Clinical Procedures and Protocols Flashcards

A PACU patient receiving a remifentanil infusion intraoperatively now reports severe pain (9/10) within minutes of arrival. The most likely explanation is:

Answer: Opioid-induced hyperalgesia from remifentanil

Remifentanil is strongly associated with acute opioid-induced hyperalgesia upon cessation due to its ultra-short half-life and rapid offset, leading to heightened pain sensitivity.

A patient in the PACU develops shivering with a core temperature of 35.2°C. Which intervention is MOST effective for treating post-anesthetic shivering?

Answer: Administer meperidine 12.5–25 mg IV

Meperidine in low doses (12.5–25 mg IV) is the most effective pharmacologic treatment for post-anesthetic shivering due to its action on kappa opioid receptors.

A patient in the PACU has a urine output of 15 mL over the past hour following a 4-hour abdominal surgery. Blood pressure is 110/70 mmHg and HR is 88 bpm. The nurse should:

Answer: Assess for bladder distension and notify the provider if no improvement

Oliguria (<0.5 mL/kg/hr) in the PACU warrants assessment for bladder distension or urinary retention and prompt provider notification if not resolved.

When caring for a patient with a regional nerve block in the PACU, the nurse's primary neurovascular assessment should include:

Answer: Capillary refill, pulses, sensation, and motor function distal to the block

Neurovascular checks distal to a nerve block assess for vascular compromise or compartment syndrome by evaluating the 5 Ps: pain, pallor, pulselessness, paresthesia, and paralysis.

A patient with known obstructive sleep apnea arrives in the PACU after general anesthesia. Which positioning measure is MOST important?

Answer: Position the patient semi-upright (30–45 degrees) or lateral

Semi-upright or lateral positioning reduces upper airway collapse in OSA patients by decreasing the effect of gravity on oropharyngeal soft tissues.

A PACU nurse is preparing to administer ketorolac 30 mg IV for pain management. Which patient condition is a contraindication to this medication?

Answer: Estimated GFR of 25 mL/min/1.73m²

Ketorolac is contraindicated in renal impairment (GFR <30 mL/min/1.73m²) because NSAIDs can further reduce renal perfusion and precipitate acute kidney injury.

Which assessment tool is specifically recommended by ASPAN for evaluating post-operative nausea and vomiting (PONV) risk in PACU patients?

Answer: Apfel Simplified Risk Score

The Apfel Simplified Risk Score uses four predictors (female sex, non-smoker, history of PONV/motion sickness, postoperative opioid use) to quantify PONV risk.