Immediate Postoperative Assessment - PowerPoint Presentation

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Immediate Postoperative Assessment

Presented By: Danyel Dorn RN, MSN, CPN, Clinical Nurse Educator-Pediatric Service Line

Purpose

Demonstrate skills to perform the initial assessment of the pediatric patient in the postanesthesia care unit. This initial assessment allows for the integration of preoperative and intraoperative data from the anesthesia provider and perianesthesia team. The handoff of care should include a systematic physiologic assessment, identification of any abnormal or deteriorating conditions and pertinent psychosocial information that includes patient/family centered care. Furthermore, the initial assessment focuses on the prioritization of treatment, implementation, and stabilization of the patient in the postanesthesia phase of care.

Competency Statement

The perianesthesia registered nurse will demonstrate the ability to systematically collect and integrate pertinent developmental, psychosocial, preoperative, and intraoperative healthcare information upon admission to Phase I, while performing a physical review of systems of the pediatric patient.

Preparing for Admission to the PACU

Assure patient bed space is equipped with necessary safety equipment such as suction, suction catheters, bag/mask, oxygen source, and appropriately sized monitoring equipment.

Obtain necessary supplies (i.e., IV fluids, ice bags, laboratory tubes)

If time allows, review any relevant clinical data from the patient’s health record, noting allergies, weight and past medical history.

Description of Initial Assessment

Conduct the initial assessment of the patient upon arrival to PACU. The assessment will establish a baseline postanesthesia status, allowing recognition of potential physiologic alterations or life-threatening conditions, which may require immediate intervention and treatment during the Phase I recovery period.

Assessment

Evaluate patency of airway, adequacy of gas exchange and oxygen saturation

Assess vital signs and cardiac rhythm

Determine IV patency

Assess skin color and temperature

Ensure pediatric patient identification using two patient identifiers

Obtain handoff report/receive transfer of care

Elements in the Initial Assessment

Respiratory assessment – rate and rhythm of respirations, presence and character of breath sounds, chest expansion

Work of breathing: retractions, flaring and abnormal positioning

Amount of O2 being administered, oxygen saturation

Obstruction risk, type of artificial airway, etCO2 monitoring

Cardiovascular/Circulatory Assessment

Heart rate (apical is best)

Cardiac rhythm and presence of ectopy

Blood pressure by cuff or arterial line

Bleeding from surgical site

Peripheral perfusion: skin temperature, color, edema, extremity pulses

Neurological Assessment

Age appropriate alertness and orientation, level of consciousness (LOC), consolability, speech, cry, tone

GCS

Stimulation level

Pupils

Motor, sensory

Cough and gag reflex

Superficial sensation

Psychosocial

Additional neurological assessments (EVD, ICP)

Gastrointestinal Assessment

Assess abdomen for appearance, tenderness, distention

Presence or absence of bowel sounds

Presence of nausea and/or vomiting

Placement and patency of gastric tubes

Genitourinary Assessment

Palpate bladder for distension and/or use bladder scanner

Check patency of urinary catheter or other urinary drainage catheters/systems

Assess color, clarity and amount of urine

Skin Integrity Assessment

Skin assessment including presence of skin breakdown or redness, including location, size and characteristics. Compare to initial assessment and notify physician for any changes

Presence, location, and patency of peripheral, central, arterial, and PA catheters, note any atypical lines (epidural, intrathecal, peripheral nerve catheters)

CXR for any newly placed lines, document amount of flush/fluids infusing via the lines

Wounds assessment

Type and patency of drainage tubes, catheters and receptacles

Pain Assessment

Utilize a developmental and age appropriate pain rating scale according to facility policy

Behavioral/coping assessment, as indicated: patient/family status, comfort level, and learning readiness

Other Assessments

Position of patient on admission, discharge and with each change in position as ordered by the attending provider

Patient safety needs including fall risk assessment

Procedure specific assessment, as appropriate

Phase 1-Interventions

Set monitors to the appropriate settings until patient meets discharge

Utilize different positions to maintain airway patency (chin-lift, shoulder roll, etc.)

Administer O2 as needed and wean to room air

Complete head-to-toe assessments

Promote normothermia (temp > 36*C)

Phase 1-Interventions

Monitor and maintain effective pediatric pain management per orders

Assess effectiveness of non-pharmacological interventions

If pain management unsuccessful, consult MD for pain service

Monitor neurological status (

initate

warming measure for temperature < 36*C, notify MD of temp > 38.5*C, or per hospital policy)

Phase 1-Interventions

Monitor blood glucose per physician’s order

Consider testing for patients under two years of age who have been NPO for more than four hours and have had no dextrose containing IV fluids during surgery.

Pediatric patients who are on TPN on the inpatient unit.

Pediatric patients with known diabetes or other diagnoses that warrant blood glucose monitoring.

Notify attending anesthesiologist for any pediatric patient with blood glucose level less than 60mg/

dL

.

Safety Measures

Apply pillows or padding to protect from trauma or injuries from the gurneys

Orient pediatric patient and family members to the PACU and perianesthesia experience

Provide anesthesia and procedural discharge education

Provide psychosocial support

When transferring care, provide standardized handoff report.

Reference

ASPAN (2016). A Competency Based Orientation and Credentialing Program for the Registered Nurse Caring for the Pediatric Patient in the Perianesthesia Setting.

Answers

C

D

B

D

D

D

B

D

B