b)      :  Post-Anesthetic Recovery Score.  Patients must receive a composite score of 8 to 10 before discharge from PACU.   Refer to Potter/Perry (7^th Edition), pp. 1394, Table 50-7.

1)  Activity

2)  Respiration

3)  Circulation

4)  Consciousness

5)  O2 Saturation

b)      In addition to the categories addressed in the Modified Aldrete Score, five additional areas of functional assessment are required for Ambulatory/Outpatient Surgical Patients.  They include:  Refer to Potter/Perry (7^th Edition), pp. 1395, Table 50-8.

1)       Dressing – Dry & intact

2)       Pain – Pain free

3)       Ambulation – Able to stand & walk straight, if applicable

4)       Fasting-Feeding – No Nausea & vomiting

5)       Urine Output – Has voided

a)       Operative and PACU Report

b)      Transfer to Bed

• 1.  Intravenous (IV) Lines
• 2.  Drains
•       3.  Dressings
•       4.  Tractions
•       5.  Abdominal Pillows

c)       Special Equipment

d)      Time of Admission

e)       Vital Signs

f)        Physical Assessment

g)      Family Presence

h)       Review Post-Operative Orders

POTENTIAL COMPLICATIONS:

a)       Respiratory Function

• Airway Obstruction
• )  Atelectasis
• Pneumonia
• )  Pulmonary Emboli

Caused by blockage of the airway by the patient’s tongue.

– Alveolar collapse result of bronchial obstruction caused be retained secretions or decreased respiratory excursion.

Thrombus dislodged from peripheral venous system; lodged in pulmonary arterial system (lungs)

1)  Administer Oxygen Therapy

2)  Pain control before:  Turning, Coughing & Deep Breathing

3)  Turn, Cough & Deep Breath every 1 to 2 hrs

            4)  Use of Incentive Spirometer

5)  Early Mobilization, i.e. ambulation

6)  Monitor Breath Sounds & Temperature

POTENTIAL COMPLICATIONS

a)       Cardiovascular Function

1)  Hemorrhage – Ineffective vascular closure or alterations in coagulation

2)  Thromboembolism – Related to dehydration, immobility, vascular manipulation or injury

a)       Hemorrhage:  Nursing Interventions

1)  Monitor Vital Signs Frequently

            2)  Monitor Surgical Site & Dressing

            3)  Monitor Level of Consciousness

            4)  Review Lab Work

            5)  Report Abnormalities

1)  Early Ambulation, as allowed

2)  Leg Exercises, every 1 to 2 hrs

3)  Anti-Embolic Stockings (AE Hose)/Sequential Compression Devices (SCD)

4)  No pressure on veins

5)  Monitor Vital Signs, Labs, & Hydration Status

6)  Anticoagulation Therapy, as ordered

7)  Monitor Fluid Overload versus Fluid Deficit Status

POTENTIAL COMPLICATIONS

Gastrointestinal Function

1)  Nausea & Vomiting

2)  Paralytic Ileus

3)  Abdominal Distention

4)  Hiccoughs

5)  Constipation

g)  GI Function (Paralytic Ileus):  Nursing Interventions

1)  Monitor Bowel Sounds

2)  NPO until Positive Bowel Sounds

3)  Maintain Hydration

4)  Nasogastric (NG) Tube

5)  Monitor for Gag Reflex

6)  Advance diet as tolerated, once bowel sounds are auscultated

7)  Encourage to pass flatus

  8)  Last but not least – Ambulate Patient

POTENTIAL COMPLICATIONS:

Genitourinary Function

1)  Low urinary output

     2)  Urinary Retention

     3)  Bladder Distention

Genitourinary Function:  Nursing Interventions

1)  Monitor Intake & Output

      2)  Urinary Output should be at least 1mL/kg/hr for adults; For example, a 132-pound woman (60 kg) would be expected to produce 60 mL of urine hourly.

      3)  Position patient in as normal position as possible for voiding

      4)  Use appropriate pain measures

      5)  Provide privacy

      6)  Ambulation, if possible

7)  Urine Catheterization, as ordered 

POTENTIAL COMPLICATIONS

Neurological Function 

1)  Pain

            2)  Sensory-perceptual

            3)  Alterations in temperature

            4)  Foster Preoperative Intervention (FPI) – Incorporates self-efficacy concepts to teach specific mobility and breathing techniques with imagery during post-operative activities.  The use of FPI through video-taped instruction enhances self-efficacy, decreases post-op pain, and promotes earlier independent mobilization.

k)       Neurological Function:  Nursing Interventions

1)  Medicate – Narcotic analgesics:  Initial doses provided by Intravenous Route (IV)

            2)  Non-narcotic analgesics

            3)  Patient-Controlled Analgesia (PCA) – Allows patient to administer own IV analgesic

            4)  Reassess patient

5)  Other Pain Relief Measures

                  a)  Pillow for incision splinting while turning, coughing & deep breathing

                  b)  Repositioning patient

                  c)  Distraction

                  d)  Imagery (FPI)

POSSIBLE COMPLICATIONS

k)       Skin Integument

1)  Surgical Incision

2)  Risk for Infection

3)  Risk for Pressure Ulcers

4)  Wound Dehiscence – Separation and disruption of previously joined wound edges.

1)  Monitor surgical incision, drains, and tubes

2)  Wound care

3)  Monitor nutritional status

4)  Monitor Vital Signs & Signs/Symptoms of infection

5)  Handwashing!!!

POSSIBLE COMPLICATIONS

Psychological Function  

a)  All PACU Criteria Met – By PARSAP must achieve a score of 18 or higher before discharge

b)      No Nausea/Vomiting

c)  Able to Ambulate, if not contraindicated

d)  No IV Narcotics in use

e)  Adult available to drive and help patient at home

f)  Discharge Instructions

• 1)  Diet – Dietary Restrictions
• 2)  Activity Level
• 3)  Ambulation Devices
• 4)  Wound Care -
• 5)  Driving
• 6)  Medications – Prescriptions Teaching
• 7)  What to look for ****
• 8)  Follow-Up

a)  VITAL SIGNS, go back to basics

     b)  Be on the look out for Signs/Symptoms of Hypoxia

     c)  Take care of pain first, and then Turn, Cough, Deep Breathe, Incentive Spirometer, Leg exercises, and Ambulation

     d)  Early ambulation of patients prevents many complications

     e)  Listen for Bowel Sounds

f)  Prevention of infection starts with HANDWASHING

COMPLETE BLOOD COUNT: