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Topic question- explains the PACU nurses role in management of a post-operative patient in a recovery room?
The Role of Post Anesthesia Care Unit Nurse Sample Answer
The Role of Post Anesthesia Care Unit Nurse
During the recovery of patients from surgical anesthesia, they must be monitored until they are fully awake and have stable vital signs. In our era of complicated major surgeries, emergence from anesthesia often comes with life threatening complications. As a result, it is important to have “short term ICUs” technically called Post anesthesia Caring Units or PACUs. This report explores a three-week placement in a PACU. The major findings were that the PACU was staffed by specialized nurses who were skilled in recognizing and managing postoperative nausea and vomiting, airway problems, hypotension, pain, hypothermia and hypoxemia and the other adverse effects of anesthetic agents. PACU nurses had to cope with bleeding surgical cuts, mental dysfunction, hypertension, tachycardia and myocardial infarction. Therefore, these findings support the idea that PACU nurses are an essential component of critical care.
The Role of Post Anesthesia Care Unit Nurse
This research paper explores the role of Post-Anesthesia Care Unit (PACU) nurse in the management of postoperative patients in a recovery room. Anesthesia plays a central role in reducing pain and discomfort during surgical procedures (Story, 2013). However, recovery from anesthesia ranges from completely uncomplicated to life threatening and must be managed by a specialized nurse whose main responsibility is to stabilize the patient immediately after surgery.
Several studies have shown that most of the postoperative deaths are preventable (Street et al., 2015). Hence the PACU and its staff including nurses, are considered a standard of care. All patients who undergo general, regional or localized surgery should receive post anesthesia care from the PACU nurses.
PACU facilitates recognition and management of postoperative complications which saves lives, time and health resources. Patients are admitted directly to the PACU from the operating room. The probability that a specific complication will arise during surgery is partly determined by patients preoperative comorbidities, nature of the operation, and the anesthetic technique used (Hilly et al., 2015). Thus, the PACU nurse must have knowledge of standards of care, type of anesthetic agents and management of anesthetic complication. For instance, inhalation agents cause devastating effects such as tachycardia (isoflurane), hypotension (enflurane), decreased cardiac output (desflurane) and systemic vascular resistance (sevoflurane) by making the more heart sensitive to catecholamines. Other anesthetic agents used include analgesics (fentanyl), induction agents (propofol), neuromuscular blocking agents (vecuronium) and antiemetics (dexamethasone) (Seglinieks et al., 2014).
Patients given general anesthesia should receive oxygen supply usually via a nasal cannula until they can maintain an oxygen blood saturation of more than 90% as shown by pulse oximetry. Also, hypothermia which is body temperature of less than 36oC may occur recurrently hence thermoregulation is necessary in some postoperative patients. Adverse effects associated with hypothermia include increased oxygen demand, vasoconstriction, increased afterload, myocardial infarction, angina, and dysrhythmias. Rewarming is used to treat shivering patients (Duff et al., 2012).
Other surgical complications treated at the PACU include laryngospasms which are frequently related to intubation, suctioning and aspiration (Erb et al., 2012). Hypotension is another critical complication in the postoperative period. It is to be believed caused by sympathetic activation and leads to cardiac and neurological problems (Duff et al., 2012). Also, ventricular tachycardia and fibrillation often occur in postoperative patients with a pre-existing electrolyte imbalance. Pain management is an important PACU nursing intervention. Blood sugar abnormalities are very common because of stress surgery dehydration. Surgery related stress also increases the blood levels of cortisol and glucagon, two hormones that synergistically increase blood sugar levels leading to diabetic-like phenotype (Duncan et al., 2012). Therefore, based on available literature, it is evident that patients in the PACU are highly vulnerable, less resilient, unstable and less predictable.
Observation, Analysis, and Evaluation for The Role of Post Anesthesia Care Unit Nurse
Few people are oblivion of the multifactorial role played by PACU nurses mainly because most of their patients are in a critical condition and will barely remember the nurse who took care of them as noted by (Story et al, 2013). The experience of a three-week placement in a PACU is critically analyzed in this section. The PACU most of the guidelines (Simpson and Moonesinghe, 2013) of a critical care unit. The unit was located in proximity to the operation theatre and PACU nurses had immediate access to a blood bank, X-ray machines, blood gas and clinical diagnostic laboratory. The PACU also had standby complementary equipment recommended by (Simpson and Moonesinghe, 2013) such as airway facilities, oral and nasal airway tubes, oxygen masks and cannulas, tracheostomy tubes, ventilators, cardiac equipment (defibrillator), ECG equipment, infusion pumps and a complete stock of medicines such as pain killers and cardiopulmonary drugs. There were five PACU beds per each operating suite used. The PACU was an open ward to allow optimized patient monitoring. The ward had sufficient ventilation to prevent exposure to bio-hazardous anesthetic gasses according to (Simpson and Moonesinghe, 2013).
The PACU nurses looked after a variety of patients ranging from newborns to the elderly. All patients who had received general, regional or localized anesthesia received post anesthesia care as per the guidelines of the standard of care. The nurse to patient ratio was often 1:1 for the patients emerging from the operating room and sometimes 2:1 for critically, ill or pediatric patients. All PACU nurses received continuous practical training on basic life support, airway management, acute surgical bleeding care, drainage (catheters) and advanced cardiac support according to (Ross et al., 2013).
The day of a PACU nurse usually began at 7:30 am with the first patients dispatched from the operating room at approximately 9:00 am. Before then, the PACU nurses confirmed that all the emergency equipment were in working order and restocked, especially the defibrillators, suction, monitors, oxygen supply, intubation and emergency trolleys. After the end of surgery, the PACU Coordinator received a call from the operating suite to alert her that the patient was being released. The PACU Coordinator then assigned the patient to a nurse and bed space. Following transfer from the operating room, PACU nurse connected the patients mask to an oxygen supply and evaluated the patient for air potency and consciousness by monitoring oximetry, carbon (IV) oxide, blood pressure, ECG, and temperature. The PACU nurse then received full patient handover from the operating nurse and confirms that relevant documentation has been completed. According to (Braaf et al., 2011) improver perioperative documentation can be detrimental.
Depending on the patient condition, the PACU nurse monitored patient parameters such as pain, bleeding, nausea, drainage (catheters), central venous pressure, fluid intake and output as well as intracranial pressure as previously noted by (Seglinieks et al., 2014). These vital signs together with blood oxygen saturation were recorded after every five minutes until the patient was fully awake and stable which took an average of 15-30 minutes for most patients. 40% humidified oxygen supplementation was given to all postoperative patients recovering from general anesthesia. Older patients, those with pre-existing lung problems and those recovering from thoracic or abdominal surgery had a greater risk of developing hypoxemia and hence needed more oxygen supplementation (Hilly et al., 2015). Postoperative pain was usually assessed by letting the patient describe the intensity of their pain on a scale of zero to ten as described by (Simpson and Moonesinghe, 2013). Facial expressions were helpful when assessing patients with severe dementia who had lost their ability to utilize language to describe pain. PACU nurse managed pain using non-opioid and opioid analgesics.
A PACU nurse usually recovered around four to six patients in a day with an average length of stay of one to three hours per patient. Patient features such as duration of surgery, ventilation ability and pre-existing physiological problems prolonged the time required for recovery at the PACU as described by (Hilly et al., 2015). The decision to release the patient from the PACU to the inpatient ward was based on some conditions such as recovery from anesthesia, the stability of vital signs, pain control, normothermia, and absence of postoperative nausea and vomiting. After all the discharge criteria described by (Philips et al., 2013) was met, the patient was discharged from the PACU by their anesthetist to an inpatient room or to a surgical unit if they were ready to go home.
The Role of Post Anesthesia Care Unit Nurse Conclusion
The PACU nurse provides critical care to patients immediately after surgery. Following a comprehensive patient handover from an escorting theater nurse, the PACU nurse monitors the patient closely until discharge criteria is met. Also, patients arrive in the PACU in a weakened state and it is the duty of the PACU nurse to augment their physiological condition.
The Role of Post Anesthesia Care Unit Nurse References
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Duff, J., Staso, R. D., Cobbe, K.-A., Draper, N., Tan, S., Emma Halliday, . . . Walker, K. (2012). Preventing hypothermia in elective arthroscopic shoulder surgery patients: a protocol for a randomised controlled trial. BMC Surgery, 12, 14.
Duncan, A.E. (2012). Hyperglycemia and Perioperative Glucose Management. Curr Pharm Des 18(38), 6195-6203.
Erb, T. O., Von Ungern-Sternbe, B. S., Keller, K., & Frei, F. J. (2012). The effects of intravenous lidocaine on laryngeal reflex responses in anaesthetised children. Anesthesia, 68, 13-20. doi: 10.1111/j.1365-2044.2012.07295.x
Hilly, J., Heorlin, A.-L., Kinderf, J., Ghez, C., Menrath, S., Delivet, H., . . . Dahmani, S. (2015). Preoperative preparation workshop reduces postoperative maladaptive behavior in children. Pediatric Anaesthesia, 25, 990-998. doi: 10.1111/pan.12701
Philips, N.M., Street, M., Kent, B., Haesler, E., and Cadeddu, M. (2013). Post-anesthesia discharge scoring criteria: key findings from a sytematic review, International Journal of Evidence-based healthcare 11(4), 275-284.doi:10.1111/1744-1609.12044
Ross, K., Barr, J., & Stevens, J. (2013). Mandatory continuing professional development requirements: what does this mean for Australian nurses. BMC Nursing, 12, 9.
Seglenieks, R. (2016). The History of modern general anaesthesia. Australian Medical Student Journal.
Simpson, J.C., and Moonesinghe S.R. (2013). Introduction to Postanesthestic care unit. BioMed Central Open Acess Publisher 2, 5. doi: 10.1186/2047-0525-2-5.
Seglinieks, R., Painter, T. W., & Ludbrook, G. L. (2014). Predicting patients at risk of early postoperative adverse events. Anaesth Intensive Care, 42, 649-656.
Story, D. A. (2013). Postoperative complications in Australia and New Zealand (the REASON study). Perioperative Medicine, 2(1), 16.
Street, M., Phillips, N. M., Kent, B., Colgan, S., & Mohebbi, M. (2015). Minimising post-operative risk using a Post-Anaesthetic Care Tool (PACT): protocol for a prospective observational study and cost-effectiveness analysis. BMJ OPEN, 5, e007200. doi: 10.1136/bmjopen-2014-007200