Critical care nursing clinics of North America
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In the last decade, nurses and physicians have increasingly recognized the importance of eliminating postoperative pain in speeding a patient's recovery after surgery. In an effort to improve postoperative pain management, many regional anesthetic techniques have been continued from the operating room to the recovery room, and into the intensive care and medical-surgical units. The methods have been shown to be superior to traditional modes of postoperative pain relief. ⋯ To provide optimum care, nurses must be well-versed in the different regional techniques employed and the drugs used with these techniques. They must recognize complications attributable to these procedures and the toxic potential of the local anesthetics and narcotics. Early detection of these complications is essential.
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This article has discussed the phenomena of postoperative delirium in the PACU. Common causes have been reviewed and treatment strategies have been presented. Postoperative delirium is a challenging patient care problem that can jeopardize postoperative recovery. The critical care nurse who is astute to the possible causes of postoperative delirium and to treatments and interventions required will help to minimize the morbidity associated with postoperative delirium.
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The assessment and management of a child's pain in the postoperative period remain a challenge to the PACU nurse. Assessment of pain in children is often difficult; ongoing clinical research in this area continues to expand knowledge of how to improve children's communication of their pain to caregivers. Many pain management strategies are available, both pharmacologic and nonpharmacologic, to ease pain and distress postoperatively. Through understanding and knowledge of pain, its assessment and its management, the PACU nurse contributes positively to the child's surgical experience.
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Sophisticated practice modalities, advances in technology, and the increase of sicker and older patients undergoing surgery mandate an expansion of all PACU nurses' skill and knowledge base. Invasive hemodynamic monitoring, as well as the quantitative assessment of cardiovascular function that it provides, is both feasible and necessary as an adjunct tool in today's PACU. Hemodynamic monitoring should be used only when a specific management decision is being considered and when the physician is committed to act on the data obtained. Once instituted, it is the nurse's responsibility to care for the patient safely and provide accurate and reliable data for collaborative assessment.
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The use of PCA for the treatment of pain is a valuable and growing practice. The technique for PCA initiation and management has been described. This mode of therapy should be in the therapeutic armamentarium of every clinician managing postoperative pain because PCA provides better analgesia than conventional IM or IV narcotic therapy and is generally associated with fewer side effects.