Nursing Care and Pain Management for Postoperative Patients Surgical Procedure - Essay Example

NURSING CARE AND PAIN MANAGEMENT FOR POSTOPERATIVE PATIENTS SURGICAL PROCEDURE: Abstract Surgery is a broad term used in medicine which is carried out by a qualified and certified surgeon. There are three main steps involved in surgery which are preoperative phase, operative phase and the postoperative phase. The preoperative phase is the stage before surgery which involves assessment of the patient on whether he/she is fit for the operation. The operative phase where the actual surgery is carried out, that is the incision of muscles and tissues and the postoperative phase where the patient is monitored for any complications after the surgery and management of those problems like wounds. (Jarrell, B. E., & Carabasi, R. A. page 67 (2008). INTRODUCTION Surgery is a branch of medicine that is concerned with the manipulation of body structures to cure, prevent and diagnose a disease. During the ancient days, human beings used certain tools to incise fellow human beings and this made surgery a risky thing to do but with the industrial evolution, surgeons have advanced into more sophisticated and non risky practice that is able to treat many diseases and conditions with minimal bleeding, infections and pain. This has been achieved by the introduction of anesthetic which renders patients free from pain during the operation. Due to advancement in technology, special tools have been incorporated to incise human tissues following the principle of sterility to prevent infections. Nurses have also advanced in education so as to be able to monitor and mange the post operative patients in order to allow for quicker healing of wounds and special care for the wounds to prevent infection. Proper diet has also been introduced to aid in healing and new pain management techniques to lessen the pain to the patients. ( Levien, D. H. page 112 (1999) A-MINOR SURGERY Minor surgery now involves the surgical procedures that take less time to carry out, minimal effects to the person, cheap to carry out in terms of the instruments and the qualified medical personnel to be involved in conducting the surgery. In minor surgery, the effectiveness of the surgery is often very high in terms of recovering from a specified condition or a disease and less risks are experienced to the life of the patient as he/she recovers within a short duration of time. Some of the examples of minor surgeries include tonsillectomy, stitching up of a broken skin cut, male circumcision,that is the removal of the fore skin, skin biopsies, insertion of contraception devices, fracture manipulation, The main surgical procedure in minor surgery are minimal medical examinations pertaining to the surgery. These tests aid the person carrying out the procedure to identify some complications that might arise during and after the operation. The surgical area has to be cleaned up using an antiseptic so that the area is free from microorganisms that could cause infections. Prior commencing with the actual minor surgery, an anesthesiologist has to conduct a local anesthesia at the surgical area that will render the area painless for a certain duration of time so as to make sure that the patient does not experience any pain during the operation. Different anesthetic drugs have different effects on the site, some may render the area of operation painless for a longer period while others puts the pain under control for a short duration of time and this may depend with the dosage or concentration of the drug at the site. The surgeon then proceeds with the operation by either making incisions at the site, removal of an organ or a tissue, re arrangement of body parts into their normal positions, insertion of substances or materials into the body, repair and/or introduction of an opening in the body, removal of stones, dead and damaged tissues and unclogging of ducts or blood vessels. Soon after the operation, the patient is assessed on whether he/she has recovered from the anesthesia and then management. ( British Journal of Surgery, 94, 10, 1220-1225.) B. MAJOR SURGERY Major surgery is a branch of surgery that involves delicate procedures that must really be handled with care and conducted by a qualified surgeon. Major surgeries may take hours to conduct. It is a very expensive procedure and involves very many risks and recover time may be prolonged. Some of the examples of major surgeries include spine surgery, jaw surgery, breast surgery, major plastic surgery, brain surgery, organ transplants etc. Before the commencement of the major surgery, the patient has to undergo preparations that must be conducted prior the surgery. Various tests are usually carried out to ascertain the wellness of the patient for the surgery by a trained and well equipped medical staff who can be a surgeon. The patient has to fill in some forms which he/she is supposed to fill in and sign and afterwards issued with a surgical clearance which shows that the patient is fit for operation and ready for any outcome that may arise during and after the surgery. Some major surgeries may at times result in loss of huge amounts of blood and to avoid death due to such an occurrence, donations of blood same as that of the patient undergoing the surgery are made earlier before the surgery day. Some pre-operative medications such as sedatives are vital thus the patient has to have the peripheral Intravenous line in place to convey the medications to various body systems. The site where operation is to be conducted has to be thoroughly prepared by cutting any hair present. General anesthesia which is always recommended and must be conducted by a qualified anesthesiologist who must always be present during the operation to monitor the systems. This leads to paralysis and unconsciousness thus the patient cannot experience pain during the surgery. There are commonly two ways by which the patient can be put under anesthesia, he/she can either be put under a mechanical ventilator or through intubation where there is a combination of the inhaled and injected agents of anesthetic. To keep the site open after cutting through the skin surface various retractors are used and to prevent bleeding of the blood vessels, the blood vessels are clamped. At times especially when performing surgery that involves internal organs for example the heart and/or the brain, bones around these regions have to be cut using special surgical saws. The surgeon then proceeds in alignment of bones and cartilages into their original positions, stopping substances from flowing through certain ducts commonly known as ligation, organ transplant, connection of bones adjacent to one another so that they can grow as one, making adjustments on the digestive tract a common method for fighting obesity, sex altering, plastic surgery, draining of fluids that have accumulated on various organs and tissues and afterwards the area is stitched or by the use of special staples. The agents used for anesthetic purposes are then stopped and the patient is transferred to a post anesthesia care unit and later on to a surgical ward. (Australian and New Zealand Journal of Surgery, 26, 4, 248-261.) C. DAY CASE SURGERY A day case surgery is a minor procedure of operation that takes a relatively short duration of time (a day) as compared to minor surgery. The surgical procedure involves a minimal examinations and tests on the patient explaining the nature of the condition and the importance of the surgery to the patient. Local anesthetics are used and after the short surgical procedure the patient is allowed to go home though restricted from performing certain duties such as driving, lifting heavy objects,avoid exercises and maximum rest and specified diet with large amounts of vitamins and proteins is recommended toenhance faster recovery of the patient. 1. Some of the of the procedures that can easily be done as day cases include extraction of a teeth, circumcision which involves removal of the fore skin in males, termination of pregnancies, fracture repair, plating of fractured clavicles, repair of tendons, draining an abscess. The procedure should be in such manner that the patient can use oral medication, be able to move a few hours after the operation. Patients undergoing the day case surgery should be satisfactorily assessed using systems like the ASA status, their age and their BMI. Patients with chronic diseases are better handled as day cases as their normal routine is never interfered with. (Applied Cognitive Psychology, 21, 1, 87-101. POST OPERATIVE PERIODS POST OPERATIVE PAIN MANAGEMENT A. pain assessment Pain assessment is very vital to the patient as it stops unnecessary pain to the patient after an operation. It is very important to establish and assess the source of pain after an operation as this will be very helpful in coming up with pain intervention techniques which will further lead to maximum relief from pain after an operation. Pain assessment which is usually conducted by nurses involves asking the patient of the pain he/she is experiencing, characteristics of the pain which includes the frequency or the number of times the patient is experiencing the pain, the part on the body where the pain is being experienced, time interval of the pain, that is how many minutes the pain is affecting the patient. Pain can also be assessed to a postoperative patient are the non - verbal signs from the patient for example kicking of the legs, abnormal movements of the patient, crying and screaming which is a evidence sign of pain to the patient, body movements especially if touched or palpated at the site where the pain is emanating from the affected region. In pain assessment details like the history of the patient on various drugs and pain relievers, medical, family and personal history, examinations and tests on active and passive body movements not forgetting gait posture. Failure to carry out pain assessment to the patient can lead to the patient developing some complications such as deep vein thrombosis, pulmonary embolus, activation of the pituitary – adrenal axis which leads to suppression of the body’s immune system and the wound may fail to heal as required and it may take a longer to heal. Pain causes poor work output and can lead to stress. The body system that releases hormones known as the endocrine system releases a lot of hormones which leads to excessive breakdown/catabolism of important food constituents such as the carbohydrate, protein and fat. Loss of weight, fever, shock, higher than normal breathing rate and later leads to death. ( Journal of Clinical Nursing, 11, 6, 724-733.). Postoperative nursing management This entails nursing care management of patients after a surgery. It aids in faster and efficient recovery in terms of wound healing and close monitoring and observation of the patients. Patients are go through various observations including checking on whether the patient is experiencing pain and introducing pain relievers to stop the pain. Body temperature and body fluid balance are also checked. When the body fluids are below the normal required levels additional fluids are given to the patient. In some surgical procedures, there is much blood loss thus need to ask for blood donations to avoid cases of hypoxia after a successful surgery. The blood pressure of the patient is also assessed and necessary actions are taken to make sure they have a normal blood pressure. At times, normal respiration of an individual may be altered thus nurses ought to ensure that the patient sleeps at safe positions and necessary facilities to help in this provided The main issues here period include control of pain by the use of pain killers, mental status of the patients as most patients after anesthesia usually develop minimal confusions. Care of the wound to avoid infection as some wounds may take weeks to heal. Fever, retention of urine and at times constipation is experienced by the patients. Urine retention may be monitored and controlled by use of catheterization whereas for constipation cases stool softeners are always recommended. In cases where the patient was a smoker or had a respiration disorder, clearing the airway before leaving the operation room is very vital. Proper positioning of patients to avoid pain and quicker recovery of the patient for example those undergoing hip surgery. Bed rest, minimal exercises and proper diet should always be recommended for all postoperative patients. (Journal of Clinical Nursing, 6, 3, 191-201.) Wound care management Clean wounds After a surgery is completed, the wound present ought to be managed properly to avoid infection to the patient. A clean and sterile dressing bandage should cover the wound to prevent entry of microorganisms like bacteria, keep the wound as dry as possible and absorb the blood or any fluid coming out of the wound. The area near the wound should not come into contact with water until after two or three days after the surgery. The dressing should be replaced after a day or in accordance to doctor’s instructions. The wound should be thoroughly cleaned and dried before dressing and not tightly dressed. The person doing this should wash his/her hands and putting on medical gloves before and after dressing and dispose-off the glove and the dressings appropriately. (Journal of Surgical Oncology, 97, 4, 298-313.) Septic wounds A septic wound is a wound that has come into contact with microorganisms and has been infected. Invasion of a wound by bacteria may lead to prolonged periods of healing. This may be as a result of the surrounding environment, the patient’s skin, doctor’s hands and/or infected equipment used. Pus evidence, swelling and foul smell are some of the general indicators of a septic wound. The wound should be as moist so as to allow for better functioning of cells that are necessary in wound healing. Prior dressing, some antibiotics should be applied on the wound, taken orally or in severe infections, intravenous antibiotics should be given to stop sepsis(blood infection). Dressing should be carried out as often as possible or rather on daily basis and if need be, special dressing should be incorporated as this will allow for faster wound healing.All these procedures should be done while hands are clean and with medical gloves on to prevent further infection. Postoperative complications. Postoperative complications are those problems and risks that may arise after a surgery though they are not necessarily related to the initial disease that the patient was suffering from. Firstly, the patient may lack appetite for food which may arise immediately after the operation and may take several days for the patient to adjust. Swellings and pain on different parts of the body may also be experienced by the patient which is a clear indication that there is a blood clot in his/her body.. At times, some surgeries may lead to loss of large volumes of blood thus leading to anemia. Patients may feel weak in restless soon after the operation. Sometimes vomiting, weight loss, diarrhea, temperature rise, stress and at times constipation may be arise after the surgery. Lastly the patient may have periods where he/she is unable to breath, swallow and even more wound infection and nutritional disorders. (International Journal of Urology, 17, 3, 206-214.) CONCLUSION In conclusion, surgery as we saw from the beginning is a process that has various phases that must be followed. The phases include the preoperative phase whereby assessment and examinations are carried out to the patient, immediately after these phase is the operative phase where the surgeon steps in and carries out the operation and finally the postoperative phase which includes postoperative care and assessment of the patient mostly executed by the nurses. Surgery has saved many lives as far as cure, prevention, diagnosis of ailments is concerned. It has moreover helped in physical manipulation of body structures such as plastic surgeries. References Meretoja, T. J., Rasia, S., von, S. K. A. J., Asko-Seljavaara, S. L., Kuokkanen, H. O. M., & Jahkola, T. A. (October 01, 2007). Late results of skin-sparing mastectomy followed by immediate breast reconstruction. British Journal of Surgery, 94, 10, 1220-1225. www.bjs.co.uk/ onlinelibrary.wiley.com/journal/10.1002 (Nicks, R. (May 01, 1957). THE SURGERY OF MAJOR ARTERIAL OBSTRUCTION AND OCCLUSION. Australian and New Zealand Journal of Surgery, 26, 4, 248-261.) www.surgeons.org/policies-publications/.../anz-journal-of-surgery/onlinelibrary.wiley.com/journal/10.1111. Stollery, B. (January 01, 2007). Delayed recovery of working memory following day-case surgery. Applied Cognitive Psychology, 21, 1, 87-101. www.wiley.com › ... › General Cognitive Psychology/onlinelibrary.wiley.com/journal Manias, E., Botti, M., & Bucknall, T. (November 01, 2002). the complexities of − Observation of pain assessment and management clinical practice. Journal of Clinical Nursing, 11, 6, 724-733. www.wiley.com/bw/journal CARR, E. L. O. I. S. E. C. J., & THOMAS, V. J. (May 01, 1997). Anticipating and experiencing post-operative pain: the patients' perspective. Journal of Clinical Nursing, 6, 3, 191-201. www.scimagojr.com/journalsearch.php?q=28191&tip=sid Dalal, K. M., Antonescu, C. R., & Singer, S. (March 15, 2008). Diagnosis and management of lipomatous tumors. Journal of Surgical Oncology, 97, 4, 298-313. www.journals.elsevier.com/surgical-oncology Elsamra, S., & Pareek, G. (March 01, 2010). Complications of laparoscopic renal surgery. International Journal of Urology, 17, 3, 206-214. https://www.urol.or.jp/en/journal.html Polk, H. C. (March 01, 1993). The American Journal of Surgery. British Journal of Surgery, 80, 3, 308-309. www.bjs.co.uk › Home › JournalBritish Journal of Surgery Read More