Foster is a 72-year-old man who has returned to the post-anaesthetic care unit following an inguinal hernia repair. He is very drowsy, lying flat and is snoring. He is receiving 5 litres oxygen and his saturations are 92%. His respiratory rate is 16, he is taking shallow breaths and there is reduced misting on his oxygen mask. His blood pressure is 144/80 and his heart rate is 95. Considering these assessment findings, what do you think the main issues are and how can you resolve these?

Assessment

• Patient is drowsy and lying flat with no airway adjunct in situ – reduced protective reflexes following general anaesthetic and surgery – increased risk of airway obstruction
• Snoring noise – indicative of tongue occluding airway
• As patient is on 5 litres oxygen, would expect that oxygen saturations be higher than 92% respiratory rate and increased to compensate for partial airway obstruction and shallow breaths, to increase amount of oxygen being breathed in – expect to see some use of accessory muscles
• Heart rate is elevated in order to increase movement of oxygenation blood around the body (compensation)
• As heart rate has increased – blood pressure has increased.
• Using a look, listen, feel approach to airway assessment:
• Look: respiratory rate, respiratory pattern, depth of breathing, sats, colour of patient, mask misting
• Listen: abnormal airway sounds/absence of sound
• Feel: air exhalation at mouth/noise

Management

• Increase oxygen
• Jaw thrust
• Stir up regime – encourage patient to deep breathe, cough (NAGGING!)
• Airway adjunct
• Patient position – left lateral
• Reassurance and reassess