pacu preceptor

In PACU, we always say ABCs! LOL, but it's true. When the OR circulator and anesthesiologist/CRNA brings you a patient, start hooking them up to the monitors while they are giving report. Always look at the patient's chest for breathing! Look at how they are moving air, is the patient obstructing. This comes before anything else! Someone once told me that the #1 cause of lawsuits from PACU are airway/sedation issues. Sometimes the patient hasn't blown off the gas yet or there is still a little paralytic hanging around and I've had patients brought out either obstructing or apneic.

If the patient is obstructing, hold the airway open by chin tilt or jaw thrust. Usually the patient will have an oral airway or nasal trumpet to help out. If the patient comes out intubated or with an LMA know what the hospital's policy is on extubation. For example, holds head up x5 secs, follows commands, hemodynamically stable. Always make sure there is suction handy.

Make sure you know the most common drugs, like anti-hypertensives, narcotics, sedative, reveral agents, paralytics, vasoactives, antiemetics. For example: Labetalol, Hydralazine, Morphine, Dilaudid, Demerol, Versed, Valium, Robinol, Narcan, Romazicon, Anectine, Phenylephrine, Phenergan, Zofran. Reviewing ACLS will help.

In PACU it's usually pretty fast paced, once the patient can maintain an airway, is reactive, VSS, pain controlled (not necessarily totally relieved), and isn't having bleeding/complications, call report and send them on their way.

Make sure you review the orders for anything that is to be done in PACU, like labs or meds.

HTH. Good luck!

Thank you for your advice, thats was helpful! Could you give me an idea about on average and i am sure it depends on the facility but the number of patients a nurse may have at one time? I assume that PACU nurses take call as well? Do you think this is a good experience for someone in their last semester (esp getting comfortable with giving more complex meds etc). Any more info would be great.

Thank you!

My hospital follows ASPAN pt ratio guidelines, which is a max of 2 for 1 nurse. Sometimes 1 on 1 if the pt is unstable, vented, or a pediatric pt. If we are holding a bunch of patients for several hours due to a lack of floor beds, then the nurse will have 3 or 4 of them. That nurse takes care of them like she's out on the floor and not assigned any PACU patients. We move all those patients to a separate area anyways, because they are getting trays and visitors.

Yes, I think most PACU nurses take call. We rotate every 6th weekend, and then various weeknights. We take call for only one holiday per year. For example, if I take call for 4th of July, that means I have all the other ones off. That part is pretty sweet. However, the downside is taking a weeknight call when you've worked all day! It has happened where a nurse goes home around 6 pm only to be called back in around 11pm.

I think going through PACU is great experience, hopefully you enjoy it.

HI,

I work in the icu, been there for about 4 mths. I'm in the process of transfering to PACU. You gave some really great feedback. Any words of advice of advice for me. I'm going to shadow in the PACU in a few days can you tell me what to look for so when I get there I don't look like I have no clue what I'm doing. Anything you can tell me that will keep me alert to what is going on would be great.