Pre Op
How many hours should a patient be fasted from food / milk and clear fluids?
Food/milk: 6 hours
Clear Fluids: 1 hour
What should a patients level of sedation (UMSS) be to be deemed safe for discharge from PACU?
Must be UMSS of 2 or below.
2 = moderately sedated: solomnent sleeding, easily roused with tactile stimulation or simple verbal command.
What are the 5 P's of Compartment Syndrome?
Pain, Pallor, Pulselessness, Pressure, Paralysis, Paraesthesia
Name 2 symptoms of possible appendicitis
Fever, N&V, localised tenderess, guarding, rebound tenderness, increase WBC & CRP, Periumbilical pain migrating to RLQ - exacerbated by movement
Minimum frequency of post anaesthetic obs and what should it include
Vital signs (RR, effort, spo2, HR, T, BP, LOC, Pain score, o2 therapy, assessment of dressings, drains, catheters, IVs)
1/2 hourly for 2 hours. If discharging the same day, a full set of obs must be done prior to DC.
Who must be notified of pt precautions prior to transfer to OT and what must be on top of the patient notes?
Theatre Coordinator
3C staff who contact for transfer
A precaution card must be on top of the notes.
You notice an opaque substance in your pt's PIVC at handover from the PACU nurse. What do you need to do?
Do not flush the IV line or remove PIVC. Contact the Anaesthetist involved, or the DA. Request the IV line to be reviewed. If unable to contact the Anaesthetist, liaise with the pt's treating team or RMO to discuss with the on-call theatre team.
Does a patient need to be woken to assess NVO overnight?
YES minimum 4/24
How to you calculate a SFBC in a baby who has no IDC?
pre weigh nappies & write weight of nappy on front. Then put on pt. Once pt has PU weigh nappy & subtract nappy weight :)
How many hours post op with no void would be a indication to follow the POUR algorithm?
4 hours after transfer to PACU
Is a patient >50kg is required to wear hospital pyjamas or a theatre gown
Theatre gown
*exceptions can be made for pts with hx of autism, sensory disorders or behavioural issues. Crop top/bra must be removed under, can offer second gown to wear as a dressing gown
If a pt is requiring IV opioid protocol, how long post last dose are they required to be in PACU?
Min of 20 mins! Pt needs to be reviewed by Anaesthetist if 5 doses administered and pt remains in pain.
What are the 3 A's of Compartment Syndrome?
Increased Analgesic requirement
Agitation
Anxiety
What 4 things should you note about drainage (e.g. in a varivac/grende drain)
Volume, Colour, Consistency and Patency
1/24 readings
any sudden rapid increase/change in colour or patency report to shift-co +/- team
When should a skin, pressure and falls assessment be completed?
On admission (within 2 hrs), daily, change in condition, transferred from another ward or from theatre
Your patient had aritifical nails and they dont want to take them off! What should you do?
Inform Anaesthetist for the list that artificial nails are present and discuss if removal is required. Generally one from each hand is removed
What 2 things must accompany a pt when transferring from PACU to the ward?
Portable 02 & BVM (appropriate size)
What are the 2 pulses of the foot called and where are they located?
Posterior Tibialis - is found behind the inner ankle.
Dorsalis Pedis - on the top of the foot
What is normal urine output for children and infants? AND is it the same for adolescents?
children/infants = 1-2ml/kg/hr
adolescents = 0.5ml/kg/hr
How many mls of clear fluids should be offered to a patient 1-6yrs old (up to 1 hr prior to procedure).
approx 60mls (equiv to 1/2 cup CF)
How long following adminsitration of Parecoxib can the patient have ibuprofen?
The next NSAID dose should be separated by 12 hours
What is normal compartment pressure in a child?
13mmHg - 17mmHg
Provide 5 examples of patients who require a SFBC
Deteriorating pts, complex abdo surgeries (with NGT's/Asps), infusions (IVT, TPN), epidurals, IDC, Drains, FTT/feeding difficulties, renal or cardiac history, burns patients, Cleft lip/palate, cranial vault, trauma patients, flap or re-vascularisation, large orthopaedic cases (long OT time) e.g. limb replacement
Provide 3 examples of risk factors for POUR
Spinal/epidrual, those on opioids, poorly controlled pain, history of urinary problems, surgery to pelvis, surgery that immobilises (spinal, lower limb - ortho), large volumes of IV fluids intraop, Operation greater than 2 hrs.