03.01 Post-Anesthesia Recovery

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Hi guys!  Today I am going to talk a little about post-anesthesia recovery!So what is post-anesthesia recovery?  So guys this is the destination or where surgical patients go to “wake up” after receiving anesthesia.  We call this area the PACU or post-anesthesia care unit and the PACU RN is going to be the one providing the care.So what are the sequence of events that occur in the PACU?  So guys I just want to mention that things can occur slightly different than this list as all facilities are different but this will give you a good idea of what occurs.  Ok so after surgery the surgical patient is going to come into PACU from the OR and will be met by the PACU RN who will provide an immediate admission assessment, hand-off from the anesthesia provider and the perioperative RN will provide information to the PACU RN, a more thorough assessment will be completed along with implementation of interventions and an evaluation to prepare the patient for discharge.Ok so lets look a little closer look at the steps!  Ok so when the patient arrives and is immediately admitted to the PACU the RN will perform an initial assessment that includes the ABCs or airway confirming patency, breathing which would include applying oxygen and a pulse oximeter, and circulation by connecting the patient to a cardiac monitor to evaluate the heart rate, rhythm, and blood pressure.So once the patient has arrived and an immediate assessment by the PACU RN is completed the hand-off report will take place.  The anesthesia provider will give any important information about the patient and the surgery. This can include information like the anesthesia type, the ASA classification of the patient or basically how sick the patient is, anesthesia medications and fluids given, lines, and estimated blood loss or EBL.The hand-off report from the perioperative RN will give the PACU RN slightly different information.  This information can include the perioperative diagnosis, procedure performed, any complications, location of drains, dressings, incision site, any medications given by the surgeon during the procedure as well as any specific patient information that needs to be provided.  It is very important to mention that the hand-off of the patient is never complete until the PACU RN assumes responsibility of the patient.Alright guys so after the hand-off the PACU RN is going to complete a thorough initial assessment this is typically specific to the surgery that the patient has had.  So guys there are quite a few things that the PACU RN assesses in their patient to determine their safety in the moments just after surgery. Ok so lets go through this list!  Of course the vital signs are going to be continued to be assessed which includes the respiratory status of the patient confirming the airway patency, breath sounds, or even the artificial airway settings if the patient is on a vent.  Also the patient’s blood pressure will be assessed by cuff or even arterial line. Temperature is very important to assess in surgical patients as they are prone to perioperative hypothermia. Guys be sure to check out the lesson on intraoperative complications for more information.Assessing pain, sedation level, and comfort are all included in the initial assessment.  Also guys the condition and color of the skin will be considered. A neurovascular check will be completed especially if the surgery occurred on an extremity which includes the peripheral pulses and sensation of the extremity.  Also guys it is important for the PACU RN to verify the condition of the dressings, suture line, drains, as this could really indicate a serious issue if the drains are draining too much or the dressings are saturated. Guys be sure to check out our lesson on post-operative complications!Also guys the muscular response of surgical patients is also important to indicate any issues and also the pupillary response and the post-anesthesia score which can help to indicate if the patient is still sedated and how ready the patient is for discharge.  There are different scoring systems for this but a super common one is the Aldrete Score. So the Aldrete score like I mentioned is a scoring system that evaluates how ready a patient is to go home safely. So based on a few different categories like consciousness, mobility, color, breathing, and circulation the patient will receive a score, 0 being the lowest and worst score and 8-10 being a score that is needed for discharge….just remember 8 is great!!  Also guys we always want to monitor the intake and output of the patient as this could indicate an issue like dehydration.So what happens after the patient receives a very thorough assessment by the PACU RN?  Well of course the RN is going to continue monitoring the patient closely but they are also going to begin promoting interventions like deep breathing, oxygen delivery that can eventually be decreased, mobilization, and pain management.  So guys the hospital where I work is super quick with some of the patients being discharged within an hour. So as you can imagine the PACU RN must be very efficient and focused in the care of their patients.So finally guys the PACU RN will evaluate the patient to assess their readiness for discharge.  We want to see the patient exhibit adequate ventilation, blood pressure, heart rate, and a tolerable pain level.  We also at this point want to make sure that pharmacologic and nonpharmacologic interventions have been initiated and we also want to be sure that the patient is starting to gain an understanding of discharge instructions.  And don’t forget about any post-operative orders from the provider!So after a patient receives anesthesia they can be sleepy or even a little out of it in recovery.  So with that in mind sometimes teaching is difficult until they wake up a bit. But always try your best to teach and encourage patients to express their pain and comfort needs and of course ask questions!So when we consider nursing concepts that apply to the topic of post-anesthesia recovery safety is the first to come to mind!  Oxygenation is huge as our surgical patients have just emerged from anesthesia with comfort being key.Ok guys lets look at some key points! Post-anesthesia recovery is the destination of anesthetized patients where they “wake up” after surgery, this occurs in the post-anesthesia care unit and care is provided by the PACU RN.  The anesthesia provider and perioperative RN will provide information regarding the surgery like anesthesia type, procedure performed, lines, drains, incision site, complications. After the hand-off an initial assessment is performed that is usually specific to the surgery but includes vital signs, pain, sedation, comfort, muscular, neurovascular check, and post-anesthesia score or Aldrete.  The PACU Rn implements interventions while still monitoring the patient with deep breathing, mobilization, comfort interventions. The end goal is discharging the patient so evaluation is necessary to be sure the patient is adequately ventilating, they have an adequate vital signs, and a tolerable pain level.Okay guys I hope you enjoyed this lesson on post-anesthesia recovery!  Make sure you check out all the resources attached to this lesson, as well as the rest of the lessons in this course! Now, go out and be your best self today. And, as always, happy nursing!
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