b. Patients are concentrated in a limited area to make it possible for one nurse to
give close attention to two or three patients at the same time. Each patient unit has a
recovery bed equipped with side rails, poles for IV medications, and a chart rack. The bed
is easily moved and adjusted. Each unit has outlets for piped-in oxygen, suction, and
blood pressure apparatus. The following are nursing implications for the general care of a
patient in the recovery room:
(1) Maintain proper functioning of drains, tubes, and intravenous infusions.
Prevent kinking or clogging that interferes with adequate flow of drainage through
catheters and drainage tubes.
(2) Monitor intake and output precisely, to include all Intravenous fluids and
blood products, urine, vomitus, nasogastric tube drainage, and wound drainage.
(3) Observe and document the patient's level of consciousness. The return of
central nervous system function is assessed through response to stimuli and orientation.
Levels of consciousness return in reverse order: unconscious, responds to touch and
sound, drowsy, awake but not oriented, and awake and oriented. Specific criteria is
usually used for categorizing the recovery room patient.
(a)
Comatose -- unconscious; unresponsive to stimuli.
(b)
Stupor -- lethargic and unresponsive; unaware of surroundings.
(c)
Drowsy -- half asleep, sluggish; responds to touch and sounds.
(d)
Alert -- able to give appropriate response to stimuli.
(4) Implement safety measures to protect the patient. Keep the side rails
raised at all times. Assure that the patient is positioned so that he is not tangled in or
laying on IV or drainage tubes. Do not use a head pillow while the patient is unconscious,
or for eight hours if the patient had spinal anesthesia. Turn the patient's head to one side
when he is in the supine position so that secretions can drain from the mouth and the
tongue will not fall into the throat to block the air passage. When the patient is alert, show
him how to use the call bell and place it where it is readily available.
(5) If the patient had a spinal anesthetic, observe and report any feeling or
spontaneous movement. Movement usually returns before feeling. Movement returns in
the patient's toes first, and moves upward. As the anesthesia wears off, the patient will
begin to have sensation often described as "pins and needles." Spinal anesthesia wears
off slowly. Keep the patient in a supine position for six to eight hours to prevent spinal
headache. Turn the patient from side to side and prop up with pillows for a few minutes to
relieve pressure on the back, but only if permitted by the doctor.
(6) Prevent nosocomial infections. Wash your hands before and after working
with each patient. Maintain aseptic technique for incisional wounds. Turn the patient
MD0906
8-21
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