Lesson 1Pain assessment and multimodal analgesia planning specific to laparoscopic cholecystectomyFocuses on systematic pain assessment after laparoscopic cholecystectomy, selection of multimodal analgesia, differentiation of visceral, somatic, and shoulder pain, and safe opioid and non-opioid use to optimise comfort and recovery.
Validated pain scales and documentationTypical pain patterns after lap choleOpioid selection, dosing, and titrationNon-opioid and regional analgesia optionsManaging opioid side effects in PACULesson 2Monitoring for anaesthesia emergence issues: nausea, vomiting, shivering, deliriumDiscusses monitoring for common anaesthesia emergence issues such as nausea, vomiting, shivering, and delirium, including risk factors, assessment tools, and evidence-based pharmacologic and non-pharmacologic interventions.
Risk factors for PONV in PACUAssessment and treatment of shiveringRecognition of emergence agitationPharmacologic management strategiesNon-drug comfort and safety measuresLesson 3Safe transfer and mobilisation criteria from PACU to wardDefines safe criteria for transfer and early mobilisation from PACU to the ward, including haemodynamic stability, pain control, respiratory adequacy, and nursing responsibilities in preparing, educating, and safely moving the patient.
Physiologic stability requirementsPain and nausea control before transferRespiratory and airway safety criteriaFall risk and mobilisation precautionsPatient education before ward transferLesson 4Documentation and handoff from PACU to ward: required elements and timingDetails essential elements of PACU documentation and structured handoff to the ward, including assessments, interventions, medications, and stability criteria, emphasising timing, clarity, and use of standardised communication tools.
Required PACU assessment recordsMedication and fluid administration summaryUse of SBAR or similar handoff toolsStability and transfer readiness criteriaLegal and quality aspects of documentationLesson 5Primary survey on arrival: airway patency, respiratory rate and oxygenation, need for supplemental oxygenCovers structured primary survey on PACU arrival, focusing on airway patency, respiratory status, oxygenation targets, and safe use of supplemental oxygen and adjuncts to prevent hypoxia and airway compromise in post-anaesthesia patients.
Airway patency and obstruction signsRespiratory rate, pattern, and effortPulse oximetry and oxygen saturation targetsIndications for supplemental oxygen deliveryUse of oral and nasal airways in PACULesson 6Wound and port site inspection: haemorrhage, drainage, dressing evaluationCovers systematic inspection of laparoscopic port sites and wounds, recognising haemorrhage, haematoma, or bile leak, evaluating dressings and drains, and documenting findings to guide timely surgical or nursing interventions.
Inspection of port sites and incisionsSigns of active bleeding or haematomaAssessment of drainage and bile leakageDressing integrity and reinforcementDocumentation and escalation of concernsLesson 7Urine output monitoring and renal considerations for CKD patientsAddresses urine output monitoring in PACU, interpretation of oliguria, fluid status assessment, and specific renal considerations for patients with chronic kidney disease, including medication dosing and avoidance of nephrotoxins.
Expected urine output and thresholdsAssessing volume status and perfusionSpecial issues in CKD and dialysis patientsAdjusting fluids and nephrotoxic drugsResponding to acute oliguria in PACULesson 8Neurologic and mental status checks: orientation, sedation scales, pain vs deliriumExplores neurologic and mental status evaluation, including level of consciousness, orientation, sedation scales, and distinguishing pain, hypoxia, or delirium, enabling early detection of neurologic or anaesthesia-related complications.
Level of consciousness and orientation checksUse of standardised sedation scalesScreening for emergence deliriumDifferentiating pain, anxiety, and deliriumAssessment of motor and sensory functionLesson 9Blood glucose monitoring and insulin correction protocols in PACUExplains blood glucose monitoring in PACU, target ranges for surgical patients, recognition and treatment of hypo- and hyperglycaemia, and safe use of insulin correction protocols, especially in diabetic or high-risk individuals.
Indications for PACU glucose checksTarget glucose ranges postoperativelyRecognition of hypoglycaemia symptomsInsulin correction scale applicationPreventing rebound dysglycaemiaLesson 10Circulation assessment: heart rate, blood pressure, peripheral perfusion, continuous monitoringReviews circulation assessment in PACU, including heart rate, blood pressure, rhythm, and peripheral perfusion, with emphasis on continuous monitoring, early detection of bleeding, shock, or arrhythmias, and prompt nursing interventions.
Baseline vitals and trend recognitionNoninvasive and invasive BP monitoringPeripheral perfusion and capillary refillDetecting postoperative bleeding or shockResponding to arrhythmias in PACU
