Located adjacent to OR Quiet, clean, painted with soft

pleasing colors and have indirect lighting Has equipment that controls noise (plastic emesis basins, rubber bumpers on beds and tables)

 Isolated but with visible quarters to

disruptive patients Should be ventilated Beds should provide easy access to the patient, safe and easily movable, can be readily placed in shock position and has features that facilitates care (IV poles, side rails, wheel brakes and chart storage rack)

Responsibility of the anesthesiologist New gown Transferred to stretcher Avoid the following during transfer: 1. Undue exposure 2. Rough handling 3. Hurried movements and rapid changes in position Side rails up

Position with the head to the side and the chin extended forward on a lateral Sims position. If required to lie flat, carefully monitor respiratory status. Elevate client s upper arm on a pillow.

 Immediately make baseline:

1.Check airway patency 2.VS, visual assessment (general

color, IV infusion, drains, special equipment, condition of the dressing) 3.LOC

Attach apparatus Communicates intra-op info

(name, surgical procedure, anesthesia, response to surgery) Arouse clients

DOCUMENTATION: 1. Time of admission 2. Absence of reflexes 3. LOC 4. Skin color and dryness, VS 5. Condition of dressing 6. IV infusion, BT, drainage tubes, bladder catheter

MAINTENANCE OF PULMONARY VENTILATION to prevent hypoxemia and hypercapnea ASSESSMENT: Noisy and irregular respirations cyanotic
1.

INTERVENTION: Leave plastic oral airway in the mouth. Assess RR, Oxygen saturation and breath sounds Check the order and apply supplemental oxygen Prevent choking

 Maintain patent airway (prevent

aspiration) Turning from one side Elevate head of bed unless contraindicated Prepare emesis basin always at bedside Open mouth manually but cautiously with padded tongue depressor Suction as necessary

PROTECTION AND PREVENTION OF INJURY Provide side rails, place up Turn patient frequently and placed in good alignment Never leave the patient alone
2.

PROMOTION OF COMFORT Never leave the patient alone Administer narcotic analgesic to relieve pains
3.

AREA OF ASSESSMENT: 1. Muscle activity 2. Respiration 3. Circulation 4. Consciousness level 5. Color *Required for discharge from PACU = 7 to 8 points

Activity

2 1 0

able to move 4 extremities able to move 2 extremities not able to move able to cough & deep breath dyspnea or limited breathing apneic

Respiration 2 1 0

Circulation 2 1 0 anesthesia Consciousness 2 1 0 Color 2 1 0

20% pre anesthesia 20-50% pre anesthesia above 50% pre fully awake rousable on calling not responding pink pale, dusky, blotchy cyanotic

Activity score of 2; able to obey commands. Respiration score of 2; easy, noiseless breathing. Circulation 20 of pre anesthesia; BP is within +/-20 mmHg of the pre op level. Consciousness score of 2; responsive. Color score of 2; pinkish skin and mucus membrane.

 Conscious and coherent Able to maintain a clear airway

and deep breathe and cough freely VS stable and/or consistent with pre-op VS for at least 30mins Protective reflexes are active

 Able to move four extremities Urinary output is adequate Afebrile or a febrile condition

has been attended to Dressings are dry and intact, no overt drainage

Maintain patent airway Head turned to side Suctioning Administer oxygen B BREATHING DBE Coughing Administer oxygen

A AIRWAY

C CIRCULATION VS q15 for 2h, q30 for 2h, q hour for the first 24 houror until stable CRT not > 2-3s Skin color Monitor BT

C CONSCIOUSNESS LOC Ability to command D DRESSING Keep it dry and intact D DRAINAGE Tubings attached, keep it patent and intact D DRUGS Antibiotics Pain reliever

E ELIMINATION F FLUIDS F FOOD

Monitor I & O Monitor passing of flatus IVF 30 gtts/min NPO until peristalsis returns (clear liquid full liquids soft diet full diet/DAT

S SAFETY/COMFORT Side rails up Turn to sides, early ambulation Relief from discomforts Prevent complications