Review maintenance of airway and post operative resuscitation interventions for general anesthesia and spinal anesthesia. How are they different?

How are they the same?

Discuss these in your REPORT. What are the common post-operative complications?

What are the assessments and interventions you need to do?

How do the assessments and interventions differ for the type of anesthesia received?

What are the different ways you see patient receiving oxygen?

What are the necessary components of a report from the PACU to the floor nurse?

Find and discuss an Evidence Based Practice article that relates to your experience in the PACU.

Is there special education required to be a PACU nurse? If so, what is it? Is there a professional organization for this type of nurse? Is there a certification?

What is peripheral nerve block procedure ?

 

PACU Report

Review maintenance of airway and post operative resuscitation interventions for general anesthesia and spinal anesthesia. How are they different?

The general anesthesia requires securing the airway with tubes and other gadgets such as tracheal intubation; airway clearing suction devices; and transtracheal access (Rajagopalan et al., 2017). It is to ensure that the anesthesia does not cause excessive dilation which can result in shallow breathing and hypoxia. In contrast, the spinal anesthesia only blocks the pain sensation to the lower extremities, mostly, and does not require any airway maintenance unless in case of emergencies where the patient experiences breathing difficulties (DeLeon & Wong, 2020). However, the main reason for giving spinal anesthesia is to carry out surgeries in patients who have breathing issues as well as those who take blood thinning medicines.

During generally long lasting major operations done with general anesthesia, an anesthesiologist controls the whole intake and fluid loss in many different forms, including haemorrhage, ascite drainage, urine and insensitive water loss (Kayilioglu et al., 2015). However, the postoperative treatment unit should address long-term consequences of such intraoperative occurrences such as potential excess dehydration and bleeding by the anesthesiologist. Therefore, the fluid is administered by accessing the rate of flow in the inferior vena cava. Fluid treatment with spinal anesthesia is commonly used to reduce hypotensive episodes (Hasanin et al., 2017).

How are they the same?

The airway management is different for both types of anesthesia as there is no need of securing the airway in spinal anesthesia while in general anesthesia it is essential to secure the trachea. However, the fluid management post-operative in both types of anesthesia is due to quiet similar reasons as the ultimate aim is to prevent hypotension due to excessive bleeding or loss of fluids during the surgery.

Discuss these in your REPORT. What are the common post-operative complications?

The most common post-operative complications for general and spinal anesthesia usually vary however, the common ones include nausea, headache, hypothermia as well as backache. Other than that, the general anesthesia pose a threat to the teeth of the patient as well as, it can cause excessive bronchodilation, hypoxia to brain and other organs as well as aspiration pneumonitis (Rull, 2019). In contrast, spinal anesthesia can cause direct nerve damage, damage to the spinal cord, spinal infection, aseptic meningitis as well as urinary retention. Therefore, the post-operative management should be based on periodically evaluating these factors and a complete assessment by the anesthesiologist (Rull, 2019).

What are the assessments and interventions you need to do?

The blood pressure and body temperature of the patient should be checked every two hours after surgery. In case of hypothermia, warm blankets should be provided to the patient. Likewise, for hypotensive crisis, fluids should be administered to the patient. Likewise, a complete dental assessment should be performed after general anesthesia to make sure there is no damage to the patients’ teeth. Likewise, after spinal anesthesia, the peripheral nerves should be assessed and tested for sensation and reflex responses to make sure that all nerves are intact.

How do the assessments and interventions differ for the type of anesthesia received?

For general anesthesia, the assessment and interventions focus on maintaining a steady respiratory rate as well as ensure that the patient does not have any breathing related complications as well as, that their brain is not deprived of oxygen as it can lead to prolonged unconsciousness and even permanent brain damage. For spinal anesthesia, the patients need to be checked for all their nerves and their reflexes that could be potentially involved below the point of administration of spinal anesthesia. Likewise, the site of administration should be carefully assessed after the surgery to see if it is bulging, leaking or show any signs of infection.

What are the different ways you see patient receiving oxygen?

Patients receiving oxygen can be assessed in different ways to establish that the oxygen flow is successful. The easy and most commonly used way is by using a pulse oximeter that measures the oxygen saturation of the patient. If the oxygen delivery to the patient is a success, the oxygen saturation will remain above 90 at all times (Ramachandran et al., 2017). Another way, which is invasive, can be by performing All Blood Gasses (ABGs) assessment on the patient where a blood sample is drawn from the artery of the patient and relative concentrations of different gases present in the blood is measured. The test can prove that if the blood concentration of oxygen is normal, the oxygen has been received by the patient successfully.

What are the necessary components of a report from the PACU to the floor nurse?

The PACU nurse assesses the patient's level of consciousness, respiratory sounds, exertion, oxygen saturation, blood pressure, rhythm, and muscular strength. The patient is being prepared for the phase 2 after surgery, which may include an ICU stay or admission to a hospitalization unit. Therefore, when transferring the patient, a complete history of their stay in the PACU should be discussed in details along with the medications being provided, complications (if any) that the patient developed as well as, it should have a complete history of the procedure performed on the patient.

Find and discuss an Evidence Based Practice article that relates to your experience in the PACU.

While there has been a great emphasis on what a PACU nurse should do, I read an article that discusses how the PACU nurse should receive the patient. When the patient is admitted to the PACU, a PACU nurse is provided with a complete intraoperative care report by the anesthesiologist and nurse. This report should include the kind of treatment performed, the type of anesthetic used, any difficulties, the medicines utilized, allergies, history of the patient, blood loss, relevant laboratory results, and IV fluid status. Both the anesthesiologist and the surgeon write post-operative instructions. These instructions should include oxygen supply parameters, intravenous fluid parameters, NPO status, medication for pain and nausea, and infection prevention. Operation-specific instructions may also be provided. The PACU nurse must accept these instructions and explain them if there are any questions. These parameters ensure that the PACU nurse is fully aware of the condition of the patient as well as, knows how to respond to any post-operative complications that may arise after anesthesia (Fossum et al., 2019).

Is there special education required to be a PACU nurse? If so, what is it? Is there a professional organization for this type of nurse? Is there a certification?

In order to become a PACU nurse, it is essential to complete a 1-2 years training in an acute patient care such as in ICU after becoming an RN. After that, the nurse is supposed to take admission in accredited anesthesia program after which a 2-3 years CRNA is to be done which makes a nurse eligible to become a PACU nurse.  The American Society of PeriAnesthesia Nurses (ASPN) is an organization that collaborates with nurses practicing pre-anesthesia and post-anesthesia care.

What is peripheral nerve block procedure ?

Peripheral nerve blocks are a local anaesthetic. The anaesthetic is given near a specific nerve or bundle of nerves in order to block pain sensations in a specific area of the body. Nerve blocks often last longer than local anaesthesia. Local anaesthetic allergy, noncompliance, or patient rejection are all absolute contraindications to peripheral nerve blocks. It is suggested that an active infection occur at the injection site, that there be a pre-existing neurological impairment along the block distribution, and that patients with coagulopathies or who are on antithrombotic medicines delay or reconsider the nerve injection (Chang et al., 2021).