A question about the PACU and arthroscopy

Posted

Hello,

I am doing an NCLEX question that is in my book, thus there is no rational and no, I can't find the answer in the material I just read. If you could explain to me this answer, I'd greatly appreciate it!

The question:

A client returns to PACU after an athroscopy to repair several knee ligaments. What is the nurse's priority when caring for this client?

A. Take vital signs every hour

B. Check for swelling and bleeding

C. Perform frequent neurovascular assessments

D. Ensure that the surgical dressing is intact

I thought it would be B, because swelling would be a concern for infection (though not necessarily bleeding). But the correct answer is actually C. Is performing frequent neurovascular assessments something standard in the PACU?

Thanks in advance,

Sara

Rose_Queen, BSN, MSN, RN

Specializes in OR, education. Has 16 years experience.

First, you shouldn't be posting copyrighted material (the quoted question). But to think through the question, think about what the patient just experienced: anesthesia and a surgical procedure. What are some of the complications of both of those? Also, what type of anesthesia was used? I know you mentioned swelling and infection; generally, PACU stays after surgery are brief at 30-90 minutes. Do you think in that short of a time period a patient would be showing any signs of infection?

No, obviously I don't think that in a short period of time a patient would be showing signs of infection. I don't know what the PACU entails. And you don't know that that is taken exactly the way it is written in the book. Thanks for your answer, I understand the logic now. And no thanks for the attitude! Whats with all you people on this site? Is it so hard to communicate without being rude?

Rose_Queen, BSN, MSN, RN

Specializes in OR, education. Has 16 years experience.

I'm not sure what attitude you are referring to. I simply pointed out that posting copyrighted material is a potential issue. Then, instead of spoon feeding you answers, I posed a few questions to get you thinking in the right direction. NCLEX is a test of application; it is not a test of regurgitating facts. Looking at a patient situation and applying what you know about the patient is how you will need to think as a nurse.

rob4546, ADN, BSN, MSN

Specializes in ICU/ Surgery/ Nursing Education. Has 7 years experience.

No, obviously I don't think that in a short period of time a patient would be showing signs of infection. I don't know what the PACU entails. And you don't know that that is taken exactly the way it is written in the book. Thanks for your answer, I understand the logic now. And no thanks for the attitude! Whats with all you people on this site? Is it so hard to communicate without being rude?

I can understand that reading on forum pages may sound rude but I have to tell you I didn't see anything rude here. It is hard to portray feelings and emotions in words. Anyway, I have another way to look at the question.

Take each answer and evaluate the options. A:Take vital signs every hour... This patient just went through a surgical procedure and was under anesthesia, would checking the vital signs every hour be prudent or would you want to check them sooner. Most complications at this point would show in the vitals.

B: Check for swelling and bleeding... Would you assume that there would be some swelling or possible bleeding? Damage to tissues cause swelling and bleeding, but is this your priority?

C: Perform frequent neurovascular assessments.... If there is a problem with the appendage would you assume that neurovascular checks would be key? For injury and surgery to limbs you check CMS (Circulation, Motor, and Sensation). Would you want to know this once or frequently? Why would you check it frequently? Think about it, there would be a reason.

D: Ensure that the surgical dressing is intact.. I don't even think you thought that this answer would be correct. Are the dressings the priority? I wouldn't think so. Complications or prevention of complications would be the priority.

From this I think you can see the question differently. On these questions it is best to ask why you would do this or that.

Thanks rob4546. Right, the dressings would not be a priority for me. Checking vital signs is good but it was too vague, and, I didn't see how that would fit the question. Of course, I am not familiar with the PACU and I just started clinicals this year, much of the hospital is not second-knowledge for me. I thought swelling would be a good choice because I'd want to assess for infection, though bleeding seemed inappropriate. Process of elimination says neuro checks, but I didn't understand why I'd need neurochecks for that! From what I had read in my med-surg book, it seemed that this procedure used local anesthesia (I guess it does, right? not general?) and I think I assumed that local anesthesia did not need neurvascular checks. My thinking must be wrong here. Any type of anesthesia, local on the LE even, will still need neurovascular checks, yep? Thanks for your explanation!!

Rose_Queen, BSN, MSN, RN

Specializes in OR, education. Has 16 years experience.

While the surgeon may inject local during the procedure, it's typically for postop pain control. The patient would have either general or spinal anesthesia.

Pacu is the post anesthesia unit where you go to recover after surgery. One of the main things to watch for due to the effects of anesthesia and other drugs are respiratory depression, airway compromise and hypotension. Basically they need to be awake enough to breathe, let the drugs wear off and stabilize their vitals. There are many other things you need to assess that are focused based on the type of surgery they have had.

This case most likely used general anesthesia or maybe an epidural/ spinal block. You do not want to be awake while a surgeon cuts your knee open. Answer A is not correct because you take vitals much more frequently like every 5 min, then every 15, etc. Answer B is not correct because while it is important to assess those things, they are expected. If the patient was hemorrhaging or the swelling was so severe that it was turning into compartment syndrome then you would notify the surgeon ASAP, they need to be back in the OR. And that leads into c. Answer C is correct. You need to check NEUROVASCULAR status frequently. This is not just a "neuro check" ie pupils, a/o, etc. think about the surgery he had. You need to check your CMS. Is the pt's foot warm, is there a palpable pulse? This would indicate that the foot has adequate circulation. Can the pt move his toes? Feel your touch? This would indicate that the nerves weren't somehow damaged during the procedure. If these aren't assessed frequently, it could lead to loss of function or possibly the limb itself. Answer D is not a priority, yes you want to assess your dressing, the surgeon will write orders for that ie reinforce PRN, they usually will want to be there for the first dressing change.

Hope this helped a little. Kudos to you for studying early. There is so much to learn, as you get further along in school things will start to make more sense and the pieces will fit together. You are always welcome to post your questions, we are all here to help each other learn and to share our experiences.

Thank you 87RN! !!!!! I appreciate you're detailed response! It is much more than I expected. Thanks to you and Rob, I have answered more of these PACU questions correctly, understanding the neuroVASCULAR option better as well.

Yes I do not have to take the NCLEX for another year but I am studying now. My professor says ATLEAST 25-50 questions a day! Our university uses the silvestri nclex preparation book and online questions. I wonder what other preparations students have used and which one is more agreed upon to be the better...?

No, obviously I don't think that in a short period of time a patient would be showing signs of infection. I don't know what the PACU entails. And you don't know that that is taken exactly the way it is written in the book. Thanks for your answer, I understand the logic now. And no thanks for the attitude! Whats with all you people on this site? Is it so hard to communicate without being rude?

Maybe you're just sensitive right now, with the NCLEX failure so recent. But Rose_Queen wasn't being rude, she was trying to TEACH you something. Something useful for studying for this exam....how to THINK THROUGH each question. But you smacked her for that, which is a shame. She would have been a very good resource for you.

I saw her response and thought "no work to do here"; only thing I thought I might add would be that 'a' was obviously wrong as in PACU you'd be taking vitals every five minutes, moving up to every 15. The wording alone, without thinking about it, would tell you it was wrong. Hourly? Ridiculous. But you weren't asking about that question, so I let it go.

Next time you have a question for studying purposes, remember that the person who takes the time to respond to you isn't getting paid for it, isn't earning course credits, is JUST doing it to help out a student. Post a few more responses like you did here, and you might just get less help going forward.

Just my two cents.