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Lewis: Medical-Surgical Nursing~Chapter 20

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A 42-year-old patient is recovering from anesthesia in the post anesthesia care unit (PACU). On admission to the PACU, the blood pressure (BP) is 124/70. Thirty minutes after admission, the blood pressure falls to 112/60 ...

A 42-year-old patient is recovering from anesthesia in the post anesthesia care unit (PACU). On admission to the PACU, the blood pressure (BP) is 124/70. Thirty minutes after admission, the blood pressure falls to 112/60, with a pulse of 72 and warm, dry skin. The most appropriate action by the nurse at this time is to: a. increases the rate of the IV fluid replacement. b. continues to take vital signs every 15 minutes. c. administers oxygen therapy at 100% per mask. d. notifies the anesthesia care provider (ACP) immediately. - ANSWER: b. continues to take vital signs every 15 minutes. A slight drop in postoperative BP with a normal pulse and warm, dry skin indicates normal response to the residual effects of anesthesia and requires only ongoing monitoring. Hypotension with tachycardia and/or cool, clammy skin would suggest hypovolemic or hemorrhagic shock and the need for notification of the ACP, increased fluids, and high-concentration oxygen administration. During recovery from anesthesia in the post anesthesia care unit (PACU), a patients vital signs are blood pressure 118/72, pulse 76, respirations 12, and SpO2 91%. The patient is sleepy but awakens easily. Which action should the nurse take at this time? a. Place the patient in a side-lying position. b. Encourage the patient to take deep breaths. c. Prepare to transfer the patient from the PACU. d. Increase the rate of the postoperative IV fluids. - ANSWER b. Encourage the patient to take deep breaths. The patients borderline SpO2 and sleepiness indicate hypoventilation. The nurse should stimulate the patient and remind the patient to take deep breaths. Placing the patient in a lateral position is needed when the patient first arrives in the PACU and is unconscious. The stable BP and pulse indicate that no changes in fluid intake are required. The patient is not fully awake and has a low SpO2, indicating that transfer from the PACU is not appropriate. After a new nurse has been oriented to the post anesthesia care unit (PACU), the charge nurse will evaluate that the orientation has been successful when the new nurse: a. places a patient in the Trendelenburg position when the blood pressure (BP) drops. b. assists a patient to the prone position when the patient is nauseated. c. turns an unconscious patient to the side when the patient arrives in the PACU.

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