What is perianesthesia nursing ?
Care of a pt before and after admin of anesthesia
Nurse and anesthesia responsible for hand off
- Continuity of care
What is ASPAN?
American society of perianesthesia nurses
Establish standards for perianesthesia nurses
Who sets PACU standards?
American society of anesthesiologists
- recovery from anesthesia gases
- specialized equipment
- advancement of sx procedures
PACU nurse skills?
Critical care experience
Competent regarding age specific care - cardiac, resp
Knowledge of general, regional, local
Holds PCLS, PALS
Stages of surgical experience
Decides on sx Pre op OR PACU Pt returns home
Benefits of eras?
Improve surgical outcomes and decrease cost
Examples of eras protocols?
Improved nutritional status
Pre op education
Multidisciplinary, pt/fam centered
What is ASA classification based on?
- systemic disease
- physiological dysfunction
- anatomic abnormalities
Normal Healthy pt No smoking Minimal ETOH Normal BMI
Mild/controlled systemic disease Smoker Social drinker Pregnancy BMI > 40
Severe/poorly controlled systemic disease BMI < 40 Alcohol dependence Pacemaker Dialysis Recent cardiac hx (MI, CVA, stents)
Severe systemic disease that is a constant threat to life
Patient not expected to survive without surgery Massive trauma AAA Intracranial bleed Ischemic bowel
Declared brain dead pt going for organ donations
Levels of care in PACU?
Phase 1 - constant vigilance and life sustaining care
Phase 2 - focuses on in home care
Phase 3 - extended, continued observation
Factors affecting levels of care in PACU?
Type and length of surgery
Type of anesthesia
Anticipated post anesthesia requirements
Phase 1 PACU
Life sustaining needs are highest priority
airway, LOC, VS
Prep to transition to phase 2
Maintains until critical elements are met
One unconscious, stable pt without artificial airway (8yrs and older)
One conscious stable pt free of complications
2 conscious stable pts free of complications
(2 pt 1 nurse)
One critical unstable complicated pt
Discharge from phase 1
Meet criteria Example: aldrete scale post anesthesia scoring system - resp - activity - circulation - consciousness - O2 sat
Max score 10
Step down recovery
Pt being admitted to unit will bypass stage
Pt may be fast tracked into phase 2
Encouraged to eat, drink and walk
D/C by WC, no driving
- follow P&P
What is main focus of phase 2?
Pt and fam education
Last opportunity before d/c
- use teach back method
Waiting for inpatient bed or discharge arrangements
Part of PACU
Ratio can be 1:3-5 pt
Blended levels of PACU?
All levels in same location
- staffing reasons
Phases = level of care not locations