PACU

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Questions and Answers

When does postoperative planning begin?

During the preoperative phase (correct)

During the intraoperative phase

During the anesthesia induction phase

During the postoperative phase

What is a requirement to transfer care from the anesthetist to the PACU RN?

Completion of the surgical procedure

Patient's anesthesia is reversed

Patient's vital signs are stable

Hand-off report from the anesthetist (correct)

How is hypovolemia typically assessed in the PACU?

Monitoring of blood pressure and heart rate

Measurement of urine output

Assessment of skin turgor and capillary refill

All of the above (correct)

What is included in discharge criteria?

All of the above Signup and view all the answers

What is a major cause of patient discomfort and dissatisfaction in the PACU?

Nausea and vomiting Signup and view all the answers

What is the primary goal of a multimodal approach to analgesia?

To improve pain management Signup and view all the answers

What is a risk associated with PONV?

Aspiration Signup and view all the answers

Why is glycemic monitoring and control important postoperatively?

To reduce the risk of wound infection Signup and view all the answers

What is the primary purpose of Phase I postanesthesia care?

To provide critical assessment and stabilization of patients with prevention and detection of complications Signup and view all the answers

What should be done during transport of a stable patient?

Monitor ventilation, administer O2 as needed, and use essential monitors and resuscitation equipment Signup and view all the answers

What is the role of anesthesia in PACU triage?

To stabilize, oxygenate, and assess the patient Signup and view all the answers

What is the primary goal of the initial assessment in PACU?

To determine the physiologic status of the patient and establish a baseline for medical conditions Signup and view all the answers

What is the Aldrete scoring system used for?

To determine the patient's fitness for discharge or transfer Signup and view all the answers

When can anesthesia transfer responsibility of care?

When the patient is stable and handoff report is completed Signup and view all the answers

What is included in the major body systems assessment in PACU?

Cardiac, respiratory, neuro, renal, LDAs, and surgical site Signup and view all the answers

What is the minimum Aldrete score required for a patient to be considered fit for discharge or transfer?

Score ≥ 9 Signup and view all the answers

What is the primary goal of the PACU report?

To facilitate the exchange of essential information between healthcare providers Signup and view all the answers

What percentage of patients are at high risk of developing postoperative nausea and vomiting (PONV)?

70-80% Signup and view all the answers

What is a common consequence of postoperative nausea and vomiting (PONV)?

Prolonged hospital stays Signup and view all the answers

According to the Apfel simplified risk score, what is the likelihood of PONV with 2 risk factors?

Medium risk Signup and view all the answers

What is a recommended anesthetic strategy for reducing the risk of postoperative nausea and vomiting (PONV)?

Implementing regional anesthesia over general anesthesia Signup and view all the answers

What is a potential complication of postoperative nausea and vomiting (PONV)?

Wound dehiscence Signup and view all the answers

What is the recommended approach to PONV prophylaxis in patients with 1-2 risk factors?

Administer 2 agents Signup and view all the answers

What should be considered when assessing a patient's risk of postoperative nausea and vomiting (PONV)?

Medical history and surgical procedure Signup and view all the answers

What is a PACU complication that can be prevented with effective communication and handovers?

Sentinel events Signup and view all the answers

Study Notes

Phases of Perianesthesia Care Continuum

Phases of care: preanesthesia preparation, intraoperative care, postoperative care
Postoperative care consists of Phase I: postanesthesia/ICU care and Phase II: outpatient care

Postoperative Phase

Purpose: critical assessment and stabilization of patients with prevention and detection of complications
Monitoring involved: immediate postanesthesia nursing care, transitioning to Phase II

PACU Triage

Admission involves collaboration between CRNA and PACU staff
Evaluate which level of care is appropriate based on clinical condition, length/type of procedure, length/type of anesthetic, and potential complications

Initial Assessment

Determine physiologic status of patient
Evaluate periodically to identify trends
Establish baseline of medical conditions
Assess surgical site
Prevent and treat complications

Aldrete Scoring System

Most commonly used scoring system
Evaluates: activity, respiration, circulation, consciousness, oxygen saturation
Fit for discharge or transfer: score ≥ 9

PACU Handoff

Critical time: exchange of essential information
Communication checklists: situation, background, assessment, recommendation

PACU Report

General information: name, DOB, surgical procedure, surgeon, anesthesia providers
Patient history: acute (indication for surgery), chronic (allergies, comorbidities, medications)
Intraoperative course: anesthetic related, other medications, time of last opioid, total opioid dose
Postoperative plan: concerns, interventions, lab and hemodynamic limits, discharge criteria, contact person

PACU Complications

PONV (postoperative nausea/vomiting): incidence, consequences, risk factors (female, non-smoker, history of PONV, postoperative opioid use, intraoperative volatile anesthetic or nitrous oxide, type of surgery)
Apfel simplified risk score: 0-1 (low risk), 2 (medium risk), 3-4 (high risk)
Prophylaxis strategies: anesthetic strategies, PACU strategies

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Description

This quiz covers the phases of perianesthesia care, postoperative monitoring, handoff practices, and postoperative reporting. It also addresses potential complications, risks, and treatments during postanesthesia care.