Epidural & post-op pain management - page 2

How are others caring for post-op patients with epidurals? Nurse to patient ratio? Are patients on any electronic monitoring? Are these patient on the general surgical floors? Before removal of... Read More

  1. by   Lysa
    On my unit we have a step down unit with three beds and one nurse. This is where our epidural pts go post-op. They are monitered here for at least the first 24 hrs. VS are as follows: post-op-B/P, P, R, and T, sedation level, SpO2 q 1h x8h then B/P, P, R, T q4h (R q1h-SpO2 q2h). The main complication has been over sedation(R @5-6/min). Ok after narcan.
  2. by   SurgRN
    Quote from Jemma
    How are others caring for post-op patients with epidurals? Nurse to patient ratio? Are patients on any electronic monitoring? Are these patient on the general surgical floors? Before removal of epidural, are others getting Duramorph? Any complications?
    The nurse-patient ratio on our 21 bed Surgical floor is 1:5(occassionally 1:6). Epidurals must be check by PACU and surgical RN upon arrival to our floor. According to our policy the RN checks the epidural settings, level of sedation, patient's pain level, Resp. rate, blood pressure, and SaO2 q 2 hours. 2 RNs are required when settings are changed or when the erpidural medication needs to be changed. At our facility, the patients are not receiving duramorph at the time of the epidurals removal... however usually PO pain medication is started before the removal of the epidural. At most we have had 4 patients with epidurals on the floor at the same time, occassionally(but seldom) one RN may have 2 epidurals,

    As far as complication: It seems that the elderly can get confused if the epidural contains a narcotic(sometimes the epidural are bupivacaine only). Also in some indviduals hypotension can be an ongoing battle. In order to minimize over medication in these patients, hospital policy states that patients with epidurals can only get other narcotics or sedatives if ordered by anesthesia.
  3. by   VivaLasViejas
    Where I work, patients with epidurals get VS taken Q 1 hour X 24 hrs., plus Q 5 mins. X 3 after ANY change is made to the dosage. It's a royal PITA for the nurse, especially when you don't have a CNA to do vitals and you're having trouble with a) pain control, b) keeping BP/RR/O2 sats up, c) loss of sensation that doesn't resolve when the dosage is decreased, or d) all of the above. On top of that, the hassles of dealing with epidurals are never figured into "the numbers" when making assignments. Personally, I hate total knees anyway......between the epidurals, the pain-control issues, and the back-breaking physical work of getting the patients in and out of the *******' CPM machines, it's sheer hell when our ortho docs schedule a batch of them all at once. :angryfire
  4. by   jett01
    On our 37 bed med-surg/ortho floor RN's can have 4-6 patients of their own and responsibility for an LPN's patient group for a combined total of 10-12 patients. Two RNs must verify initial settings. VS q1h x 8 hrs, q 2 X 16 hrs, then q 4 until dc'd. Any dosage change reverts to q 1h. LPNs can get vs but RN has to verify settings at shift beginning and clear pump at shift end and give any iv pushes of supplemental meds. We generally use fentanyl/bupivicaine. No tele or apnea monitors are used. Settings tend to run from 8-12 cc/hr although they seem to be drifting higher. Toradol or morphine IV tend to be supplemental meds of choice. It seems the more teaching I do with patients about possible epidural side effects the more often these patients develop them. We begin weaning TKR pts off epidural on 3-11 shift of day two and pull it in the AM of day three. No duramorph used, just PO meds.
  5. by   barefootlady
    Great post jezebel and jett. What you describe jezebel is what I am used to when having an epidural patient. Apnea monitor for at least 24 hours.
  6. by   gwenith
    Is anyone doing cold/ice tests for defining level of pain relief???

    One complication that is never mentioned but I can report on from a person perspective is back pain. In some patients - especially pregancy where weight has been shifted off the spinal column the epidural causes relaxation of the back muscles and therefor causes massive back pain - believe me - I spent a horrific night attempting to lie on a new suture line because the pain in my back was so severe!!!
  7. by   leemacaz
    Please excuse an ignorant question I guess..but are Foley's an automatic with an epidural?..I did not know until recently that many (if not all) general anesthesia pts get one while under.
  8. by   lovetoride
    an epidural for a hyst and a sling? That's a little much. We do pca or im/po depending on the doc. I've never seen and epi with a hyst. That's strange that anesth. would ever offer that!

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