PACU Things to Know Study Guide 2024, Exams of Nursing

PACU Things to Know Study Guide 2024

Typology: Exams

2023/2024

Available from 06/28/2024

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PACU Things to Know Study Guide 2024
Role of the PACU nurse
โœ” PACU nurse helps patients recover from the effects of anesthesia. (helps them
recover ABC)
Specifics:
1. Receive report from the anesthetist, Assess wound.
2. Monitor VS every 15 minutes and chart
3. Manage pain and n/v with doctor ordered meds. (IV push, oxygen, encourage deep
breathing)
4. patients wake up in 15 to 30 minutes to become fully awake and become VS stable;
5. know that older adults, COPD, upper ab surgery, thoracic surgery many need more
oxygen
6. know that longer surgeries build higher concentrations of anesthetic in their tissues ->
they wake up more slowly
7. know that people with liver, kidney problem recover more slowly from anesthesia..
(metabolism, excretion problem?)
Adrete score
โœ” Activity: 2. Moves well
Respiration: 2. Breaths deeply and coughs
Circulation: 2. BP within 20 of preanesthetic level
Consiousness: 2. Fully Awake
O2Sat: 2: greater than 92; 1: greater than 90% on supplemental O2
Generally, to be discharged from PACU patients must be:
1. awake and oriented
2. have clear airways, can breathe autonomously
3. acceptable vital signs for 15-30 mins
4. tolerates pain; extra 20 mins after pain med administration
5. not vomiting
6. not hypothermic
7. not bleeding
8. patients with regional anesthesia must be able to feel and move extremities..
3 lead ECG
โœ” White is right, red is bottom left
https://prezi.com/-qkl30xfzmqq/3-lead-ecg-interpretation/
PACU Meds
โœ” NSAIDS: Aspirin, acetaminophen, ibuprofen, ketorolac, ketoprofen
Opioid analgesics: Morphine, Codeine, Medepridine, Fentanyl
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PACU Things to Know Study Guide 2024

Role of the PACU nurse โœ” PACU nurse helps patients recover from the effects of anesthesia. (helps them recover ABC) Specifics:

  1. Receive report from the anesthetist, Assess wound.
  2. Monitor VS every 15 minutes and chart
  3. Manage pain and n/v with doctor ordered meds. (IV push, oxygen, encourage deep breathing)
  4. patients wake up in 15 to 30 minutes to become fully awake and become VS stable;
  5. know that older adults, COPD, upper ab surgery, thoracic surgery many need more oxygen
  6. know that longer surgeries build higher concentrations of anesthetic in their tissues -> they wake up more slowly
  7. know that people with liver, kidney problem recover more slowly from anesthesia.. (metabolism, excretion problem?) Adrete score โœ” Activity: 2. Moves well Respiration: 2. Breaths deeply and coughs Circulation: 2. BP within 20 of preanesthetic level Consiousness: 2. Fully Awake O2Sat: 2: greater than 92; 1: greater than 90% on supplemental O Generally, to be discharged from PACU patients must be:
  8. awake and oriented
  9. have clear airways, can breathe autonomously
  10. acceptable vital signs for 15-30 mins
  11. tolerates pain; extra 20 mins after pain med administration
  12. not vomiting
  13. not hypothermic
  14. not bleeding
  15. patients with regional anesthesia must be able to feel and move extremities.. 3 lead ECG โœ” White is right, red is bottom left https://prezi.com/-qkl30xfzmqq/3-lead-ecg-interpretation/ PACU Meds โœ” NSAIDS: Aspirin, acetaminophen, ibuprofen, ketorolac, ketoprofen Opioid analgesics: Morphine, Codeine, Medepridine, Fentanyl

Side effects of opiods โœ” Respiratory depression, N/V, Sedation, Constipation, Addiction/Dependence Signs of Narcotic toxicity โœ” 1. Unresponsive

  1. Respiratory less than 7
  2. Bradycardia
  3. Pinpoint pupils Naloxone is the antidote Respiratory complications โœ” 2/3 of major incidents (r/t anesthesia) are respiratory.
  4. Airway obstruction
  5. Hypoxemia Tx:
  6. Assess resp
  7. Clear airway obstruction
  8. Mask O2 ventilate (there was no ambu bag there)
  9. Intubate and secure if needed
  10. look for underlying cause : ABG, CBC, CXR Failure to Regain consciousness โœ” 1. Residual anesthetics: IV or inhaled.
  11. Profound neuromuscular block
  12. Profound hypothermia
  13. Electrolyte abnormalities 5.. Thromboembolic cerebrovascular accident
  14. Seizure Myocardial Ischemia (heart attack) โœ” Risks
  15. History of coronary artery disease
  16. CHF
  17. Smoker
  18. HTN
  19. Tachycardia
  20. Severe hypoxemia
  21. Anemia The risks factors are the same whether the anesthetic given is general or regional Tx:

2.4. Nerve blocks in Leg 2.4.1 Ant. Tibial 2.4.2. Post. Tibial 2.4.3. Lateral Popliteral 2.4.4 Sural 2.5. Field block Relationship between anesthetics and diabetes โœ” diabetes affects all systems. selection of anesthesia depends on existing DM comorbidities. Know that Patients with DM has increased risk of infection Know that surgical removal of necrotic tissue results in dramatic reductions in Insulin requirements Know people with DM w/ comorbidities are at higher risk of dying after a major surgery Know that Mortality of DM patients are 5X normal patients. often related to end-organ damage caused DM Know that Intensive glycemic control has shown to have profound effect on reducing the incidence of DM complications in surgical populations Know that OHG (Oral hypoglycemic agent) must be stopped preoperatively: Sulfonylureas should be stopped (may cause hypoglycemia, myocardial ischemia, infarction) Metformin should be stopped (may cause lactic acidosis in pts with kidney problems) Know that hyperglycemia at the time of stroke is associated with poor outcome. General Aneaesthesia : Indications โœ” 1. Any Pt. on Ventilator

  1. Any Pt. Hypersensitive to L. A. Agent
  2. Refusal from Pt.
  3. Failure of Regional Anesthesia General Anesthesia Additional Uncommon Indications โœ” 1. Risk of Aspiration and PONV (post operative N/V)
  4. Difficult intubations
  5. Resistant hypotension which may last for longer time
  6. Management of ischaemic changes and arrhythmias
  1. Management of blood sugar Spinal and Epidural Anaesthesia โœ” 1. Prevention and management of hypotension (spinal sympathetic nerves are anesthetized) Mild Sx are treated with: volume expansion, ephedrine, atropine.. by the anesthetist..
  2. Cannot be repeated frequently (except in continuous epidural analgesia) especially for small but painful procedures. ephedrine โœ” ... ephedrine โœ” Indirectly acting sympathomimetic: like amphetamine but less CNS stimulation, more smooth muscle effects Regional anesthesia indications (best option for surgeries on the limbs) โœ” 1. Day care patients
  3. Safety in high risk patients
  4. No intra-op regurgitation & aspiration
  5. No PONV
  6. Minimal alteration in drug schedule - especially in diabetics
  7. Minimal effects on vital parameters
  8. Safer in emergency situations
  9. Can be repeated frequently
  10. Conscious & arousable patient at the end of the surgery
  11. Reduction in morbidity & mortality propofol โœ” Produces both rapid anesthesia and recovery, has antiemetic activity and commonly used for outpatient surgery, may cause marked hypotension. fastest rate of recovery How to reassure patients going into surgery โœ” 1. Verbal reassurance
  12. Tactile reassurance
  13. Sedation - mild to moderate
  14. Reassurance - under light sedation mild sedation โœ” is an example of pharmacological restraint, as is pre medication prescribed to claim and ease the patient before treatments. Exact anesthetic techiques for podiatrists (the source of this quizlet)