Nursing Contribution to Patient Recovery from Anesthesia - Essay Example

 I will fulfill this objective by using a case study of the Driscoll (1994) model of reflection to aid logical flow on a patient in a post anaesthetic care unit (PACU). From the case study, I will demonstrate how I applied my understanding of anatomy and physiology in relation to airway management. Among the various aspects of practice in relation to the care of post anaesthetic patients in the PACU environment, I will mainly major on applying specialist knowledge in the assessment, planning, implementation and evaluation of the preoperative patient in recovery. Ideally, this will ultimately enable me to develop an explicit understanding of psychological, social and cultural influences affiliated with patient care in PACU and how to manage them as well as any other possible outcomes. Adhering to the code of professional conduct of the Nursing and Midwifery Council (2008), I will maintain patient privacy and confidentiality, by referring to the patient in this essay as Ben. Ben is a 65 year old male patient who presented himself on the day care unit for a routine cystoscopy procedure. On pre-assessment, no allergies were detected but he had a medical history of hypertension and hip replacement surgery. His baseline observations on admission were as follows: BP 170/95, HR 70, Temp 36.4, RR 14, SPO2 97%. I ensured that the recovery unit where Mr. Smith was going to recover from was well equipped with the following equipment: suction, oxygen supply, IV stands, yankauer suckers, intubation equipment, oxygen saturation monitors, CO2 monitors, other invasive monitors in relation to airway management. I also checked the tilt bed mechanism to ensure that it was in good working condition should the need to use this equipment arise during recovery (Sdrales, Miller, and Stoelting, 2011). The other important equipment checked includes automatic blood pressure monitors, CVP, ECG, the Cardiac Trolley and the Bair Hugger™ for warmth. This was in accordance with the hospital policy (2012) as supported in the work of Fraulini (2007). Following a successful transfer of Ben into the recovery area post-op from theatre, I checked his body temperature, introduced myself and explained that I was waiting for the hand-over from the theatre staff. As per the post operation instructions, the anesthetist handed over the drugs used in theatre and then the scrub nurse briefed me on the progress of Ben. General anesthesia is known to significantly affect the behavioral responses of individuals which are considered as imperative in normal thermoregulation such as shivering or vasoconstriction. This occurs due to the combination of drugs administered during anesthesia which affects the anaesthetized patients by hampering their ability to respond to the degree or extent of pain suffered by them (Woodhead and Wicker, 2005). Pain assessment tools are particularly useful in cases of assessing the extent and degree of pain in highly complicated and chronic illnesses such as cancer (Breivik et al, 2008). Poorly managed pain attracts the risk of legal action among clinicians and results in a series of psychological responses such as anxiety and depression among the patients and their families. Pain is reportedly inadequately managed and continues to be so in various hospitals across the U.S. The under treatment of pain is one of the key concerns among the healthcare providers. Statistics suggest that almost eighty per cent of surgical patients in the U.S. reported to have experienced varying degrees of pain, ranging from moderate to severe, post surgery. This included patients of chronic illnesses such as cancer as well as elderly patients (Hughes, 2008). From the response that Ben provided, I inferred that he had only minimal pain. This is because Ben provided scores of zero to 3 and not more than that. I went ahead and performed a comprehensive examination using the ABCDE approach. The second goal is to disintegrate as much as possible the otherwise complex clinical procedures into smaller chunks. Thirdly, the technique is used as an algorithm for assessment as well as treatment. The fourth goal for ABCDE is the establishment of some middle ground of the awareness of the issue at hand for all the health practitioners that are involved in restoring the health and wellbeing of the patient. Lastly, this technique is supposed to lead to the accurate diagnosis and treatment of a patient. However, if the patient has already undergone treatment like is the case with Ben, the technique is used for the purposes of assessment of the progress of the patient. Further observation of Ben yielded the following results: BP 90/61, SPO2 98%, Heart rate 90, Temperature 36.5, Respiratory rate 14 which was different from his baseline observations; in that he had a decline in his blood pressure. This prompted me to further conduct an analysis on the following: Airway: was patent without signs of obstruction. Breathing: was monitored through the blood pressure monitors in intervals of five minutes, and was found to be satisfactory. Circulation: through monitoring of Ben’s peripherals i.e. fingernails, lips and overall Skin color; and were all pink indicating good overall blood circulation. He was then commenced on IV infusion to raise his BP (Barash et al., 2009). To aid cerebral blood flow, the Bed head down tilt approach was adopted ( McLeod, McCartney, and Wildsmith, 2012) Further monitoring of the BP was done using the Blood Pressure Automatic Monitor. On recording, there was significant improvement to BP 140/75. Disability: at this stage, the A, B, C levels are revisited and Ben’s SBP had shown signs of improvement after half an hour. To ensure that all areas of this care were covered, I performed an AVPU (Alert, responsive to Voice, responsive to pain, Unresponsive to stimuli) neurological assessment and then did a blood sugar test to ensure that the patient wasn’t suffering from hypoglycaemia At every stage of intervention, I ensured that Ben was reassured and informed of what I was doing and that I gained consent prior every nursing or medical intervention. Further monitoring of Ben documented a decrease in BP which resulted in me notifying both the anaesthetist and fellow health care professionals present on the unit at the time. The anaesthetist consequently prescribed some IV fluids to be administered immediately in order to restore fluid balance and then monitored for another hour to ensure cardiovascular stability. His blood pressure improved significantly and was charted after every fifteen minutes until it was back to his baseline after completion of the IV course. He was reassessed by the anesthetist and having met the ABCDE discharge criteria, observations remained stable and he was awake, alert and pain free; he was discharged from PACU and transferred to the discharge unit. During the recovery process, I was prepared and well informed of the various complications that may occur at this stage following surgery of this nature. However, I was nervous but received adequate support from fellow workers during the patients stay. Throughout Ben’s care in recovery, I maintained safe practice bearing in mind the importance of practicing within my limitations as suggested by the NMC code (2008). The patients, who care still under the influence of anesthesia and under recovery, are required to be transferred to the post anesthesia care unit, more popularly referred to as the PACU. The nurses in charge of the patients are required to review all the vital information related to the patients and conduct an immediate assessment. The patients are expected to be cared for by the nurses until they have completely recovered from the effects of anesthesia and their health is stabilized as is indicated by the effective resumption of their sensory functions and vital signs. It is imperative to ensure that the care is extended until the patient is cleared of all concerns such as signs of hemorrhage and other similar complications (O'Connell et al., 2010). In delivering care for Ben, there was adequate support from the team during the incident which in return boosted my confidence in administering the IV fluids prescribed. However, I needed to ensure this was done in a safe manner and that patient was made aware of what was going on and that consent was gained prior to administration in accordance with the guidelines laid out by the NMC code of professional conduct (2008). The Royal College of Nursing (2011) also agrees that all health care professionals should practice informed consent at all times to further ensure patient safety and choice in health. In addition to this, I asked a colleague to check the IV which had been prescribed by the anaesthetist in order to avoid making a drug error seeing; as the situation at hand made me feel under pressure. This has helped me to improve my own practice and also informed my practice on how to act promptly and professionally. According to Nursing Times (2008) double checking of medicines is commonplace and is thought to reduce errors. In caring for Ben, I used Hartmans Solutions to manage his hypovolaemia in accordance with evidence-based practise, Bench and Brown (2011). Ben’s core temperature was checked using the tympanic approach to ensure that he wasn’t hypothermic and it appeared to be normal. Ayres (2004) states that, “older patients are continually at high risk of hypothermia.” Therefore, an understanding of the specific disease prevalent in old age coupled with knowledge of the physiological impact of ageing in all body systems, underpins the role of the anaesthetic nurse”. In addition, ArcMesa Aducators (2012) new onset of hypotension in the recovery area is almost a sign of drug overdose or interaction, hypovolaemia or blood loss. Curry, et al (2006) agrees that patients who are male, older or have undergone surgery under general anesthesia or any other form of sedation are likely to experience hemodynamic instability at recovery stage, hence need closer monitoring as they are likely to decline and experience one or more of the following: nausea, hypoxemia, hypotension, hypothermia, respiratory complications. I also improved my clinical skills in caring for Ben as he was the first patient that was presented with such prognosis and also administered fluids using evidence based practice in order to ensure that care was not compromised in any way. The American Society of Anesthesiologist (2004) published guidelines for PACU to follow. Some of the suggestions include; the presence and supervised care of patients in the PACU by an anaesthetist, maintaining full records of all measurements and events during the patients stay in the unit, monitoring of the patients breathing, blood oxygenation, circulation and temperature and recording using numerical scales to chart this. The Royal College of Anaesthetists (2010) also agrees with these highlights in its framework that all doctors practicing anesthesia, critical care and pain management have a primary duty to provide the best care of patients that they can, whether they practice as consultants, non-consultant career grade doctors or trainees, and whether in the National Health Service or in the independent sector. I followed these suggestions fully, thereby ensuring my practice was safe and in the patients best interest at all times. According to Sackett et al (1996) cited in NIHCE (2005) evidence based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. This means integrating individual clinical expertise with the best available clinical evidence from systemic research. I ensured that the patient received sufficient oxygen supply, thereby avoiding the possibility of hypoxemia. Woerlee (2009) states that anesthesia can have an effect of mild to severe hypoxia on the brain, therefore it’s crucial that the patient’s saturations SPO2 levels are monitored closely pre and post operatively. Hamlington (2009) also agrees that all patients who have had a general anaesthetic should have oxygen administered. I also monitored his heart rate with an ECG monitor to ensure that Ben was not at risk of experiencing a right ventricular infarction as one of the clinical trials used to describe its manifestation of hypotension (O’Donnovan, 2012). This was monitored alongside Ben’s respiratory rate. Massey and Meredith (2010) stipulate that respiratory assessment helps to identify problems in patients and can influence early nursing and medical interventions if the need arises. The Royal College of Nursing (2005) suggests that nurses should make additional observations indicated by patient’s condition and according to your local hospital policy as this can improve practice and also avoid adverse incidence occurring this promoting patient safety. I was satisfied that I have achieved this competently. The NMC code of conduct suggest that health care professionals must maintain a Continuous Professional Development Portfolio hence keeping their practice up to date throughout their working like NMC (2008). NICE Guidelines (2007), guidelines on how to change practice, also stipulates that health care professionals can overcome barriers in practice by keeping their knowledge and skills update which is return ensures safer practice in patient care. Overall, the recovery practice has challenged me to continue to maintain professionalism as a health professional by keeping up my knowledge and skills up to date and delivering care to patients using evidence based practice by adopting a ‘’think before you do’’ approach. However in comparison to my colleagues, I feel that there is still need for improvement in areas such as my confidence in dealing with sudden issues that may arise in this particular area. However, I know this will improve on more experience in this critical area. I feel strongly that my colleagues managed the situation well as they have had more years of experience than I do. Burnard (2002) suggest that a learner is a passive recipient of received knowledge, and that learning through activity engages all of our senses. Reflecting on this experience has further improved my skills and also enlightened me on how continuous practice of reflecting can help inform my professional practice as a recovery nurse. It has been extremely stimulating and informative. Conclusion I have been able to discuss the care of a patient in PACU whilst also demonstrating how I applied an understanding of homeostasis which underpins preoperative care in the PACU environment. My understanding of anatomy and physiology in relation to the ABCDE approach was also demonstrated in this process and various aspects of practice in relation to the care of post anaesthetic patients in the PACU environment was discussed. The tool of reflection was very helpful as this provided a systematic approach in being able to effectively write this essay as well as reflect in a holistic manner. Bulman and Schutz (2008) stipulates that in order for a health professional to nurture and retain their passion on practice, a reflective model is a good tool to use as it encourages the practitioner to explore his or her experiences in everyday nursing. Sharples (2009) also concurs with this suggestion. 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