of aspiration (Tighe Et al., 2014). For patients with abdominal incision, they should be repositioned every two hours (Seglenieks, Painter & Ludbrook, 2014).
If the patient is fully responsive, the head should be raised slightly so that the respiratory expansion is facilitated (Shah Et al., 2014). Most patients present with a reaction to anesthesia such nausea and vomiting (Simpson & Moonesinghe, 2013). For such clients, antiemetic drugs should be administered. It is also important for the nurse to assess the patient sensations and movement in the extremities (Tighe Et al., 2014).
The nurse also assessed the patient’s bladder for distention and the catheters in situ for patency. The patient’s frequency in urination, the urine color, odor and the amount of urine were also assessed. The Nurse checked the surgical wound to check for signs of excessive drainage. The surgical wound did not indicate any complication. Pain assessment was scored at 7/10. For this high pain scores, the nurse was required to administer pain medication (Harrop-Griffiths, Et al., 2013).
All the assessments procedures were within the normal range. Once the patient is ready for transfer, other investigations should be conducted including biochemistry analysis of the patient’s complications, the secondary symptoms associated with the surgical process. This way, the patient educational demands will be addressed adequately on the nutritional requirement and the job/mobility restrictions (Madenski, 2014).
- How effective was the communication between the two nurses? Did it promote teamwork?
Effective communication in nursing is important because it increases opportunities to interact with one another. Effective communication between the two nurses facilitates quick and informed decision making with minimal chances for medical errors (Lunn Et al., 2012). Communication between the nurses can face some hurdles such as perceived loss of autonomy, clashing perceptions and trust issues. However, the two healthcare providers had an open attitude, trust and some mutual respect for each other. Consequently, the process was conducted with utmost professionalism and increased satisfaction; thus promoting teamwork (Haenke, 2013).
- How effective was the communication between the nurses and the patient?
Engaging in communication is also portrayed in the way the nurses engage the patient in communication during the assessment (Law Et al., 2011). This ensures that the patient is informed and can be integrated in the decision making process (Haenke, 2013). Additionally, through communication, the healthcare providers understood the patient demands thereby ensuring that the patient received individualized care. This nurse-patient interaction indicated nurses’ extent of courtesy, sincerity and kindness (Lunn Et al., 2012).
- Identify the post -op orders. Were all of these discussed?
The Post-op orders were well communicated both verbally and in written form. For instance, the clinical handover highlighted issues that were important throughout the intraoperative period. These included issues such as patient’s body temperature, which recorded low, and the inability of the patient to do a deep breathe and cough, among others. The patient pre-surgery conditions were also explained in detail to the PACU nurse to ensure that the PACU nurses had a baseline for comparison (Christensen Et al., 2013).
- Based on literature, are there any recommendations to improve for future practice?
Post-operative patients are normally taken to the post anesthesia unit (PACU) in order to monitor their recovery from anesthesia (Price Et al., 2011). During this time, the nurses conduct relevant assessments and provide medication as necessary, in order to relieve pain, or to avoid further complications (Lovestrand, Phipps & Lovestrand, 2013). Postoperative processes are associated with many complications resulting from immobility, a compromised respiratory system and thrombophlebitis (Milby Et al., 2014). The patient is also at risk of suffering from anemia due to excess blood loss resulting in reduced circulating blood volume. Tissue perfusion also commonly referred to as Hypovolemia may occur due to reduced circulating blood volume (Demirel Et al., 2014).
The evidence-based practice acknowledges the importance of evaluating patient recovery system from anesthesia using Aldrete scoring system (Yip Et al., 2014). Each of the vital body organ must exhibit stability and these includes circulatory system, oxygen saturation, consciousness and activity. The patient is ready for discharge from PACU if the Aldrete score is 8 out of 10. The patient must also exhibit stability in most of the vital signs (Ganter Et al., 2014). Additionally, there should be no bleeding and the reflexes must have returned to normal including swallowing, cough and gags. The surgery wound should be minimal to moderate and the urine output must be at least 30mL/ hr (Yazicioglu, Akkaya & Kulacoglu, 2013).
Other recommendations provided by evidence-based practice are provision of discharge education of the patient. This includes education relating to medications, in terms of the dosage, purpose of dosage and possible adverse effects. Dietary guidelines should be provided as well as all activity restrictions. The patient should also be advised wound treatment instructions and how to use assistive devices (Ganter Et al., 2014). This involves care givers roles implying that they must be integrated in the process. Future studies should look into staff beliefs and attitudes on patient relative’s visitations in the PACU; and how this impacts patient satisfaction and during the recovery process.
References
Barnes, C., Stowelt, KM., Bulger, T., Langton, E., & Pollock, N. (2015),Safe duration of postoperative monitoring for malignant hyperthermia patients administered non-triggering anaesthesia: an update). (2015, February 22). Medical Devices & Surgical Technology Week, 157. Retrieved from http://go.galegroup.com.ezproxy2.acu.edu.au/ps/i.do?id=GALE%7CA406363429&v=2.1&u=acuni&it=r&p=AONE&sw=w&asid=07227708e60596f007e8f97b391b611a.
Bittner, E., George, E., Eikermann, M. and Schmidt, U. (2012). Evaluation of the association between quality of handover and length of stay in the post anaesthesia care unit: a pilot study. Anaesthesia, 67(5), pp.548-549.
Christensen, R., Voepel-Lewis, T., Lewis, I., Ramachandran, S., & Malviya, S. (2013). Pediatric cardiopulmonary arrest in the postanesthesia care unit: analysis of data from the American Heart Association Get With The Guidelines®-Resuscitation registry. Pediatric Anesthesia 23: 517–523
Demirel, I., Et al., (2014) Comparison of patient-controlled analgesia versus continuous infusion of tramadol in post-cesarean section pain management. J. Obstet. Gynaecol. Res. Vol. 40, No. 2: 392–398
Ganter, M.T., Et al (2014). The length of stay in the post anaesthesia care unit correlates with pain intensity , nausea and vomiting on arrival. Perioperative medicime 3:10
Haenke, R. (2013). Letter to the Editors: Post-Anesthesia Care Unit and Six Sigma Process. HERD: Health Environments Research & Design Journal, 7(1), pp.126-128.
Harrop-Griffiths., W., Hosie, H., Kilvington, B., MacMahon, M., Smedley P. & Verma, R. (2013). Immediate post anaesthesia recovery 2013 Association of Anaesthetists of Great Britain and Ireland. Anaesthesia 2013, 68,
Law, C.J., Sleigh, J.W., Barnard, J.P.M., & MacCOLL., J.N. (2011). The association between intraoperative electro-encephalogram-based measures and pain severity in the post-anaesthesia care unit. Anaesth Intensive Care 2011; 39: 875-880
Lovestrand, D., Phipps, S., & Lovestrand, S. (2013). Posttraumatic stress disorder and anesthesia emergence. AANA journal 81:3; 199-205
Lunn, T.H., Kristensen, B.B., Gaarn-Larsen, L., Husted, H., & Kehlet, H. (2012). Post-anaesthesia care unit stay after total hip and kneearthroplasty under spinal anaesthesia. Acta Anaesthesiol Scand 2012;56: 1139–1145
Madenski, A.D. (2014). Improving nurses pain management in the post anesthesia care unit. Retrieved from http://scholarworks.umass.edu/cgi/viewcontent.cgi?article=1034&context=nursing_dnp_capstone
Milby, A., Bohmer, A., Gerbershagen, M.U., Joppich, R., Wappler, F. (2014). Quality of post-operative patient handover in the post anesthesia care unit: a prospective analysis. Acta Anaesthe siol Scand 58: 192-197
Parekh, J., Roll, G.R., Feng, S., Niemann , U., & Hirose, R. (2013). Peri-operative hyperglycemia is associated with delayed graft function in deceased donor renal transplantation. Clin Transplant 2013: 27: E424–E430 DOI: 10.1111/ctr.12174
Price, C., Golden, B., Harrington, M., Konekwo, R., Wasil, E., Herring, W. (2011). Reducing Boarding in a Post-Anesthesia Care Unit. Production & operations management 20:3;431-441
Seglenieks,R., Painter, T.W., & Ludbrook, G.L. (2014). Predicting patients at risk of early postoperative adverse events. Anaesth Intensive Care 2014; 42: 649-656
Shah, P., Dongre, V., Patil, V., Pandya, S., Mungantiwar, A., & Choulwar, A. (2014). Correspondence: Comparison of post-operative ICU sedation between dexmedetomidine and propofol. Indian Journal of Critical Care Medicine May 2014 Vol 18 Issue 5 291-298
Simpson, J., & Moonesinghe, R.S. (2013). Introduction to post-anaesthetic care unit. Peri-operative medicine 2:5;
Tighe, P.J., Harle, C.A., Boezaart, A,P., Aytug, H., & Fillingim, R. (2014). Acute pain & Periopeartive pain section. Of Rough Starts and Smooth Finishes: Correlations Between Post-Anesthesia Care Unit and Postoperative Days 1–5 Pain Scores. Pain medicine 15: 306-315
Yazicioglu, D., Akkaya, T. and Kulacoglu, H. (2013). Addition of lidocaine to bupivacaine for spinal anaesthesia compared with bupivacaine spinal anaesthesia and local infiltration anaesthesia. Acta Anaesthesiologica Scandinavica, 57(10), pp.1313-1320.
Yip, P.C., Hannam, J.A., Cameron, J.D., & Campbells, D. (2010). Incidence of residual neuromuscular blockade in a post anaesthetic care unit. Anaesthesia & intensive care 38; 91-95
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