Nursing Interventions Involved in Addressing the Patients Pain - Case Study Example

Amy Case Study Name Institution Date Amy Case Study Psychosocial impact of surgical intervention 1. Emergence Delirium This is an occurrence after surgery that is categorized by disorientation and distress as shown by Amy after her arrival in PACU. Emergence delirium is influenced by factors such as young age evident in Amy’s case and the type of procedure which in Amy’s case was tonsillectomy +/- adenoidectomy. They also state that preoperative anxiety shown by Amy’s reluctance to have her surgery as she is worried that she will miss out on the ‘fun stuff’ they do at school, miss her teacher and playing with her friends in the playground contributes to emergence delirium. This is according to one study which found that the chances of experiencing noted symptoms of emergence delirium amplified with increased nervousness which was evident in Amy’s short and laboured breathing (Cote, Lerman, & Todres, 2009). 2. Sleep changes Studies have shown that a certain number of patients showed decrease in percentage of sleep after surgery. Sleep complications have been mainly indicated by postoperative pain. In Amy’s case the postoperative pain is treated by ordering of further PRN pain relief. There is also a psychological change that result to sleep complications, most notably the child’s measure of externalizing behaviour which affects the sleep efficiency of the child. The administration of elective and emergency admissions is a key responsibility of doctors. It has a psychosocial impact on all features the patient’s experience. In Amy’s case, it affected her comfort as her mother notes that that Amy does not seem comfortable (Cote et al., 2009). An admission procedure consists of three good practice points namely: a brief admission outline that is filed by the admission doctor, a nursing assessment that includes social evaluation by a suitable nurse and finally the admittance directives. Amy’s discomfort can be attributed to her nervousness during admission as she has never been away from home nor had she had any previous experience with hospitals. 3. Behavioral changes postoperative behavioral changes are mainly negative, they include separation unease, withdrawal, eating disorder just to name but a few (Jibawi & Cade, 2009). In Amy’s case there is a case of separation unease that could make her become unsettled again as revealed by her being upset and asking for her mother. Pessimistic postoperative behavioural variations may be the result of relations between the pain the child experiences during the perioperative time and the personality traits of the child (Cote et al., 2009). Recovery Process of Amy There are two periods of recovery after undergoing tonsillectomy. The first is between 5-7 days in children and the second is takes an extra 5-7 days. Airway management can be done through breathing workouts. It can also be done by administration of reversal drugs and providing oxygen therapy (Hamlin, 2008). Controlling Pain: it is vital to manage pain the patient experiences after tonsillectomy. Pain in the throat and ears is experienced. Amy’s pain is controlled by administering regular 4-6hrly oral Paracetamol 855mgs plus PRN pain relief consisting of oral Codeine 28.5mgs and IV Tramadol 57mgs. The drugs are administered within the first days after surgery so as to keep the pain from growing out of control. It’s important because if the pain grows out of control, it’s difficult to get it back under control (Adams, 2011). Hydration: Amy is infused with Dexamethasone 5.7mg and Ondansteron 4mgs running for hydration at 90mls/hr, which is to remain insitu until she is tolerating oral fluids. This hydration is done as it aids in reducing the pain in the throat, aids in avoiding constipation and helps keep the scabs in the throat moisturized. Failure to ensure hydration may cause an increase in the danger of bleeding, increase in pain and slowed healing (Ottawa Shores E.N.T. Associates, P.C.). Taking all prescribed medications: Amy is to have 5 days of post-operative Cephalexin antibiotics; an IV dose has been given intraoperatively however she is to continue the remaining 5 day course on 570mgs oral antibiotics. It is important for her to take the above prescriptions as this reduces the possible side effects of her surgery. The antibiotics aid in the healing of the throat without occurrence of an infection (Adams, 2011). Assessment and Nursing Interventions Involved in Addressing the Patient’s Pain The assessment of pain after the operation should be done early. The assessment of pain is regarded as the fifth important sign. Precise evaluation of this pain is very fundamental and should be done using an authenticated pain estimation tool that is utilized throughout the medical institution to support understanding of the tool. Pain evaluation in the emergence period of anaesthesia is quite a challenge because of the patient’s condition such as consciousness. Amy is still unconscious on her arrival to the PACU. The patient’s ability to communicate their pain may not be possible and as such, the nurse may observe for changes in facial language of the patient, grinding of teeth or clasped teeth by the patient which are dependable signs of pain. The location of the pain should be evaluated, in most cases the surgical cutting point is the cause of pain for a postoperative patient. Pain can also be caused by an uncomfortable throat from intubation or by lengthened placing in the operating room which in Amy’s case; she is still placed in the left lateral position in the PACU (Hamlin, 2008). Nursing interventions involved in addressing the patient’s pain include administration of drugs used for pain management. In Amy’s case, the nurse has written her up for regular 4-6hrly oral paracetamol 855mgs. Further PRN pain relief has been ordered consisting of oral Codeine 28.5mgs and IV Tramadol 57mgs. Dexamethasone 5.7mg drug has been charted. It is a corticosteroid which helps decrease swelling and allergic responses which may be a source of pain (Hochadel, 2006). Nursing Care Plan Focusing on Post Operative Care in the First 24 Hours A nursing care plan incorporates enhancing physical and emotional wellbeing, averting problems that may arise, and teaching the patient how to care for him or herself on going back home. Post operative care is the taking care of a patient to relieve his or her recovery from surgery. It involves the evaluation, analysis, intrusion, and result assessment. Once the Amy is received from the PACU, the patient should be placed in the position ordered by the physician. If the patient is not totally awake, place him or her in a side-lying manner and hoist the side rails. If the patient, in this case Amy complains of hurting or pain, the exact origin and attributes of the pain should be evaluated. It is of uttermost significance to distinguish between pains of surgical procedure and ischemic pain (Carpenito-Moyet, 2009). The nurse should tell the patient to give information on any lack of sensation in the lower body edges. The formation of a blood clot inside a blood vessel or artery delivering blood to the legs results in numbness. The signs of formation of a blood clot in arteries away from the origin or distal should be checked for, they include: reduced pulses and dark skin patches. Lengthened period of low blood pressure may result in formation of blood clots due to diminished blood flow (Carpenito-Moyet, 2009). The temperature of the body should be kept in check. This is because patients are usually in low body temperature after surgery. Thus, they may require a warming material such as a blanket. The respiratory status should be checked often. This should include evaluation of sounds from the lung and the chest movement. In regard to intravenous fluids, the nurse should evaluate the kind and quantity of fluid solution, the infusion spot and the tubes delivering the fluid. The velocity at which the intravenous fluid is infusing should also be checked (Brookside Associates Medical Education Division, 2007). In Amy’s case, the infusion delivering Sodium Chloride 0.9% should be checked to ensure it remains insitu until she is tolerating oral fluids. The wound of the surgical incision should be checked often within the first 24 hours. The wound bandage should be checked for fluid drainage. If there is any fluid drainage, the colour and quantity of the fluid should be noted. In Amy’s case, the wound bandage should be checked and notes on colour and quantity of fluid taken. In case of bleeding, it should be reported immediately to the doctor. If the patient has any draining tubes such as a urinary catheter and input tubes, the amount of input and output should be evaluated every one to two hours. It should be ensured that the bags containing the input fluid are hanged and positioned properly (Brookside Associates Medical Education Division, 2007). If the patient does not have a urinary catheter, he or she should be checked for distention and if he or she is able to urinate. If after six or eight hours the patient has not been able to urinate, the doctor should be notified (Abby, & Crystal, 2013). If the patient is receiving oxygen, in Amy’s case through a Hudson mask on 6L, it should be ensured that it is monitored accordingly. The patient’s skin softness, colour and paleness should be checked. This determines the level of perspiration and blood flow in the patient’s body. It should also be checked if the patient is comfortable (Brookside Associates Medical Education Division, 2007). For Amy, her mother commented that she did not seem to be comfortable. This is the importance of allowing family members to visit the patient. References Abby W., Crystal H. K. (n.d.). Encyclopedia of Surgery. Postoperative care. Retrieved on March 20, 2013, from Surgery Encyclopedia Web site http://www.surgeryencyclopedia.com/Pa-St/Postoperative-Care.html Abdullah J., David C. (2009). Current Surgical Guidelines. Oxford: Oxford University Press Abigail, A. (2011). Tips for Recovering From Tonsillectomy as an Adult. Retrieved March 20, 2013, from Livestrong foundation Web site http://www.livestrong.com/article/112404-tips-recovering-tonsillectomy- adult/#ixzz2O5igpJRN Brookside Associates Medical Education Division. (2007). Lesson 8: Perioperative Patient Care, Section IV. Post operative Patient Care. Retrieved March 20, 2013, from Brookside Press Web site http://www.brooksidepress.org/Products/Nursing_Fundamentals_II/lesson_8_Section _4.htm Charles J. C., Jerrold L., David T. (2009). A Practice of Anesthesia for Infants and Children. (4th ed.). Elsevier Health Sciences. Lois H. (2008). Perioperative Nursing: An Introductory Text. Elsevier Australia. Lynda J. C. M. (2009). Nursing Care Plans and Documentation. (5th ed.). Lippincott Williams & Wilkins. MaryAnne H. (2006). The AARP Guide to Pills: Essential Information on More Than 1,200 Prescription & Nonprescription Medications, Including Generics. Sterling Publishing Company, Inc. Ottawa Shores E.N.T. Associates, P.C. Post-Operative Care for Tonsillectomy. Retrieved on March 20,2013, from Osenta Web site Read More