Complications in Post Anesthesia Care Unit (PACU)
Management starts in the OR and continues to PACU:
- NSAIDs
- Opioids (Fentanyl, Morphine, Dilaudid)
- Anxiolysis (Benzodiazepines)
- Regional anesthesia (epidural, spinal, peripheral nerve blocks)
- PCA
(Odem-Forren, 2019)
PACU Discharge Criteria
- The Aldrete score is used to assess readiness for discharge. It evaluates activity, respiratory, circulation, consciousness, and oxygen saturation.
- Patients are ready for discharge when vital signs are stable, they have recovered from anesthesia, and there are no presenting complications.
- The Aldrete score must be 8/10 before discharge or follow the hospital policy.
- Post op nausea and vomiting delays discharge from PACU because this increases the incidence of aspiration.
- Prevention includes responding immediately to complaints of nausea and vomiting.
- It also includes avoiding conversations and rapid movements. Elevating the head can prevent post op nausea and vomiting.
| Parameters | Description of the Patient | Score |
|---|---|---|
| Activity Level | Moves all extremities voluntarily/on command Moves 2 extremities Cannot move extremities | 2 1 0 |
| Respiration | Breathes deeply and coughs freely Is dyspneic, with shallow, limited breathing Is apneic | 2 1 0 |
| Circulation (Blood Pressure) | Is 20 mmHg > Preanesthetic level Is 20 to 50 mmHg > Preanesthetic level Is 50 mmHg > Preanesthetic level | 2 1 0 |
| Consciousness | Is fully awake Is arousable on calling Is not responding | 2 1 0 |
| Oxygen Saturation as Determined by Pulse Oximetry | Has a level > 90% when the breathing room air Requires supplemental oxygen to maintain 90% Has level < 90% with supplemental oxygen | 2 1 0 |
(Odem-Forren, 2019)
🧠Graded Activity
In Blackboard, complete the Graded Activity: Case Study
Summary
The debriefing phase of the SSC allows for the interprofessional team to discuss post-op plans for the patient, outline any issues or challenges that occurred intraoperatively, and discuss follow-up. Also, it provides room to discuss what went well. It is the final communication between the team about the patient, to minimize untoward events and improve patient outcomes. Communication plays a vital role in safe care. Therefore, it is important that the perioperative RN provides a thorough transfer of care to the PACU RN. The information provided by the perioperative team will assist the PACU RN in assessing and monitoring the patient postoperatively.