stable.

When spinal anesthesia is used, the client

may be required to remain flat for a specified period.
POSTOPERATIVE PHASE
 Nursing during the postoperative phase is especially  The return of the client's reflexes, such as
important for the client's recovery because swallowing and gagging, indicates that
anesthesia impairs the ability of clients to respond anesthesia is ending. Time of recovery from
to environmental stimuli and to help themselves, anesthesia varies with the kind of anesthetic agent
although the degree of consciousness of clients will used, its dosage, and the individual's response to it.
vary. Moreover, surgery itself traumatizes the body Nurses should arouse clients by calling them by
by disrupting protective mechanisms and name, and in a normal tone of voice repeatedly
homeostasis. telling them that the surgery is over and that they
are in the PACU.
 The postoperative phase begins with the
admission of the client to the post-anesthesia POST-OPERATIVE CARE
area and ends when healing is complete.
Aldrete Score also known as the Post-anesthetic
 Is the time during the surgical experience that Recovery Score is used in PACUs to objectively
begins with the end of the surgical procedure and assess the physical status of clients recovering from
lasts until the client is discharged not just from the the anesthesia and served as a basis for discharge
hospital or institution, but from medical care by the from the PACU.
surgeon.  The first five items are used to discharge from the
PACU. Clients are assessed at the time of
 During the postoperative phase, nursing activities admission to the PACU and every 15 minutes until
include assessing the client's response discharge.
(physiological and psychological) to surgery, per  The first five items include assessing activity,
forming interventions to facilitate healing and respiration, consciousness, circulation, and color
prevent complications, teaching and providing (oxygen saturation). Each of the five items is
support to the client and support people, and scored from 0 to 2, according to the degree of
planning for home care. functional disturbance.
 The score is expressed as a total score, from the
 The goal is to assist the client to achieve the most PACU with 10 being the maximum. Interpretation
optimal health status possible. Also, it is directed of score:
toward prevention of complication and post-  "Score of 9 or greater allows patient to leave
operative discomfort. Post Anaesthetic Care Unit" for ambulatory
surgery:
IMMEDIATE POSTANESTHETIC PHASE  "Patients who score 9 or greater and have an
appropriate escort can go home."
 Recovery of surgical clients who required
anesthesia is performed in the PACU or RR. Aldrete Post-Anesthetic Recovery Score provide an
 During the immediate post-anesthetic stage, an objective scoring system to help in the discharge
unconscious client is positioned on the side, with decision-making process.
the face slightly down. A pillow is not placed Activity 2: Moves all extremities
under the head. In this position, gravity keeps the voluntarily/on command
tongue forward, preventing occlusion of the 1: Some weakness in
pharynx and allowing drainage of mucus or movement of extremities
vomitus out of the mouth rather than down the o: Unable to move
respiratory tree. extremities
 The nurse ensures maximum chest expansion by
elevating the client's upper arm on a pillow. The Respiration 2: Breathes deeply and
upper arm is supported because the pressure of an coughs freely
arm against the chest reduces chest expansion 1: Dyspneic, shallow or
potential. An artificial airway is maintained in place, limited breathing
and the client is suctioned as needed until cough (splinting)
and swallowing reflexes return. Generally the client o: Apneic
spits out an oropharyngeal airway when coughing
returns. Endotracheal tubes are not removed until Circulation 2: BP ± 20 mmHg of
clients are awake and able to maintain their own preanesthetic level
airway. The client is then helped to turn, cough, and 1: BP + 20-50 mmHg of
take deep breaths, provided that vital signs are preanesthetic level
o: BP + 50 mmHg of
 preanesthetic level Clients are usually discharged from the PACU when:
Consciousness 2: Fully awake
1: Arousable on calling •They are conscious and oriented.
o: Not responding •They are able to maintain a clear airway and deep
Oxygen Saturation 2: breathe and cough freely.
Maintains value > 90% •Vital signs have been stable or consistent with
on room air preoperative vital signs for at least 30 minutes.
Oxygen Saturation 1: Requires oxygen to • Protective reflexes (e.g., gag, swallowing) are active.
maintain value > 90% •They are able to move all extremities.
o: Value > 90% with • Intake and urinary output is adequate.
supplemental oxygen •They are afebrile or a febrile condition has been
attended to. Dressings are dry and intact; there is no
overt drainage