Post Procedure Vital Signs...help??

minnib · Apr 18, 2006

I am very confused about post procedure vital signs. I am new at my facility and have heard different things from different people about different procedures regarding post procedure vital signs. For example, when someone comes back to the medical floor from having a paracentesis, how often should their VS be done at first? At times the patient stays in PACU and sometimes they bring them straight to the floor. One of our nurse educators told me we should not be doing VS every hour since they are in PACU, but they aren't all staying in PACU.
I'm really wondering what your hospital policies are on your med surg floors regarding post procedure VS for patients who have received versed and lidocaine.
I need to get with my nurse manager and ask for the policies and if they aren't up to date I need to ask that they be updated.

when the pts come up to the m/s floor the md will usually write an order for how often they want the vs taken, if not then ask MD or refer to hosp. policy but just make sure you get a set asap when they come to you!, I had come out of report one night at 1115p and the evening nurse just standing around at the nurses station said to me" oh your new admission(2 hrs post op lap/chole) is here and I said ok ty, how are his vs?, to that she said" i dunno if the aide made it back there yet and proceeded to talk with someone about a non related work issue:angryfire nice huh? so I just went back and got them..bp was high but fortunately did not become a problem.

jusmy2cents

Thunderwolf, MSN, RN · Apr 18, 2006

On our Ortho-Neuro Med Surg floor, post op vitals are broken down as such:

On arrival, then at 1/2 hr, then q1 hr x3, then q4 hrs x 72 hrs, then q shift if they are with us that long. Anyone with a PCA or Epidural are automatic q 4hrs. We tend to watch the Epidurals more closely than that though...just in case we need to break out the Narcan. Personally, I consider urinary output as a an assessment vital, especially for the first 24-48 hrs...and especially so with a low/lower BP....in case an IV fluid bolus/blood is needed.

ljds · Apr 18, 2006

Ours are a little different, I think, than thunderwolf's. But ours are CLEARLY printed on the post procedure orders sheet. We now have specialty post-procedure orders (like for heart caths) and then generalized ones, for procedures that don't occur as often. There are choices for the doc to check off--how often he wants vitals, what sort of assessments (vascular, neuro, pulmonary, etc) and how often, what diet, what fluids and for how long, which meds and labs, and then a space for any specific, handwritten orders. There is no default, so if a doc leaves something blank, it must be clarified (for example, they must check "no IVaccess" if they don't want any access, not just leave that area blank).

Perhaps this is something that your facility could look into. Docs like it cause every procedure has a similar form, and it is easy for them to go through and check what they want, instead of having to write everything out. Clerks and pharmacy like it because there is no question about poor handwriting. Nurses like it because we know exactly what sort of care the physician wants. If something isn't checked, it is easy to call and ask them about it. They know it is their fault if they didn't check it.

Another advantage is that this has standardized and in my opinion improved patient care. We have these type of orders not just for procedures, but also for certain diagnoses, like chest pain, ETOH detox, et acute respiratory infection. Prior to these standardized, preprinted orders, the care and treatment one received depended on the doctor; some docs were up on the latest treatments, some were not. Now, although a doc always has the right to customize the treatments and orders, they are at least prompted to, say, order librium and antiemetics for our detox patients, or RT treatments for our pnuemonia patients!

Good luck!

Lori

UM Review RN, ASN, RN · Apr 18, 2006

I am very confused about post procedure vital signs. I am new at my facility and have heard different things from different people about different procedures regarding post procedure vital signs. For example, when someone comes back to the medical floor from having a paracentesis, how often should their VS be done at first? At times the patient stays in PACU and sometimes they bring them straight to the floor. One of our nurse educators told me we should not be doing VS every hour since they are in PACU, but they aren't all staying in PACU.
I'm really wondering what your hospital policies are on your med surg floors regarding post procedure VS for patients who have received versed and lidocaine.
I need to get with my nurse manager and ask for the policies and if they aren't up to date I need to ask that they be updated.

Our post-procedure vitals are as follows: q 15 min. X4, then q 30 min. X4, q 1 hr. X4, and q 4 hrs. X4.

Even though it's time-consuming for the first couple of hours, I prefer this way because it reminds me that post-ops can go down the tubes quickly, and need to have someone checking on them frequently.

Shell5 · Apr 19, 2006

Thanks To All Of You Who Responded. This Has Helped Me Out A Lot. I Appreciate It...

jillyk*rn · Apr 19, 2006

hi,

if it is not ordered in the post-procedure notes, then check you policy&procedures. all hospitals are different. that is probably why you are getting different opinions.

good luck!!!

meownsmile, BSN, RN · Apr 26, 2006

True a lot of facilities have policy, but as a general rule,, and i think ive seen this in print in the med/surg books.. q15 x4, q30 x4, q 1hr x4 then q4 x72 hrs.

Otherwise at least in my facility it is dictated by the RN (unless specifically ordered by the dr) who has the ability to make adjustments to that.