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Perianesthesia Care and Postoperative Management
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Perianesthesia Care and Postoperative Management

Created by
@LK3

Questions and Answers

What is a major risk factor for postoperative nausea and vomiting (PONV)?

  • Obstructive sleep apnea
  • History of motion sickness (correct)
  • Male gender
  • History of hypertension

    • Which of the following is NOT a component of a multimodal approach to analgesia?

  • Steroids
  • Benzodiazepines (correct)
  • Opioids
  • NSAIDs

    • What is a key criterion for discharge from the postanesthesia care unit (PACU)?

  • Vital signs within normal limits
  • Ability to void
  • Adequate pain control
  • All of the above (correct)

    • What is a common cause of urinary retention in the postoperative period?

    <p>Opioid use</p> Signup and view all the answers

    What is a key intervention to minimize cardiac risk in the postoperative period?

    <p>All of the above</p> Signup and view all the answers

    What is a common blood pressure issue in the postoperative period?

    <p>All of the above</p> Signup and view all the answers

    What is a method to minimize hypothermia in the postoperative period?

    <p>All of the above</p> Signup and view all the answers

    Which of the following is a risk factor for PONV?

    <p>Female gender</p> Signup and view all the answers

    What is the primary goal of multimodal analgesia?

    <p>All of the above</p> Signup and view all the answers

    What is a key assessment parameter for PONV?

    <p>Nausea severity</p> Signup and view all the answers

    What is the primary purpose of Phase I postanesthesia care?

    <p>To critically assess and stabilize patients with prevention and detection of complications</p> Signup and view all the answers

    What is assessed during the initial assessment in PACU?

    <p>The patient's physiologic status and medical conditions</p> Signup and view all the answers

    What is the primary risk factor for urinary retention in PACU?

    <p>Opioid analgesia</p> Signup and view all the answers

    What is the main goal of multimodal analgesia in PACU?

    <p>To reduce opioid consumption</p> Signup and view all the answers

    What is the discharge criterion using the Aldrete Scoring System?

    <p>Score ≥ 9</p> Signup and view all the answers

    What is a critical component of the PACU handoff report?

    <p>Communication of critical information and care plan</p> Signup and view all the answers

    What is a major risk factor for cardiac complications in PACU?

    <p>Hypertension</p> Signup and view all the answers

    What is the main concern during transport of a patient in PACU?

    <p>Vulnerable period with limited monitoring</p> Signup and view all the answers

    What is the primary responsibility of the anesthesiologist during PACU triage?

    <p>Stabilizing and oxygenating the patient</p> Signup and view all the answers

    What is a key aspect of Phase II postanesthesia care?

    <p>Outpatient care and management</p> Signup and view all the answers

    Which of the following is a weak evidence for predicting PONV?

    <p>Duration of surgery</p> Signup and view all the answers

    What is the estimated likelihood of PONV for a patient with an Apfel simplified risk score of 3-4?

    <p>High risk</p> Signup and view all the answers

    What is an important aspect of multimodal analgesia in postoperative pain management?

    <p>Combining opioids with non-opioid analgesics</p> Signup and view all the answers

    A patient is at risk for urinary retention due to which of the following?

    <p>Spinal anesthesia</p> Signup and view all the answers

    What is a critical aspect of discharge criteria in the PACU?

    <p>All of the above</p> Signup and view all the answers

    Which of the following is a cardiac risk factor in the postoperative period?

    <p>Hypertension</p> Signup and view all the answers

    What is a common complication of PACU care?

    <p>Hypothermia</p> Signup and view all the answers

    A patient's blood pressure in the PACU is 90/60 mmHg. What should the nurse do?

    <p>All of the above</p> Signup and view all the answers

    What is the primary goal of prophylaxis in PONV management?

    <p>Preventing PONV from occurring</p> Signup and view all the answers

    What is a consequence of untreated PONV?

    <p>Delayed return to self-care</p> Signup and view all the answers

    What is a common complication that can occur if voiding is not addressed in the recovery unit prior to discharge?

    <p>Urinary Retention</p> Signup and view all the answers

    Why is glycemic monitoring and control important postoperatively?

    <p>To prevent both hypo and hyperglycemia</p> Signup and view all the answers

    How is hypoxemia treated in the PACU?

    <p>Supplemental oxygen</p> Signup and view all the answers

    What can cause obstruction of the upper airway in the PACU?

    <p>Relaxation of the pharyngeal muscles</p> Signup and view all the answers

    How is hypovolemia assessed in the PACU?

    <p>Blood pressure monitoring</p> Signup and view all the answers

    What is a common cause of hypovolemia in the PACU?

    <p>Surgical bleeding</p> Signup and view all the answers

    What is a consequence of untreated hypoxemia in the PACU?

    <p>All of the above</p> Signup and view all the answers

    What is a sign of hypovolemia in the PACU?

    <p>Tachycardia</p> Signup and view all the answers

    What can affect voiding ability in the PACU?

    <p>All of the above</p> Signup and view all the answers

    How is glycemic control achieved in the PACU?

    <p>Frequent blood glucose monitoring</p> Signup and view all the answers

    What is a critical complication that can occur due to inadequate voiding in the PACU?

    <p>Urinary Tract Infection</p> Signup and view all the answers

    What is the primary reason for glucose monitoring in the PACU?

    <p>To assess for hypoglycemia</p> Signup and view all the answers

    What is a common cause of hypoxemia in the PACU?

    <p>Respiratory depression</p> Signup and view all the answers

    What is a common cause of airway obstruction in the PACU?

    <p>All of the above</p> Signup and view all the answers

    What is a critical complication of hypovolemia in the PACU?

    <p>Acute kidney injury</p> Signup and view all the answers

    What is the primary goal of fluid management in the PACU?

    <p>To prevent hypovolemia</p> Signup and view all the answers

    What is a common cause of voiding difficulties in the PACU?

    <p>All of the above</p> Signup and view all the answers

    What is a critical parameter to monitor in patients at risk of hypovolemia in the PACU?

    <p>Urine output</p> Signup and view all the answers

    What is a common cause of respiratory failure in the PACU?

    <p>All of the above</p> Signup and view all the answers

    What is a critical component of voiding assessment in PACU?

    <p>Assessing for urinary retention</p> Signup and view all the answers

    What is a critical aspect of glucose management in the PACU?

    <p>Preventing hypoglycemia</p> Signup and view all the answers

    Which of the following is a common cause of hypoxemia in PACU?

    <p>Respiratory depression</p> Signup and view all the answers

    What is the primary concern during transport of a patient with suspected upper airway obstruction in PACU?

    <p>Securing the airway</p> Signup and view all the answers

    What is a key aspect of glucose monitoring in PACU?

    <p>Evaluating for hypoglycemia</p> Signup and view all the answers

    What is the primary cause of hypovolemia in PACU?

    <p>Blood loss</p> Signup and view all the answers

    Which of the following is a critical aspect of postanesthesia care in patients with hypoxemia?

    <p>Administering oxygen therapy</p> Signup and view all the answers

    What is the primary goal of glucose management in PACU?

    <p>Maintaining normoglycemia</p> Signup and view all the answers

    Which of the following is a key intervention for preventing hypovolemia in PACU?

    <p>Fluid resuscitation</p> Signup and view all the answers

    What is the primary concern during transport of a patient with suspected hypoxemia in PACU?

    <p>Administering oxygen therapy</p> Signup and view all the answers

    Which of the following is a critical aspect of postanesthesia care in patients with upper airway obstruction?

    <p>Securing the airway</p> Signup and view all the answers

    Study Notes

    Perianesthesia Care Continuum

    • The perianesthesia care continuum consists of three phases: preanesthesia preparation, intraoperative care, and postoperative care.
    • Postoperative care is divided into two phases: Phase I (Postanesthesia/ICU care) and Phase II (Outpatient care).

    Postoperative Phase and Monitoring

    • The purpose of the postoperative phase is critical assessment and stabilization of patients with prevention and detection of complications.
    • Monitoring involves:
      • Respiratory and cardiac status
      • Level of consciousness
      • Oxygen saturation
      • Essential monitors, medications, and resuscitation equipment

    Transport

    • Notify PACU of impending patient, extraordinary equipment needed, urgent procedures, and acuity of the patient.
    • Decide on patient care based on:
      • General anesthesia to sedated
      • Spontaneous ventilation requirement
      • Responsive or unconscious patient
      • Airway reflexes
    • Stabilize the patient before transport.

    PACU Triage

    • Admission involves collaboration between CRNA and PACU staff.
    • Evaluate the level of care based on:
      • Clinical condition
      • Length and type of procedure
      • Length and type of anesthetic
      • Potential for complications
    • Immediate assessment involves:
      • Respiratory and cardiac status
      • Surgical site assessment
      • Anesthesia's role: stabilize, oxygenate, and assess.

    Initial Assessment

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

    Aldrete Scoring System

    • Most commonly used scoring system in Phase 1-2.
    • Evaluates:
      • Activity
      • Respiration
      • Circulation
      • Consciousness
      • Oxygen saturation
    • A score ≥ 9 indicates fitness for discharge or transfer.

    Major Body Systems Assessment

    • Cardiac
    • Respiratory
    • Neuro
    • Renal
    • LDAs
    • Surgical site

    PACU Handoff and Report

    • Critical time for information exchange.
    • Communication checklists:
      • Situation
      • Background (comorbidities, history)
      • Assessment (postoperative course)
      • Recommendation (allow time for questions)
    • Report includes:
      • 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, unexpected response)
      • Postoperative plan (concerns, interventions, lab and hemodynamic limits, discharge criteria, contact person)

    PACU Complications: PONV

    • Incidence: 20-30% overall, 70-80% in high-risk patients.
    • Consequences:
      • Aspiration
      • Wound dehiscence
      • Prolonged hospital stays, unplanned admission
      • Delayed return to self-care
      • Lost work time for patients, care providers
    • Risk factors:
      • Female
      • Non-smoker
      • History of PONV or motion sickness
      • 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)

    Perianesthesia Care Continuum

    • Phases of care: preanesthesia preparation, intraoperative care, and postoperative care
    • Postoperative care includes Phase I: postanesthesia/ICU care and Phase II: outpatient care
    • Purpose of Phase I: critical assessment and stabilization of patients with prevention and detection of complications

    Postoperative Planning

    • Begins before surgery
    • Considers patient's age, medical history, and type of surgery
    • Involves identification of potential complications and development of a plan to prevent or treat them

    PACU Admission and Handoff

    • Admission involves collaboration between CRNA and PACU staff
    • Evaluation of patient's clinical condition, length and type of procedure, and potential for complications
    • Immediate assessment of respiratory and cardiac status
    • Note deviations between preop/intraop/postop status

    PACU Report

    • General information: patient's name, DOB, surgical procedure, surgeon, and anesthesia providers
    • Patient history: acute and chronic medical conditions, allergies, and medications
    • Intraoperative course: anesthetic type, unexpected responses, medications, and lab data
    • Postoperative plan: concerns, interventions, lab and hemodynamic limits, and discharge criteria

    PACU Complications

    • Postoperative nausea and vomiting (PONV): incidence, consequences, and risk factors (female, non-smoker, history of PONV or motion sickness, postoperative opioid use, and intraoperative volatile anesthetic or nitrous oxide)
    • Apfel simplified risk score: 0-1 (low risk), 2 (medium risk), and 3-4 (high risk)
    • Prophylaxis is key in preventing PONV

    Transport and Triage

    • Notify PACU of impending patient, extraordinary equipment needed, and urgent procedures
    • Decide on level of care based on patient's condition, anesthesia type, and potential for complications
    • Stabilize patient before transporting to PACU
    • Transport stable patient with monitoring and essential equipment

    Initial Assessment and Aldrete Scoring System

    • Determine physiologic status of patient and evaluate periodically to identify trends
    • Establish baseline of medical conditions
    • Assess surgical site and prevent/treat complications
    • Aldrete scoring system: evaluates activity, respiration, circulation, consciousness, and oxygen saturation
    • Fit for discharge or transfer with score ≥ 9

    Major Body Systems Assessment

    • Cardiac, respiratory, neuro, renal, and surgical site assessments
    • Evaluate patient's overall condition and identify potential complications

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    Description

    This quiz covers the phases of perianesthesia care, postoperative phase monitoring, hand-off practices, postop reports, and potential complications during post anesthesia care. It also evaluates risks and treatments for common perioperative complications.

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