Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses
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Hospitals and ambulatory surgery centers may choose to voluntarily apply for accreditation from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Accreditation Association for Ambulatory Health Care (AAAHC), or the American Association for the Accreditation of Ambulatory Surgical Facilities (AAAASF) as appropriate. The facilities must comply with written standards regarding the environment of care, the provision of care, and the quality of care. Regular surveys of the organization's performance by the accrediting agency are intended to ensure the quality of care provided to the patients entrusted to our care. ⋯ Perianesthesia nurses should have an understanding of the regulatory agencies that influence daily patient care. This article provides an overview of the 3 accrediting bodies: JCAHO, AAAHC, and AAAASF. These agencies are committed to improving safety by providing standards of care, survey evaluations, and professional consultative and educational services, and they have an important role in our health care environments.
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Traditionally, the role of the PACU nurse has been to evaluate patient readiness for extubation, with the responsibility of tracheal extubation performed by the anesthesiologist or Certified Registered Nurse Anesthetist (CRNA). In our PACU, registered nurses routinely evaluate and extubate the majority of surgical cases. Our experience has shown that extubation by the PACU nursing staff improves airway management skills without compromising patient safety and facilitates OR turnover time. In this article, tracheal extubation performed by PACU nurses is detailed and a case study is presented.
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J. Perianesth. Nurs. · Dec 2002
ReviewA systematic approach to the management of postoperative nausea and vomiting.
Postoperative nausea and vomiting (PONV), a common complication after anesthesia and surgery, often results in delayed discharge with the patient's unpleasant symptoms continuing at home. To effectively prevent and treat PONV, it is important to understand the factors implicated in PONV, the mechanisms of PONV, the pharmacology of the antiemetic agents, and the nonpharmacologic measures that have been shown to be effective. The cause of PONV is likely to be multifactorial, with important predictors being female gender, history of PONV, and history of motion sickness. ⋯ Transdermal scopolamine and dexamethasone have a role in the prevention of PONV, particularly for certain high-risk patients. Nonpharmacologic measures and alternative treatments such as hydration, maintaining blood pressure, acupressure techniques, trancutaneous acupoint stimulation, and isopropyl alcohol must not be overlooked. Finally, an evidence-based algorithm for the prevention and treatment of PONV in adults is presented.
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J. Perianesth. Nurs. · Dec 2002
ReviewAcute postoperative delirium: definitions, incidence, recognition, and interventions.
Emergence excitement or delirium is a common postanesthesia complication. Often, the emergence excitement resolves quickly, and the patient's continued recovery is uneventful. Although the initial period of excitement may be short lived and resolve without long-term sequela, some patients may experience acute postoperative delirium, a phenomenon that is more difficult to assess and of potentially longer duration. ⋯ Patients at risk present in ambulatory surgery centers and inpatient perianesthesia settings daily. Identification of at-risk patients is crucial to avoiding the development of delirium in the acute postanesthesia care setting. The purpose of this selective review is to define acute postoperative delirium and its incidence, discuss assessment and recognition, describe interventions, and identify future considerations related to this phenomenon.