CLINICAL JUDGMENTS

Clinical Judgments to Safely and Effectively meet the Health Care Needs of Patients

Clinical Judgments to Safely and Effectively meet the Health Care Needs of Patients

Introdcution

Caring for patients immediately postoperatively is a regular occurrence for many nursing staff. As this task is carried out on a daily basis, it is at risk of becoming ritualised. The purpose of this paper is to identify the theories that underpin the care of the postoperative patient, and to improve the reader's knowledge and practice within this field. (Domrose, 2010: 11-14)Regular observations made in the postoperative period assist the health-care team to build up a complete picture of the patient's condition following surgery and recovery from the anaesthetic (see panel). These should be compared against baseline observations taken pre-operatively and against previous postoperative readings, as these will assist nurses accurately to chart the patient's progress.

Importance of Pain Control in Post-Operative Care

Effective postoperative pain control is an essential component of the care of the surgical patient. Inadequate pain control, apart from being inhumane, may result in increased morbidity or mortality. Evidence suggests that surgery suppresses the immune system and that this suppression is proportionate to the invasiveness of the surgery(Boud & Walker, 2008: 191-206). Good analgesia can reduce this deleterious effect. Data available indicate that afferent neural blockade with local anesthetics is the most effective analgesic technique. Next in order of effectiveness are high-dose opioids, epidural opioids and clonidine, patient controlled opioid therapy, and nonsteroidal anti-inflammatory agents. The advantages of effective postoperative pain management include patient comfort and therefore satisfaction, earlier mobilization, fewer pulmonary and cardiac complications, a reduced risk of deep vein thrombosis, faster recovery with less likelihood of the development of neuropathic pain, and reduced cost of care (Issenberg, 2009: 10-28). The failure to provide good postoperative analgesia is multifactorial. Insufficient education, fear of complications associated with analgesic drugs, poor pain assessment, and inadequate staffing are among its causes.

Potential Effects of Uncontrolled Pain for Josie Elliot

Acute pain is a predictable response to an insult associated with Josie Elliot's surgery. It usually decreases over a period of over a period of few minutes, hours, days or weeks. In contrast, chronic pain is pain associated with a chronic medical condition or extending beyond the period of tissue injury and normal healing. Chronic pain is variously defined as pain lasting more than a month, more than three months or more than six months(Abrums, 2011: 270-275).

Inadequately controlled pain can cause postoperative morbidity, prolong recovery time, delay return to normal living, and decrease satisfaction with care. Inadequate pain management increases the use of health care resources, thereby increasing total health care costs(Cotton, 2010: 512-519).

Postoperative pain may be a factor in the development of chronic pain for Josie Elliot . In case of Josie Elliot , chronic pain as an outcome of surgery, the severity of postoperative pain was positively correlated with theincidence of chronic pain after breast surgery, thoracotomy, and inguinal hernia repair. Chronic pain is a major health problem that afflicts a significant number of patients, resulting in ...