Pacu Patient Assessments/Interventions

[cspurlin33]

:heartbeatI did clinicals in PACU(RECOVERY) the other day and now I have paperwork to do on my experience. I have to identify patient assessments and nurse interventions for my two patients. They had: anterior cervical diskectomy and fusion with autologous bone graft & cervical epidural steroid injection.

Some assessments I have are: assess pain lvls, I&O, VS q 5 minutes for 20 minutes including O2 sats.

Some interventions I have are: arterial line, IV started, warmed Lactated Ringer.

These have to be extremely indepth. Does anyone have any added details or things I have left out that may pertain to these surgeries as far as recovery? Thank you so much, I am soo lost.:heartbeat

[EricJRN, MSN, RN]

Your nursing interventions will vary based on your assessment of the patient's current condition. Try looking at your assessments and differentiate between the normal and abnormal findings. That will probably get you going in the right direction.

[scoochy]

Having had an ACDF with autologous bone graft in the past, here is some help:

1. It is of the utmost importance to assess neuro status.

2. Assess pain level. Was the bone graft taken from the patient's hip? If so,

there will be more pain at this site than at the neck (my personal exper-

ience). It hurts!!!

3. Provide optimal positioning; i.e., HOB elevated, arms supported by pillows.

4. Ice to hip if bone graft taken from hip.

I have given you some assistance, but you will need to do some research re: the surgery itself. If you understand what this surgery entails, nursing interventions will logically follow.

Arterial line..this is not a nursing intervention. Put on your thinking cap; what are possible adverse outcomes of arterial line insertion, and how would you be able to prevent an adverse outcome??

[GHGoonette, BSN, RN]

It might be a good idea to tackle this from absolute grassroots level, starting with the patient's history, eg what accident/condition led to the need for this op, previous interventions, anaesthetic history etc. If a pre-op visit by theater staff was carried out, and what was the perioperative nursing care plan; expected outcomes and was the patient properly informed prior to consent, and who informed the patient, ie did the surgeon explain it fully prior to admission? Also, were there any underlying conditions that might have influenced the intra and post operative care of the patient? What premed was prescribed and what would be the rationale behind the choice?

Scoochy already told you what you need to find out re the operation details, so all I would add to that is the anaesthetic drugs used, possible drug interactions and nursing interventions. Positioning of the patient during surgery and steps taken to prevent injury/tissue damage intra-operatively through correct attention to pressure points. Diathermy placement and post-operative nursing observations relating to these areas. Instructions regarding breakthrough pain, whether administration was necessary, and condition on discharge from PACU.

Interesting that they placed a cervical epidural, I usually only see epidurals for ops lower down, eg major abdominal surgery, hip & knee replacements etc, and they are placed lower down. Relating to that, was it run continuously or just retained for bolus doses? And, of course, what was administered via the epidural?

Include the post-operative instructions for the ward/ICU and post-operative visit by theater staff to assess nursing care plan outcomes and success or (hopefully not!) failure. Good luck!