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Stir-Up Regimen There Are Five Steps to the Stir-Up Regimen: Deep Breathing, Coughing, Positioning, Mobilization and Pain Management

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Stir-Up Regimen There Are Five Steps to the Stir-Up Regimen: Deep Breathing, Coughing, Positioning, Mobilization and Pain Management www.NYSPANA.NET Newsletter of the New York State PeriAnesthesia Nurses Association Volume 37 No. 1 March 2015 Back To Basics: Stir-Up Regimen There are five steps to the stir-up regimen: deep breathing, coughing, positioning, mobilization and pain management. One of the most basic and important as- should be sitting, semi-Fowler or side- by 100-300%! Hypoxia should be con- pects of perianesthesia nursing is the stir lying and splinting the incision. The cas- sidered when the patient has hypertension up regimen. It comes after the airway is out cade cough is the best technique for open- from carbon dioxide build up and from the and pain is being assessed. Why is it ing airways and expelling secretions. The effect of hypo-ventilation. An oxygen important? The regimen is the steps taken patient takes a rapid deep breath and saturation of less than 85%, indicates a to prevent atelectasis and venous stasis. coughs multiple times at low lung vol- PaO2 of less than 50mmHg. (Stir-Up) (Stir-Up) umes. This series of small coughs causes airways to compress and improve the ef- Get that airway out, control the pain, Oxygen saturations only tell us how much fectiveness of the cough.(Drain) Forcing cough, deep breath, and move those limbs. oxygen is dissolved on the patient’s he- patients to cough will eventually lead to Hopefully all of this was explained to the moglobin. It is not an indicator of the spontaneous coughing. Sitting or semi- patient before they became your patient! patient’s ventilation status. What causes Fowler’s positioning promotes mainte- Barbara Ochampaugh, RN, BSN, CPAN atelectasis? Post operative patients breathe nance of the patient’s airway, prevents in a shallow, monotonous pattern without aspiration and allows optimal expansion References: sighs. This breathing pattern is from gen- of the lower lobes. (Stir-Up) Some patients Drain, C. (2013). Perianesthesia nursing: eral anesthesia, pain and use of opioids. should not cough, such as the patient with a crtical care approach.Saunders. p.385- 386. The patient needs full inhalations to elimi- eye, plastic surgery or any risk of increased Stir-up regimen. Internet. 2/11/15. nate anesthesia gases, inflate the lungs to intracranial pressure. Patients who re- open areas of atelectasis, and hasten the ceive Ketamine must be awakened in a awakening process. Intravenous anesthe- quiet environment. (Drain) sia has no gas to be expelled, the drugs must be absorbed, but these patients have Prevention of venous stasis occurs when Inside This Issue the same monotonous breathing patterns. the patient moves their legs and arms. Patients must be stimulated to take three Flexing muscles aids in venous return. It Stir-Up Regimen . 1 to four deep breaths every 5-10 minutes. also automatically causes deep breaths President’s Message . 2 Full lung expansion is difficult to achieve which will improve cardiac function. Ide- if the patient hasn’t fully emerged, is in ally patients should ambulate, but this is Treasurer's Report . 3 pain, or has reduced consciousness. (Drain) not possible upon wakening and when NYSPANA Network . 3-4 pain isn’t fully controlled. There are five steps to the stir up regimen: ASPAN Regional Director . 5 deep breathing, coughing, positioning, Patients cannot properly move, deep breath mobilization and pain management. The or cough if their pain is not adequately Community Service . 6 technique for deep breathing is called the controlled. Opioids will depress the cough EMR Alert Fatigue . 7 sustained maximal inspiratory maneuver reflex and ciliary action as well as depress PANAW Week . 8 (SMI). The patient takes as deep of a the respiratory centers. Careful titration of breath as possible, holds the breath for 3- medication insures adequate pain con- New CAPA/CPAN . 8 5 seconds, and then exhales. (Stir-Up) trol. This helps in assessing the patient’s ABPANC . 9 Incentive spirometer gives the patient a sedation level as well as their respiratory visual of deep breathing, but the patient effort. Medication administration is a care- Fall Conference . 8 must be able to cooperate! Patients should ful dance between pain control and respi- GAC Report . 10 be taught both techniques preoperatively. ratory effort! Daisy Award Winner . 11 Coughing is the best way to clear air pas- A few more “pearls of wisdom in closing”: sages of secretions. A cough is only effec- a shivering patient needs supplemental ASPAN Survey . 11 tive based on the patient’s tidal volume oxygen as well as warming. Shivering Future ASPAN Conferences . 12 and velocity of the expelled air. Patients increases oxygen consumption demands NEW YORK Page 2 STATE March 2015 PANA NYSPANA OFFICERS PRESIDENT: RESEARCH CHAIR: Barb Ochampaugh Kathleen Pecoraro H: (518) 459-5334 H: 845-223-3742 From The President W: (518) 525-1415 W: 914-666-1476 E: [email protected] [email protected] Happy Perianesthesia Nurse Awareness Week VICE PRESIDENT: TREASURER: Bronwyn Ship Susan Alati (PANAW)! My units, celebrated with a cake H: (585) 313-4198 H: (585) 264-9673 and a luncheon in PACU. All the nurses W: (585) 396-6274 W: (585) 273-1821 E: [email protected] E: [email protected] received pens. We had one colleague join SECRETARY: ASPAN and is considering studying for the GOVERNMENTAL AFFAIRS: Kathleen Anderson Caitlin Bickhart, RN CAPA exam! H: (315) 685-6775 E: [email protected] E: [email protected] NYSPANA has 901 members. Forty-two percent of membership IM. PAST PRESIDENT: is certified perianesthesia nurses. New York State has 780 Martha Maresco NOMINATING CHAIR: H: (914) 762-1176 perianesthesia certified nurses, and 30 are dual, 290 CAPA and Position Open W: (914) 366-3578 460 CPAN. This does not include other certifications our nurses Cell: (716) 698-9000 E: H: [email protected] E: [email protected] hold. These numbers reflect the dedication to education and the willingness to provide excellent nursing skills to our patient NYSPANA ADDRESS: Barb Ochampaugh, 6 Wilkins Avenue, Albany, New York 12205 populations. The list of the newly certified nurses can be found on our website, NYSPANA.net. NYSPANA’s Website: www.nyspana.net Michele Rossignol, Web Coordinator - [email protected] The NYSPANA board and districts, work very hard to provide Daniel F. Palmieri, Website Designer - [email protected] educational opportunities and scholarships for membership. An application for the Shining Star Award for our component from NYSPANA DISTRICT PRESIDENTS ABPANC has been submitted. This award is given to the DISTRICT 1: (Long Island) DISTRICT 10: (Albany) Tina Stoebe . Shari DuGuay, BS, RN, CAPA,NE-BC components that provide education and recognition to its certi- C: (631) 835-8917 E: [email protected] fied members. Next year, we will again be eligible for ASPAN’s W: (631) 476-2729 DISTRICT l3 (Syracuse) E: [email protected] Gold Leaf Award. Ginger Giarrusso DISTRICT 6: (NYC) C: (518) 382-1957 Our board will be meeting this March to review our bylaws and Trina Mills, RN, BSN, MS W: (518) 329-7055 C: (914) 562-9231 E: [email protected] consider a slate of officers for next year. So far, no one has come E: [email protected] DISTRICT l4 (Rochester / Buffalo) forward as a candidate for the Nominating Chair or Vice DISTRICT 8: Sally Sackett Presidency. If you want NYSPANA to continue to provide (Weschester, Rockland, Putnam, E: [email protected] educational opportunities and scholarships, we need you, the Orange, Dutchess, Ulster, Suffolk) members, to reach out from your area of comfort and be willing Maryanne Carollo Region IV Director H: (914) 763-5955 Amy Dooley to serve this component as an officer. For information on W: (914) 242-8176 H: (603) 889-8665 vacancies you can contact me at: [email protected] E: [email protected] W: (781) 744-8123 or 518-459-5334. I or any board member would be happy to DISTRICT 9: (Binghamton) E: [email protected] discuss our roles. Susan See ASPAN Donna Ingram E: [email protected] 1-877-737-9696 ext. 219 W: (607) 584-0187 Barb Ochampaugh, RN, BSN, CPAN Fax: W (607) 798-6789 E: [email protected] 2015 NYSPANA State Conference COPY SUBMITTAL DEADLINE: Deadline for submitting material for next issue of October 23-25, 2015 UP TO PAR will be JUNE 1, 2015. Please forward all articles to NYSPANA or to: Crowne Plaza, White Plains, New York Michele Rossignol, Editor 7949 Boxford Road, Clay, NY 13041 C: (315) 264-8195 Email: [email protected] A publication of New York State PeriAnesthesia Nurses Association © 2015 NYSPANA All Rights Reserved Nurses Building Bridges Mission Statement A Discussion of The New York State PeriAnesthesia Nurses Association PeriAnesthesia Care advances nursing practice through education, research and standards. NEW YORK March 2015 STATE Page 3 PANA NYSPANA Network District 1 News District 6 News Although the weather has been difficult the district is turn- District 6 NYC will be hosting an ASPAN Seminar in NYC this ing its attention to preparing for our Spring Conference summer, date to be determined. The topic will be, “Surrounding which will be held on the beautiful ocean front in Long Your Practice with Excellence; Legalities, Standards and Advo- Beach. It will be at the Allegria Hotel on May 2, 2015. cacy”, as requested. We look forward to a great turn out. Having selected a location for the conference closer toward our colleagues in the city and surrounding area we hope to Trina Mills, RN, BSN, MS, President see new faces partake in the event. One of the benefits of attending these educational opportunities is the network- ing. It is such an important part of the educational process District 13 News where fellow nurses can openly exchange information.
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