Post-Operative Pain Management - Essay Example

Post-operative pain Management Name Institution Date Introduction The International Association for the Study of pain (IASP) defines pain as a feeling that is not pleasant, and is carried to the brain through sensory neurons and emotional experience which is associated with actual or possible injury to the body. Surgical incisions disrupt cells resulting into a release of intracellular substances such as phospholipids, bradykinins, prostanoids and other chemical pain mediators. Release of these substances may result in local or widespread inflammatory conditions depending on the degree of surgical exploration. Inflammation also results in increased cellular tension leading to mechanical stimulation of the sensory pain conducting neurons activation. Postoperative pain results after surgery. It may be of variable range, from mild to moderate to severe depending on the type of surgery performed. The major aim of postoperative care is to relieve suffering by the patient. Pain management should be tailored to the needs of each patient taking into account their medical, physiological and physical condition to avoid adverse drug effects. Importance of Pain Control in Post-operative Care Invasive procedures invariably lead to suppression of the immune system mainly by premedication that may be given to purposely lower chances of hypersensitive reaction to foreign bodies planted in the body e.g. in the case of kidney transplants. Suppression of immunity has also been found to be directly proportional to the degree of invasiveness of the surgery High heath standard can prevent complication development (Ramsay, 2000. pg. 1). Effective postoperative management prevents development of many complications that are associated with a lot of surgeries. The most important advantage is of patient comfort and satisfaction. Pain alleviation enables the patient to be mobile at an early stage. Mobilization leads to early recovery which translates to shorter hospital stay periods and lower hospital bills. Longer bed rests is associated with conditions such as deep venous thrombosis which may threaten the patient’s life. By mobilizing the patient early enough by pain alleviation, a lot of complications can be prevented. Potential Effects of Uncontrolled pain Poor management of postoperative pain may result in detrimental effects, acute and chronic. Attenuation of perioperative analgesia can result in reduction of complications in the immediate postoperative period. It may also facilitate recovery and discharge from hospital. Chronic postsurgical pain (CPSP) is a condition that has been underestimated by many medical practitioners but is common and tends to occur in 10 – 65% of postoperative patients depending on the type of surgery with up to 2 to 10% displaying severe CPSP poorly controlled acute postoperative pain may be implicated in CPSP pathogenesis (Hurley & Wu, n.d.). CPSP that develops as a result of poor acute pain control has far reaching effects and may lower quality of life of the patient afterwards. Other negative clinical complications that may develop include; deep vein thrombosis, which results from protracted periods of immobilization; pulmonary embolism, suspension of a clot of blood that has formed intravascular; coronary ischemia, myocardial infarction, pneumonia and poor wound healing. Wounds can be infected leading to other complications such as sepsis. Poor management also results in poor response to drugs and other medical procedures. The patient is also dissatisfied due to protracted hospital stay and pain. Clinical Judgment Making Process Clinical judgment is the ways in which nurses comprehend the problems or issues and concerns their patients or clients have, attend to salient information and respond in a concerned and involved way (Benner et al. 1996, pg. 2). A comprehensive review was conducted that led to the development of a clinical judgment model. The model (Tanner, 2006) formed the framework to develop a rubric that breaks down and also defines the stages in the development of clinical judgment (Kathie Lasater, 2007. pg. 497). The four stages of clinical judgment making process include noticing, interpreting, responding and reflecting. These are the components of clinical judgment in a case involving a complex patient care that includes changes in status and uncertainty regarding the course of management. These concepts may be summarized as the thinking –in-action skills which has three stages; noticing, interpreting and acting during the process. A fourth stage in the thinking-on-action skills of reflection after the nurse responds to the condition (Cotton, 2007). Clinical judgment process requires that the nurse be cognizant with their client needs either through evidence or available data. The nurse should also be able to make sense of the data and prioritize the data surrounding the situation. They should also be able to come to a conclusion about the best option of management and respond promptly. The nurse’s response then provides the basis for reflection afterwards whether the action taken is appropriate or if there is need for change of management plan. This may also provide a chance for learning and appropriate and prompt action in future. According to Tanner’s model, practical practice experience and the context of the event strongly influence the nurse’s perception. Other variable that shape the nurse’s perception include theoretical knowledge, ethical perspectives and the relationship between the nurse and the patient. Tanner’s model also enables for some unique differences in the manner the nurse may notice events that set the process on. Another provision in the model states that clinical judgment is demonstrated through a variety of reasoning processes such as; analysis, which is common in students; intuitive, which is based on practical experience and narrative, the learning that occurs from nurses and students (Coles, 2002). According to Tanner, 2006, reflection is considered as the catalyst for clinical learning. It has been known even in early educational research and development that reflective thought alone is educative (Dewey, 1933). Allowing for reflection enables learners the opportunity to sort out learning through exploration. Clinical judgment bridges clinical learning to the nurse’s background. It also implies that the nurse is learning and developing with each encounter that they have with patients. Reflection, therefore, fosters the nurse’s development and expertise. Postoperative pain management is different depending on whether it is acute pain or chronic pain. In the 1st stage of clinical judgment formation process, the nurse should look at the patients face for signs of pain elsewhere. Facial expressions should be observed as they can point out the severity of pain. Interpretation of pain depends on theoretical knowledge of the nurse and physical examination. The nurse should palpate to identify the site of pain and try to classify its character as dull or sharp. This is because sharp pain origin is different from dull pain’s origin. For example, dull colicky pain is visceral in origin whereas sharp chest pain which radiates to the inner left upper limb may be of cardiac origin. Management for these two types of pain is completely different; therefore, wrong interpretation can result in mismanagement and development of complications. Responding will be affected by the nurse’s interpretation. Wrong interpretation will result in false management which might result in major complications e.g. giving a painkiller instead of a vasodilator in ischemic heart disease. Reflection will depend on the response of the patient as if the intervention is pain subsides or change of plan if symptoms do not change. Nursing Progress Notes Nursing progress notes are written to monitor the progress of the patient from the time they were received in the wards to when they are discharged. Josie is received in a ward at 7.00 am from the theatre and assisted to get into her bed. She seems to be in severe pain as evident by her facial expressions and the agonizing sounds that she produces. She is also holding her abdominal area and leans forward. On questioning, she reveals that she has severe pain which is dull and colicky in nature. On further questioning she reports that the pain was sudden in onset as she felt it immediately she woke up after the surgery. She also points the origin to be around the area where the surgery was performed and it is acute at the incision. The nurse then will makes a diagnosis of postoperative pain since it is acute on onset and is severe due to the destruction of tissues around the place of surgery. Narcotic analgesics are given at 7.10 am. Allowed to lie in bed and monitor after every 30 minutes. This is the responding that the nurse will take so as to make the patient comfortable. Patient looks stable and is asleep. This reflects that the intervention works and if the pain doesn’t subside then other management methods should be considered. Conclusion Postoperative pain management has a significant part to play in patient recovery. The nurse therefore needs to understand their patients’ attitudes and concerns about postoperative pain for them to provide improved health care and save their clients the hassle of longer hospital stay periods and hasten recovery. A multidisciplinary approach is useful in the forming the management plan of postoperative patients especially of complicated individuals. These include those who have undergone extensive surgeries, are on narcotics for protracted periods or have comorbidities such as hypertension or diabetes. Failure to take good care of postoperative patients results in poor recovery, extended hospital stays and high bills. The nurse should have vast knowledge of clinical judgment so that they can intervene promptly and change the management plan if the initial regimen does not work. References Michael A.E. Ramsay, MD, Proc (Bayl Univ Med Cent), Jul 2000; 13(3); 244-247. ‘Acute Postoperative Pain Management’ pg. 1. Robert W. Hurley, Christopher L.Wu. n.d. ‘Acute Postoperative pain’, in Miller’s Anesthesia (7th ed) Churchill Livingstone: An imprint of Elsevier, chapter 87. Kathie Lasater, EdD,RN, November 2007. Clinical Judgment Development: Using Simulation to Create an Assesment, pg. 497. vol. 46, No. 11. Anesthesia & Analgesia 2006, Jeffrey L. Apfelbaum,MD, Connie Chen, PharmD, Shilpa S. Mehta, pharmD, Tong J. Gan,MD. Postoperative Pain Experience: Results from a National Survey Suggest Postoperative Pain continues to Be Undermanaged, pg. 534 – 543. Read More