Preoperative Risk Factors Associated With PACU Pediatric Respiratory Complications: An Integrative Review.

PURPOSE: This article reviews state of the science of preoperative risk factors associated with postanesthesia care unit (PACU) pediatric respiratory complications. DESIGN: An integrative review. METHODS: A search of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, Scopus, Cochrane, and Joanna Briggs Institute databases was performed. Thirty-one articles, published between 2006 and 2018, were appraised for quality and the level of evidence using the Johns Hopkins Nursing Evidence-Based Practice Model. FINDINGS: These articles were grouped into the following categories: age, American Society of Anesthesiologists status, gender, airway comorbidities, syndromes, anomalies, pulmonary comorbidities, ethnicity, obesity, neurologic comorbidities, and cardiac comorbidities. CONCLUSIONS: Evidence identified significant preoperative and anesthesia risk factors that are associated with PACU pediatric respiratory complications. This article reveals the importance for the perioperative team to identify, assess for, communicate, and develop a management plan for pediatric respiratory complications.

Perceived Needs, Preparedness, and Emotional Distress of Male Caregivers of Postsurgical Women With Gynecologic Cancer

OBJECTIVES: To describe the perceived needs, preparedness, and emotional distress of male caregivers of postsurgical patients with gynecologic cancer during the transition from hospital to home. 
. SAMPLE & SETTING: 50 male caregivers of patients with gynecologic cancer on an inpatient unit at University Hospitals Seidman Cancer Center in Cleveland, OH.
. METHODS & VARIABLES: Caregiver needs, perceived preparedness, and emotional distress were measured at admission and at one week postdischarge. Instruments included the Comprehensive Needs Assessment Tool for Cancer Caregivers, Preparedness for Caregiving Scale, and National Comprehensive Cancer Network Distress Thermometer. The analysis consisted of descriptive statistics, Spearman's correlations, and univariate linear regressions.
. RESULTS: At both time points, male caregivers' greatest needs were interaction with the healthcare staff and information. Perceived preparedness was not associated with emotional distress. Male caregivers who were young, were employed, were unmarried, and had a lower income had greater needs.
. IMPLICATIONS FOR NURSING: A relational nursing care approach that maintains effective communication with male caregivers is essential. Nurses should broaden the caregiver assessment beyond the practical care of the patient.

Analysis of specialized nursing on respiratory functions in thoracotomy patients.

To analyze the nursing effect on the respiratory function of thoracotomy patients, sixty thoracotomy hospitalized patients were studied. The subjects were divided into a normal group (A) and an observation group (B). The patients in group A received routine nursing only, while those in group B received chest physiotherapy as well as routine nursing. Afterwards, the respiratory function indicators of the two groups were compared and a data analysis was performed. The results showed that the partial pressure of oxygen (PO2) value of the patients in group B was greater than that of the patients in group A while the partial pressure of carbon dioxide (PCO2) value in group B was smaller than that in group A, and there was a significant difference between the two groups (p less than 0.05). The vital capacity under normal circumstances and forced breathing of group B were greater than that of group A and the difference was statistically significant (p less than 0.05). The incidence of complications (atelectasis, respiratory infections, pleural effusion) was statistically significant between the two groups (p less than 0.05). The degree of autonomic respiratory dysfunction in group B was lower than that in group A, and there was a significant difference (p less than 0.05), suggesting that the respiratory function in patients receiving chest physiotherapy improved significantly.

Sistematização da Assistência em Enfermagem perioperatória em uma unidade de recuperação pós-anestésica / Systematization of Perioperative Nursing Care in a postanesthetic recovery unit / Sistematización de la Asistencia de Enfermería perioperatoria en una unidad de recuperación post anestésica

Objetivo: descrever os diagnósticos de enfermagem em uma sala de recuperação pós-anestésica (SRPA) e propor os resultados e intervenções para os cinco diagnósticos mais frequentes. Método: estudo descritivo e retrospectivo de registro dos principais diagnósticos de enfermagem identificados e analisados segundo frequências. A amostra foi composta por 63 prontuários referentes ao período de internação no mês janeiro de 2013. Resultados: foram identificados 623 diagnósticos de enfermagem (67 categorias diagnósticas) em 10 domínios da NANDA-II. Os cinco diagnósticos mais frequentes foram: Dor aguda (100%); Risco de desequilíbrio do volume de líquidos (73,4%); Risco de infecção (68,8%); Mobilidade no leito prejudicada (60,7%) e Ansiedade(34,3%). Conclusão: o conhecimento sobre diagnósticos de enfermagem mais frequentes contribui para uma melhor aplicabilidade do processo de enfermagem de forma individual e holística para que possam ser implementadas intervenções com resultados mais específicos e direcionados às necessidades prioritárias desta clientela.(AU)

Objective: to describe the nursing diagnoses in a post-anesthesia care unit (PACU) and to propose the outcomes and interventions for the five most common diagnoses. Method: a descriptive and retrospective registration of the main nursing diagnoses identified and analyzed according to frequency. The sample consisted of 63 records for the period of hospitalization in the month of January 2013. Results: we identified 623 nursing diagnoses (67 diagnostic categories) in 10 areas of NANDA-II. The five most frequent diagnoses were acute pain (100%); liquid volume risk of disequilibrium (73.4%); Risk of infection (68.8%); Mobility Impaired bed (60.7%) and anxiety (34.3%). Conclusion: knowledge about more frequent nursing diagnoses contributes to better application of the nursing process of an individual and holistic manner so that they can be implemented interventions with more specific results and targeted to the priority needs of this clientele.(AU)

Objetivo: describir los diagnósticos de enfermería en un salón de recuperación post anestésico (PACU) y proponen los resultados e intervenciones para los cinco diagnósticos más frecuentes. Método: estudio descriptivo y retrospectivo del registro de los principales diagnósticos de enfermería identificados y analizados según frecuencias. La muestra fue compuesta por 63 prontuarios para el período de hospitalización en el mes de enero de 2013. Resultados: fueron identificados 623 diagnósticos de enfermería (67 categorías diagnósticas) en las 10 áreas de NANDA II. Los cinco diagnósticos más frecuentes fueron: dolor agudo (100%); Riesgo de desequilibrio de volumen de líquido (73,4%); Riesgo de infección (68,8%); Personas con problemas de movilidad en la cama (60,7%) y ansiedad (34,3%). Conclusión: el conocimiento de los diagnósticos de enfermería con frecuencia contribuye a una mejor aplicabilidad del proceso de enfermería de manera individual e integral para que puedan aplicarse con intervenciones dirigidas a las necesidades prioritarias de esta clientela y resultados más específicos.(AU)

Local Anesthesia Combined With Sedation Compared With General Anesthesia for Ambulatory Operative Hysteroscopy: A Randomized Study.

PURPOSE: The purpose of this study was to compare two anesthetic techniques for postoperative pain after ambulatory operative hysteroscopy. DESIGN: A randomized trial. METHODS: Women (N = 153) scheduled for ambulatory operative hysteroscopy were assigned to receive either paracervical local anesthesia combined with sedation (group LA + S; n = 76) or general anesthesia (group GA; n = 77). Primary outcome was the worst pain intensity score in the postanesthesia care unit (PACU) rated by the patients on a numerical rating scale. FINDING: Data from 144 patients were available for analysis (LA + S: n = 69; GA: n = 75). There were no significant differences in worst pain intensity between groups in the PACU (P = .13) or after discharge from PACU (P = .40). In group LA + S, fewer patients received treatment with intravenous fentanyl intraoperatively (P < .01) and time until discharge from PACU was shorter (P < .01). More patients in group LA + S experienced vomiting after discharge (P < .05). CONCLUSIONS: Local anesthesia with sedation can be recommended as a first choice anesthetic technique for operative ambulatory hysteroscopy.

The effectiveness and cost of passive warming in adult ambulatory surgery patients.

Hypothermia is a common problem for surgical patients and can result in many complications. Because few studies compare methods of passive warming, we used an unblinded, prospective, experimental, randomized design to compare the effectiveness of two passive methods of normothermia management in the postanesthesia care unit (PACU). We assigned a total of 578 adult ambulatory surgery patients to either a control group that was given two folded, warmed cotton blankets or a treatment group that was given a warmed, unfolded cotton sheet and cotton blanket. We recorded patients' temperatures on their arrival in the PACU and at 30 minutes after arrival. The treatment group had temperatures that were significantly higher than those of the control group 30 minutes after arrival in the PACU, and the treatment group experienced a greater change in temperature from baseline measurements to those taken at 30 minutes. The treatment group also used fewer warmed blankets, resulting in cost savings for the PACU.

The effect of needle bevel position on pain for subcutaneous lidocaine injection.

It is a common practice for medical practitioners to use subcutaneous infiltration of lidocaine to alleviate the pain of intravenous cannulation or line insertion. Although previous studies have assessed several factors affecting the pain associated with local anesthetic infiltration, there is a paucity of data on the effects of needle bevel position. In this prospective, randomized, controlled trial, we compared the effect of two different needle bevel positions (bevel up versus bevel down) and the pain associated with the subcutaneous injection of 1% lidocaine in 50 adult volunteers. Significantly higher pain scores were observed when the needle was placed bevel down compared with bevel up (P = .02). No significant differences in pain scores were noted between the groups for age and gender.

Patients' perception of music versus ordinary sound in a postanaesthesia care unit: a randomised crossover trial.

We performed an experimental single-blind crossover design study in a postanaesthesia care unit (PACU): (i) to test the hypothesis that patients will experience a higher degree of wellbeing if they listen to music compared to ordinary PACU sounds during their early postoperative care, (ii) to determine if there is a difference over time, and (iii) to evaluate the importance of the acoustic environment and whether patients prefer listening to music during their stay. Two groups received a three-phase intervention: one group (n=23) experienced music-ordinary sound-music and the second group (n=21) experienced ordinary sound-music-ordinary sound. Each period lasted 30 min, and after each period the patients assessed their experience of the sound. The results demonstrated a significant difference (p<0.001) between groups in the proportions of patients reporting that the acoustic environment was of great importance for their wellbeing during the three-phase intervention, and most participants (n=36 versus n=8) noticed that they were exposed to different sounds during the PACU period. The results also revealed that most participants (n=32) preferred listening to music versus listening to ordinary sound (n=3) while in the PACU (p<0.001). These findings promote use of listening to music to establish a healing environment for patients in a postanaesthesia care unit.

Assistência de enfermagem na terapia dialítica

A enfermagem tem um papel essencial no cuidado aos pacientes em terapia de substituição renal e sua continuidade. Dentre os fatores determinantes do sucesso na realização da terapia de substituição renal, destaca-se a disponibilidade de uma equipe de enfermagem habilitada para o seu manuseio. Objetivos: Identificar os cuidados de enfermagem prestados aos pacientes em terapia dialítica. Metodologia: Estudo de caráter exploratório descritivo com abordagem qualitativa. Resultados: A enfermagem presta assistência ao individuo em terapia de substituição renal observando, monitorando, realizando técnicas de enfermagem com habilidade e compromisso. Cuidados com acesso vascular, anticoagulação do sistema, dialisadores e demais componentes utilizados para realizar a terapia, condutas de enfermagem tomadas mediante complicações compõe a sistematização da assistência. Conclusões: Os cuidados de enfermagem indicados ao paciente em diálise continua ou convencional requerem assistência sistematizada da enfermagem e o paciente crítico com insuficiência renal será bem assistido mediante a visão holística das suas necessidades humanas associado a protocolos assistenciais baseados na literatura.

The effects of stimulation of acupressure point p6 on postoperative nausea and vomiting: a review of literature.

Postoperative nausea and vomiting (PONV) can complicate and delay patient recovery from general and neuraxial anesthesia. Even with a new generation of anesthetic drugs and antiemetics, a high number of patients are affected by PONV. PONV has a multifactor etiology, but there are ways to reduce its occurrence. Although it is not a traditionally recognized method, stimulation of acupressure points, specifically P6, has been identified as a potentially effective method of reducing PONV. This study is a state of the science paper reviewing research on both pharmacologic and nonpharmacologic prophylaxis and various methods of acupressure. It was conducted to add information to the currently available knowledge regarding PONV in hopes of stimulating the use of acupressure for treatment of PONV. The study is divided into six categories: pathophysiology of PONV, background studies of PONV, nonpharmacologic prophylaxis, pharmacological prophylaxis, acupressure and related techniques, and benefits of routine antiemetic prophylaxis.

Vocal cord dysfunction: a case report.

Vocal cord dysfunction (VCD) is a respiratory condition characterized by the paradoxical closure of the vocal cords. This condition results in a myriad of symptoms that would be expected from an upper airway obstruction including anxiety, hyperventilation, wheezing, stridor, shortness of breath, dyspnea, and suprasternal and neck muscle retraction. with known VCD who underwent local anesthesia with intravenous sedation for perianal skin tag removal. Postoperatively, the patient experienced respiratory distress, prompting interventions and investigation. A review of the literature revealed limited information on VCD, and no anesthesia literature was found regarding this entity.

Herbal supplements: Facts and myths--talking to your patients about herbal supplements.

The use of herbal supplements in the United States is steadily growing and raises concerns about safety, efficacy, and how they affect safe patient care. The direct health risks associated with herbal supplements include hypertension, prolonged bleeding, and the potential for drug-herb interactions. These potential drug interactions are of particular concern for patients undergoing anesthesia. This article provides a review of literature on the 10 most popular herbal supplements and addresses the herbal supplements' reported use, possible adverse effect(s), patient teaching, possible drug interaction(s), and recommendations regarding discontinuation before surgery.

Whole lung lavage in the treatment of pulmonary alveolar proteinosis.

Although a rare condition, pulmonary alveolar proteinosis (PAP) can be a very devastating diagnosis with life-altering consequences. This case study follows the path of a young woman who is currently undergoing whole lung lavage as treatment for pulmonary alveolar proteinosis. The entire concept of flooding a lung with large quantities of saline as a treatment for lung disease is contrary to normal respiratory care. Caring for the patient with PAP provides many challenges for the perianesthesia nurse. Management of the postanesthesia airway, oxygen administration and maintenance of oxygen saturation, and pain relief skills are all of high importance to the patient with PAP. These skills plus the emotional support provided by the experienced perianesthesia nurse can ensure a safe recovery from this unusual procedure.

A guideline for incorporating holistic nursing interventions into perianesthesia practice.

As alternative or holistic interventions become more popular, perianesthesia nurses will be exposed to more opportunities for providing some of these interventions in their daily practice. This article shares the experience of 1 perianesthesia nurse in developing a holistic interventions program and changing practice to meet patient needs.

Aromatherapy with peppermint, isopropyl alcohol, or placebo is equally effective in relieving postoperative nausea.

To determine whether aromatherapy can reduce postoperative nausea, the investigators studied 33 ambulatory surgery patients who complained of nausea in the PACU. After indicating the severity of nausea on a 100-mm visual analogue scale (VAS), subjects received randomized aromatherapy with isopropyl alcohol, oil of peppermint, or saline (placebo). The vapors were inhaled deeply through the nose from scented gauze pads held directly beneath the patients' nostrils and exhaled slowly through the mouth. Two and 5 minutes later, the subjects rated their nausea on the VAS. Overall nausea scores decreased from 60.6 +/- 4.3 mm (mean +/- SE) before aromatherapy to 43.1 +/- 4.9 mm 2 minutes after aromatherapy (P <.005), and to 28.0 +/- 4.6 mm 5 minutes after aromatherapy (P < 10(-6)). Nausea scores did not differ between the treatments at any time. Only 52% of the patients required conventional intravenous (IV) antiemetic therapy during their PACU stay. Overall satisfaction with postoperative nausea management was 86.9 +/- 4.1 mm and was independent of the treatment group. Aromatherapy effectively reduced the perceived severity of postoperative nausea. The fact that a saline "placebo" was as effective as alcohol or peppermint suggests that the beneficial effect may be related more to controlled breathing patterns than to the actual aroma inhaled.

The effect of music listening on acute confusion and delirium in elders undergoing elective hip and knee surgery.

This study was undertaken to determine the effect of music on elders undergoing elective hip and knee surgery who experience acute confusion and delirium postoperatively. Postoperative confusion and delirium in elders often cause complications that negatively effect recovery. Music listening was introduced as an intervention to an experimental group. Nurses documented episodes of acute confusion and delirium experienced by elders postsurgically. Scores from a readiness-to-ambulate profile to determine if patients were cognitively ready for postoperative therapy were evaluated. There was a significant decrease in the number of episodes of postoperative confusion among those in the experimental group compared with those in the non-listening control group. In addition, the experimental group had significantly higher scores on the readiness-to-ambulate profile than the control group. These findings indicate that music listening is an effective nursing intervention that can be used to decrease acute postoperative confusion and delirium in elders undergoing elective hip and knee surgery.