Postoperative Nursing Care

[dbaldemor]

Hello everyone, I am a nursing student and for our nursing theory class we have been asked to pose a professional question (supported by two professional nursing articles) and write a summary paper of our findings. I would like to thank you in advance for your participation, it is greatly appreciated!

Recently in a clinical rotation I observed a procedure for a patient who was suspected of having a right leg arterial aneurism in the popliteal area. They performed a peripheral cath procedure, with contrast, and put the patient under general and local anesthesia. After the procedure they held pressure on the femoral artery for 20 minutes in the cath lab and then, per hospital policy, took the patient back to the medical floor. The doctor’s orders were to lay flat for 6 hours, with vital signs taken every 15 minutes for the first hour, every 30 minutes for the following two hours, and then every hour for the remaining three hours. When I returned to the unit, with the patient, they were busy (each nurse was assigned six patients). The patients first set of vitals was taken by me about 30 minutes after we had returned, and I was the first person to look at the dressing about an hour after the procedure. The patient had also been NPO since midnight, and I hadn’t seen the CNA since we has returned. I made sure the patient had something to drink (since the patient had to lay flat someone had to hold the cup) and I reinforced that if the patient needed anything (including going to the restroom) he/she needed to call for assistance. My clinical rotation was ending and I needed to leave, but I felt very uncomfortable because I knew that patient was not going to get the care required to promote patient safety.

According to Myrna Mamaril, MS, RN, CPAN, CAPA “The patient receiving general or regional anesthesia should never bypass Phase I and be admitted directly to the floor in the inpatient setting.” (Journal of PeriAnesthesia Nursing, Vol 15, No 2 (April), 2000: pp89-93). Also according to Sandra Barnes, MS, RN, CPAN and Denise O’Brein, BSN, RN, CPAN, CAPA “Not all patients are candidates for bypass of Phase I, and we must be ever vigilant that the level of care required in each situation is provided and patient safety is never compromised.” (Journal of PeriAnesthesia Nursing, Vol 17, No 3 (June), 2002: pp 193-195).

So here is my question that has two parts, what are the current practices in your hospital regarding postanesthesia care, and what have your knowledge and experiences shown to be effective postanesthesia care?

[suzanne4, RN]

Was their an anesthesioloigst or nurse anesthetist with the patient, and were ther intubated? Meaning that a machine was doing all of the work of breathing for them?

Usually they do conscious sedation in these areas, and it is given by the RN in the room.

And yes, you are correct, if they actually were under general anesthesia, they need to be recovered first.

[dbaldemor]

Thanks for clarifying that for me. There was a nurse who administered the conscious sedation and the patient was not intubated. So is it then routine practice to have a patient under conscious sedation with this type of procedure sent back to the floor? At another facility I did a rotation in they had a specific unit where these patients returned to for close monitoring before they were either discharged home or admitted to another unit.

Thanks for you help!