Post-Surgical Pain Management
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Post-Surgical Pain Management
Introduction
Management of post-operative pain is an essential and important period compared to the surgical period. After the surgery, a patient tends to undergo different types of pains which are physical, emotional and cultural factors. Although the post-surgical management has no total assurance of working on all patience, it is essential. Most post-surgical caregivers don’t tend to pay attention to it. Activities such as exercises, deep breathing, splinting and moving around and good sleep are just but a few post-surgical which reduce the patients stress. In this study we are going to look at the problems after surgery, how to handle a post-surgical patient considering the health position of the patient and analysis of the patient information.
The Clinical Issues and Interventions
The post-surgical management method is guided by the patients’ health history and also the type of surgery underwent. Mrs. Wendy is a patient with abdominal pains and diarrhea whom after tests shows that she has a tumor in her colon and is scheduled for a surgery. She undergoes open right hemicolectonomy due to a colon growth. After the surgery she may experience the after surgical complications such as severe pain, Deep Vein Thrombosis (DVT) and wound or anastomosis dehiscence and paralytic ileus especially considering her health history of Asthma, Hypertension, Obstructive sleep apnoea and myocardial infection. During this post-surgical complications, a nurse should be able to take the right measures to ensure the patients fast recovery.
Under-treatment of pain in patient is one of the major problems identified among many surgical patients which lead to incomplete pain relive of post-operati0on pain (Topolovec-Vranic et al., 2010). This leads to delay in patient recovery and increase the suffering hence delay in hospital hence high unnecessary costs (Barr et al., 2013). According to the research done, some patients experience sever pain while others tend to experience moderate pain. Even after the post-surgical pain management it does not show much effectiveness to total pain relive. This has contributed to non-pharmacologic strategies to help the patients such as music and cold therapy which are fully medical integrated (Barr et al., 2013; Chou et al., 2016). The strategy to combine both medical and non-pharmacologic pain management adding splinting and sleeping has shown much effectiveness to acute pain.
During a research in the USA by the American Society for Pain Management (ASPMN), the committee found out that most nurses are able to employ the non-pharmacologic strategies like music and cold therapy on patients. Music in response has shown lower pain ratings (Liu and Petrini; 2015) as it did not work effectively in analgesia, post- operative complications or long hospital stay. Although it’s not very effective, it showed an association with ones perspective on pain control. This encouraged use of cold therapy also called cryotherapy which is the application of to the skin which is used to reduce edema and provides local analgesia to the surgical site. Combining music and cold therapy is a free-risk non-pharmacologic pain management strategy god to be adopted on the patient.
Splinting is also another effective non-pharmacologic method that is used on patients. This is the use of splinting device to support the incision by reducing stress by equalizing the pressure across the incision and allow comfort during position changes. It enables the patient to have easy time during deep breathing and coughing and while moving in bed or out of bed. Splitting devices can either be pillows, binders or other recommended devices by nurses although pillows are the common ones as they are specially designed to provide comfort at various incision areas especially abdominal incision. Deep breathing is also another non-pharmacologic strategy which has shown vast effectiveness. After chest or abdominal surgery, coughing and breathing are one of the affected natural tasks and painful. As deep breathing is one of the best after surgery recommendations, some tools may be adopted to make it easier for the patient to perform the task. Spirometer is one of the technical devices used to encourage deep breathing among surgical patients. Another device might be acapella which is recommended as per the patient’s condition and ability to take the deep breaths.
Deep Vein Thrombosis (DVT) is occurs often in deep veins of a patient legs or pelvic and the clot might cause pulmonary embolism (PE) if it travels to the heart (Dr. Hayley Willacy et al., 2020). A nurse taking care of a patient should be in a position to identify the symptoms of DVT on a patient for early diagnosis as its one of the post- surgical causes of death especially to patients with cancer, 60 years and above of age and smoking patients. Research show that the a very small percentage of around 15% are the ones who are able to be diagnosed with DVT on time and treated while others lose their lives before its known. Some of the symptoms are limb pain and tenderness along the line of deep veins, thigh or calf swelling, distension of superficial veins, high temperatures, skin discoloration and pitting oedema. Some similar signs can also be due to other causes like trauma, vacuities, cellulites, septic arthritis, compartment syndrome and others If ant of the signs are identified, the nurse should recommend for DVT tests for assurance on the patient and treatment commenced as per the results.
Wound or anastomosis dehiscence is a disorder when it comes to wound healing process. It can occur in a patient if she has certain complications or contributed by factors such as immunosuppressive therapy, radiotherapy, long term steroids, poor blood supply, malnutrition and vitamin deficiency and severe rheumatoid diseases. It does not commonly occur but it can cause mortality in patients. This disorder show 7-10 days after the surgery and is noticed by wound serosanguinous discharge and may affect the whole wound. Some of the complications may come hand in hand with this is condition are; infection of the wound inviting germs inside the wound and If noticed early, the infection can be treated using antibiotics, Osteomyelitis which attack the bone, gangrene which is loss of blood supply, periwound dermatitis around the tissue surrounding the wound, periwound edema and wound dehiscence. The nurse should immediately recommend for opiate analgesia, sterile dressing to the wound, fluid resuscitation or early return to theater for re-suture under general anesthesia.
Considering Mrs. Wendy’s health history and lifestyle, all this conditions have a likelihood of occurring at different times. The nurse should be watchful of any unusual signs of either of the above post-surgical complications and give the necessary recommendations. The exercises should also be upheld to minimize the risks involved and also assist in fast recovery of Mrs. Wendy and ensure that no harmful practice is taken by the patient like smoking and alcohol consumption during the recovery. Any medicines that may also have side effects on the wound or the patient condition should be avoided like steroids to assist in wound healing. The therapies should be administered on how effective they are to the patient and the most effective be recommend while in hospital example hourly exercise, regular deep breathing, movement in and out of bed often and cold therapy after a period of time. Blood circulation observation and air circulation are also critical observation areas.
Discharge Plan
The surgery done may take some time mostly 6 weeks to heal and some instructions are required to be followed to assist the healing process at home. You should look after the wound to avoid and infection which may lead to sever condition or even back to the theater if not careful, ensure you take stool softeners if prescribed by the surgeon. Pain relive medicines will be prescribed and its not necessarily you wait for severe pain to take them. Antibiotics will also be given to treat any infections if at all they occur. In terms of diet , follow any instructions given by the nutritionist starting with taking liquid foods fast and slowly going to hard foods. Incase of constipation, fiber may be added in your diet and stool softeners. A lot of fluids intake will be of much help but not alcohol. Ensure you take enough rest at all times and do not overstrain your muscles to avoid rupture. Avoid lifting heavy weights or any work involving the surgical area and do not take a dive shower until the wound is completely healed. Ensure you walk often and do the deep breathing excises and coughing and await instructions after your check up on when you can return to work.
Health Recommendation for Recovery
After discharge, lifestyle from usual to unusual happens. It might be permanent or temporary depending on the type of incision and also the risk involved if a certain lifestyle continuous or its not adapted. Some fun things like alcohol consumption and smoking are examples of a few lifestyles that are to be avoided during and possibly after recovery. Looking at the health history of Mrs. Wendy , some recommendations are made in order to facilitate her healing and ensure that no future occurrence of the same case is repeated. Some changes may cause discomfort but they are for the best of the patient. After recovery and total checkup, the doctor will further advice, as time goes by on which recommendations might be withdrawn. At first the lifestyle may also seem expensive and unmanageable due to a lot of dependency but its better to adthere to it for a while and solve long lasting complication.
During the healing period kindly do and avoid the following; Ensure the incision is kept clean and dry but do not touch the incision with soap or soapy water maybe the area around it, ensure you change the dressing minimum every 48 hours, ensure you do not pick, scratch or pull at the incision even when itchy, do not use oils or creams on the incision, ensure to avoid any negative medical information that are not confirmed medially or not approved by the doctor, ensure you do not engage in drinking or smoking during the healing process as it may lead to serious damage to the incision and your health in general. If you need to take any other drug please reach out to the doctor for approval first. Music is an effective way to settle the psychological effects of surgery, ensure you listen to soothing music which lifts ones spirit and create a positive notion in one’s mind.
Ensure you put on comfortable loose-fitting clothes, soft and comfy and avoid sleeping on the incision side but get a comfortable position. If any complications is experienced such as high fever, chest pains, pain and leg tenderness, nausea and vomiting, diarrhea for more than 3 days, dark coloring or bloody urine, bright red stool or dark. Swollen or skin rash or incision separation please reach out to the medical facility. Most importantly ensure you take proper care of your body no to trigger another disease or complication during the healing process. Follow the routine check-ups allocated without missing so as to know the progress of the incision and other health conditions. Kindly ensure you have someone to drive you around until your body recovers and also assist you in basic activities including bathing and wound incision dressing.
Further recommendations and instructions will be issued as the checkups and healing process continuous by the doctor and the nutritionists on diet and lifestyle
Conclusion
Surgical solution is commonly used to solve so many health issues in so many aspects. The procedure involved in each surgery depends on the health of the patient, the problem or condition of the patient and the age and other physical characteristics. A patient recovery fully depends on the nurse in charge keenness on the patient and the therapy strategies and also the patient’s observation to the prescriptions given during discharge. A patient’s mentality also matters a lot on the healing process; how well he/she is ready to adhere to the prescriptions and the mentality of the patient towards healing
References
Grosu, I., & De Kock, M. (2011). New concepts in acute pain management: strategies to prevent chronic postsurgical pain, opioid-induced hyperalgesia, and outcome measures. Anesthesiology clinics, 29(2), 311-327.
Joshi, G. P., & Kehlet, H. (2013). Procedure-specific pain management: the road to improve postsurgical pain management?. Anesthesiology, 118(4), 780-782.
Levy, N., Mills, P., & Rockett, M. (2019). Post-surgical pain management: time for a paradigm shift. British journal of anaesthesia, 123(2), e182-e186.
Macintyre, P. E., Loadsman, J. A., & Scott, D. A. (2011). Opioids, ventilation and acute pain management. Anaesthesia and intensive care, 39(4), 545-558.
Milotte, H. (2018). The Effect of a Therapeutic Pillow On Pain Following Nephrectomy: A Randomized Clinical Trial. Urologic Nursing, 38(3).
