Clinical
Patients may experience this post-extubation especially if their airway is irritated by secretions
What is laryngospasm?
Score introduced in the 1970s to document patient readiness for discharge
What is Aldrete score?
Discharge criteria: minimum modified Aldrete score 12 out of 14 and a score of 2 for respiratory parameter.
What is the criteria for Fast Tracking ?
It stands for enhance recovery after surgery + improve continuum of care provided by interprofessional team
What is ERAS?
A tool created for children to help them communicate about their pain
What is Wong-Baker pain scale?
A life threatening pharmacogenetic reaction that occurs on administration of GA, characterized by hypermetabolism. This results in dangerously high body temp, muscle rigidity/spasms and rapid HR.
What is malignant hyperthermia?
Mr River, 70/M, underwent a procedure with short GA. After procedure, at 15:00 his VS are: BP 110/65 HR 90 RR 12 SpO2 97% RA, complained of mild nausea and pain 3/10. GCS 15/15. What phase recovery would patient be in.
What is Post Anesthesia Phase 2?
It must be removed with the cuff inflated and at the very height of inspiration and beginning of expiration
How do we remove LMA?
Patient engagement, nutrition, mobility, fluid management, pain relief
What are the core competencies of ERAS?
These are some examples: Distractions, popsicles, Tylenol, Opioids.
What are some examples of pain interventions for peds?
The symptoms are: SOB, tachycardia, increased RR, nose flaring and cyanosis
What are the symptoms of respiratory distress?
After surgery, Mrs Humber’s VS: BP 94/52, HR 45bpm, SB, RR 16, SpO2 95% on RA. NRS 2/10, no nausea and vomiting. GCS 15/15. What phase recovery would patient be in.
What is Post Anesthesia Phase 2 ?
Spon breathing 10-25 breathes/min, SpO2 >94% when receiving <FiO2 40% (5L), patient is awake and obeying commands, gag reflex present, able to lift head off bed > 5secs and is hemodynamically stable
What criteria must be met prior to LMA removal?
ERAS emphasizes this to facilitate early mobility, early return of bowel function and decreases post-op morbidity
Why multi-modal analgesia?
Child shows signs of fatigue, weak cry, cricoid tug, grunting.
What are the signs and symptoms of respiratory distress?
A life threatening reaction after a large amount of LA reaches systemic circulation. This results in tingling/numbness around lips, metallic taste, dizziness, restlessness, tremors and decreased hearing. Late signs include: arrythmia, seizures and hypotension.
What is local anesthetic toxicity?
30mins ago, Mrs River was given Naloxone in the OR for potential opioid overdose. Her VS are stable, alert and orientated x3. What phase recovery would patient be in.
What is Post Anesthesia Phase 1 patient?
At discharge, a patient must score >/= 8 with respirations scoring 2 and a minimum 2 sets of VS completed 15mins apart
What is the minimum score for patients to be discharged from PACU?
ERAS protocol avoids this because its undesired effects include: delayed recovery of bowel function, respiratory depression, post-op nausea and vomiting
Why do we avoid opioid use in ERAS?
Child shows stridor, hoarseness and increased work of breathing during inspiratory phase.
What are signs and symptoms of upper airway obstruction in peds?
A concern in perioperative nursing, these population are more prone to this condition:
Female, Non-smoker, history of motion sickness and use of post-op opioids
What are the risk factors for PONV?
Mr Humber, 50/M, underwent direct anterior hip arthroplasty. After surgery, he complained of headache, muscle stiffness, nausea and very thirsty. His blood glucose: 15mmol/L. BP 125/70, HR 90, RR 14, SpO2 95% RA, all VS are similar to baseline. GCS 15/15. What phase recovery would patient be in.
What is Post Anesthesia Phase 1 ?
The parameters are: Reparation, Circulation, Consciousness, Activity and Oxygen saturation
What are the 5 post anesthesia recovery parameters when determining patients’ readiness for discharge from PACU?
Pain management, early mobilization and discharge planning
What are the 3 key components in post-op care?
Child appears confused, he’s crying + screaming + kicking. He doesn’t respond to verbal cues nor open his eyes.
What are the signs and symptoms of emergence delirium?