New Job in PACU!

Specialties PACU

Published

I am so excited! I recently got offered a job in the PACU, and I will be starting soon. I have never worked in the PACU before, but I have some experience in Med-Surg and Endoscopy. What advice can you give to a "newbie" about the PACU? I have always wanted to be in the OR setting, so I am extremely excited about this opportunity, and really want to learn, and hone my craft.

If you know of any good books, websites, etc., about PACU or anything, please let me know. I really want to start work as prepared as I can be.

Thanks for your help and advice!

brownbook

3,413 Posts

ASPAN, the American Association of Peri Anesthesia Nurses is a good organization to join, with good resources for PACU nurses.

As a new employee your best resource is your courage to ask, ask, ask, don't feel dumb, don't think you can't ask..."what is that drug, how does that work, what type of surgery is that...(even) what part of the body is that". (Some plastic procedures, or surgeries on parts of the ear and eye can have obscure names!)

Learn about anesthesia drugs, propofol, fentanyl, versed, etomidate, pentothal, you don't need to be an expert in these, just kind of know baseline what they do, why they are used. Anesthesia reversals, glycopyrolate neostigmine, narcan. You probably will never give these drugs, except maybe narcan, the anesthesiologists may mention they were used in OR. Know some of the common antiemetics, Zofran, ephedrine, vistaril, compazine. But different areas of the country, even different hospitals in the same city, have their own routine, their frequently used drugs that may differ from what I mention.

You will know what type of surgery the patient had from the OR schedule so you will have time to use the hospital computer to Google what the procedure is before you get your patient.

Your co-workers will be a resource for what the surgeon likes their patient to have in PACU, Ideally there is a unit resource manual of surgeons preferences so you don't have to guess or memorize..."does he like ice?" "does she require her patients to void prior to discharge?" etc. Unfortunately many surgeons "assume" the nurse knows some of the basics about ice, void, etc. and don't write them down as an order.

Airway, airway, airway, is the priority for a fresh post op patient. They are routinely placed on O2 nasal cannula, cardiac monitor, BP monitor, and pulse oximeter. Actually where I work, out patient surgery, we rarely put them on a cardiac monitor, and only use nasal cannula if they are sleepy (even with good O2 saturations) or obviously if their O2 sat is low.

You can Youtube different surgeries to see what goes on in the OR.

brownbook

3,413 Posts

PS, commonly used pain medications in the PACU, fentanyl, morphine, dilaudid, sometimes you may need versed or ativan.

TSBSNRN

13 Posts

Thank you for the information. I will look at the website and review those medications you listed. I just do not want to show up on my first day completely lost. I am so thankful for this website and all of the nurses out there willing to help, guide, support one another. Thanks again for the advice!

glb1960

62 Posts

Specializes in Peds leukemia, APON, GI in a clinic.

I couldn't agree more with what brownbook posted. I would like to add a few of my own. Demerol is under used/available to PACU RN's. It has good, longer term pain control and a secondary trait that comes in handy. General anesthesia pt.s can have chemical/gas shaking that looks very different from shivering. If they are 97.6F or warmer and are experiencing large-scale, almost seizure-like shaking, request a 12.5mg dose from your provider, administer, wait 5 minutes and watch them disappear. Phenergan is another anti-nausea med that works wonders and is under available. There is a risk of tissue damage if administered into an infiltrated IV (but we don't do that anyway). So, draw up your dose into a 10cc syringe, dilute with your carrier fluid(0.9NS, LR...) and administer. No tissue risk with dilution.

One more thing, be prepared/patient to answer the same question multiple times from the same pt. until they have really woken up.

TSBSNRN

13 Posts

Thank you for your additional information. I think that between the information that you both have provided, it will give me a good place to start reviewing certain medications, and what to look for in patients coming out of anesthesia. Thank you so much! I am so excited to start my new job, and this information has given me a little boost of confidence so I don't start my first day totally confused. Thanks so much!

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