A Post Anesthesia Care Unit or PACU is a critical care unit and specialty that focuses on the recovery and treatment of patients immediately following surgical procedures and anesthesia. PACU nurses are responsible for the recovery of the patient following their procedure and have a variety of knowledge and skills due to the wide range of patients seen in a PACU. Their main focus is monitoring and treating complications that may arise from the procedure and anesthesia. Here is an overview of this dynamic unit!
The PACU is a unique area of the hospital where patients go immediately after surgical procedures, or procedures requiring anesthesia, for recovery. It is usually adjacent to the OR suites and procedural areas. Patients arrive in this unit immediately postoperatively to be carefully monitored for any surgical complications or any complications as they recover from the effects of anesthesia. The PACU staff have the goal of stabilizing the patient postoperatively and safely recovering them for either transfer to an inpatient unit or their later discharge to home. They will monitor the patient’s surgical incision and dressing, treat pain and nausea, administer ordered medications such as antibiotics, ensure follow up labs or tests such as xrays are completed, and confirm floor orders are placed for the patient before transferring to an inpatient unit.
A very wide variety of postoperative cases are seen in the PACU, depending on the facility that you are working at! Any surgical cases, for the most part, will first come to the PACU for monitoring before being transferred to another unit- so PACU nurses see all different types of surgical patients! A PACU nurse can recover anything from very minor podiatric surgery, appendectomies, to craniotomies and orthopedic traumas, as well as patients of all ages, from infancy through adulthood, all in the same shift! This makes for some very exciting shifts! Nurses in a PACU may also recover patients who did not have surgery but required anesthesia, an example being patients who require anesthesia for an MRI. The PACU is a very versatile unit and no two days are ever the same! Nurses who chose this area usually enjoy the variety and challenges of such a versatile unit!
The PACU differs from other units in that patients are typically not remaining in the PACU for an extended length of time, making it very fast paced! Patient’s stay in this unit until they meet criteria for safe transfer or discharge. This could be anywhere from less than an hour to eight plus hours for major surgeries that involve complications. In addition, due to the effects of anesthesia- your patients may not even remember their time spent under your care in this unit! Nonetheless, the PACU plays a very important and integral role in any surgical patient’s hospital stay and recovery!
Complications can arise quickly in the postoperative period so it is important for a PACU nurse to be vigilant in their monitoring of the patient and that they are ready to intervene quickly! The goal of the PACU is to ensure the patient is stabilized post operatively before safely transferring the patient to their final unit or discharging home. The PACU staff has a rigid set of criteria they follow to ensure that the patient is adequately recovered, stabilized, and is safe to transfer. Any complications as well as a patient’s pain and nausea must also be under control and treated prior to being transferred to another inpatient unit or their final recovery stop prior to being discharged to home.
When a patient first arrives in PACU, they are hooked up to continuous monitors and the main priority of the nurse is maintaining the patient’s airway. Since they are still under the effects of anesthesia, a patient may still be intubated, have an oral or nasal airway in place, or require certain maneuvers to keep their airway patent. The anesthesiologist is responsible for giving a safe handoff report of the patient at this time, including a patient’s history and any complications that arose during the case. An initial set of vital signs helps the nurse to identify any potential complications that may require treatment. The nurse also conducts an initial assessment of the patient’s surgical site and dressing and receives a safe handoff from the OR nurse. Throughout the patient’s stay and recovery in PACU, the nurse will continue close monitoring for complications and assess and treat the patient for any pain or nausea they may be experiencing as a result of the procedure and anesthesia.
A PACU nurse typically sees patient ratios of 1:1 or 1:2. This allows for the careful monitoring needed during this important time in a patient’s recovery. It also allows for the nurse to be able to quickly identify any changes in the patient’s condition and intervene quickly should complications arise. Teamwork is very important in the PACU as the nurses often work together to treat complications. A PACU nurse must also have strong interdisciplinary communication in order to work with the surgical team and anesthesia closely in order to see best outcomes for the patients in their care.
PACU nurses oftentimes have diverse backgrounds from many different areas of the hospital and most PACU nurses have a critical care background. Because of the fast paced nature of the unit, nurses should be comfortable responding quickly to status changes of the patients and be prepared to learn a wide range of skills due the variety of surgical patients cared for each day!
There is no one path to becoming a PACU nurse but it is often important to have a critical care background! Nurses who are interested in working in PACU often begin in ICU positions and many places require you to have at least one year of critical care experience. PACU nurses must be BCLS certified but usually also require ACLS/PALS certification.
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