Sheila Dalton_Final_Clinical_Surgical_Pain_Management_Unfolding_Reasoning_1 | NURSE 400 Post-op Pain Management: Day of Surgery (1/2) - American River College

Post-op Pain Management: Day of Surgery (1/2) Primary Concept Pain Interrelated Concepts (In order of emphasis) 1. Gas Exchange 2. Glucose Regulation 3. Perfusion 4. Inflammation 5. Clinical Judgment 6. Patient Education 7. Communication 8. Collaboration UNFOLDING Reasoning Case Study: STUDENT Post-op Pain Management: Day of Surgery (1/2) History of Present Problem: Sheila Dalton is a 52-year-old woman who has a history of chronic low back pain and COPD. She had a posterior spinal fusion of L4-S1 today. She had an estimated blood loss (EBL) of 675 mL during surgery and received 2500 mL of Lactated Ringers (LR). Pain is currently controlled at 2/10 and increases with movement. She was started on a hydromorphone patient-controlled analgesia (PCA) with IV bolus dose of 0.1 mg and continuous hourly rate of 0.2 mg. Last set of VS in post-anesthesia care unit (PACU) P: 88; R: 20; BP: 122/76; requires 4 liters per n/c to keep her O2 sat 90 percent. You are the nurse receiving the patient directly from the PACU. Personal/Social History: Sheila is divorced and currently lives alone in her own apartment. She has two grown children from whom she is estranged. What data from the histories is RELEVANT and has clinical significance to the nurse? RELEVANT Data from Present Problem: Clinical Significance: 1. Low back ache, COPD 2. Had surgery today 3. Blood loss 1. COPD- might have exacerbations of COPD 2. Pain due to surgery 3. Blood loss can lead to poor perfusion RELEVANT Data from Social History: Clinical Significance: Estranged from her children Divorced Pt might not be able to care for herself post-surgery, We need to assess if she needs assistance at home, Pt lives alone What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds? (Which medication treats which condition? Draw lines to connect.) PMH: Home Meds: Pharm. Classification: Expected Outcome: • Low back pain with lumbar compression fracture • Depression • COPD • Pulmonary hypertension • 2 ppd smoker x 32 years 1. Citalopram 40 mg daily 2. Oxycontin SR 40 mg bid 3. Oxycodone 10 mg every 4 hours prn 4. Fluticasone/salmeterol 250/50 diskus 1 puff every 12 hours 5. Sildenafil 20 mg tid One disease process often influences the development of other illnesses. Based on your knowledge of pathophysiology, (if applicable), which disease likely developed FIRST that created a “domino effect” in her life? • Circle what PMH problem likely started FIRST. • Underline what PMH problem(s) FOLLOWED as domino(s). - - - - - - - - - - - Situation: Name/age: BRIEF summary of primary problem: Day of admission/post-op #: Background: RELEVANT past medical history: Assessment: Most recent vital signs: RELEVANT body system nursing assessment data: INTERPRETATION of current clinical status (stable/unstable/worsening): Recommendation: Suggestions to advance plan of care: Education Priorities/Discharge Planning 1. What will be the most important discharge/education priorities you will reinforce with Sheila about her medical condition to prevent future readmission with the same problem? 2. What are some practical ways you as the nurse can assess the effectiveness of your teaching with this patient? Caring and the “Art” of Nursing 1. What is the patient likely experiencing/feeling right now in this situation? 2. What can you do to engage yourself with this patient’s experience and show that she matters to you as a person? Use Reflection to THINK Like a Nurse Reflection-IN-action (Tanner, 2006) is the nurse’s ability to accurately interpret the patient’s response to an intervention in the moment as the events are unfolding to make a correct clinical judgment. 1. What did I learn from this scenario? 2. How can I use what has been learned from this scenario to improve patient care in the future?