NURS 5450 Exam 2 - PACU Recovery: Questions With
Expert-Approved Solutions
What is the PACU? Correct Answer - - The primary transitional care area
where patients are monitored until the effects of anesthesia have abated
enough to allow for safe transfer of the patient to the ICU, post surgical floor,
ambulatory care unit, or directly home
- PACUs must be fully equipped with physiologic monitors and the capacity to
resuscitate unstable patients
The primary purpose of postanesthesia care is critical assessment and
stabilization of patients with an emphasis on prevention and detection of
______. Correct Answer - complications
PACU Complications (image) Correct Answer -
PACU Complication Rates (image) Correct Answer -
Assessment and monitoring in PACU should focus on: Correct Answer - 1.
Oxygenation - Pulse oximetry
2. Ventilation - RR, airway patency, chest movement, capnography
3. Circulation - Systemic BP, HR, ECG
What are the physiological effects of loss of pharyngeal tone? Correct
Answer - . A reflex compensatory ↑ in respiratory effort and negative
inspiratory pressure
→ ↑ airway obstruction
. Respiratory efforts against an obstructed airway → paradoxical breathing
pattern
. Sternal retraction
. Exaggerated abdominal motion - rocking
Post World War II - caring for large #'s of surgical patients from battle
casualties, realization that many deaths occurred in the immediate post
anesthesia & surgery time period-AND deaths were ______!! Prompted trend
for a centralized area for immediate postoperative care- where nurses could
pay close attention to the patients- RECOVERY ROOM! Correct Answer -
preventable
,What is the treatment for loss of pharyngeal tone? Correct Answer - . Jaw
thrust
. Continuous positive airway pressure (CPAP)
. Oral airway
. Nasal airway
. LMA
. Endotracheal tube
Phase I Correct Answer - Immediate ICU level of care- from emergence
and awakening from anesthesia- continues until standard discharge criteria
are met...
What are the anesthetic implications for Sleep Apnea (OSA)? Correct
Answer - - Patients more prone to airway obstruction due to redundant
airway tissue
- Should not extubate OSA patients until fully awake and following commands
- (Re)intubation may be difficult
- Preoperative benzodiazepines can contribute to postoperative airway
obstruction
- OSA patients are very sensitive to opioids → consider regional anesthetic
techniques for postoperative pain management when possible
- If patient was on home CPAP, plans should be made to initiate as soon as
possible in the postoperative period - Bring home CPAP into hospital
Phase II Correct Answer - - Less intense care, ensures patient ready to go
home. Certain situations may allow pt. to bypass phase I & go directly to Phase
II
recovery (i.e.- MAC cases-HOWEVER- pt must fit same criteria- awake,
oriented, clear , patent airway, VSS, etc)...
NMB Agent Muscle Sensitivity Correct Answer - - Most resistant
. Vocal cords
. Diaphragm
. Orbicularis oculi
. Abdominal muscles
. Adductor pollicis
. Masseter
. Pharyngeal
, . Extraocular
- Most sensitive
Transfer to PACU Correct Answer - . Notify PACU nurses about ETA of
patient transfer
. Inform of need of any special equipment needed immediately on
arrival:
. Ventilator, capnography
. Nebulizer
. CPAP machine
. Invasive monitoring equipment
. Medication infusions
________ must be high in the differential for upper airway obstruction in the
PACU. Correct Answer - Residual NMB
DO NOT LEAVE OPERATING ROOM UNLESS: Correct Answer - Airway is
patent, adequate oxygenation/ventilation, hemodynamically stable,
Anesthesia provider assists with transport!!!
The ______ recovers from NMB more quickly than the pharyngeal muscles →
adequate respiratory parameters in the OR → extubation → loss of patent
airway manifests in the PACU. Correct Answer - diaphragm
Use ________ during transport. Correct Answer - supplemental O2
Clinical Assessment of Residual NMB Correct Answer - . Train-of-four
assessment is subjective; a decline (fade) may not be appreciated until values
are less than 0.4 to 0.5
. Sustained tetanus is more reliable (50-Hz vs. 100-Hz)
. Use of a peripheral nerve stimulator on an awake patient in the PACU is less
than ideal
. Awake patients with residual NMB will likely become very agitated → → →
If unstable or inadequate extubation criteria- ______ and transport with
monitors/drugs to PACU. Correct Answer - LEAVE INTUBATED
What are some less invasive clinical assessment of residual NMB: Correct
Answer - . Grip strength
Expert-Approved Solutions
What is the PACU? Correct Answer - - The primary transitional care area
where patients are monitored until the effects of anesthesia have abated
enough to allow for safe transfer of the patient to the ICU, post surgical floor,
ambulatory care unit, or directly home
- PACUs must be fully equipped with physiologic monitors and the capacity to
resuscitate unstable patients
The primary purpose of postanesthesia care is critical assessment and
stabilization of patients with an emphasis on prevention and detection of
______. Correct Answer - complications
PACU Complications (image) Correct Answer -
PACU Complication Rates (image) Correct Answer -
Assessment and monitoring in PACU should focus on: Correct Answer - 1.
Oxygenation - Pulse oximetry
2. Ventilation - RR, airway patency, chest movement, capnography
3. Circulation - Systemic BP, HR, ECG
What are the physiological effects of loss of pharyngeal tone? Correct
Answer - . A reflex compensatory ↑ in respiratory effort and negative
inspiratory pressure
→ ↑ airway obstruction
. Respiratory efforts against an obstructed airway → paradoxical breathing
pattern
. Sternal retraction
. Exaggerated abdominal motion - rocking
Post World War II - caring for large #'s of surgical patients from battle
casualties, realization that many deaths occurred in the immediate post
anesthesia & surgery time period-AND deaths were ______!! Prompted trend
for a centralized area for immediate postoperative care- where nurses could
pay close attention to the patients- RECOVERY ROOM! Correct Answer -
preventable
,What is the treatment for loss of pharyngeal tone? Correct Answer - . Jaw
thrust
. Continuous positive airway pressure (CPAP)
. Oral airway
. Nasal airway
. LMA
. Endotracheal tube
Phase I Correct Answer - Immediate ICU level of care- from emergence
and awakening from anesthesia- continues until standard discharge criteria
are met...
What are the anesthetic implications for Sleep Apnea (OSA)? Correct
Answer - - Patients more prone to airway obstruction due to redundant
airway tissue
- Should not extubate OSA patients until fully awake and following commands
- (Re)intubation may be difficult
- Preoperative benzodiazepines can contribute to postoperative airway
obstruction
- OSA patients are very sensitive to opioids → consider regional anesthetic
techniques for postoperative pain management when possible
- If patient was on home CPAP, plans should be made to initiate as soon as
possible in the postoperative period - Bring home CPAP into hospital
Phase II Correct Answer - - Less intense care, ensures patient ready to go
home. Certain situations may allow pt. to bypass phase I & go directly to Phase
II
recovery (i.e.- MAC cases-HOWEVER- pt must fit same criteria- awake,
oriented, clear , patent airway, VSS, etc)...
NMB Agent Muscle Sensitivity Correct Answer - - Most resistant
. Vocal cords
. Diaphragm
. Orbicularis oculi
. Abdominal muscles
. Adductor pollicis
. Masseter
. Pharyngeal
, . Extraocular
- Most sensitive
Transfer to PACU Correct Answer - . Notify PACU nurses about ETA of
patient transfer
. Inform of need of any special equipment needed immediately on
arrival:
. Ventilator, capnography
. Nebulizer
. CPAP machine
. Invasive monitoring equipment
. Medication infusions
________ must be high in the differential for upper airway obstruction in the
PACU. Correct Answer - Residual NMB
DO NOT LEAVE OPERATING ROOM UNLESS: Correct Answer - Airway is
patent, adequate oxygenation/ventilation, hemodynamically stable,
Anesthesia provider assists with transport!!!
The ______ recovers from NMB more quickly than the pharyngeal muscles →
adequate respiratory parameters in the OR → extubation → loss of patent
airway manifests in the PACU. Correct Answer - diaphragm
Use ________ during transport. Correct Answer - supplemental O2
Clinical Assessment of Residual NMB Correct Answer - . Train-of-four
assessment is subjective; a decline (fade) may not be appreciated until values
are less than 0.4 to 0.5
. Sustained tetanus is more reliable (50-Hz vs. 100-Hz)
. Use of a peripheral nerve stimulator on an awake patient in the PACU is less
than ideal
. Awake patients with residual NMB will likely become very agitated → → →
If unstable or inadequate extubation criteria- ______ and transport with
monitors/drugs to PACU. Correct Answer - LEAVE INTUBATED
What are some less invasive clinical assessment of residual NMB: Correct
Answer - . Grip strength
