Tips for a new PACU RN

sbfairy · Oct 5, 2013

Recovering endoscopy is somewhat different than recovering post surgical patients. I've worked pacu in 2 hospitals and I don't think I've ever seen a patient get general for and endoscopy. This means your patients will wake up fairly quick and should have little to no pain. You can recover them and get them out the door in a very short period of time. Pt's in pacu almost always receive general anesthesia so it takes longer to recover them and probably 97% of my patients have to be medicated for some level of pain or discomfort. In pacu my day isn't scheduled as much as I have routine. I never know what's going to roll out and I may have one pt or two at the the same time. We rarely have more than 2 at once. My routine with my patients is putting on oxygen and monitors while listening to report, then depending on the state of the patient I may do my assessment first and then chart, or I may do a quick initial assessment and then medicate for pain and nausea or any problem that comes up. Once pain and/or nausea is under control and I've charted I get them to day surgery or to the floor. Depending on the patient this can take an hour or more (my hospital likes us to try for an hour), the minimum time we keep them is half an hour. In my pacu we typically use fentanyl, dilaudid, morphine, and toradol for pain relief. For other issues we medicate accordingly, this include hyper/hypotension, brady/tachycardia, etc. As far as my biggest challenge, I would say it's knowing which doctors like what. We use order sets but anesthesia may put a drug on the set that the surgeon hates. My advice to you is to make sure that you are comfortable with knowing what do with a patient in case of obstruction (chin lift or jaw thrust) or if an emergency does come up. I think in endo your patients will mostly do just fine. I think the hard part will be managing 4 patients at once and trying to get them out in 30 minutes. Hope this helps

newrnltc · Oct 5, 2013

Sbfairy thank you so much for your reply! Ive been trying to learn as much about this as possible. You are right. It seems with endoscopy recovery it may be a bit easier to manage (I hope) because the kinds of procedures they are coming from are more focused rather than all sorts of post op. I will take your words to heart and study how to handle obstruction, pneumothorax etc. Hope I can keep up! This will be my first acute care position since graduation and I'll be working 6 days a week!

sbfairy · Oct 5, 2013

I think you'll like recovery. I love it. I think there are parts that get to be routine but I think all areas of nursing have some form of that. You are definitely right in saying that endoscopy recovery is more focused. I've recovered some endoscopy cases but usually after we recovered them in pacu they went back to endoscopy for discharge. Mainly we recovered patients that had issues, aside from GI, that made them unstable. Even then, most did fine. I still think it would be worthwhile for you to read some books on recovery. I like Drain's Perianesthesia Nursing, it is very in depth and gives information on all systems, drugs, etc. It reads more like a textbook for critical care but it will be helpful to you as it has a very in depth GI section. If I were you I'd get an inexpensive copy that is not the latest edition (I think the new editions cost about $80). Clinical Coach for Perioperative Nursing is a much smaller book that you can carry in your pocket and it gives the basics on recovering patients, it was very helpful to me when I first started. It's about $30 but it tries to give a brief overview of the periop process from preop to or to recovery. There are a ton of books on ambulatory surgery which may benefit you more than Drain's or Clinical Coach because they have more info on the criteria for discharge home. Try Handbook of Ambulatory Anesthesia or Ambulatory Surgical Nursing. I think any of these books will have a lot of info that you can use. In any case I hope this helps and I wish you the very best. Btw, I can't believe you will be working 6 days a week. Be careful not to burn yourself out.

wannabecnl · Jan 16, 2014

We recover some endoscopy pts in the PACU, those who need more anesthesia or have underlying conditions that are riskier. Endo pts typically do well. Sore throats are very common, and pts who have an ERCP (not sure if you do those in endo) can't have anything to drink afterward and might have some residual swallowing difficulty afterward (must resolve before we send them home). Our inpatients who have endoscopy have more issues; usually they are having pain or other problems necessitating the test. Good luck!