NURS 5450 Exam 2 - PACU Recovery
Study Guide With Solution
What is the PACU?
- 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
______.
complications
PACU Complications (image)
PACU Complication Rates (image)
Assessment and monitoring in PACU should focus on:
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?
,. 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!
preventable
What is the treatment for loss of pharyngeal tone?
. Jaw thrust
. Continuous positive airway pressure (CPAP)
. Oral airway
. Nasal airway
. LMA
. Endotracheal tube
,Phase I
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)?
- 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
- 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
- Most resistant
. Vocal cords
. Diaphragm
. Orbicularis oculi
. Abdominal muscles
. Adductor pollicis
. Masseter
. Pharyngeal
. Extraocular
- Most sensitive
Transfer to PACU
. 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
Study Guide With Solution
What is the PACU?
- 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
______.
complications
PACU Complications (image)
PACU Complication Rates (image)
Assessment and monitoring in PACU should focus on:
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?
,. 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!
preventable
What is the treatment for loss of pharyngeal tone?
. Jaw thrust
. Continuous positive airway pressure (CPAP)
. Oral airway
. Nasal airway
. LMA
. Endotracheal tube
,Phase I
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)?
- 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
- 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
- Most resistant
. Vocal cords
. Diaphragm
. Orbicularis oculi
. Abdominal muscles
. Adductor pollicis
. Masseter
. Pharyngeal
. Extraocular
- Most sensitive
Transfer to PACU
. 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
