June is help a nursing student out month!

sailornurse · Jun 15, 2016

Welcome to AN, I see you joined today. Are you an LPN, ADN/RN or BSN student? What class is this for? (Name of the course); When is your graduation date? You say you have done several searches, where have you searched? What have you found? Please post the draft of your paper here so we can help you & include the grading rubric here also. Did you select this topic or did the instructor assign the topic?

As to how long the patient remains in PACU, what did your research tell you? This is something you should have found a time range for. Have you spent any time in PACU as part of your clinical? Have you watched any orthopedic surgeries as a student?

I have not searched but there are probably you tube videos on this. What medications were given to your patient in this scenario for pain? What are the usual meds/dosages usually used after TKR?

While we like to help students with homework, we won't write your paper for you. If you want to know more about this, there is a thread by Rose Queen called Dear Nursing Student. You can do a search for this.

TheCommuter, BSN, RN · Jun 15, 2016

Although this is an inquiry from a student, this thread has been moved to our PACU Nursing forum to elicit the feedback of PACU nurses.

lilbitmore · Jun 16, 2016

Thank you for your interest in my post. I am a BSN student in a concurrent enrollment program. If all goes well I should graduate in December of 2017. The paper I am working on is for a research and evidence based practice class. The purpose of the paper is to create a quantitative research proposal based on a clinical nursing question we previously submitted. Unfortunately, I will not begin my med-surg clinical rotation until the middle of the upcoming fall semester so I do not have any acute-care, clinical experience to draw from. The questions I asked in my previous post are to assist me in the methods, data collection and setting portion of my purposed research study. My study involves the effects of massage as an adjuvant pain management therapy in postoperative TKA patients. I am trying to determine the appropriate setting for initiating an intervention approximately one hour after surgery. My research indicated that the time in PACU for TKA patients should be approximately 60 minutes; however, a lack of available beds on the nursing unit often results in an extended PACU time. If patients rarely make it to the unit after 60 minutes in PACU, then I will want the setting for my study to be the PACU. If the patients are generally on the unit floor after 60 minutes, then I will want the setting to be the unit. I mainly just need a little help figuring out where my patient will most likely be located an hour after his surgery. Any insight you are willing to provide would be deeply appreciated. Thanks!

azhiker96, BSN, RN · Jun 25, 2016

In my experience, average time in PACU for such a patient is 1 - 2 hours. When you say no epidural I'll interpret that as no nerve block. I've more often seen a nerve block for the operative side rather than an epidural or spinal.

For pain I give narcotics as ordered while maintaining sufficient respiratory drive in the patient. If they don't breathe then I don't push more narcotics. How much is given depends on the patient and OR meds given.

You are correct, the time could be lengthened due to room availability. Other things that lengthen PACU time are the patient's response to anesthesia. I've had patients who were still intubated half an hour after arriving from the OR. I've also had patients who were awake on arrival to PACU. I'm not sure that one hour post surgery is a fair starting point for the patients. Perhaps consider one hour post meets discharge criteria from PACU.

There are a couple of factors that could give the PACU nurses a little grief. First, I am often trying to get my patient to relax and rest. Someone manipulating their new knee would probably be counter to my goals. Even something as benign as post-op x-rays elicit groans and scowls.

Secondly, if you started the massages at 1 hour after arrival to PACU it could delay transport to a bed that gets assigned at 61 minutes.

OlivetheRN, ADN, BSN, RN · Jun 25, 2016

We typically keep total joints whether they are knees or hips 45 minutes to an hour, assuming vitals are stable and their pain is well controlled. With that being said, the majority of our total joints get spinals (except shoulders, they get blocks). In the rare instance they either can't get the spinal in or there in a contraindication to a spinal, then we use IV narcotics for pain control in PACU.

We sometimes have to wait on bed assignments but try to head that off early in the day. Bed control will call us and verify which patients on the OR schedule will need beds in which units so they can start working on bed assignments, and reserve rooms and beds and such. On days when beds are tight, sometimes that doesn't work out, but for the most part we don't have to wait on beds.

I can tell you right now, the majority of my patients would not be happy campers if you were to massage their freshly replaced knee an hour post-op. But if you were to do so, it would most likely be in their room on the unit :)

lilbitmore · Jun 25, 2016

Thank you azhiker96 for your reply! I appreciate your suggestion of using "one hour post meets discharge criteria from PACU" as the starting point for the massage intervention. I seriously doubt my instructor is going to care about the intricacies of the where, when, and why of my initial intervention but to me this is important.

You mentioned that your are often trying to get your patient to relax and rest. That is great because my purposed study is aimed at just that! In the immediate postoperative stage, I have no intention of manipulating the TKA patient's new knee but massage tends to have a relaxing effect. What type of massage might help this particular patient? I am inclined to use hand, foot and perhaps lower leg massage massage techniques that increase lymphatic drainage, but would definately appreciate your insight.

lilbitmore · Jun 25, 2016

Thank you azhiker96 for your reply! I appreciate your suggestion of using "one hour post meets discharge criteria from PACU" as the starting point for the massage intervention. I seriously doubt my instructor is going to care about the intricacies of the where, when, and why of my initial intervention but to me this is important.

You mentioned that you are often trying to get your patient to relax and rest. That is great because my purposed study is aimed at just that! In the immediate postoperative stage, I have no intention of manipulating the TKA patient's new knee but massage tends to have a relaxing effect. What type of massage might help this particular patient? I am inclined to use hand, foot and perhaps lower leg massage techniques that increase lymphatic drainage, but would definitely appreciate your insight.

lilbitmore · Jul 6, 2016

Thank you OlivetheRn for your insight. Based on what you and azhiker96 have told me I have decided to initiate my intervention on the floor but added intervention would be initiated in the PACU if assignment to the floor was delayed as a result of bed availability. I have also decided to use only upper body massage for the intervention in my purposed study, because from what you guys are telling me, the inclusion of foot massage will most likely increase patient discomfort in the immediate postoperative stages. I can't thank you guys enough for sharing your thoughts with me. I know my instructor is not going to look into the finer details of this paper, but I truly appreciate the time you took to share your real life experience.