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Perianesthesia nursing
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Encompasses the care of the patient before, during, and after anesthesia administration
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Departments where perianesthesia nurses practice
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Pre admission testing (PAT)
Pre-Op Care Unit (ACU) Pre-Op holding unit Post Anesthesia Care unit (PACU) Extended Care |
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PAT nurses responsibilities
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Obtaining as much information as possible, communicating the information to the appropriate team members, preparing the patient for surgery.
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Scope of the PAT interview:
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Compile health history
compile list of medications including OTC and herbals Determine any labs, x-rays, or tests Initialize education confirm surgery details (time, place, NPO) schedule tests related to the surgery report relevant abnormalities |
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Pre-Op Care Unit assessment should include:
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Patient safety needs
pain assessment comfort assessment cultural/language preference psycho/social needs drug use/abuse previous anesthtetic history pre-op teaching discharge planning advance directives cognitive ability of caregivers |
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PACU Phase 1
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Where all patient's who have had General Anesthesia go.
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First priority of Phase 1 PACU nurse
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AIRWAY
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PACU Phase 1 monitoring
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Airway is priority
BP, O2, HR monitor lines monitor LOC assess dressing assess pain temp N/V opiod and non opiod narcotics for pain relief Discharged when patient meets criteria (i.e. Aldrete score) |
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Aldrete score
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Scoring system to determine how patient is recovering from anesthesia, Score must be > 8
Category 1:Activity (Ability to move 4 extremities voluntarily or on command) Category 2: Respiration: Ability to deep breathe and cough freely, assessment of dyspnea, hypoventilation Category 3: Circulation: BP levels +/- 20-50% of preanesthetic level Category 4: Consciousness: Fully awake, arousable, unresponsive Category 5: O2 Sat: able to maintain vs needs O2 |
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Responsibility of the Anesthesiologist
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Care of the patient from time of induction until d/c to unit or home.
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Drugs given in PACU Phase 1
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IV opioid and non opioid narcotics
PCA anti-emetics |
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PACU Phase 2
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Assess pain, drains, dressing, loc, vitals, respiratory status, dvt propholaxis; pt education is the focus; pt encouraged to ambulate
Ratio is 1: 3 pt for pt over 8 and 1: 2 for pt under 8 |
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What must patient's do before d/c?
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Void
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Nurse patient ratio for perianestheisa nursing units:
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Upon admission to Phase 1---->1:1
Extended Care Unit--> 1:3/5 Pt under 8 ---> 1:2 pt recovering in CCU--> 2:1 |
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Extended Care Unit
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For patient's who need additional monitoring after d/c from PACU prior to d/c home.
can be hospital unit, CCU, observation unit Primary focus: safety |
