The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [620]
The length of patient stay in the recovery room is dependent on the patient’s cardiovascular and respiratory condition and the rate at which that patient recovers physically and emotionally from the anaesthetic. A prior knowledge of the patient’s cardiovascular and respiratory parameters as well as past medical history obtained through preoperative contact is of great value when assessing their return to normal state. It also has the advantage of helping the patient to orientate to time and place, as familiarity generates a degree of security and confidence. The patients must meet the criteria in Box 14.6 before they can be discharged from the recovery room to the ward.
Box 14.6 Discharge criteria from PACU to ward
The patient is fully conscious, able to maintain own airway, exhibits protective airway reflexes and is orientated.
Respiratory function and good oxygenation are being maintained.
The cardiovascular system is stable with no unexplained cardiac irregularity. The specific values of pulse and blood pressure are within normal preoperative limits on consecutive observations.
There is no persistent or excessive bleeding from wound or drainage sites.
Patients with urinary catheters have passed adequate amounts of urine (more than 0.5 mL/kg/h) (Eltringham et al. 1989).
Pain and emesis should be controlled and suitable analgesia and antiemetic regimes should be prescribed by the anaesthetist (AAGBI 2002).
Body temperature is at least 36°C (Kean 2000).
Complications
While the majority of patients can be expected to achieve uneventful recovery, 24% of all patients have complications (Hines et al. 1992). Although nausea and vomiting are high on the list of complications (Jolley 2001), the most notable are respiratory and circulatory complications. Obstruction of the upper airway is the most common respiratory complication in the immediate postoperative period (Dhara 1997). Close observation and appropriate action can prevent the sequence of respiratory obstruction resulting in hypoxia leading to cardiac arrest (Peskett 1999).
Postoperative care
Definition
Postoperative care is the physical and psychological care given to the patient directly following transfer from the recovery room to the ward. Postoperative care continues until the patient is discharged from hospital, and in some cases continues on as ambulatory care on an outpatient basis.
Related theory
Ineffective breathing pattern
Respiratory function postoperatively can be influenced by a number of factors:
increased bronchial secretions from inhalation anaesthesia
decreased respiratory effort from opiate medication
pain or anticipated pain from surgical wounds
surgical trauma to the phrenic nerve
pneumothorax as a result of surgical or anaesthetic procedures
co-morbidity, for example asthma, chronic obstructive airways disease (COAD).
All factors affecting adequate expansion of the lung and the ejection of bronchial secretions will encourage the development of atelectasis and consolidation of the affected lung tissue (AAGBI 2002).
Haemodynamic instability
Haemodynamic instability is most commonly associated with an abnormal or unstable blood pressure, especially hypotension (Anderson 2003). A reduction in systolic blood pressure following surgery can indicate hypovolaemic shock, a condition in which the blood vessels do not contain sufficient blood (Hatfield and Tronson 2009). Bleeding is the most common cause but other causes can occur when tissue fluid is lost from the circulation, for example bowel obstruction and nausea and vomiting (Hughes 2004). Hatfield and Tronson ((2009), p. 348) outline three stages of hypovolaemic shock.
Compensated shock: blood flow to the brain and heart is preserved at the expense of the kidneys, gastrointestinal