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Postoperative Care. PACU. Postanesthesia care unit (PACU) Allows for ongoing evaluation and stabilization of patients to anticipate, prevent, and treat complications after surgery Anesthesia Care Provider (ACP) gives PACU nurse a verbal report. PACU Nurses Functions Assessment. Airway
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PACU • Postanesthesia care unit (PACU) • Allows for ongoing evaluation and stabilization of patients to anticipate, prevent, and treat complications after surgery • Anesthesia Care Provider (ACP) gives PACU nurse a verbal report
PACU Nurses FunctionsAssessment • Airway • Breathing • Circulation • Neurologic • Genitourinary • Surgical site • Pain
Impaired Gas Exchange Interventions include: • Airway maintenance • Positioning the patient in a side-lying position or turning his or her head to the side to prevent aspiration • Encouraging breathing exercises • Encouraging mobilization as soon as possible
Potential Complication: Hypoxemia • Interventions include: • Maintenance of airway patency and breathing pattern • Prevention of hypothermia • Maintenance of oxygen therapy as prescribed
Cardiovascular Assessment • Vital signs • Heart sounds • Cardiac monitoring • Peripheral vascular assessment
Neurologic System • Cerebral functioning • Emergence Delirium • Delayed Emergence
Discomfort/Pain Assessment • Pain and discomfort expected after surgery, however, can contribute to post-op complications so has to be controlled. • Consider type, extent, and length of the surgical procedure in assessing patient’s discomfort and need for medication.
Physical and Emotional Signs of Acute Pain • Assess for: • Increased pulse and blood pressure • Increased respiratory rate • Profuse sweating • Restlessness • Confusion (in older adults) • Wincing, moaning, or crying
Altered Temperature • Hypothermia • Hyperthermia
Gastrointestinal System • Postoperative nausea and vomiting remain most common postoperative complications. • Peristalsis may be delayed for up to 24 hours. • Monitor for bowel sounds and passage of flatus.
Nasogastric Tube Drainage • Tube inserted during surgery to: • Decompress and drain the stomach • Promote GI rest • Allow the lower GI tract to heal • Provide an enteral feeding route
Nasogastric Tube Drainage (Cont’d) • Assess drained material every 8 hr. • Do not move or irrigate the tube after gastric surgery without an order from the physician/surgeon.
Renal/Urinary System • Check for urine retention. • Consider other sources of output such as sweat, vomitus, or diarrhea stools. • Report a urine output of <0.5 mL/kg/hr.
Skin Assessment • Assessment of the wound and dressing requires knowledge of the type of wound, the drains inserted, and expected drainage related to the specific type of surgery. • Dehiscence—a partial or complete separation of the outer wound layers • Evisceration—a total separation of all wound layers and protrusion of internal organs through the open wound
Impaired Skin Integrity Interventions include: • Nursing assessment of the surgical area • Dressings • Drains—provide an exit route for air, blood, and bile as well as help prevent deep infections and abscess formation during healing
Discharge from the PACU • Home care management • Health teaching • Health care resources