Postoperative Nursing Care | NCLEX RN Review

Summary

This video tutorial focuses on postoperative nursing, particularly the postanesthesia care unit (PACU) phase. It covers the importance of monitoring vital signs, managing pain, assessing the surgical site, and maintaining fluid balance. The video outlines three phases of postanesthesia care, highlighting the necessity of a stable patient state for transfer to other units or home. It also addresses potential complications like hypoxemia, laryngospasm, and cardiovascular issues, emphasizing the critical role of nurses in immediate postoperative care.

Takeaways

• 🏥 Perioperative nursing includes preoperative, intraoperative, and postoperative care, with postoperative care beginning in the PACU.
• 👩‍⚕️ Postanesthesia nurses must be prepared to manage complications and implement interventions based on the patient's status.
• 📈 Nursing interventions involve monitoring vital signs, managing pain, assessing the surgical site, and maintaining fluid and electrolyte balance.
• 🛏️ The PACU is equipped with essential monitoring and emergency equipment, and its layout facilitates patient care and observation.
• 📊 The length of stay in the PACU is determined on a case-by-case basis, with no mandated minimum stay.
• 📚 PACU nurses require in-depth knowledge of anesthetic agents, surgical procedures, pain management, and potential complications.
• 🔄 Postanesthesia care is divided into three phases: immediate post-anesthesia, continued recovery, and ongoing care or discharge.
• 🌡️ The PACU nurse performs assessments including level of consciousness, respiratory effort, oxygen saturation, and cardiac rhythm.
• 🏋️‍♂️ Respiratory complications such as airway obstruction, hypoxemia, and laryngospasm are serious and require prompt treatment.
• 🩺 Cardiovascular complications like hypotension, hypertension, and cardiac dysrhythmias are common and need to be monitored closely.
• 💊 Pain management is critical after surgery, with various methods available to ensure adequate relief and prevent complications.

Q & A

What is the definition of perioperative nursing?

Perioperative nursing encompasses the preoperative, intraoperative, and postoperative phases of the patient's surgical experience.

What is the primary focus of the video tutorial?

The video tutorial focuses on the postoperative phase of perioperative nursing, specifically the care in the postanesthesia care unit (PACU).

What is the role of the postanesthesia nurse?

The postanesthesia nurse must understand the patient's risks for complications and be prepared to implement interventions should there be a change in the patient's status.

What are the key nursing interventions in the PACU?

Key nursing interventions include monitoring vital signs, airway patency, neurologic status, managing pain, assessing the surgical site, assessing and maintaining fluid and electrolyte balance, and providing a thorough report of the patient's status.

What is the significance of the PACU location?

The PACU should be located near the operating rooms for efficient patient transfer and emergency response.

What are the three phases of postanesthesia care?

The three phases of postanesthesia care are: Phase 1 - immediate post-anesthesia period requiring one-on-one care, Phase 2 - continued recovery with stable pulmonary, cardiac, and renal functioning, and Phase 3 - ongoing care for patients needing extended observation and intervention.

What is the purpose of the Aldrete score in the PACU?

The Aldrete score is used to determine if a patient is stable enough to be discharged from the PACU. It measures activity, respiration, circulation, consciousness, and oxygen saturation.

What are the symptoms of laryngospasm mentioned in the script?

The symptoms of laryngospasm include sternal retractions, crowing sounds, hypoxemia, and hypercapnia.

Why is monitoring for hypothermia important in the PACU?

Hypothermia can extend recovery, delay wound healing, and increase postoperative morbidity. It also increases oxygen demands and can impair coagulation.

What are the common cardiovascular complications encountered in the immediate postoperative period?

Common cardiovascular complications include hypotension, hypertension, and cardiac dysrhythmias.

How does the PACU nurse assess a patient's level of consciousness?

The PACU nurse assesses a patient's level of consciousness using tools like the AVPU scale or the Glasgow Coma Scale.

Outlines

00:00

🏥 Postoperative Nursing Overview

This paragraph introduces the postoperative phase of perioperative nursing, which begins when a patient is admitted to the postanesthesia care unit (PACU) and ends when they are transferred to a nursing unit after anesthesia has worn off. The nurse's role includes monitoring for complications, managing pain, assessing the surgical site, maintaining fluid balance, and providing a comprehensive patient status report. The PACU is described as a large, open room with individual patient care spaces equipped for monitoring and emergency response. The length of stay is determined on a case-by-case basis, and the American Society of PeriAnesthesia Nurses (ASPAN) advises separating critically ill patients from ambulatory surgical patients. Nurses in the PACU must have in-depth knowledge of patient responses to anesthesia, surgical procedures, pain management, and potential complications. The postanesthesia care is divided into three phases: immediate post-anesthesia, continued recovery, and ongoing care for patients needing extended observation.

05:02

🌡️ Monitoring and Managing Postoperative Respiratory Complications

This section discusses the assessment of respiratory status in the PACU, including pulse oximetry, arterial blood gases, and chest x-rays. It highlights common respiratory complications such as airway obstruction, hypoxemia, hypoventilation, aspiration, and laryngospasm. The paragraph explains the causes and symptoms of these complications and outlines treatments such as administering oxygen, suctioning, jaw-thrust maneuvers, and in severe cases, intubation or surgical airway procedures. Special attention is given to patients with obstructive sleep apnea, who are at higher risk for airway obstruction and hypoxemia. The importance of monitoring oxygen saturation and the potential need for positive pressure ventilation is emphasized.

10:06

🩹 Postoperative Cardiovascular Care and Fluid Management

The third paragraph focuses on cardiovascular complications in the immediate postoperative period, such as hypotension, hypertension, and cardiac dysrhythmias. It details the signs of hypotension and common causes like blood loss or inadequate fluid replacement. The paragraph also addresses hypertension and its potential causes, including pain and pre-existing conditions. The importance of treating hypertension before PACU discharge is stressed. Cardiac dysrhythmias are discussed, along with the necessary nursing interventions. Additionally, the paragraph covers the disruption of thermoregulation, the risks of hypothermia and hyperthermia, and the importance of rewarming. Fluid management is also discussed, including the loss of fluids during surgery and the need for monitoring fluid and electrolyte balance, as well as the common issue of postoperative nausea and vomiting.

15:06

🏠 Discharge Criteria and Ongoing Postoperative Care

The final paragraph discusses the criteria for discharging patients from the PACU, which often involves a numeric scoring system like the Aldrete score. It explains the phase 1 and phase 2 Aldrete scores, which assess activity, respiration, circulation, consciousness, and oxygen saturation. A score of 9 or 10 is required for discharge. The paragraph also covers the transition of care from the PACU nurse to the inpatient unit nurse and the ongoing postoperative care in the third phase of postanesthesia care. The video concludes with a question about identifying symptoms of laryngospasm, highlighting the importance of recognizing sternal retractions and crowing sounds as indicators. The tutorial ends with a prompt to watch more videos for further education on postoperative nursing.

Keywords

💡Postoperative nursing

Postoperative nursing refers to the care provided to patients after surgery. It is a critical phase of perioperative nursing, which includes preoperative, intraoperative, and postoperative care. In the video, postoperative nursing is the main theme, focusing on the period starting from the patient's admission to the PACU until they are stable enough to be transferred to a regular nursing unit. The script discusses various interventions and assessments that are crucial during this phase to ensure the patient's safety and recovery.

💡PACU

PACU stands for Post-Anesthesia Care Unit, which is a specialized unit where patients are closely monitored after surgery while they recover from anesthesia. The PACU is highlighted in the script as a key location for postoperative care, where nurses must be prepared to manage potential complications and provide immediate interventions. The script mentions that PACU should be near the operating rooms and is equipped with various monitoring devices and emergency equipment.

💡Complications

Complications in the context of the video refer to any unfavorable and unintended outcomes that can occur after surgery. The script emphasizes the importance of nursing interventions to monitor for and manage potential complications such as respiratory issues, cardiovascular instability, and pain. It also mentions that the potential for developing complications extends beyond the immediate postoperative phase, necessitating ongoing nursing assessment.

💡Vital signs

Vital signs are a group of measurements taken to determine a patient's state of health, including heart rate, blood pressure, respiratory rate, and body temperature. In the video script, monitoring vital signs is a key nursing intervention in the PACU to assess a patient's stability and detect any changes that may indicate a complication. The script specifies that the PACU nurse must monitor these signs closely to ensure the patient's well-being.

💡Airway management

Airway management is a critical aspect of postoperative care that involves ensuring that a patient's airway remains clear and open to facilitate breathing. The script discusses various airway management equipment available in the PACU and interventions such as suctioning of secretions and the use of airway adjuncts. It also mentions potential respiratory complications like airway obstruction and laryngospasm that require prompt management.

💡Neurologic status

Neurologic status refers to the assessment of a patient's nervous system function, including consciousness, motor function, and sensory perception. In the video, neurologic status is a key aspect of postoperative nursing care, as changes may indicate complications such as stroke or brain injury. The script describes how nurses assess neurologic functions using tools like the Glasgow Coma Scale and by evaluating responses to verbal stimuli and motor strength.

💡Fluid and electrolyte balance

Fluid and electrolyte balance is crucial for maintaining proper body function. In postoperative care, as discussed in the script, patients can experience imbalances due to fluid loss during surgery or changes in the body's regulatory mechanisms. Nurses must monitor and manage this balance to prevent complications such as dehydration or water intoxication. The script mentions the importance of assessing fluid intake and output and the potential need for IV fluid replacement.

💡Pain management

Pain management is the process of alleviating a patient's pain after surgery. The script highlights pain as a significant postoperative problem and emphasizes the importance of prompt and adequate pain relief. It discusses various methods of pain relief, including preemptive analgesia, patient-controlled analgesia (PCA), and non-pharmacologic interventions. The video stresses the negative effects of unresolved acute pain and the importance of assessing pain regularly using tools like pain rating scales.

💡Aldrete score

The Aldrete score is a numeric scoring system used to assess a patient's readiness for discharge from the PACU. The script explains that the score evaluates activity, respiration, circulation, consciousness, and oxygen saturation, with each category scored from 0 to 2. A score of 9 or 10 is typically required for discharge. The Aldrete score is used in phase 1 and phase 2 of postanesthesia care to ensure that patients are stable before they are transferred to a regular nursing unit or discharged home.

💡Laryngospasm

Laryngospasm is a respiratory complication characterized by the involuntary contraction of the laryngeal muscles, leading to partial or complete closure of the airway. The script describes laryngospasm as a serious concern in postoperative care, which can cause symptoms like sternal retractions and crowing sounds. If not treated promptly, it can lead to hypoxia and other severe complications. The video uses laryngospasm as an example of a complication that requires immediate nursing intervention.

💡Hypoxemia

Hypoxemia refers to low oxygen levels in the blood, which can occur postoperatively due to various factors such as hypoventilation or airway obstruction. The script mentions hypoxemia as a common complication that requires monitoring with pulse oximetry and can be managed with interventions like supplemental oxygen. The video emphasizes the importance of recognizing and treating hypoxemia to prevent further complications like brain damage or death.

Highlights

The postoperative phase begins with the patient's admission to the PACU and ends when they are transferred to the appropriate nursing unit.

Postanesthesia nurses must be prepared to implement interventions for potential complications.

Nursing interventions include monitoring vital signs, managing pain, and assessing the surgical site.

The PACU should be located near the operating rooms for efficient patient transfer.

Each PACU space is equipped with essential monitoring and emergency equipment.

The length of stay in the PACU is determined on a case-by-case basis.

ASPAN recommends separating the recovery areas for critically ill and ambulatory surgical patients.

PACU nurses need in-depth knowledge of patient responses to anesthetic agents and potential complications.

There are three phases of postanesthesia care, focusing on immediate recovery, continued recovery, and ongoing care.

Phase 1 of postanesthesia care requires one-on-one care and close monitoring of the patient's level of consciousness.

Many patients may bypass phase 1 and go directly to phase 2, known as 'fast-tracking'.

Phase 3 involves ongoing care for patients needing extended observation after phases 1 or 2.

The PACU nurse receives a detailed verbal report and performs an immediate assessment of the patient's status.

Neurologic functions can be assessed using the AVPU scale or the Glasgow Coma Scale.

Respiratory complications include airway obstruction, hypoxemia, hypoventilation, aspiration, and laryngospasm.

Treatment for airway obstruction may involve administering oxygen, suctioning, and airway management.

Patients with obstructive sleep apnea are at an increased risk of airway obstruction post-anesthesia.

Hypoxemia can result from various causes and is a common complication in the immediate postoperative period.

Aspiration can lead to pneumonitis and secondary infection if gastric contents are inhaled.

Laryngospasm is a serious respiratory complication that requires immediate treatment to prevent hypoxia.

Cardiovascular complications such as hypotension, hypertension, and cardiac dysrhythmias are monitored in the PACU.

The PACU nurse is responsible for monitoring the patient's temperature and managing hypothermia or hyperthermia.

Fluid and electrolyte balance is crucial, with the body naturally retaining fluid for 24 to 48 hours post-surgery.

Nausea and vomiting can prolong recovery time and lead to fluid and electrolyte imbalance.

Prompt and adequate pain relief is essential to prevent negative effects such as increased complications and longer hospital stays.

The Aldrete score is a numeric scoring system used to determine discharge from the PACU.

The PACU nurse provides a thorough report to the inpatient unit nurse for ongoing postoperative care.

Transcripts

Welcome to this video tutorial on postoperative nursing.

You may have heard the term "perioperative nursing" - this encompasses the preoperative,

intraoperative, and postoperative phases of the patient's surgical experience.

This video will focus on the postoperative phase which begins with the patient's admission

to the postanesthesia care unit (PACU) and ends once the anesthesia has worn off enough

for the patient to be safely transferred to the appropriate nursing unit.

The postanesthesia nurse must understand the patient's risks for complications and be prepared

to implement interventions should there be a change in the patient's status.

Nursing interventions include monitoring vital signs, airway patency, and neurologic status;

managing pain; assessing the surgical site; assessing and maintaining fluid and electrolyte

balance; and providing a thorough report of the patient's status to the receiving nurse

on the unit, as well as the patient's family.

The patient must be stable and free from symptoms of complications in order to transfer from

the PACU to the clinical unit or home.

However, the potential for developing complications goes beyond the immediate postoperative phase

and ongoing nursing assessment is essential on the postoperative nursing floor as well.

In this video we will be focusing on the immediate postoperative care in the PACU.

The PACU should be located near the operating rooms.

It is usually a large open room, divided into individual patient care spaces.

There are usually 1.5 to 2 patient care spaces per operating room.

Each patient care space is supplied with a blood pressure monitoring device, cardiac

monitor, pulse oximeter, oxygen, airway management equipment, and suction.

Emergency equipment and medications are often centrally located.

The length of stay in the PACU is determined on a case-by-case basis, there is not a mandated

minimum stay requirement.

The American Society of PeriAnesthesia Nurses (ASPAN) recommends that critically ill patients

do not recover in the same area as ambulatory surgical patients.

Registered nurses in the PACU demonstrate in-depth knowledge of patient responses to

anesthetic agents, surgical procedures, pain management, and potential complications.

There are three phases of postanesthesia care.

Phase 1 is the immediate post-anesthesia period, when the patient is emerging from anesthesia

and requires one-on-one care.

The PACU nurse assesses the level of consciousness, breath sounds, respiratory effort, oxygen

saturation, blood pressure, cardiac rhythm, and muscle strength.

The patient is being prepared for transfer to phase 2, ICU, or an inpatient nursing unit.

Phase 2 is continued recovery; when the patient's consciousness returns to baseline and the

patient has stable pulmonary, cardiac, and renal functioning.

Many patients bypass phase 1 and go directly from the OR to phase 2; this process is known

as 'fast-tracking.'

The patient then moves to phase 3, home, or an extended care facility.

Phase 3 is ongoing care for patients needing extended observation and intervention after

phase 1 or 2, such as a 23 hr observation unit or in-hospital unit.

Nursing care continues until the patient completely recovers from anesthesia and surgery and is

ready for self-care.

The PACU nurse will receive a detailed verbal report from the circulating OR nurse and/or

anesthesiologist that is bringing the patient to recovery.

The PACU nurse performs an immediate assessment of the patient's airway, respiratory, and

circulatory status, then focuses on a more thorough assessment.

Immediate post-anesthesia nursing care (phase 1) focuses on maintaining ventilation and

circulation, monitoring oxygenation and level of consciousness, preventing shock, and managing

pain.

The nurse should assess and document respiratory, circulatory, and neurologic functions frequently.

Neurologic functions can be assessed by the patient's response to verbal stimuli, pupils'

responsiveness to light and accommodation, ability to move all extremities, and strength

and equality of a hand grip.

A level of consciousness assessment is also helpful, such as the AVPU scale or the Glasgow

Coma Scale.

The AVPU scale assesses if the patient is alert and oriented, responds to voice, responds

to pain, or is unresponsive.

The Glasgow Coma Scale is an objective way to record the conscious state of a patient,

examining eye, verbal, and motor responses.

The lowest possible score is 3, indicating deep coma or death, while the highest score

is 15, a fully awake person.

Assessment of the respiratory status may include pulse oximetry, arterial blood gases, and

chest x-ray.

Respiratory complications exist for all patients and include airway obstruction, hypoxemia,

hypoventilation, aspiration, and laryngospasm.

Airway obstruction is a serious complication after general anesthesia, and commonly results

from the movement of the tongue into the posterior pharynx; changes in the pharyngeal and laryngeal

muscle tone; or laryngospasm, edema, and secretions of fluid collecting in the pharynx, bronchial

tree, or trachea.

Symptoms include gurgling, wheezing, stridor, retractions, hypoxemia, and hypercapnia.

Treatment includes administering 100% oxygen, suctioning of secretions, jaw-thrust maneuver

to maintain airway, and insertion of an oral or nasal airway.

If none of these interventions are successful, then endotracheal intubation, cricothyroidotomy,

or tracheostomy may be necessary.

Patients with obstructive sleep apnea have a complete or partial collapse of the pharynx

during inspiration, and are at an increased risk of airway obstruction from the effects

of anesthesia.

They are also at risk for hypoxemia because of the residual effects of anesthetic agents.

The nurse should monitor the patient for apnea and dysrhythmias and continuously monitor

oxygen saturation.

Hypoxemia is a common complication in the immediate postoperative period when pulse

oximetry is less than 90% and PO2 is less than 60 mmHg per ABG.

It may be a result of hypoventilation, related to:

- opioids - causing respiratory center depression General anesthesia

- Insufficient reversal of neuromuscular blocking agents - resulting

in residual muscle paralysis - Increased tissue resistance - from emphysema

or infections - Decreased lung and chest wall compliance

- from pneumonia - Obesity or gastric and abdominal distention

- Incision site close to the diaphragm - Constrictive dressings

- Postoperative pain

Aspiration is when gastric contents or blood is inhaled into the tracheobronchial system.

It is usually caused by regurgitation; however, blood may result from trauma or surgical manipulation.

Risk for aspiration is the reason patients need to be NPO prior to surgery, so there

is nothing in the stomach.

Aspiration of gastric contents can cause pneumonitis, chemical irritation, destruction of tracheobronchial

mucosa, and secondary infection.

Laryngospasm is another respiratory complication, in which the laryngeal muscle tissue spasms,

and causes a complete or partial closure of the vocal cords, resulting in airway obstruction.

If not treated, laryngospasm can result in hypoxia, cerebral damage, and death.

If the patient is extubated too quickly, they are at risk for airway spasm, aspiration,

coughing, and airway obstruction.

If there is repeated suctioning and irritation by the ET tube or artificial airway, laryngospasm

can occur after extubation.

Symptoms of laryngospasm include dyspnea, crowing sounds, hypoxemia, and hypercapnia.

Treatment includes removing the irritating stimulus, hyperextending the patient's neck,

elevating the head of the bed, giving oxygen, suctioning if necessary, and positive pressure

ventilation by bag and mask.

Medication may be given to reduce swelling and airway irritation, or a muscle relaxant

may be needed.

Re-intubating is only done as a last resort.

Maintaining circulation and assessing for cardiac complications in the immediate post-op

period is a priority for nursing care.

The most commonly encountered cardiovascular complications are hypotension, hypertension,

and cardiac dysrhythmias that occur as a result of anesthetic agents affecting the central

nervous system, myocardium, and peripheral vascular system.

The signs of hypotension include increased heart rate, systolic pressure of 90 mmHg or

less, decreased urinary output, pale extremities, confusion, and restlessness.

A common cause of postoperative hypotension is blood loss or inadequate fluid replacement.

The PACU nurse should be ready to return the patient to the OR if excessive bleeding or

hemorrhage occurs.

Hypertension can also occur postoperatively, due to pain, pre-existing hypertension, sympathetic

stimulation, bladder distention, anxiety, or reflex vasoconstriction due to hypoxia,

hypercarbia, or hyperthermia.

Untreated hypertension may lead to cardiac dysrhythmias, left ventricular failure, myocardial

ischemia and infarction, pulmonary edema, and cerebrovascular accident.

The hypertension must be adequately treated before the patient is discharged from the

PACU.

Cardiac dysrhythmias commonly occurring in the immediate postoperative period include

sinus tachycardia, sinus bradycardia, and supraventricular and ventricular dysrhythmias.

The nurse should assess for airway patency, adequate ventilation, and administer medications

and supplemental oxygen as needed.

A crash cart should be readily available.

The PACU nurse is also responsible for monitoring the patient's temperature, as normal thermoregulation

is often disrupted due to medication, anesthesia, and the stress of surgery.

Many patients experience hypothermia, which can extend recovery, delay wound healing,

and increase postoperative morbidity.

Shivering increases oxygen demands up to 400%, which results in an increased metabolic rate

and myocardial workload.

Hypothermia also impairs coagulation, causes decreased cerebral blood flow, and vasoconstriction.

Signs of hypothermia include shivering, tachypnea, and tachycardia.

Rewarming is essential in the immediate postoperative care of the patient in PACU.

Hyperthermia, when core temp gets above 102.2 degrees F, may be caused by infection, sepsis,

or malignant hyperthermia, which can occur for 24-72 hours after surgery.

If unrecognized or untreated, malignant hyperthermia results in death.

Fluids are lost during surgery through blood loss, hyperventilation and exposed skin surfaces.

Volume may be replaced with IV fluids, and excessive blood loss replaced with blood,

blood products, colloids, or crystalloids.

The body naturally retains fluid for at least 24 to 48 hours after surgery, due to the stimulation

of antidiuretic hormone as part of the stress response and the effects of anesthesia.

The patient should be monitored for fluid and electrolyte imbalances, pulmonary edema,

and water intoxication.

Fluid intake usually exceeds output during the first 24 to 48 hours.

Even if the IV fluid intake is 2000-3000 mL, the first void may not be more than 200 ml,

and total urinary output for the surgery day may be less than 1500 mL.

As the body stabilizes, fluid and electrolyte balance returns to normal within 48 hours.

Nausea and vomiting is a common postoperative problem and can also lead to fluid and electrolyte

imbalance.

It is often caused by the effects of general anesthesia, abdominal surgery, opiate analgesics,

and history of motion sickness.

Nausea & vomiting usually occurs in the first 24 hours, with the highest incidence in the

first 2 hours.

It can prolong recovery time, sometimes resulting in an unplanned hospital admission for an

outpatient surgery patient.

Pain is a common occurrence after most all types of surgical procedures, and is probably

the most significant postoperative problem in the eyes of the patient.

Prompt and adequate pain relief is a critical nursing intervention.

Unresolved acute pain has many negative effects, including more complications, longer hospital

stays, greater disabilities, and the potential for chronic pain.

There is an association between high pain scores and nausea, respiratory complications,

slower return of GI function and increased risk of DVT.

Effective methods of postoperative pain relief include preemptive analgesia (which is given

prior to surgery or prior to pain), giving around-the-clock analgesics, PCA (patient-controlled

analgesia, PRN (as needed) dosing, management of breakthrough pain, and nonpharmacologic

interventions.

Assessment of the patient's pain is the first priority.

The patient's report is the most reliable indicator of pain intensity, and using a numeric

or faces pain rating scale is a reliable tool.

Other important assessments include:

- Surgical site - dressing dry and intact - Proper draining of drainage tubes

- Rate & patency of IV fluids - Level of sensation after regional anesthesia

- Circulation/sensation in extremities after orthopedic or vascular surgery

- Patient safety

During the patient's stay in PACU, the nurse documents all assessments and interventions.

Patients usually remain in the PACU until their vital signs are stable and they are

reasonably capable of self-care.

Discharge from the PACU is usually determined by a numeric scoring system; the most common

one in use is the Aldrete score.There is a phase 1 Aldrete score that measures activity,

respiration, circulation, consciousness, and oxygen saturation (or color).

Each measurement is scored from 0 to 2, with a total score of 9 or 10 qualifying for discharge

from the PACU.

The anesthesiologist often discharges the patient from phase I.

The phase II Aldrete score is used for patients who are conscious or those who received local

or regional anesthesia, and have moved on from phase I.

The patient will then be discharged home, a short-stay unit, or an inpatient unit.

If the patient is staying in the hospital unit, the PACU nurse gives report to the nurse

on the inpatient unit who will take over care of the patient.

When the patient moves to the inpatient unit or short-stay unit, they are in the 3rd phase

of postanesthesia care - ongoing postoperative care.

Here's a question to get you thinking...

The nurse in the PACU suspects laryngospasm in the patient who develops which of the following

symptoms?

1.

Decreased oral secretions 2.

Sternal retractions 3.

Crowing sounds 4.

Hypocapnia

If you chose 2, sternal retractions, and 3, crowing sounds, you're right.

The symptoms of laryngospasm include dyspnea (difficulty breathing - which can cause sternal

retractions), crowing sounds, hypoxemia (low oxygen in the blood), and hypercapnia (elevated

carbon dioxide levels in the blood).

I hope this helps you in studying for the NCLEX!

Thank you for watching this video tutorial on postoperative nursing - be sure to check

out our other videos!