Priority Nursing Actions in the PACU
- Perform a comprehensive circulatory assessment immediately upon arrival, including vital signs (blood pressure, heart rate, respiratory rate, oxygen saturation) every 15 minutes or per institutional protocol for the first hour.
- Inspect the surgical dressing and perineal pad for any signs of active bleeding, noting the color, amount, and consistency of any drainage.
- Palpate the abdomen for firmness, distention, or tenderness, which may indicate internal hemorrhage, and measure abdominal girth if distention is noted.
- Monitor for early signs of hypovolemic shock such as tachycardia, hypotension, pallor, cool clammy skin, decreased urine output, and altered mental status.
- Ensure patent intravenous access and verify the type and rate of maintenance fluids or blood products as ordered.
Differentiating Immediate vs. Later Postoperative Priorities
- Hemorrhage (First 0-6 hours): The greatest risk period. Continuous monitoring for circulatory collapse is non-negotiable.
- Thromboembolism Prevention (6-24 hours): Initiate early ambulation and apply sequential compression devices once hemodynamic stability is confirmed.
- Infection Surveillance (After 24-48 hours): Begin systematic monitoring for fever, wound erythema, purulent drainage, and elevated white blood cell count.
Key Patient Education Points Before Transfer from PACU
- Teach the patient to report any sudden increase in vaginal bleeding or soaking through a perineal pad in an hour.
- Instruct on splinting the abdominal incision with a pillow during coughing and deep breathing exercises to reduce pain and protect the wound.
- Explain the purpose and expected duration of the indwelling urinary catheter to monitor accurate urine output.