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Perianesthesia Care Unit (PACU) Nursing
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Perianesthesia Care Unit (PACU) Nursing

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@LK3

Questions and Answers

When does postoperative planning begin?

  • During the postoperative phase
  • During the preoperative phase (correct)
  • During the intraoperative phase
  • During the recovery phase

    • What is a major consideration when determining the level of PACU care?

  • Patient's medical history
  • Type of anesthesia used
  • Type of surgery performed
  • All of the above (correct)

    • What is included in discharge criteria?

  • Pain management
  • Voiding ability
  • Vital signs stability
  • All of the above (correct)

    • How is hypovolemia assessed and treated in the PACU?

    <p>Assessed through urine output monitoring and treated with fluid administration</p> Signup and view all the answers

    What is used in a multimodal approach to analgesia?

    <p>Combination of opioids and NSAIDs</p> Signup and view all the answers

    What is a risk associated with PONV?

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

    Why is glycemic monitoring and control important postoperatively?

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

    What can affect voiding ability in the recovery unit?

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

    What is the primary purpose of Phase I postanesthesia care?

    <p>To provide immediate postanesthesia nursing care and transitioning to Phase II</p> Signup and view all the answers

    What is assessed during the initial assessment in the PACU?

    <p>The physiologic status of the patient, surgical site, and medical conditions</p> Signup and view all the answers

    What is the role of anesthesia in the PACU?

    <p>To stabilize, oxygenate, and assess the patient</p> Signup and view all the answers

    What is the Aldrete Scoring System used for?

    <p>To determine when a patient is fit for discharge or transfer</p> Signup and view all the answers

    What is assessed during PACU triage?

    <p>The clinical condition, length and type of procedure, and potential for complications</p> Signup and view all the answers

    What is the score required for a patient to be fit for discharge or transfer according to the Aldrete Scoring System?

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

    What is the purpose of notifying the PACU of an impending patient?

    <p>To notify them of extraordinary equipment needed, urgent procedures, and acuity of the patient</p> Signup and view all the answers

    When can anesthesia transfer responsibility of care?

    <p>When the patient is stable and anesthesia is no longer required</p> Signup and view all the answers

    What is the primary purpose of the PACU report?

    <p>To exchange essential information between healthcare providers</p> Signup and view all the answers

    Which of the following is a complication of postoperative nausea and vomiting (PONV)?

    <p>Wound dehiscence</p> Signup and view all the answers

    According to the Apfel simplified risk score, how many predictors are used to estimate the likelihood of PONV?

    <p>4</p> Signup and view all the answers

    What percentage of patients are at high risk for PONV?

    <p>70-80%</p> Signup and view all the answers

    What is the most commonly reported fear before elective surgery?

    <p>Postoperative nausea and vomiting</p> Signup and view all the answers

    What is included in the patient history section of the PACU report?

    <p>Acute indication for surgery and chronic comorbidities</p> Signup and view all the answers

    Why is exchange of essential information crucial in the PACU?

    <p>To reduce sentinel events and poor patient outcomes</p> Signup and view all the answers

    What is the focus of prophylaxis in PONV management?

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

    What is the main consequence of postoperative nausea and vomiting (PONV)?

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

    Which of the following is a strong evidence for PONV risk?

    <p>History of PONV or motion sickness</p> Signup and view all the answers

    What is the primary focus of prophylaxis in PONV management?

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

    What is included in the intraoperative course section of the PACU report?

    <p>Anesthetic-related information and unexpected response</p> Signup and view all the answers

    What is the estimated incidence of PONV in high-risk patients?

    <p>70-80%</p> Signup and view all the answers

    What is the purpose of the Apfel simplified risk score?

    <p>To predict the likelihood of PONV</p> Signup and view all the answers

    What is included in the patient history section of the PACU report?

    <p>Acute and chronic medical history, allergies, and medications</p> Signup and view all the answers

    What is the main benefit of multimodal analgesia in postoperative pain management?

    <p>Reducing opioid side effects</p> Signup and view all the answers

    What is the focus of anesthetic strategies for PONV prophylaxis?

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

    Why is exchange of essential information crucial in the PACU?

    <p>To ensure effective handover of care</p> Signup and view all the answers

    What is the primary goal of multimodal analgesia in the postoperative period?

    <p>To reduce the dose of opioids</p> Signup and view all the answers

    Which of the following is a key component of postoperative nausea and vomiting (PONV) prophylaxis?

    <p>Prophylactic administration of antiemetics</p> Signup and view all the answers

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

    <p>History of motion sickness</p> Signup and view all the answers

    What is a critical element of the PACU report?

    <p>Anesthesia-related complications</p> Signup and view all the answers

    What is the primary purpose of assessing for PONV risks in the PACU?

    <p>To guide prophylactic administration of antiemetics</p> Signup and view all the answers

    What is a common anesthesia-related complication in the PACU?

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

    What is a key aspect of pain management in the PACU?

    <p>Using a multimodal approach to analgesia</p> Signup and view all the answers

    Which of the following is a strategy for PONV prophylaxis?

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

    What is an important consideration when assessing PONV risk in the PACU?

    <p>Obtaining a thorough medical history</p> Signup and view all the answers

    What is the primary purpose of the postanesthesia care unit (PACU) report?

    <p>To communicate anesthesia-related information to other healthcare providers</p> Signup and view all the answers

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

    <p>Evaluating the patient's physiologic status</p> Signup and view all the answers

    Which of the following is a major consideration in determining the level of PACU care?

    <p>Clinical condition of the patient</p> Signup and view all the answers

    What is the primary purpose of the Aldrete Scoring System?

    <p>To evaluate the patient's readiness for discharge</p> Signup and view all the answers

    Which of the following is a risk factor for postoperative nausea and vomiting?

    <p>History of motion sickness</p> Signup and view all the answers

    What is the primary goal of multimodal analgesia in the PACU?

    <p>To combine different analgesic techniques for optimal pain management</p> Signup and view all the answers

    Which of the following is an anesthetic strategy for PONV prophylaxis?

    <p>Using total intravenous anesthesia</p> Signup and view all the answers

    What is the primary purpose of the PACU report?

    <p>To communicate essential information to the PACU staff</p> Signup and view all the answers

    Which of the following is a potential complication of postoperative nausea and vomiting?

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

    What is the primary focus of prophylaxis in PONV management?

    <p>Identifying high-risk patients</p> Signup and view all the answers

    Which of the following is a key aspect of exchange of essential information in the PACU?

    <p>Standardized communication checklists</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)

    PACU Report

    • Includes general information, patient history, intraoperative course, postoperative plan, and discharge criteria
    • General information: name, DOB, surgical procedure, surgeon, anesthesia providers
    • Patient history: acute and chronic information, allergies, comorbidities, medications

    Intraoperative Course

    • Anesthetic-related information: general, neuraxial, MAC, unexpected response, preoperative sedatives
    • Other medications: antiemetics, multimodal analgesics, antibiotics, vasopressors
    • Reversal agent information and rationale for use
    • Intraoperative data: EBL, ins and outs, fluids, blood administration, UO, lab data

    Postoperative Plan

    • Concerns: potential or unexpected problems
    • Interventions: lab and hemodynamic limits, normal ranges, baseline, and intraoperative values
    • Discharge criteria and contact person information

    PACU Complications: PONV

    • Incidence: 20-30% overall, 70-80% in high-risk patients
    • Consequences: aspiration, wound dehiscence, prolonged hospital stays, delayed return to self-care, lost work time
    • Identification of high-risk patients: 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)

    Phases of Care

    • Perianesthesia care continuum: preanesthesia preparation, intraoperative care, postoperative care
    • Phase I: postanesthesia/ICU care, immediate postanesthesia nursing care, transitioning to Phase II
    • Phase II: outpatient care, management of patients after a surgical or nonsurgical procedure

    Transport

    • Notify PACU of impending patient, extraordinary equipment needed, urgent procedures, and acuity of the patient
    • Decide: general anesthesia to sedated, spontaneous ventilation requirement, responsive or unconscious patient, airway reflexes
    • Stabilize: assure stable condition, administer O2 as needed, monitor ventilation, monitor level of consciousness, essential monitors, medications, and resuscitation equipment

    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 for complications
    • Immediate assessment: respiratory and cardiac status, deviations between preop/intraop/postop status

    Initial Assessment

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

    Aldrete Scoring System

    • Evaluates activity, respiration, circulation, consciousness, and oxygen saturation
    • Fit for discharge or transfer = score ≥ 9

    Major Body Systems Assessment

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

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    Description

    This quiz covers the phases of perianesthesia care, postoperative phase monitoring, handoff practices, postop reporting, and potential complications during post anesthesia care. It's designed for nursing students and professionals working in the PACU.

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