Download
nursing care of clients in acute pain n.
Skip this Video
Loading SlideShow in 5 Seconds..
Nursing Care of Clients in Acute Pain PowerPoint Presentation
Download Presentation
Nursing Care of Clients in Acute Pain

Nursing Care of Clients in Acute Pain

478 Views Download Presentation
Download Presentation

Nursing Care of Clients in Acute Pain

- - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

  1. Nursing Care of Clients in Acute Pain Larry Santiago, MSN, RN

  2. The Fifth Vital Sign • Acute pain - Pain lasting from seconds to 6 months

  3. The Fifth Vital Sign 2 • Chronic (malignant)pain - Lasts for 6 months or longer

  4. The Fifth Vital Sign 3 • Cancer-related pain

  5. Pathophysiology of Pain • Pain transmission - Among the nerve mechanisms and structures involved in the transmission of pain perceptions to and from the area of the brain that interprets pain are nociceptors

  6. Pathophysiology of Pain 2 • Nociceptors • Free nerve endings in the skin that respond only to intense, potentially damaging stimuli • Part of complex multidirectional pathways

  7. Pathophysiology of Pain 3 • Peripheral Nervous System - Nociception: the transmission of pain

  8. Nursing Assessment of Pain Pain assessment is high subjective • Report of pain is a social transaction • Review the patient’s description of pain • Review the patient’s response to pain relief strategies

  9. Characteristics of Pain • Intensity • Timing • Location • Quality • Personal meaning • Aggravating and alleviating factors • Pain behaviors

  10. Pain Assessment • Visual Analogue Scales

  11. Pain Assessment 2 • Faces Pain Scale

  12. Nurse’s Role in Pain Management • Identify Goals • Elimination of pain may be unrealistic • Factors to determine goal: severity of pain, anticipated harmful effects of pain, anticipated duration of pain

  13. Nurse’s Role in Pain Management 2 Establish Trust • Positive nurse-patient relationship and teaching are key • Teaching

  14. Nurse’s Role in Pain Management 3 • Providing Care

  15. Nurse’s Role in Pain Management 4 - Managing Anxiety

  16. Pain Management Strategies • Premedication assessment • Ask the patient about allergies • Obtain medication history

  17. Pain Management Strategies 2 • Individualized dosage • Based on the patient requirements rather than on standard

  18. Patient-controlled analgesia (PCA) • Indications • Allows patients to control the administration of their own medication • The pump has predetermined safety limits

  19. PCA 2 • Desired patient outcomes • To achieve better pain relief • Require less pain medication than those who are treated PRN • Can maintain a near-constant level of medication

  20. PCA 3 • Patient education • Teach about operation of the pump • Side effects of the medication • Strategies to manage side effects

  21. PCA 4 • Nursing implications • Warn family not to push PCA button • Be very careful when programming pump, can accidently overdose or underdose patient

  22. Epidural Analgesia • Indications • Childbirth • Post-operative pain

  23. Epidural 2 • Desired Patient Outcomes • Provide effective pain relief • Able to suppress the stress response

  24. Epidural 3 • Patient education • Can provide pain relief for days after surgery • Often times a combination of narcotics and anesthetics are used • A PCA to give additional boluses may be implemented

  25. Epidural 4 • Nursing implications -assess pain, motor, and sensory function -check LOC and sedation -assess epidural site for hematoma or displaced catheter -assess for CSF leakage

  26. Acute pain management for the geriatric patient • Conditions that cause pain in older persons: • Exacerbations of degenerative joint disease • Flare-ups of chronic conditions like gout or rheumatoid arthritis • Trauma from falls

  27. Acute pain management for the geriatric patient 2 • Conduct a baseline patient assessment • First priority for acute pain is relief through analgesics • Watch for greater possibilities of adverse effects • PCA may not be an option if patient has cognitive impairment

  28. Perioperative Concepts and Nursing Management Larry Santiago, MSN, RN

  29. Preoperative Phase • Begins with decision to proceed with surgical intervention • Baseline evaluation • Preparatory education

  30. Intraoperative Phase • Begins when patient is transferred to operating room table • Provide for patient safety • Maintain aseptic environment • Provide surgeon with supplies and instruments • Documentation

  31. Postoperative Phase • Admission to PACU • Maintain airway • Monitor vital signs • Assess effects of anesthesia • Assess for complications of surgery • Provide comfort and pain relief • Ends with follow-up evaluation in clinical setting or home

  32. Preparation for Surgery • Informed Consent • Assessment of health factors that affect patients preoperatively

  33. Definition • Informed consent – prior to granting a consent, the client must be fully informed regarding treatment, tests, surgery, etc., and must understand both the intended outcome and the potentially harmful results

  34. Physician’s Responsibility • The clinician who will carry out the procedure has the responsibility of explaining to the patient its risks, benefits, and possible alternatives

  35. Nurse’s Responsibility • If the patient has not adequately grasped the implications of the procedure, the nurse must either: • Give the patient the appropriate information in terms he can understand • Communicate with the appropriate person who can provide the information

  36. Witness signature • When a nurse has signed the witness section of the consent form, she believes the client is informed about the upcoming treatment including: • Anticipated risks and benefits • Answers to questions • Statements that consent may be withdrawn at any time

  37. Ethical dilemma • What if the med-surg nurse finds that the patient does not fully understand what he has consented for? • What are the responsibilities of the nurse at this point?

  38. Deference to Physicians • In the early days of the profession, nurses were taught to obey doctors without question: • “Above all, let her remember to do what she is told to do and no more…implicit, unquestioning obedience is one of the first lessons a probationer must learn” • From Nursing Ethics: For Hospital and Private Use, by Isabel Hampton Robb (1901)

  39. Code of Ethics • Quote from 3rd provision of ANA’s 2001 Code of Ethics for Nurses with Interpretive Statements • “The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.”

  40. Informed Consent and Autonomy • Each person must be considered the authority on his or her own best interests. • Nurses must recognize that adults of sound mind have the right to determine what may be done to their bodies

  41. Informed Consent and Advocacy • Nurses are obligated to be their patient’s advocates. • 2001 Code of Ethics for Nurses – nurses must be alert to and take appropriate action regarding instances of incompetent, illegal, or impairedpractice by any member of the health care team

  42. Incompetance vs. Refusal • If a patient is unable to accomplish simple mental tasks, he may be unable to make more complex judgments • The patient’s wishes must be respected, even though the consequences of refusal may be death

  43. Case Studies • 1) The patient signed a consent for Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy, but she told the nurse later that she did not wish to have her ovaries removed.

  44. Case Studies • 2) The patient consented for a right breast biopsy with possible modified radical mastectomy. However, she told the nurse that she thought, depending on the results, the mastectomy would be scheduled at a later date.

  45. Special Considerations • Ambulatory Sugery Patient • Quickly assess and anticipate patient’s needs

  46. Special Considerations 2 • Elderly • Hazards of surgery are proportional to the number and severity of co-existing health problems

  47. Special Considerations 3 • Obese • Disabilities • Emergency Surgery

  48. Preoperative Teaching • Deep-breathing, coughing and incentive spirometry - Teach patient how to promote optimal lung expansion