PACU Clinical Report

On December 5th through 7th, I spent my clinical experience in the Post Anesthesia Care Unit (PACU) at Our Lady of Fatima Hospital. The PACU is a Critical Care Unit where patients go following surgery to receive specialized care. The nursing staff is skilled in identifying and managing complications in patients after they received anesthesia. The patient’s vital signs are closely observed, fluids are given, and pain is managed as the patient returns to their baseline in level of consciousness. When the patient first arrives to the PACU holding area the nurse receives a summary of the patient’s surgery from the OR nurse and the anesthesiologist. The report includes how the surgery was tolerated, amount of fluids given, blood loss, medications
and sedation used, as well as anything else out of the ordinary. As the report is being given, monitoring equipment is being put into position by another nurse, which includes blood pressure cuffs, pulse oximeter, and EKG, all to observe the patient’s vital signs. Paperwork regarding the doctor’s orders, allergies, diagnosis, vital signs, prescriptions, and DVT prophylaxis orders are also passed to the nurse. The PACU nurse then typically conducts a physical assessment, assesses the dressing, hangs fluids, and applies SCD boots if necessary. The other nurse or the CNA then gets warmed blankets for the patient. During this time the patient is assessed for complications, pain is managed, and vital signs are monitored every 15 minutes until they’re hemodynamically stable. The first day I shadowed a nurse named Bev, the day was hectic due to having thirty-nine patients who were going to becoming to the PACU. Patient’s surgical procedures ranged from laminectomy to knee replacements. When assessing each patient the same routines were followed but certain steps were added to provide individualized care depending on the patient’s needs. For example, the 57 year old male with a left knee replacement needed to have pedal pulse obtained and compared to the non-effected extremity to assess adequate blood flow. Bev provided a great amount of information and it was a good day to get acclimated to the floor and learning they’re routines. The next day I shadowed a nurse named Liz, upon arriving to the unit there was a 43 year old male who need to have an elective electrical cardioversion due to having an irregular heart rhythm.
The patient received a sedative to make the patient sleepy, so he wouldn’t feel pain during the procedure. Two pads were placed on the patient’s anterior chest. The shock lasted less than a second and the doctor then stop to reassess the patient’s rhythm. The patient woke up quickly and was successful converted to a normal sinus rhythm on the first attempt. In lecture we had learned about using a defibrillator in emergency situations and using it on different settings to convert a patient back to sinus rhythm but I had never seen it in person. It was interesting to see how much the patient jolted once the shock was delivered, so I understand why it’s so important for everyone to stand clear when delivering the shock. Also, during this day a gentleman in his 50’s had previously had procedures done at Fatima but had an adverse reaction while waking from the anesthesia. Previously he had woken up agitated, pulled his monitor equipment off and a code gray had to be called. During this visit the anesthesiologist administered additional anti-anxiety medication to help the patient transition
smoother. The final day I followed the registered nurse Liz again and it happened to be another busy day. There was a male patient in his forties who had a partial thyroidectomy. Due to the placement of where this patient had his surgery it was vital the nurses assessed his airway, breathing and circulation because if the patient experienced complications it could be serious. After leaving the OR all patient’s bodies are vulnerable to things like hypothermia, airway, breathing, circulation, urinary and GI complications due to the extremes their bodies endure during surgery from the anesthesia and the surgery itself. In lecture and during this opportunity we got to see how important it is to monitor patients as they return to their baseline or within normal ranges. The PACU has taught me how efficient and compassionate these specialty nurses are.
They utilize teamwork and have advanced assessment skills. The staff did a great job of explaining the steps of the process, medications, equipment and showing up practice EKG strips. During my experience fortunately non of the patient’s had experience any life-threatening difficulty but Liz did a great job of providing us with “what-if” scenarios that made us apply much of the knowledge we had learned in lecture. In the future I would love to develop some of the confidence and be able to utilize teamwork like these nurses demonstrated. I think this was a great rotation and should definitely be continued for the future
classes.