Post-Operative Patient Care PDF

Care Learning Outcome 1. Explain the Main goal of Postanaesthesia 2. Identify measures that influence the duration and type of postoperative observation 3. Describe the knowledge and skills of a PACU nurse 1. Post -anaesthesia Care Post anaesthesia care phase Begins after surgical proc...

Care Learning Outcome 1. Explain the Main goal of Postanaesthesia 2. Identify measures that influence the duration and type of postoperative observation 3. Describe the knowledge and skills of a PACU nurse 1. Post -anaesthesia Care Post anaesthesia care phase Begins after surgical procedure is completed and the patient is admitted to PACU until discharge to the Ward/ homes Main goal of post anaesthesia To assist patient in returning to a safe physiologic level after receiving anaesthetic agent and surgical procedure 1.Postanaesthesia Care Postanaesthetic Care Unit Located proximity to the Operating Room It is large enough with cubicles for each patient Isolation Room Each cubicle should contain Cardiac Monitor Pulse oximeter BP Devices Suction Machine O₂ Administration equipment Warming devices Emergency Trolley  1. Postanaesthesia Care Postoperative Observation of the patient The duration and type of postoperative observation vary according to the following Patient’s Condition: Alert and oriented Vs unresponsive Need of Physiologic Support: Ventilator dependent Vs awake and extubated Complexity of the surgical procedure: Open laparotomy Vs Laparoscopy Type of anaesthetic agent administer: General inhalation agent Vs. Local infiltration Need for pain therapy: Intermittent analgesic administration Vs epidural infusion Prescribe period for monitoring parameters for 1. Postanaesthesia Care Perianaesthesia Patient Care Personnel Adequate number of personnel should be available to monitor patient and provide appropriate care as needed. 10 % postoperative patient mortality related to less nursing staff to workload PACU nurses should have knowledge and skills for the following a) Airway management and technique Positioning Suctioning Bagging 1. Postanaesthesia Care Perianaesthesia Patient Care Personnel PACU nurses should be competent Physical Assessment  Lung and heart sounds Recognition of physiologic complication  Airway obstruction  Hypothermia  Malignant hyperthermia  Pain  Hydration  Nausea vomiting  Oropharyngeal aspiration 1. Postanaesthesia Care Perianaesthesia Patient Care Personnel PACU nurses should be competent Management of physiologic emergencies Airway obstruction Haemorrhage Cardiac arrest Post operative complication Interpret monitors and devices CPR 2. Admission to the Postanaesthesia Care Unit Circulating nurse call PACU nurse to give time of arrival and needs to have special life support equipment on standby Immediate physiologic and psychologic status is reported PACU nurse simultaneous assess patient for immediate support care Upon receiving the report the PACU nurse receive hand off report Provides information from anaesthesia provider, surgeon and circulating nurse The post operative orders Patient Condition Intraoperative care document 2. Admission to the Postanaesthesia Care Unit Postoperative Hand-off Report Anaesthesia Provider’s Report Patients Detail Type of anaesthesia and patients response Baseline preoperative vital signs and summary of vitals signs flow intraoperative until PACU admission Sensitivities and allergies Any physiologic changes Medication administered Intravenous fluid administered, urine output and drainage content Specific patient care orders  2. Admission to the Postanaesthesia Care Unit Postoperative Hand-off Report Surgeon’s Report Postoperative orders that pertain to immediate treatment or therapies Serial diagnosis test Specific intervention surgical site  2. Admission to the Postanaesthesia Care Unit Postoperative Hand-off Report Circulating Nurse’s Hand- off report Baseline physiologic and psychologic assessment data Positioning and skin preparation Irrigation fluids Administration of medication or haemostatics Any implants, transplant or explants Type of dressing and drainage IDC and urine output Indication of pain Location of family member  2. Admission to the Postanaesthesia Care Unit Patient care activities Particular attention is given to monitor O₂ Ventilation Circulation Alleviating nausea and vomiting Prevent shock Alleviating pain  2. Admission to the Postanaesthesia Care Unit Patient care activities Assessment for pain Vital signs and level of discomfort Pain is as 5th vital signs It affects both physiologic and psychologic Adult rating scale of 0-10 Assess, vision, speech, language and hearing Management of Pain Imaging Breathing exercise Meditation Accupressure Non pharmacologic method: Electronic nerve stimulators 2. Admission to the Postanaesthesia Care Unit Patient care activities Acupressure 2. Admission to the Postanaesthesia Care Unit Patient care activities Documentation Most facility have implemented electronic medical records Observation of respiratory and circulation function and level of consciousness are recorded at frequent intervals Observation and recording of vital signs Any significant event of postoperative physiology and psychologic status should be documented 3. Discharge from the Postanaesthesia Care Unit Most remain 1 hour sufficiently recovered from anaesthesia with stable vital signs and patient capable of reasonable self-care Patient condition is scored using a scoring system Vital signs Activity level Consciousness Anaesthesia provider assess the patient’s condition if stable enough to be discharge 3. Discharge from the Postanaesthesia Care Unit Successful postoperative evaluation program requires Cooperative effort of and input from all personnel involved with patient care PMGH has a discharge criteria Reference List Phillips, N. (2013). Berry & Kohn's Operating Room Technique. St. Louis; Missouri: Elsevier Mosby. Ball, J. E., Bruyneel, L., Aiken, L. H., Sermeus, W., Sloane, D. M., Rafferty, A. M.,... & RN4Cast Consortium. (2018). Post- operative mortality, missed care and nurse staffing in nine countries: a cross-sectional study. International journal of nursing studies, 78, 10- 15.