The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [619]
8 Feel and assess the pulse. The patient’s position will probably mean that the head, carotid, facial or temporal arteries will offer the easiest access. Note the rate, rhythm and volume, and record. To assess cardiovascular function and establish a postoperative baseline for future comparisons (Peskett 1999, C).
9 Obtain full information about:
anaesthetic technique, potential problems, and the patient’s general medical condition
surgical procedure performed
the presence of drains and packs
amount of blood loss
specific postoperative instructions, and hand it over verbally to ensure that there is no delay in providing immediate care.
To ensure effective communication of the patient’s care and treatment and to aid the planning of subsequent care. E
10 Record blood pressure, pulse and respiratory rate measurements on reception and at a minimum of 5-minute intervals unless the patient’s condition dictates otherwise. To enable any fluctuations or gross abnormalities in cardiovascular and respiratory functions to be detected immediately (Peskett 1999, C).
11 Check the temperature of the patient, especially those who are at high risk of hypothermia (Nunney 2008), for example the elderly, children, those who have undergone long surgery or where large amounts of blood or fluid replacement therapy have been used. Temperature must be measured hourly or half-hourly if hypothermic. Use Bair Hugger blankets (see Action Figure 11) and extra blankets to warm the patient. More than 70% of patients undergoing surgery experience some degree of postoperative hypothermia (Wagner 2003, C).
12 Check and observe wound site(s), dressings and drains. Note and record leakage/drainage on the postoperative chart and also on the drain bottle/bag. To assess and monitor for signs of haemorrhage (Eltringham et al. 1989, C).
13 Check that intravenous infusions are running at the correct prescribed rate and the site of the venous device is satisfactory. Care of venous devices/sites prevents complications and ensures that fluid replacement and balance is achieved safely. E
14 Check the prescription chart for medications to be administered during the immediate postoperative period, for example analgesia and antiemetics. To treat symptoms swiftly and appropriately and to monitor their effectiveness. E
15 Orientate the patient to time and place as frequently as is necessary. To alleviate anxiety, provide reassurance, and gain the patient’s confidence and co-operation. Premedication and anaesthesia can induce a degree of amnesia and disorientation. C
16 Give mouth care (see Chapter 9). Preoperative fasting, drying gases and manipulation of lips, and so on, leave mucosa vulnerable, sore and foul tasting. E
17 After regional and/or spinal anaesthesia, assess the return of sensation and mobility of limbs. Check that the limbs are anatomically aligned. To prevent inadvertent injury following sensory loss (AAGBI 2002, C).
Action Figure 11 Bair Hugger.
Problem-solving table 14.1 Prevention and resolution (Procedure guideline 14.6)
Postprocedural considerations
Immediate care
Care of patients after local and regional anaesthesia
Patients having surgical procedures performed under local or spinal anaesthesia, whether intra- or extra-(epi)dural, will require a period of postoperative observation. The priorities for their care will be concentrated on considerations such as hypotension, headaches and dizziness (AAGBI 2002) as well as those for general anaesthetic.
Discharge from PACU
Discharge from the recovery room is the responsibility of the anaesthetist but the recovery staff are responsible for keeping the anaesthetist informed about any changes in the patient’s condition that may arise during the recovery phase. This could be cardiovascular, respiratory or the level of consciousness. The recovery staff use the discharge criteria