The area where a patient will be transferred to following regional or general anesthesia for monitoring until they are stabilized for discharge to a general care ward or intensive care unit or discharged home.

IMMEDIATE POSTOPERATIVE REPORT:

• )  PACU Nurse receives a report from the Surgical Team, prior to the patient arriving to the PACU.
  
•      2)  Intraoperative (O.R.) Report

• a)       Demographic data
• b)      Patient’s Diagnosis
• c)       Allergies
• d)      Surgical Procedure
• e)       Anesthesia Procedures
• • a)       Medications
  •  
  • b)      Intravenous Fluids
  •  
  • c)       Vital Signs

• a)       Blood Loss
• b)      Fluid Replacement
• c)       Blood Transfusions
• d)      Urinary Output
• Laboratory Tests
• e)       Other items to report
• 1.  Dressings
• 2.  Equipment used
• 3.  Equipment needed

.  Red blood cell transfusions are given to raise the hematocrit level in patients with anemia or to replace losses after acute bleeding episodes.

means using your own blood.

     a. Person donates blood before a planned surgical procedure.

     b. Blood can be donated up to 5-weeks before the planned surgical procedure.

     c. Blood can be frozen and stored up to 3-years.

     d. Blood donated for non-emergency (elective-type surgeries).

to confer about the patient’s status.

to describe the patient’s status, the results of the surgery, and any complications that occurred during surgery.

PATIENT TRACER METHODOLOGY:

)  In PACU

a)       Assess patient’s physiological status

b)      Ongoing assessment to establish trends

c)       Monitor surgical site

d)      Monitor recovery from anesthesia

e)       Comparison with PRE-OP Baseline, i.e. Vital Signs

a)       Every 15-minutes x 4

b)      Every 30-minutes x 4

c)       Every 45-minutes x 4

d)      Every 60-minutes x 4

COMMON POSTOPERATIVE PROBLEMS

Compromised Airway

Greatest concerns

• Airway Obstruction
• Hypoxemia
• Atelectasis
• Aspiration
• Bronchospasm
• Pulmonary Edema
• Hypoventilation

1.        Most common cause of blockage of the airway is the patient’s tongue. The base of the tongue falls backward against the soft palate and occludes the pharynx.

1.        – Is a result of an increase in bronchial smooth muscle tone with results in closure of small airway.  Patients will have wheezing, dyspnea, use of the accessory muscles, hypoxemia and tachypnea.

1.        Is caused by an accumulation of fluid  in the alveoli and may be the result of fluid overload.  Pulmonary edema is characterized by hypoxemia, crackles on auscultation, decreased pulmonary compliance, and presence of infiltrates on chest x-ray.

1.        Caused by decreased respiratory rate or effort, hypoxemia, and an increasing PaCO2 (high levels of carbon dioxide) in the lungs.  Hypoventilation may occur as a result of depression of the central respiratory drive secondary to anesthesia or pain medication.

Inadequate Oxygenation Affects Many Systems

Central Nervous System

• *Restlessness
• *Agitation
• *Confusion
• *Muscle Twitching
• *Seizures
• *Coma

  b)  Inadequate Oxygenation Affects Many Systems:

Cardiovascular System

– Absent to increased respiratory effort in accessory muscles; abnormal breath sounds; abnormal arterial blood gases

Inadequate Oxygenation Affects Many Systems

.  Renal System

1)       Neurological Compromise:

a)  Assess for:

• .  Level of Consciousness
• .  Emergence Delirium
• Delayed Awakening
• Pupillary Responses
• .  Gag Reflexes
•      6.  Hand Grips    
•     7.  Movement of Extremities
•      8.  Complete Neurological Assessment

Can include such behaviors as, restlessness, agitation, disorientation, thrashing, & shouting.

1.  Operating Rooms are very cool

     2.  Anesthesia depresses level of body function – lowering metabolism

     3.  Fall in body temperature

     4.  Patient complains of feeling cold & uncomfortable

     1.  Malignant Hyperthermia – Life-threatening complication of anesthesia

     2.  Causes – Tachypnea; Tachycardia; Premature Ventricular Contractions (PVCs); Unstable B/P; Cyanosis; Skin Mottling & Muscular Rigidity

a)  Pain perceived before full consciousness is regained

b)  Pain causes patient to become restless

c)  Pain may responsible for changes in Vital Signs

 d)  Assessment for discomfort & evaluation of pain-relief therapy

5)  Nausea & Vomiting:

a)  Anesthetics slows GI mobility & may cause nausea

b)  Auscultate for Bowel Sounds in all four quadrants

     1.  Bowel Sounds may be very faint or absent in the immediate recovery phase

      2.  Prior to offering any nourishment MUST AUSCULTATE FOR BOWEL SOUNDS

      3.  Inspect the abdomen for distention

  c)  May be an accumulation of gas

      1.  For a patient who has had abdominal surgery, distention will occur if internal bleeding has occur

        2.  Distention may also occur when a patient develops Paralytic Ileus

6)  CARDIOVASCULAR COMPROMISE:

a)       Fluid & Electrolyte Imbalance

a.       Fluid retention during the first 2 to 5 post-operative days can be the result of the stress response to surgery.

b.      Fluid overload may occur during the post-operative period of fluid retention when IV fluids are administered too rapidly.

c.       Fluid deficit may be related to slow or inadequate fluid replacement.

d.      Hypokalemia (low potassium) can be the consequence of urinary and GI tract losses, especially if potassium is not replaced in IV fluids.

a.       DVT may occur in leg veins as a result of inactivity, body position, and pressure, all which lead to venous stasis and decreased perfusion.

b.      Patients with a history of DVT have a greater tendency for pulmonary embolism. 

a.       May indicate decreased cardiac output, fluid deficits, or defects in cerebral perfusion.

b.      Frequently occurs as a result of postural hypotension when the patient ambulates.

Loss of a large amount of blood externally or internally in short period of time. 

Thromboembolism

Causes

1.  Immobility**

                     2.  Vascular manipulation

                     3.  Dehydration

Thromboembolism

)  Signs & Symptoms

1.  Redness

                       2.  Swelling

           3.  Warmth

                                  4.  Pain

                       5.  Chest Pain

                       6.  Tachypnea

                       7.  Dyspnea

                       8.  Restlessness