Care of the post-op Spinal anesthesia patient (NOT in PACU...on unit)

Annisme · Jul 31, 2008

Our hospital uses a specific protocol in addition to the standard post-op procedures. These include VS Q15 min/1 hr then Q1H/4 hrs. Standing orders for 50 mg Benedryl and Narcan (not sure of the dose). If these are necessary, CALL THE ANESTHESIOLOGIST (sp? it's late) IMMEDIATELY. I had to use these last week. While I was taking report, I noticed a downward trend in the pt's BP. Went to assess her and she was beginning to have trouble (de-sating). Sat her up, used the Benedryl, used the Narcan and called the docs. She is doing great!

mpccrn, BSN, RN · Jul 31, 2008

assess movement and sensation in addition to what was mentioned above. you are mostly looking for resp. depression due to the spinal meds moving up. 0.4mg of narcan is given if you see a rate less than 12, which can be repeated as you call anesthesia. no narcs are given for the first 24 hours afterwards unless specifically ordered by anesthesia.

Zee_RN, BSN, RN · Jul 31, 2008

Thank you. Do you do follow these polices on POST spinal anesthesia patients or patients with INFUSING spinal/epidural medications? We have a policy for patients that have epidural medications infusing but not on ones who had spinal anesthesia in the OR, went through PACU and met all criteria for discharge (sensation and movement intact) and are now on your hospital unit.

jnrsmommy · Jul 31, 2008

Agree w/ the previous posters. Been awhile since I had a spinal pt, but what I can remember, we also had to monitor dermatones w/ the vitals, and I remember something about not raising the head any higher than 30 degrees for the first eight hours after the last injection.

Babs0512 · Aug 1, 2008

agree with previous posters. You could also check the level of the spinal. The sensation of the patient should come back on stomach area first, then move down the anterior portion of the body, wrap around the feet to the posterior leg and the last feeling to come back is the buttocks. You could document level of spinal during each set of VS. Just have patient close his/her eyes, and touch patient on abdomen, and slowly move down until patient cannot feel you anymore. Next assessment, pick up where you left off on your last assessment.