Clinical Case Study
The nursing problem chosen is potential for pain related to surgical incision as evidenced by grimacing and a subjective pain score of >3/10 using the Numeric Pain Rating Scale. Pain control is a medical service that takes an interdisciplinary approach to reduce suffering and improve the quality of life of those affected. Despite all advances in the understanding of acute pain and the development of new methods of treating acute pain, postoperative pain is a major medical challenge in healthcare, and pain therapy has become one of the ethical obligations fundamentals of medicine.
According to Darren anaesthetic report, it indicates that the patient is facing some mild pain, and the pain reduces with time from 3/10 to 1/10. This document will discuss ways of managing pain.
Literature Review
The literature by Hong & Lee investigated the effects of two methods of pain management, intravenous analgesia pumps for patient control and conventional intravenous injection by a nurse. Patient-control analgesia pumps have been the most preferred method of treating postoperative pain in acute hospitals (Hong & Lee, 2014). Despite its effectiveness, patients are still dissatisfied with the treatment and often complain of side effects and side effects. The quasi-experimental study design was used to compare 70 women, a total of 140 women randomly from each group. Participants were given morphine to measure the effectiveness of the patient-controlled analgesia pump at an initial flow rate of 0.5 ml per kilogram of weight with a 1 ml bowl available upon request and the blocking interval.
With an additional dose of Ketorolac and Ramosetron, depending on age and weight. The conventional group of women received 0.1 to 0.2 mg per kilogram of body weight of morphine at the maximum dose of 50 mg in 24 hours, followed by ketorolac of tromethamine, if necessary. If necessary, antiemetics were available for both groups. This study included restrictions so that certain nursing activities and other professionals from my clinical team to help with pain control were probably not documented (Hong & Lee, 2014). The patient’s side effects were obtained by examining the table, so some responses cannot be documented by the team (Hong & Lee, 2014). At the end of the study, patients who used PCA pumps experienced significantly less pain in the postoperative period 2, 6 and 12 hours after surgery, but also reported a greater number of side effects. Indicated that the conventional analgesic method was the most preferred. However, there are many surgical services in this surgical population.
The Australian Journal of Advanced Nursing published an article on patient satisfaction with pain control and comfort after open-heart surgery by Neziha Karabulut, RN, PhD. The aim of this study was to find out if patients were satisfied with the management of pain and felt comfortable after major cardiac surgery (Karabulut et al. 2015). The design used in the study was a descriptive hospital study carried out in the cardiovascular surgery department. Final outcome measures include data collection through personal information forms, patient satisfaction surveys and general comfort scales when leaving the patient (Karabulut et al. 2015). The results of the study concluded that the patient’s greatest pain occurred immediately after the operation and in the first 24 hours after the excursion. Most customers said they should wait for the most comforting moment (Karabulut et al. 2015). It was found that the vast majority of customers were satisfied with the prescribed treatment regime. In this study, it was concluded that the patients were very satisfied with the pain control regime administered by nurses.
The Asian Nursing Research published the effect of Internet-based postoperative pain regimens on patients with postoperative abdominal surgery in South Korea to create evidence-based management guidelines for Internet postoperative pain and study the impact of the level and intensity of the patient undergoing abdominal surgery, as well as the knowledge and experience of the nurse in the treatment of postoperative pain (Mędrzycka-Dąbrowska et al., 2016). The methodology included the development of an evidence-based practise guide via the Internet at a hospital, the development of a special education program for evidence-based practices for nurses and various strategies to facilitate and support integration online(Mędrzycka-Dąbrowska et al., 2016). The study results showed that evidence-based guidelines effectively reduce pain levels in patients and improve nurses’ knowledge of pain control.
Intervention and justification
Assess the patient’s pain level, as well as location, quality and intensity, with a pain rating of 0 to 10 every two hours and check for significant pain symptoms. Increased heart rate, blood pressure and respiratory rate every two hours. Pain is a common experience and cannot be measured or denied (Ward, 2015). Careful pain assessment is important to ensure that the patient receives effective treatment.
Monitor the patient for signs of chronic pain, such as discomfort, stagnation, breathing and tears during pain testing. Because pain is imitative, response and psychological behaviour are indicators of pain in patients. A sympathetic nervous response will also be evident when the pain is acute (Ward, 2015). Acute exacerbation awakens the sympathetic branch of the ANC and causes side effects such as increased blood pressure and heart rate and respiratory rate. In addition, culture plays an important role in the perception of pain and in the expression and reporting of pain.
Respond to pain immediately, determine the patient’s current medication use and administer the prescribed medication as directed by the physician. Manage painkillers as instructed, assess their effectiveness and monitor any signs and symptoms of side effects (Ward, 2015). Check the patient’s response to painkillers 30 minutes to 1 hour after administration. Analgesics such as tranquillizers and opioids are useful to control and relieve pain. Non-opioid analgesics for mild to moderate pain and opioid analgesics for acute moderate to severe pain (Ladwig and Ackley, 2015). Inform the doctor if the interventions have failed or if the current complaint is a significant change from the patient’s previous pain experience. Patients who use painkillers more often than prescribed may need higher doses after being seen by a doctor.
Evidenced-Based Assessments
The initial phase in moderating PAIN is to prevent its destructive impacts, and doing so securely, is to guarantee that patients are appropriately surveyed for pain with the goal that proper pain alleviation measures can be actualized. Something else, the pain might be unnoticed by clinicians or might be undertreated (Ward, 2015). Self-reporting is a solid approach to assessing pain performance. If the patient can report pain, his behaviour or essential signs should never be used in place of a personal relationship. In mentally minded adults, the severity of pain in the clinic is often assessed using the numerical rating scale from zero to 10 or the FACES WAC-Baker scale from zero to 5 (Ward, 2015). The NRS consists of a straight numbered line with intermediate numbers of zero to 10 with the expressions “painless for zero”, “moderate pain” for five and “terrible pain extremely” for 10. The FACES scale consists of six areas demonstrating dynamic pain forces, showing powers of pain, starting with a smiling face and ending with a torn face (Ward, 2015). If the patient recognizes how to use a pain scale, he should be instructed on how to set a comfortable working goal. This is the level of pain at which the patient is ready to perform important exercises, for example. Walking after medical intervention or work-related exercise. Mediation is done to maintain and accomplish this pain score whenever expected.
If the patient is unable to report pain, several less reliable estimates should be used to detect the presence of pain and measure the likely effectiveness. These assessment estimates structure an advanced system in an organized manner and with plausible meaning:
- Conditions like medical procedures or methods like dealing with wounds that can cause pain.
- Patient practices that can show pain. A behavioural assessment device, discussed below, can be used. A behavioural pain scale studied at all conceivable moments must be selected to ensure reliability and legitimacy in the clinical context.
- Knowledge of others who know the patient, family or parent figures. They should be asked if they see any practice that may show pain or if they are aware of conditions, such as inflammation in the joints that causes pain.
If one of the pains suggested above is available, the doctor can assume that pain is available and use the acronym app to record the assessment if a pain resistance score cannot be obtained. The adequate defence is then interrupted, depending on the plausible power of the pain. If necessary, a preliminary portion of pain relief is administered, and the patient’s behaviour is observed during this mediation (Pogatzki-Zahn, Segelcke, & Schug, 2017). If the behaviour decreases, it may indicate that the patient is suffering and that pain relief should continue. If the behaviour is not adjusted, a greater proportion of pain relief may be shown. Social assessment tools are useful for distinguishing the presence of pain and assessing intercessions. There are two types of scales: (1) behavioural pain scales and (2) behavioural pain programs. Assess and evaluate three behaviours:
- Facial articulation, the score ranges from 1 for a sloth to 4 for the furrow
- Development of the upper appendix, the score ranges from 1 for no development to 4 for permanent retirement
- The consistency of the fan ranges from 1 for a long-term fan to 4 for uncontrollable ventilation.
Gradually, a score greater than three can indicate that pain is available, and the score can be used to assess mediation, but it cannot be deciphered to indicate the strength of the pain. For the pain behaviour scale to be valid, the patient must be able to respond to all behavioural classifications. For example, BPS would not make sense in a patient who accepts a neuromuscular block operator.
References
Hong, S., & Lee, E. (2014). Comparing effects of intravenous patient-controlled analgesia and intravenous injection in patients who have undergone total hysterectomy. Journal of Clinical Nursing, 23(7/8), 967-975. doi:10.1111/jocn.12221
Hong, S., & Lee, E. (2014). Effect of evidence-based postoperative pain guidelines via web for patients undergoing abdominal surgery in south korea. Asian Nursing Research, 8(2), 135-142. doi:http://dx.doi.org.prx-herzing.lirn.net/10.1016/j.anr.2014.05.005
Karabulut, N., Aktaş, Y. Y., Gürçayır, D., Yılmaz, D., & Gökmen, V. (2015). Patient satisfaction with their pain management and comfort level after open heart surgery. Australian Journal Of Advanced Nursing, 32(3), 16-24.
Mędrzycka-Dąbrowska, W., Dąbrowski, S., Gutysz-Wojnicka, A., & Basiński, A. (2016). Polish nurses’ perceived barriers in using evidence-based practice in pain management. International Nursing Review, 63(3), 316-327. doi:10.1111/inr.1225
Pogatzki-Zahn, E. M., Segelcke, D., & Schug, S. A. (2017). Postoperative pain—from mechanisms to treatment. Pain reports, 2(2).
Ward, C. W. (2015). Pharmacologic Methods of Postoperative Pain Management: Opioids, Nonopioids, and Adjuvants. MEDSURG Nursing, 1-15.