The PACU Cheat Sheet Every New Nurse Needs
Bookmark this page for study. It reviews modified Aldrete concepts, reversal safety, common post-op complications, and a structured handoff. It is educational—not a standing order, patient-specific plan, or replacement for facility policy, current references, or supervised orientation.
Aldrete score — discharge from Phase 1
Modified Aldrete commonly scores five categories from 0–2: Activity, respiration, circulation compared with baseline, consciousness, and oxygenation. The exact version and threshold vary. Use your facility's approved tool; a score supports but does not independently authorize transfer or discharge.
Reversal agents — dose and watch-out
Naloxone reverses opioid effects but may wear off before the opioid. Flumazenil reverses benzodiazepine effects and can precipitate seizures in susceptible patients. Sugammadex reverses selected aminosteroid neuromuscular blockers; neostigmine is paired with an antimuscarinic under an ordered plan. Verify indication, depth of blockade, contraindications, current order, dose reference, and post-reversal monitoring with anesthesia/pharmacy and facility policy.
Top 10 post-op complications and first move
1) Airway obstruction → stay bedside, reposition/open the airway, support ventilation, call for help. 2) Laryngospasm → activate airway support and prepare the approved rescue pathway. 3) Hypoxemia → assess airway, ventilation, equipment, lungs, and cause while supporting oxygenation. 4) Hypotension → verify, assess perfusion/bleeding/losses, prepare ordered support. 5) Hypertension → assess pain, bladder, hypoxia, baseline, and ordered treatment. 6) PONV → review prior prophylaxis and ordered rescue class. 7) Shivering/hypothermia → active warming per protocol and assess cause. 8) Pain → multimodal ordered plan plus timed sedation/ventilation reassessment. 9) Delirium → protect, reduce stimulation, find reversible causes. 10) Bleeding → assess site/drains, support, and notify the surgical team urgently.
SBAR handoff — memorize the shape
S — 'Mr. Smith, 62, POD 0 lap chole.' B — allergies, home meds, PMH, pre-op vitals. A — current vitals, pain, lines/drains, last meds, I/O, mental status. R — 'He's ready for the floor; next Norco due at 1400, pending amb + void, follow-up with surgeon in 2 weeks.' Read back any verbal orders.
Want the printable version + full study bundle?
The current Baddie RN PACU learning system includes a 12-week interactive orientation, 32 playbooks, cases, knowledge checks, progress tools, and an orientation companion. A comprehensive 25-chapter textbook is in private editorial review.
Preview the PACU study book →FAQ
How do I remember all this on shift?
Print this page or save it to your phone home screen. Most PACU nurses also keep a badge card with reversal doses and Aldrete scoring for the first six months.
What's the difference between Phase 1 and Phase 2 PACU?
Phase 1 is immediate post-anesthesia recovery — 1:2 ratio, continuous monitoring. Phase 2 is step-down or discharge prep — 1:3 ratio, focus on ambulation, PO, void, and teaching.