Epidural Analgesia for Post OperativePpain Relief - Essay Example

Epidural Analgesia for Post OperativePpain Relief Answer 1 Rationale for active treatment 1. Conventional versus active treatment Postoperative pain has been controlled conventionally with intramuscular opioids which are administered intermittently as required. Active pain control refers using more effort so as to optimize the control of pain which entails preoperative preparation, the treatment chosen by the patient, regular assessment of pain, the and the application of more advanced treatment methods like patient-controlled analgesia (PCA), epidural anesthesia and analgesia and constant nerve blocks. It is further realized that active pain control provides more pain relief as compared to usual or conventional treatment. 2. Ethical and humanitarian issues There is no argument that can be raised against ethical and humanitarian need to control postoperative pain. People tend to wonder whether ethical and humanitarian argument can be relevant to endorse active pain control. They also ask whether conventional techniques meet the requirements of ethical requirements to treat pain or should the conventional methods be improved. Such questions can best be answered by physicians who evaluate the risks and the merits that come with each type of treatment. They also apply their professional experience and scientific proof to make a decision on the kind of treatment to use. However, physicians are allowed to assume ethical accountability when managing pain. Moral and humanitarian responsibility is important when relieving pain because, it is the prime benefit of treating pain. 3. Barrier to effective pain management Pain management is faced by some barriers which are usually in the form discrimination from the caregivers and can also be from the patient receiving the treatment and care. However, the most prominent obstacle is the dread that patients have for opioids. This drug is feared since it is addictive and also has devastating side effects especially when used for chronic treatment. Some people also tend to have fears since they do not know how long it will take to recover due to the excessive use of analgesics and other form of prejudices such as religious and traditional believes which condemn the use of artificial ways of pain relief. 4. Patient comfort and contentment The only ideal way of satisfying an operative patient is by instituting a surgery that has minimal pain and distress. Giving a patient such kind of contentment does not necessarily require providing sufficient doses of pain relieving medication. Patient’s satisfaction is attained by giving them a therapy that suits their needs and having the side effects of the treatment put at bay as much as possible. Another likelihood of providing satisfaction is by preparing the patient adequately for the kind of experience they are expected to encounter due to the postoperative pain. When the patients are fully aware of the intensity of pain they are going to feel for some time then cease, they will have all the required information that will allow them make a choice of the kind of pain relief to be given and also understand that the doctors and nurses treating them are cooperating with them in the course of coming up with the best way of managing the pain. 5. Decreased morbidity and recovery time Despite the fact that some trials associated with administration of more aggressive pain treatments (for instance, epidural treatment and IV PCA) have demonstrated minimal recovery periods and shorter stay in hospitals, there are other attempts that have not exhibited any major improvement. It is proven that there exists no true agreement on whether hostile pain management can enhance the rate of recovery after a surgery. However, cautious analysis of every proof can lead to conclusively give the merits and demerits of aggressive pain relief in particular patients and also on specific surgical categories. For instance, pulmonary function is certainly enhanced by epidural treatment soon after thoracotomy and also laparotomy. Early outcomes of huge multicenter attempts validate the preceding and direct to a raised magnitude of the effects that patients experience with already existing lung ailments. The recovery of bowel mobility is more rapid in patients who are treated with epidural analgesia soon after bowel surgery, which allows a faster discharge from hospital Having all these in mind it is important to understand that this treatment has some advantages and also poses risks to the patients. It is therefore very essential to carry out an effective postoperative pain management when taking care of an epidural patient who has undergone surgery. Poor control of pain, unless intentional, can lead to either morbidity or death. It has been proven that surgery lowers immunity which corresponds to the invasiveness of the operation. Appropriate analgesia can lower this lethal effect. There are a number of benefits and also risks associated with epidural analgesia. This treatment is beneficial only if carried out in an effective manner. A successful postoperative pain control gives comfort to the patient and results to contentment, fast recovery of mobility, less instances of cardiac and pulmonary problems, reduces the dangers of severe vein thrombosis, quicker recuperation with minimal probabilities of having any neuropathic pain and lower care expenses. It is multifactorial in case the patient is not given the appropriate postoperative analgesia. This is caused by inadequate education and skills, dreading the complications that are arise due to analgesic drugs, inappropriate pain assessment, and insufficient human resource. Besides having all these benefits, epidural analgesia also has several risks that are quite detrimental to the patient if not taken care of in the right manner. The main of postoperative pain control is to reduce the pain while ensuring that the side effects are kept at bay. If this is not done, the patient is at risk of suffering from several side effects. For instance, using analgesics such as opioids may lead to sedation, hypotension, respiratory depression, vomiting, nausea, pruritus, and bradycardia and also inhibits the functioning of the bowel. Treating problems like nausea and pruritus may involve the administering antihistamines which exhibits effects that are additive to some side effects such as sedation and respiratory depression. Respiratory depression happens to be the main fatal complication caused by opioids. The occurrence of serious respiratory depression cases has risen at an alerting and has been reported to be 1 per 10,000 patients. These are incidences that happened on patients that were using self-controlled analgesia pumps. Such cases are normally caused by poor management. Answer 2 There are several factors that ought to be put into consideration when carrying out an insertion and nursing care for patients suffering from epidural infusions to relieve them from post-operative pain. The guidelines provide a comprehensive explanation of the analysis to be done when administering the epidural analgesia infusion for relieving postoperative pain. This treatment is termed as an ideal way of reducing the pain that patients encounter and the risks that results due to the condition. This has therefore led to the standardization of the procedure to make lower the chances of danger. Nurses responsible for taking care of patients having this condition are educated so as to be in a position of acknowledging and responding promptly and professionally whenever such problems arise and therefore curb the occurrence of any possible risks. The whole procedure of the way patients should be cared for is succinctly illustrated in the routine. Some sections also highlight the side effects which are experienced as result of this treatment and the way the epidural infusion can be terminated. Background information Epidural analgesia has been proven to be the most effective method of controlling post-operative pain that patients encounter when they are either taken through a lower limb, abdominal or thoracic surgeries. But the good thing about this method is that it has exposes the patients to minimal risks. The main aim of having the guidelines is to ensure that proper practices are done to patients when epidural analgesia is been instituted to them. The anesthetist is responsible for the kind of procedure to be done on the patient and therefore has to ensure that the right one is applied. When this is done, a patient suffering postoperative epidural is put in ward under the care and responsibility of well trained ward nurses who work collaboratively with Pain Management Service and also the surgical team who are assigned to the patient on admission. The whole process of taking care of patients having an epidural is a quite sophisticated exercise that calls for special clinical sections where patients surfing from epidural catheters are admitted. Such arrangements are put in place to avoid any incidence of having an unqualified nurse being in a circumstance that can compromise the safety of the patient. Designated wards Patients with epidural should be placed in specific wards that are clearly designated to avoid any confusion when admitting other patients. The manner in which epidural patients’ wards are allocated is the mandate and responsibility of the Pain management Service and anesthetic unit. Epidural patients are only supposed to go to the wards specially reserved for them and professional nurses are assigned to check on them on shifts so as to ensure they have an around the clock attention and care. In case of a situation where a patient is placed in the wrong ward, the anesthetist is supposed to inform the bed manager, matron or Pain Management Service team about the problem so that they can sort it out appropriately by taking the patient to the designated ward. Providing good nursing care to epidural patients also requires the following to be put into dire consideration: The roles of a specialist nurse. The nurse should be available so as to provide the required assistance to the staff dealing with epidural analgesia. The nurse should give the proper recognized education and preparation to the staff in charge of taking care of epidural infusion. They should facilitate the required ward skills that nurses ought to have in evaluating and managing epidural infusion analgesia. They should coordinate with fellow specialist so as to be in a position of meeting the patients’ needs especially in controlling the pain. They should make certain that guidelines are based on relevant evidence and portray an up to date practice. They should assess pain management through audit. They should do all the necessary evaluation on all the appropriate equipments in case a replacement is been done. The specialist nurses should come up with the epidural service that is consistent with the practices that are based on significant proof. They should develop an epidural service that is consistent with practices founded on relevant proof. They should also be in a position to identify a problem and come up with solutions and give all the necessary advice to patients that have complicated conditions. Responsibilities of an anesthetist Suitable selection of patient and informed approval. Set off epidural analgesia. Provide understandable prescriptions. They should be available to give the required advice and help solve the problems the patient is encountering. Guarantee proper administration of the required medication such as Tinzaparin to treat prophylaxis and also give the required dose prescriptions. The responsibilities of the Anesthetic/Recovery nurses They should attend infusions for epidural analgesia so that they can keep posted on a daily and annual basis. They should make updated records of the patients who are undergoing the epidural analgesia. This record should include; the type of pump being used, the ward where the patient is admitted and the date when the pump was issued to the patient. They should initiate and document pain evaluation and every data concerning the epidural infusion and put them on the right charts. They should adjust the rates of infusion as per the prescription limits and also depending on the condition of the patient. They should inform the pain management department in case of anything goes wrong with the control of the patient’s pain or epidural. Responsibilities assigned to ward nurses They should have a regular attendance to studies concerning epidural infusion. These nurses should only agree to take the responsibility for patients who are receiving epidural analgesia when they are sure that all the guidelines are followed even by the patient being taken care of. They should inform every clinical hurdle or troubleshoot the issue to the pain Management Department and take any required action as early as possible. They should report every incident that arises due to drug or equipment complications to the relevant department. They should make all the necessary changes of the epidural bags and rates of infusion as per the prescribed limits and also according to the condition of the patient. They should take out the epidural catheter immediately after the termination of the epidural analgesia if only the nurse is capable of doing so. They should also ensure that the patient is escorted out of the ward area by a nurse and also ascertain that the patient has 24hours access to patent IV when the epidural infusion is on. Patient’s observation This is important since it ensures that the patient has sufficient analgesia. It also helps in acknowledging the changes happening on the condition of the patient and therefore allows proper intervention to occur. This curbs the likelihood of problems occurring since the patient is receiving the required attention. Pump accessories These are the accessories that facilitate proper functioning of the epidural pump. They include the, epidural bags, epidural giving sets, batteries and epidural pump key When to terminate epidural infusion There is a specific duration that the patient should be under the epidural analgesia. However, this depends on the kind of procedure that was carried out, the condition of the patient and also the way they respond to paid. Nevertheless, the normal period should be around 3days on average. Answer 3 In an instance when a patient’s blood pressure is low as recorded for Mr. Johnson, the latter suffers from hydration which makes the skin to be dry and warm. This condition is referred to as hypotension and basically when the patient’s blood pressure drops by 20% of the normal pressure. There are a number of actions that a nurse should take to ensure that the patient’s blood pressure stabilizes. It is also important to check whether the drop in blood pressure is gradual or sudden. For gradual drop in blood pressure, the following actions should be taken. 1. The nurse should report the matter to the pain management service or anesthetist in charge of the patient. 2. Such conditions require the patient to be hydrated. It is therefore important to test the patient’s fluid balance and also check if there any signs indicating dehydration like dry skin, tongue, lips and check if the urine is dark in color. Having checked these, the nurse should give the patient volume expanders an example been, gelofusine. 3. The nurse should also ensure that there is ephedrine. 4. The rate of epidural infusion should either be lowered or stopped in case there is a drop in the patient’s urine output to less than 30mls/hr. 5. The nurse should lay the patient in a flat posture if the condition gets worse. The head should not be tilted. However, the legs should be raised on a pillow. The following are actions to be taken for sudden drop in blood pressure: 1. Terminate the infusion 2. The nurse should lay the patient flat 3. The nurse should call for assistance from the relevant emergency services. 4. The nurse should administer fluids to the patient for hydration. 5. The nurse should supply the patient with oxygen. 6. The patient should administer ephedrine. 7. The patient should be given positive inotropes in case it is needed. 8. The patient may also need intubation and aeration. Answer 4 A situation where the patient complains of a headache and the respiratory rate is noticed to have risen to 26 and has become shallow, this is an indication that the latter’s epidural infusion is having a complication. This condition is can be caused by an unintended Dural puncture which happens when the catheter is been inserted causing the loss of CSF from the area that has the puncture. A Dural perforation headache can be very painful and it is made more severe if the patient sits up and is usually caused by stiffness of the neck, photophobia, and queasiness/ vomiting. If a patient has this condition the nurse should take the following actions; 1. The nurse should ascertain the kind of headache. 2. The nurse should rule out any history like a migraine that had been reported previously. 3. The nurse should alert the anesthetist and Pain Management personnel in case the condition persists. 4. The nurse should make sure that the patient has a bed rest, oral or IV hydration and analgesia. 5. The nurse should try to make the ward where the patient is dark by drawing curtains so as to prevent sunlight from shining in the room. 6. The patient should avoid straining too much by either coughing or moving the bowels. 7. The nurse should prescribe easy analgesia like paracetamol. 8. The patient should have caffeine tablets. 9. The anesthetist should administer some blood patch if the headache does not stop although 90% of headaches are known to cease spontaneously. References William, B. (200). Epidural analgesia for post operative pain relief. 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