PeriAnesthesia Nursing Core Curriculum: Preprocedure, Phase I and Phase II PACU Nursing

Front Cover
IFC
PeriAnesthesia Nursing Core Curriculum: Preprocedure, Phase I and Phase II PACU Nursing
Copyright
Dedication
Contributors
Reviewers
Foreword
Preface
Acknowledgments
Contents
ONE -
Professional Competencies
	1 - Evolution of Perianesthesia Care
		I. Early Beginnings
		II. Acceptance and Decline of Recovery Rooms
		III. Ambulatory Surgery Focus
		IV. Emergence of Organized Recovery Room Groups
		V. First years (October 1980 to April 1982)
		VI. ASPAN Developments
		Bibliography
	2 - Standards, Legal Issues, and Practice Settings
		I. Definition of Standard
		II. Evolution of Nursing Standards
		III. Sources of Standards
		IV. Standard Criteria
		V. ANA Standards of Nursing Practice
		VI. Agency for Healthcare Research and Quality (AHRQ)
		VII. 2019–2020 Perianesthesia Nursing Standards, Practice Recommendations, and Interpretive Statements
		VIII. Competency-Based Practice
		IX. Ethical Issues
		X. Legal Concepts
		XI. Liability Issues
		XII. Legal Process
		XIII. Issues of Consent
		XIV. Policies and Procedures
		Bibliography
	3 - Safety, Quality Improvement, and Regulatory and Accrediting Agencies
		I. Workplace Definitions
		II. ASPAN Safety Goal, Culture of Safety Characteristic, and Safety-Related Position Statements
		III. Advocacy Organizational and Regulatory Patient Safety Resources
		IV. Patient Safety Tools and Resources
		V. Perianesthesia Nursing Implications and Approach to Data Management for Analysis
		Bibliography
	4 - Research and Evidence-Based Practice
		I. Definition of Evidence-Based Practice (EBP)
		II. Goal of EBP
		III. Stimuli for EBP Initiatives
		IV. Steps of EBP
		V. Developing an Evidence-Based Culture
		VI. Definition of Nursing Research
		VII. Goals of Perianesthesia Nursing Research
		VIII. Objectives of Perianesthesia Nursing Research
		IX. Developing and Planning a Research Study
		X. Components of a Research Proposal
		XI. Ethical Issues in Nursing Research
		XII. Providing and Analyzing Results of a Research Study
		XIII. QI and the Research Process
		XIV. Disseminating Research Findings
		XV. Professional Responsibility for EBP and Research
		Bibliography
TWO -
Preoperative Assessment Competencies
	5 - Preoperative Evaluation
		I. Timing of Preoperative Assessment
		II. Purpose of Preoperative Assessment and Programs
		III. Benefits of a Preoperative Assessment Program
		IV. Types of Preoperative Assessments and Programs
		V. Importance of Preoperative Assessment
		VI. The Nursing History and Physical Examination
		VII. Psychosocial Assessment
		VIII. Diagnostic Assessment
		IX. Scheduling Surgery
		X. Patient Types
		XI. Day of Surgery: General Preparation
		XII. Regulatory (see Chapter 3)
		Bibliography
	6 - Preexisting Medical Conditions
		I. Preexisting Medical Conditions
		II. Cardiovascular Diseases (see Chapter 19)
		III. Pulmonary Diseases (see Chapter 18)
		IV. Renal Diseases (see Chapter 25)
		V. Liver Diseases (see Chapter 22)
		VI. Neuromuscular, Skeletal, Connective Tissue Diseases (see Chapters 8, 20, and 29)
		VII. Endocrine Diseases (see Chapter 21)
		VIII. Hematologic Diseases (see Chapter 24)
		IX. Infectious Diseases
		X. Substance use Disorder (see Chapter 17)
		XI. Obesity (see Chapter 33)
		Bibliography
	7 - Transcultural Nursing and Alternative Therapies
		I. Definitions of Culture, Transcultural, and Complementary
		II. Major World Views of Health and Illness
		III. Major Sectors of Health Care
		IV. Traditional Healers
		V. Cultural Nursing Assessment
		VI. Health Habits
		VII. Cultural Beliefs
		VIII. Key Cultural Communication Techniques
		IX. Nutrition and Culture
		X. Spiritual and Religious Needs
		XI. Current Utilization of CTs
		XII. Overview of Selected CTs
		XIII. Gender Diversity
		XIV. Preoperative Assessment of Perianesthesia Patients
		XV. Perianesthesia Nursing Considerations
		Bibliography
	8 - The Developmentally and Physically Challenged Patient
		I. Overview
		II. The Developmentally Challenged Patient
		III. Alzheimer Disease
		IV. Hearing Impairment
		V. Vision Impairment
		VI. Speech Impairment
		VII. Spinal Cord Injury (SCI; see Chapter 20)
		VIII. Traumatic Brain Injury (TBI)
		IX. Parkinson Disease (PD; see Chapter 6)
		X. Multiple Sclerosis (MS; see Chapter 6)
		XI. Myasthenia Gravis (MG; see Chapter 6)
		XII. Autism Spectrum and Intellectual Disorders in the Pediatric Patient
		XIII. Pediatric Motor/Neurological Disabilities
		Bibliography
THREE -
Life Span Competencies
	9 - The Pediatric Patient
		I. Classification of Pediatric Patients by Age
		II. Growth and Development Overview (Box 9.1)
		III. Anatomy and Physiology Considerations
		IV. Stressors
		V. Family-Centered Care
		VI. Phases of Perioperative Care for Pediatric Patient
		VII. Preoperative Teaching
		VIII. Preoperative Phase
		IX. Intraoperative Treatment
		X. PACU
		XI. Discharge (Box 9.17)
		Bibliography
	10 - The Adolescent Patient
		I. Classification By Age
		II. Growth and Development (Table 10.1)
		III. Adolescent Response to Surgery and Hospitalization
		IV. Family-Centered Care
		V. Phases of Perioperative and Procedural Care for the Adolescent Patient
		VI. Postprocedural Considerations for Adolescents (see Chapters 36 to 38)
		Bibliography
	11 -
The Adult Patient
		I. Definitions
		II. Stages of Adulthood
		III. Health, Wellness, and Illness
		IV. Health and Illness Behavior
		V. Stress Response Syndrome
		VI. Stress Management
		VII. Health Promotion and Prevention
		VIII. Preoperative Health History Interview (see Chapter 5)
		IX. Health Teaching-Learning(see Chapter 38)
		Bibliography
	12 - The Geriatric Patient
		I. Overview
		II. Definition of Geriatric or Older Adult
		III. Theories of Aging
		IV. Physiological Changes of Aging: Changes in Both Structure and Function
		V. Psychosocial Consideration for the Elderly
		VI. Elder Abuse (Usually Related to Family or Other Caregiver)
		VII. Pharmacologic Alterations in Aging
		VIII. Considerations Before Surgery (Box 12.1)
		IX. Intraoperative Considerations for the Older Adult
		X. Anesthetic Options for Older Adult Patient (see Chapter 14)
		XI. Postanesthesia Priorities for the Older Adult Patient in Phase I (Box 12.2)
		XII. Postanesthesia Phase II and Extended Observation Phase (see Chapter 37)
		Bibliography
FOUR -
Perianesthesia Competencies
	13 - Fluid, Electrolyte, and Acid-Base Balance
		I. Fluid and Electrolyte Balance Overview
		II. Body Fluid Distribution
		II. Physiological Particle (Solute) Distribution
		IV. Hormonal Regulators of Blood Volume
		V. Fluid and Electrolyte-Related Perianesthesia Issues
		VI. Fluid Imbalances (Box 13.2)
		VII. Acid-Base Concepts: Physiology of Chemical Balance
		VIII. Primary Acid-Base Imbalance
		IX. Mixed Acid-Base Imbalances
		X. Physiological Compensation of Acid-Base Imbalances
		XI. Interpreting ABGs
		Bibliography
	14 - Anesthesia, Moderate Sedation/Analgesia
		I. Sedation: A Continuum (Table 14.1)
		II. Presedation Assessment
		III. Procedural Care
		IV. Airway Management and Management of Respiratory Complications
		V. Moderate Sedation, Pharmacological Agents
		VI. Recovery After Moderate Sedation
		VII. Moderate Sedation Risk Management
		VIII. Pharmacokinetics and Pharmacodynamics of Sedation and Anesthetic Agents
		IX. Stages of Anesthesia
		X. Local Anesthesia Options
		XI. Regional Techniques
		XII. Anesthetic Induction Agents
		XIII. Opioid Anesthetics
		XIV. Anesthetic Adjuncts
		XV. Volatile Inhalational Anesthetics
		XVI. Gaseous Inhalational Anesthetic: Nitrous Oxide (N2O)
		XVII. Nondepolarizing Muscle Relaxants (NDMRs)
		XVIII. Depolarizing Muscle Relaxants (DMRs) (Succinylcholine)
		XIX. NDMRs Reversal Agents: Anticholinesterases
		XX. NDMRs Reversal Agents: Sugammadex
		Bibliography
	15 - Thermoregulation
		I. Basic Terms and Definitions
		II. Thermoregulation Physiology
		III. Perioperative Thermoregulation
		IV. Planned Perioperative Hypothermia
		V. Unplanned Perioperative Hypothermia
		VI. Malignant Hyperthermia
		Bibliography
	16 - Postoperative/Postdischarge Nausea and Vomiting
		I. Definitions
		II. Consequences of PONV or PDNV
		III. Etiology of PONV and PDNV
		IV. Incidence of PONV and PDNV
		V. Risk Factors for PONV
		VI. Assessment of PONV
		VII. PONV Plan
		VIII. Prophylactic Interventions
		IX. Rescue Interventions
		X. Complementary Therapies
		XI. Pediatric PONV Therapy Considerations
		XII. PONV/PDNV Nursing Interventions
		XIII. Documentation
		Bibliography
	17 - Pain and Comfort
		I. Pain
		II. Comfort
		III. Pain and Comfort Management
		Bibliography
FIVE -
System Competencies
	18 - Respiratory
		I. Respiratory Anatomy and Physiology
		II. Respiratory Assessment
		III. Respiratory Pathophysiology
		IV. Pulmonary Diagnostic and Surgical Procedures
		V. Postanesthesia Respiratory Care
		Bibliography
	19 - Cardiovascular
		I. Cardiac Anatomy and Physiology
		II. Vascular Structure and Function (Fig. 19.3)
		III. Foundations of Tissue Oxygenation
		IV. Pathologies: Congenital Heart Disease (CHD; Box 19.1)
		V. Coronary Artery Disease
		VI. Myocardial Infarction (MI)
		VII. Valvular Heart Disease
		VIII. Other Acquired Diseases
		IX. Assessment and Management
		X. Rhythm Monitoring
		XI. Goals of Hemodynamic Monitoring
		XII. Physiological Variables Affecting Cardiac Function
		XIII. Hemodynamic Evaluation of Cardiac Function
		XIV. Limitations of Hemodynamic Monitoring
		XV. Concepts of Pressure Monitoring
		XVI. Arterial Pressure Monitoring (Arterial Line)
		XVII. CVP Monitoring
		XVIII. PA Pressure Monitoring Via PA Catheter
		XIX. Cardiac Output Measurement
		XX. SvO2
		XXI. Cardiovascular Operative and Invasive Procedures
		XXII. Cardiac Complications (see Chapters 31 and 36)
		XXIII. PACU Admission (Phase I)
		XXIV. Immediate Patient Management
		Bibliography
	20 - Neurological
		I. Anatomy and Physiology of the Central Nervous System (CNS)
		II. Anatomy and Physiology of the Spine and Spinal Cord
		III. Anatomy and Physiology of the Peripheral Nervous System
		IV. Assessment
		V. Dynamics of ICP
		VI. Neurological Complications
		VII. Diagnostic Tools
		VIII. Disorders Potentially Requiring Surgical Intervention
		IX. Selected Operative Procedures
		X. Disorders Potentially Requiring Spinal Surgery
		XI. Common Spinal Operative Procedures
		XII. Other Outpatient Procedures
		XIII. Postanesthesia Care for Spinal Surgery
		Bibliography
	21 - Endocrine
		I. Hypothalamus (Fig. 21.1)
		II. Pineal Gland (see Fig. 21.1)
		III. Thymus (see Fig. 21.1)
		IV. Thyroid Gland
		V. Parathyroid Glands (see Figs. 21.1 and 21.2)
		VI. Pituitary Gland (see Fig. 21.1)
		VII. Adrenal Glands (see Fig. 21.1)
		VIII. Diabetes Mellitus in the Surgical Patient
		IX. Pancreas Transplantation and Pancreatectomy (see Chapter 22)
		X. Reproductive Glands (see Fig. 21.1)
		Bibliography
	22 - Gastrointestinal
		I. Anatomy and Physiology
		II. Pathophysiology
		III. Diagnostic Tests or Procedures
		IV. Intraoperative Concerns
		V. GI Operative Procedures
		VI. General Postanesthesia Care Concerns
		Bibliography
	23 -
General Surgery
		I. Overview
		II. Breast
		III. Gallbladder
		IV. Spleen
		V. Esophagus-Stomach
		VI. Appendix
		VII. Intestine
		VIII. Anal-RectalDisorders
		IX. Hernias
		X. Thyroid Gland and Parathyroid Gland (see Chapter 21)
		XI. Lymph nodes
		XII. Skin
		XIII. Minimally Invasive Surgery/Robotic Surgery
		Bibliography
	24 - Hematology
		I. Overview
		II. Perianesthesia Issues Related To Hematology
		III. Hematology Components: Blood Cells and Clotting Factors
		IV. Coagulation: A Chain of Events To Ensure Hemostasis
		V. Transfusion Physiology: Blood Cell Compatibility
		VI. Administering Blood and Blood Products
		Bibliography
	25 - Renal/Genitourinary
		I. Genitourinary System Anatomy
		II. Adult Male Anatomy
		III. Adult Female Anatomy
		IV. Renal Physiology
		V. Pathophysiology
		VI. Assessment
		VII. Nursing Diagnosis
		VIII. Renal Surgery
		IX. Genitourinary Surgery
		X. Laparoscopy
		Acknowledgment
		Bibliography
	26 - Obstetrics and Gynecology
		I. Anatomy and Physiology
		II. Congenital and Anatomical Abnormalities
		III. Physiological Changes of Pregnancy
		IV. Pregnancy Complications
		V. Assessment of Fetal Well-Being
		VI. Obstetric Anesthesia/Analgesia
		VII. Postpartum Care
		VIII. Diagnostic or Preoperative Evaluation
		IX. Gynecological Operative Procedures
		X. Nursing Priorities
		XI. Postanesthesia Priorities
		Bibliography
	27 - Ophthalmology
		I. Anatomy and Physiology of the Eye (Fig. 27.1)
		II. Preoperative Considerations
		III. Common Ophthalmic Surgical Procedures
		IV. Anesthetic Considerations
		V. Drugs Frequently Used for Ophthalmological Surgery (Table 27.1)
		VI. Postoperative Considerations
		VII. Possible Complications of Ophthalmic Surgery
		Bibliography
	28 - Oral/Maxillofacial/Dental
		I. Overview
		II. Anatomy and Physiology
		III. Preanesthesia Assessment and Parameters Specific to Procedures
		IV. Intraoperative Priorities
		V. Postanesthesia Priorities
		VI. Common Operative Procedures (see also Chapters 30 and 32)
		Bibliography
	29 - Orthopedics and Podiatry
		I. Anatomy and Physiology
		II. Pathophysiology of the Musculoskeletal System
		III. Common Therapeutic Devices
		IV. Assessment Parameters
		V. Complications Common To Orthopedics
		VI. The Perianesthesia Experience
		VII. Common Operative Procedures
		VIII. Types of Orthopedic/Podiatric Surgery (Table 29.1)
		IX. Regional Anesthesia for Surgery
		X. Enhanced Recovery After Surgery (ERAS)
		Bibliography
	30 - Otorhinolaryngology
		I. Anatomy and Physiology
		II. Pathophysiology
		III. Assessment
		IV. Procedures
		Bibliography
	31 - Peripheral Vascular Disease
		I. Anatomy and Physiology
		II. Pathophysiology
		III. Diagnostic Assessments
		IV. Perioperative Assessments
		V. Procedures
		VI. PACU Nursing Interventions for Specific Vascular Procedures
		VII. Patient and Family Discharge Education (see Chapters 37 and 38)
		Bibliography
	32 - Plastic and Reconstruction
		I. Overview
		II. Anatomy and Physiology
		III. Assessment
		IV. Perioperative Concerns
		V. Cosmetic Body Procedures (Box 32.1)
		VI. Cosmetic Breast and Chest Procedures
		VII. Cosmetic Head and Neck Procedures
		VIII. General Reconstructive Procedures (Box 32.2)
		IX. Breast Reconstructive Procedures
		X. Overview of Burns
		XI. Common Surgical Burn Procedures
		XII. Intraoperative Considerations for the Burn Patient
		XIII. Postoperative Concerns for the Burn Patient
		Bibliography
	33 - Bariatrics
		I. Overview
		II. Anatomy and Physiology of Digestion and Absorption
		III. Obesity
		IV. Bariatric Surgery
		V. Nursing Process
		Bibliography
	34 - Trauma
		I. Overview
		II. Prehospital
		III. Mechanism of Injury
		IV. Stabilization Phase
		V. Diagnostic Studies and Protocols
		VI. Collaborative Approach
		VII. Postanesthesia Care
		VIII. Shock in the Multi-
		Bibliography
	35 - Interventional Radiology and Special Procedures
		I. Overview
		II. Assessment
		III. Endoscopic Procedures
		IV. IR Procedures
		V. Vascular Procedures (see Chapter 31)
		VI. Electroconvulsive Therapy
		VII. Pulmonary Procedures
		Bibliography
	36 - Perianesthesia Complications
		I. Perianesthesia Setting
		II. Critical Postanesthesia Assessments (see Chapter 37)
		III. Airway Integrity (Box 36.2)
		IV. Cardiovascular Stability (Box 36.3 and see Chapter 19)
		V. GI Issues (see Chapter 22)
		VI. Neurological Concerns (see Chapters 20 and 37)
		VII. Thermoregulation (see Chapter 15)
		Bibliography
SIX -
Education and Discharge Competencies
	37 - Postoperative/Postprocedure Assessment
		I. Definitions
		II. Postanesthesia and Postprocedural Care Settings
		III. Pacu Phase I Care
		IV. Pacu Phase II Care
		Bibliography
	38 - Discharge Criteria, Education, and Postprocedure Care
		I. Discharge Criteria
		II. Length of Stay
		III. Discharge Scoring System
		IV. Phase I Discharge—Data Collected, Documented, and Evaluated; Consider Relevant Preoperative Status, Including But Not Limite...
		V. Phase II Discharge—Data Collected, Documented, and Evaluated
		VI. Documentation of Nursing Assessment Will Reflect Patient Met Discharge Criteria
		VII. Postanesthesia Scoring System (see Box 38.1)
		VIII. Provide Follow-
		IX. Patient Education
		X. Benefits of Patient and Family Education
		XI. Challenges of Discharge Instructions
		XII. Patient Education and Training
		XIII. Applying the Principles of Learning Allows the Professional Registered Nurse To Prepare an Effective Method of Teaching
		XIV. Assessment
		XV. Nursing Diagnosis
		XVI. Planning
		XVII. Implementation
		XVIII. Discharge Teaching: Side Effects of Specialized Anesthesia Medication (Selected)
		XIX. Postprocedure Follow-Up
		XX. Postprocedure Care/Extended Care/Ongoing Care
		Bibliography
A - Certification of Perianesthesia Nurses: The CPAN and CAPA Certification Programs
	I. Benefits of CPAN and CAPA Certification
	II. Sponsorship of CPAN/CAPA Certification Programs
	III. Certification of Perianesthesia Nurses
	IV. Definition of Certification
	V. National Accreditation of the CPAN and CAPA Certification Programs
	VI. CPAN and CAPA Certification Credentials
	VII. Eligibility Requirements
	VIII. Basis for Examinations: A Role-Delineation Study (Study of Practice)
	IX. Development of Examinations
	X. Description of CPAN and CAPA Examinations
	XI. Studying for the CPAN and/or CAPA Certification Examinations
	XII. The Application and Testing Process
	XIII. Certification Period: Recertification
	XIV. ABPANC Contact Information
	Bibliography
B - Testing Concepts and Strategies
	I. Testing Concepts
	II. Purposes of Testing
	III. Types of Questions/Items
	IV. Preparing to Take a Test
	V. Time Management Guidelines
	VI. Taking the Test
	VII. Take Home Points
	Bibliography
INDEX
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