Receiving another patient helped save my other patient...
Submitted by Stacey Kast, RN, BSN
Tags: elderly experiences nursing nursing experiences PACU
I started my day in the Post Anesthesia Care Unit (PACU). I work the 7a-7p shift. It was just another routine day. I received an 84yr old female patient Mrs. R from the Main Operating Room (OR) who had undergone a Left Shoulder Replacement. Mrs. R received an interscalene block for pain in the OR and had general anesthesia. Since she was elderly and was not having good tidal volumes at the end of the case anesthesia decided to keep her on the ventilator a bit longer until she woke up more. Having a patient come to PACU on a ventilator is not out of the ordinary for someone who is elderly. These patients sometimes need a little more time to wake up and get extubated.. When Mrs. R arrived into the PACU she was still sedated from anesthesia and had not woken up. Her vital signs were as follows: hear rate (HR) 86, respiration 12, blood pressure (B/p) 145/82, temperature (temp) 98.1 oral, oxygen (O2) saturation (sat) 100% on the ventilator. Upon her initial assessment everything was within normal for her type of surgery. After about 30min she started to wake up. She was able to follow commands and hold her head off of the bead for at least 10 seconds. I called anesthesia and she was extubated and place on 4 L NC (liters nasal cannula).
I continued the oxygen and decided to give her more time to wake up. After one hour passed; it was time to reassess. Again, everything was within normal, so I decided to wean her from her oxygen. I turned her oxygen to 2L NC meanwhile talking with her the whole time. Mrs. R was my only patient at the time and she was really friendly. After about another thirty minutes I turned her oxygen off and left her on room air. I continued to talk with her and she maintained her O2 sats 96-97%. Another half hour passed and I decided to call report to 7A. I hung up the phone and went over to Mrs. R and turned her monitor off and went to disconnect her wires when I received another patient in the next slot. I went over to my new patient to hook him up to the monitor, get vitals, take report and then returned over to Mrs. R to finish what I was doing. This amount of time had only been about three to five minutes. She had her eyes closed and was sleeping. I started to talk to her again and she did not respond to me. I tapped her shoulder and still no response. I tapped the monitor to turn it on since she was still connected and it showed HR 64, O2 sat 54%. I sternal rubbed her and grabbed a NonRebreather masked and applied 100% O2. She still did not respond. After applying the NonRebreather her sats came up to 100%. I notified anesthesia, and was told to continue to monitor her and keep her in the PACU for a few hours.
After about thirty minutes she was responding and answering my questions, maintaining her Sats so I placed her on 4L NC. Another thirty minutes went by and she was able to maintain her O2 sats so I decreased her oxygen to 2L NC. Report was updated to 7A about one hour later. Mrs. R went to floor with O2 @ 2L NC and apnea monitor overnight. I am really glad I received the other patient when I did and had not sent the patient upstairs at the time. I realize that she had been talking with me the whole time and her O2 sat stayed within normal limits. If she had gone to her room and fallen asleep, her Sat would have continued to drop and she would have coded.