1. How did the scenario make you feel?
I really enjoyed the scenario with patient Doris Bowman. Doris is a 39-year old
female who underwent a total abdominal hysterectomy with bilateral salpingooopherectomy. This is the removal of the cervix, ovaries, uterus, and fallopian tubes. She
tolerated t...
1. How did the scenario make you feel?
I really enjoyed the scenario with patient Doris Bowman. Doris is a 39-year old
female who underwent a total abdominal hysterectomy with bilateral salpingo-
oopherectomy. This is the removal of the cervix, ovaries, uterus, and fallopian tubes. She
tolerated the procedure well. Doris has an abdominal incision covered with a 4x4 gauze
dressing and there is no drainage. I was in charge of caring for Mrs. Bowman in the
PACU, which is where a patient remains until they recover from the effects of anesthesia,
is oriented, and has stable vital signs with no evidence of complications.
I started by checking Doris’s vital signs. When asked about pain she replied, “It’s
pretty bad, I’d give it a 6.” I then gave her a 2mg dose of Morphine. She immediately
started developing respiratory depression. Her breaths decreased from 21 to 8 breaths
per minute. I screamed for help, ventilation was started at a rate of 2, and she was
m
administered 0.2mg of naloxone IV. This is given to reverse the effect of the morphine.
er as
The ventilator was stopped when I saw Doris begin to breathe normally. This was the
co
eH w
appropriate thing to do.
o.
2. What further intervention would have been required if naloxone hydrochloride
rs e
(Narcan) had not been effective in this case?
ou urc
If the first dose of naloxone hydrochloride was not effective within 2-5 minutes.
Another dose should be given. Repeated doses may be necessary if a person is still
showing signs of overdose even after the first dose. Narcan will not hurt you- it only
o
affects people who are using opioids. Rescue breathing should also be done while
aC s
waiting for the naloxone to take effect. If a victim is not responsive to stimulation, not
vi y re
breathing, and has no pulse after receiving naloxone and rescue breathing, then the
victim needs cardiopulmonary resuscitation (CPR) via a trained bystander and the
emergency medical system.
ed d
ar stu
3. Discuss readiness for discharge from PACU criteria.
A patient remains in PACU until fully recovered from anesthetic agent. Indicators
of recovery include a stable BP, adequate oxygen saturation level and respiratory
is
function. The Aldrete Score is used to determine a patient’s general condition and
readiness for transfer from the PACU. During the recovery period, a patient’s physical
Th
signs are observed and evaluated by a scoring system. The patient is assessed at regular
intervals and a total score is calculated on the assessment record. The Aldrete score is
between 7 and 10 before discharge from the PACU. The patient is discharged from the
sh
phase I PACU by the anesthesiologist or CRNA to the critical care unit, med-surg unit,
phase II PACU, or home with a responsible adult.
Prior to discharge, the patient will require verbal and written instructions and
information about follow-up care. The patient and caregiver are informed about
expected outcomes and immediate postop changes anticipated. Prescriptions are given
to the patient along with the nursing unit or surgeon’s telephone number.
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