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Post Anaesthetic Care Unit

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Post Anaesthetic Care Unit

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Question:
Write an essay on Patient retuning from Post Anaesthetic Care Unit with a PCA and an abdominal wound.
 
Answer:
Identification of the assessments performed:

Patient anesthetic care unit (PACU) requires skilled nurses to maintain proper and accurate care of the patient after transfer from the surgical unit or with a patient controlled anesthetic.  Appropriate assessment and prevention of complication are the foundations of effective nursing practice.  The nurses in the PACU need to evaluate and take clinical decisions for the patient’s healing (Tan, Zhao, & Tan, 2012).  In this video I found that the phase of recovery is discussed by the nurses are immediate post-operative instructions.   The assessments were not adequately prioritized by the nurse as some of them were missed by the nurse such as respiration rate, nasal prongs, IV fluids, the presence of drains, and nasal gastric tube.  After observing the video, I found the nurses discussed the preoperative orders of the patient with each other.  The assessments performed in the PACU are the respiratory rate, oxygen saturation sp02 which was near to normal, heart rate, blood pressure, pulses, and temperature.  The nurse discussed the urine output and intake of anti-emetic drugs with the patient. The nurse also discussed the diet of the patient, infusions administered to her; I also found the nurse asked the patient if she needs any analgesic. In my viewpoint, the nurses took a majority of the patient’s assessment including any redness, swelling, or abnormalities in her extremities.   The assessments are appropriately prioritized to avoid any harm to the patient. I think the patient’s assessment was carried out carefully by the nurses within the 15 minutes of observation, which further help the patient to rest and recover soon(“Video for assessment 3,” 2016). 
Communication between the two nurses and their teamwork:  In the video, I found the effective communication between the nurses as they were working together towards the evaluation of the patient’s wound, and they have effective communication between them as both the nurses are assisting themselves one by one and took initiative one after the other for the patient’s care (“Video for assessment 3”, 2016). I observed that the nurses were assisting the each other during the stepwise assessment of the patient; dressing of the patient’s wound; checking to reduce patient’s complications as the patient had the history of hypertension; process to make patient comfortable and feel secure; sitting up the patient; discussion of vital signs of the patient. The nature of working together in PACU reflects teamwork as they were mutually understanding each other and took the requisite action for the patient’s care.   In my viewpoint mutual understanding and coordinating with each other without any conflict are crucial for the nursing staff to work in an effective manner.
Communication between the nurses and the patient:  In the above video, I saw the communication between nurse and the patient was appropriate as they were continuously asking the patient if she needs anything or whether she is comfortable and happy at present or not. The nurses were helping the patient with her blanket whenever asked by the patient as she felt cold. The nurses helped the patient to reassure about her abdominal wound and its regular check to avoid any pain or discomfort to the patient. They informed patient the patient before sitting her up and guided her to take care of her abdominal wound.  I found that the nurses were acting empathetically with the patient to decreases her pain and tried to make her comfortable while conducting the vital signs assessment. The nurses asked the patient about her comfort and pain improvement at regular intervals which help the patient to heal at a fast pace.  I also found that the nurses were communicating properly with the patient to inform her about the instruments near her in the PACU area, the way she needs to inform nurse staff if she needs anything using PCI (“Video for assessment 3,” 2016). 
However, I felt one demerit from the part of nurse role is that they were maintaining little eye contact with the patient, which may impact the patient and her perception towards care in PACU.  In my viewpoint, nurses were taking an assessment of the patient rapidly as they were evaluating her vital signs both at the same time.  The nurses are required to evaluate vital signs one by one to prevent any discomfort or pain to the patient. 
Identification of the post-operative orders:
In the video I saw the nurse’s discussion about the post-operative orders, which mostly includes patient admission details (location, diagnosis, and procedure performed, attending physician, and consulting physician), vital signs, intake and output for every four hours, temperature, allergies, activity on the bed, wound care and diet.  However, I found that the post-op orders were discussed which included the following:   Admission details, vital signs (blood pressure, pulses, and respiration), an output for every four hours, fluid intake, temperature measurement, activity on the bed, keflen antibiotic, wound care, and diet.   In the video, I found the entire post-op orders are not discussed such as the procedure performed on the patient, allergies (“Video for assessment 3,” 2016).
 
Recommendations to improve for future practice: In my view point, the major areas to be considered during PACU patient’s care are criteria of assessment, time of stay, the obligation of the nurse towards the patient to discharge back.  In think the nurse’s role is very important to maintain safe recovery of the patient after operations or surgery and the nurses need to observe the patient persistently as the patient’s physiological status depends on the care provided by the PACU nurse.    I feel management plays very important role in present time as in the large hospitals, there are problems in handling the effective care in the PACU area and management of nurse so, I think more emphasis should be on management should be given to promote appropriate care (Oofuvong, Geater, Chongsuvivatwong, Pattaravit, & Nuanjun, 2015).  I feel there is a crucial need for the anesthetist presence in the PACU to prevent any complication to the patient.  I believe the primary thing is to reassure the patient as it plays a major role in patient’s healing in the patient anesthetic care unit.   In my view point, It is also required to carry qualitative research on the PACU nurses care plan and the way they take decisions for the safe discharge of the client to move the nursing care practice to the best level (Preston & Gregory, 2015). 
 
References
Miller, T. & Scott, M. (2015). Anesthetic Care for Abdominal Surgery. Anesthesiology Clinics, 33(1), i. https://dx.doi.org/10.1016/s1932-2275(15)00004-x
Moro, E., Godoy, R., Goulart, A., Muniz, L., & Modolo, N. (2009). Main Concerns of Patients Regarding the Most Common Complications in the Post-Anesthetic Care Unit. Brazilian Journal Of Anesthesiology, 59(6), 716-724. https://dx.doi.org/10.1016/s0034-7094(09)70096-0
Oliveira, E., Marques, A., Moinho, N., & Almeida, V. (2012). Does the transportation of patients from the operating room to the post-anesthetic care unit should be done with supplemental oxygen?.European Journal Of Anaesthesiology, 29, 222. https://dx.doi.org/10.1097/00003643-201206001-00737
Oofuvong, M., Geater, F., Chongsuvivatwong, V., Pattaravit, N., & Nuanjun, K. (2015). Association between Intraoperative and Post-Anesthetic Care Unit Respiratory Events among 12,641 Children in Southern Thailand. BJMMR, 6(11), 1101-1112. https://dx.doi.org/10.9734/bjmmr/2015/15789
Parente, D., Norton, M., Luis, C., Veiga, D., Silva, H., & Abelha, F. (2012). Post-operative delirium in a post anesthetic unit. European Journal Of Anaesthesiology, 29, 111. https://dx.doi.org/10.1097/00003643-201206001-00362
Preston, N. & Gregory, M. (2015). Patient recovery and the post-anaesthesia care unit (PACU).Anaesthesia & Intensive Care Medicine, 16(9), 443-445. https://dx.doi.org/10.1016/j.mpaic.2015.06.015
Spofford, C. & Easker, D. (2015). Unresponsive Patient in the Post Anesthesia Care Unit. Mededportal Publications. https://dx.doi.org/10.15766/mep_2374-8265.10005
Tan, Y., Zhao, L., & Tan, M. (2012). Using a structured handover tool for improving transition of patient care from operating room (OR) to post anesthetic care unit (PACU). International Journal Of Evidence-Based Healthcare, 10(3), 296. https://dx.doi.org/10.1097/01258363-201209000-00166
Video for assessment 3. (2016). Webconf.acu.edu.au. Retrieved 19 May 2016, from https://webconf.acu.edu.au/assess3

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