Posts Tagged ‘ PACU ’

It’s Cold In Here

Nope, the title isn’t a reference to the temperature outside. It is actually a patient quote.
Let me explain.

This is a flashback to the PACU floor. At school the other day, we were having a conversation about our very first catheter insertion on a real live, breathing person.
Mine was in the PACU. My patient was super distended, in lots of pain, and asking if there was anything we could do to make him void since it was so uncomfortable.

“Sure!”, my instructor said. “What would you do in this situation?”

I assessed his stomach and found he was extremely distended. I gave him the urinal to try once more on his own and of course closed the curtain for privacy.
Nothing.

Straight cath was the next option. His MD happened to stroll in and checked him out. He reached the same conclusion and gave the go-ahead.

I was nervous, feeling ill prepared. I hadn’t expected to do any catheters here and hadn’t reviewed.

“Calm down,” Mrs. D said. We reviewed the steps. Easy.

So, I get to work. As I’m wiping with Betadine, my patient- still groggy from anesthesia- decides it is a good idea to start talking to me.

“Hey, just so you know, it’s really cold in here,” he said with eyes half-mast.

“Oh. Uh-huh,” I nervously reply with an awkward chuckle. I mean, what do you say to that?
I insert the catheter and am having trouble getting it past the prostate. My coassigned nurse comes over and teaches me how to “walk the catheter in” because it keeps popping back out the second I let go.

“Yeah, it’s just cold in here. Just so everyone knows,” my patient states again.
More nervous laughter.

My coassigned and I finally get the catheter in and he leaves me to drain it. It was slow going. 800ml slowly drained. (Note: never drain more than 1000ml at a time!)
And while it drained, my patient decides to triple check and make sure I knew the temperature of the room.
Hint: it was not warm.

Thanks male patient. Long story short, I successfully completed my first straight cath and it was incredibly awkward.
Any good stories from you guys?

Love,
Laney

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Leads!

Memory tools are ever-so-useful. So here’s a quick way to remember the correct order to put on the leads that hook a patient up to the monitors. There are five leads in various colors and when in a hurry, it can get confusing. So, here’s the nitty gritty.

White on the right
Snow over grass
Smoke over fire
Brown on the ground

White Black
Brown
Green Red

Congrats! Now you know how to do a 5-lead placement!

PACU.

It’s official. I am in love with the PACU. Post anesthesia care unit, that is.

Basically, this unit a is fast paced, on your toes, better know your P’s and Q’s kind of place. That’s where I went today with two other classmates. It was amazing.

Here’s how it works. There are 12 beds open. Today, they were short a nurse so we were working 8 beds. Patients roll in from the Operating Room to the PACU because that is the recovery room. Each nurse gets two beds. The first patient goes to bed 1, second patient goes to bed 3, then 5, and 7. After each nurse gets their first patient, it goes around again on the even numbers.
PACU patients are ideally there for an hour or so before being transferred out, although they are often in the unit longer for various reasons.
Patients that go home same day may go the ambulatory care area to meet with family and finish getting things settled before leaving. Patients going to the floor may have to wait in PACU until they get a bed. The other reason for the longer wait time is if the patient is unstable.
Vital signs are checked every 15 minutes and your assessments better be spot on. You also have to maintain fluids going in and make sure the dressings from surgery are dry and intact. If there is too much oozing or bleeding, you’ve got to notify the right people and potentially roll them back. Depending on what kind of surgery they had, your assessment focus changes. For example, a patient with back surgery, you want to make sure they can move their legs and still have sensation while a heart patient, you’re monitoring their rhythm strips. Those are some basic examples.

The neat thing about PACU is that it starts off slow where you’re doing nothing. Well, that bit is the only dull bit. As soon as the first surgery rolls in, you hit the ground running. The patient rolls in and you jump in. Someone is charting while someone else is hooking up their leads to the monitor while someone else is hooking up the oxygen. The level of teamwork is amazing.
The PACU nurses are unbelievable. They’ll be taking report from the CRNA (certified registered nurse anesthetist) and listening to the various people calling out data and charting it all at the same time. They can listen to the breath sounds to see if they’re clear or wheezing, crackling, etc while counting how many breaths they take in a minute at the same time. A task a lot easier than it sounds.

“Pt X came in a for an inguinal hernia repair this morning and is under general anesthesia. There-”
“36.4 is temp!”
“- estimated blood loss is 5ml and-”
“12 respirations, clear and equal!”
“they’re on 8L of oxygen non-rebreather mask. They”
“BP 134/83 and there’s an 18 gauge needle in the left hand!”
” have a history of smoking and asthma. Their pre-op BP was 145/95 and they”
“Dressings dry and intact.”
“were given Ancef 1gm at 0850”

That’s just an example of a report from CRNA and call-outs from the ones assessing all happening at the same time. And it all happens in about five minutes. Then you follow it up with a more in-depth look and then reassess every 15 minutes. Plus, you could have another patient to tend to at the same time.

The other thing is that when you wheel a patient out, you could come back to another one rolling in. So fast paced! I adore the fast paced environment. And everyone is so knowledgeable there. You’re always learning and seeing new surgeries or new doctors who do the surgeries in different ways. Truly fascinating.

What else is fascinating? The way people respond to anesthesia. HILARIOUS. That’s a post for another day though.

Today was busy and I got to do more today clinically than ever before. We’re taking it to a new level and today, I finally started feeling like more of a nurse and less of a NA (nursing assisstant).
I did a straight catheter for the first time on a male (human, not a dummy), an Accucheck to test glucose, prime the tubing on a drip (medication that flows through an IV), change the tubing on a drip already hung, and learned how to/successfully put on EKG leads. And then, of course, all the normal assessment things.
I also saw some neat drains that you only see straight out of surgery. There’s one drain that pulls blood out and once it’s full, you flip it and retransfuse it back into them. So awesome.

I’m back there tomorrow starting late!! The other nice thing about PACU, they are the latest starting clinicals. I don’t have to arrive until 7.30 so that I can change into my scrubs and be on the floor at 8. Hello, luxury.