Question

Location: Post-anesthesia care unit (PACU)

Susan’s surgery is completed and she is transferred to Post Anesthesia Care Unit ( PACU). Below is your assessment of Susan:

• Drowsy but arousable
• VS: 97.2, 76, 14, 120/76
• Pulse ox 94 % on face mask at 40%
• Skin cool and pale
• Normal sinus rhythm
• Abdominal dressing midline clean and dry.
• Absent bowel sounds
• NGT to low intermittent suction/brown-green drainage
• Foley catheter draining clear yellow urine
• IV: 1000 Lactated Ringers 100ml/hr
• Insulin drip of regular insulin at 100 units/hr

Situation, Background, Assessment, Recommendation (SBAR) from the intraoperative nurse was that the tumor was removed without difficulty. Susan had general anesthesia with no problems. She had a total of 4200 ml of fluid in, and a urinary output of 2700, EBL was 525ml. The abdominal incision was closed with staples and the dressing is clean and dry.

Susan’s past medical history includes COPD, Diabetes type 1, and vascular issues.

9. What are the potential complications of general anesthesia?
10. How might his past medical history add to post-operative complications?
11. What are the primary assessments you will need to complete and follow through while Susan is in the PACU?

Answer 1

Answer 1. Complications of General Anesthesia:-

• Post Operative Nausea & Vomiting
• Hypothermia
• malignant hyperthermia
• Masseter Spasm
• Airway fire
• Nerve Injury
• Ophthalmic injuries  
• Air embolism
• Intra-operative anaphylaxis
• Mendelson's syndrome (Aspirational Pneumonitis)

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This how we can explain the Complications of General Anesthesia.

Answer 2. Post Operative complications by COPD, Diabetes type 1, and vascular issues:-

• COPS patients having cough continuously so they are at the risk of incisional hernia and due to exertion, they are also at the risk of secondary haemorrhage.
• In diabetic patients, wound healing is delayed because of several factors such as microangiopathy, atherosclerosis, decreased phagocytic activity, proliferation of bacteria due to high blood sugar and also poor immune response is seen in diabetic patients.
• issue of bleeding and DIC which is known as consumptive coagulopathy is also a complication added.

Answer 3.  Primary assessments you will need to complete and follow-through while Susan is in the PACU:-
When admitting a patient to PACU patient identification and handover should occur utilising the Handover Flowsheet. Post-operative orders must be communicated both verbally and documented in the EMR. Post-operative orders are additional to the operation report. Clinical handover should highlight any issues throughout the intra-operative period, acknowledge the process for escalation of care, should this be required and allow for clarification of any instructions before accepting care of the patient.
Once care is accepted in the PACU the initial assessment should include:

• Physical Assessment
  • Airway, Breathing, Circulation & Disability Assessment (link to Nursing Assessment Guideline)
  • Baseline Observations including, RR, Respiratory effort, SpO2, HR, BP and Temperature
  • Oxygen requirements
  • IV Fluids
  • Analgesia
  • Urine Output
  • Reportable Blood Loss
  • Assessment of Wound Sites / Dressings
  • Presence of drains and patency of same
  • NGT In situ

Observations continue at least 15 minutely, or more frequently as clinically indicated

• HR, RR, SpO2, Temperature and BP
• Sedation Score (AVPU, Michigan sedation score or formal GCS as indicated)
• Pain Score
• Nausea Score

Continuous Oximetry monitoring should be initiated for all patients admitted to PACU
Cardiorespiratory monitoring should be applied to all patients under 6 months of age and as clinically indicated for all other patients

That how we can explain the different answers.
I hope you have got your answer.
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