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Group Discussion 2

Florida International University

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Scientific and Theoretical Foundations for Advanced Nursing Practice


Shirley Germain

January 23, 2018



Group Discussion 2

 Pain is an unpleasant sensory and effective experience. Usually, it is associated with tissue injury following trauma or invasive procedures (Peterson & Bredow, 2017). Post-operative care after a right hemi-colectomy consists of infection prevention, hemodynamic stability and pain management. Of all, pain management is the most challenging and essential part of the plan of care. Patients who are in pain endure physical and mental strain and are at risk for long-term adverse effects. This includes slower wound healing, down-regulation of the immune system, and cancer reoccurrence (Joint Commission Resources, 2012). In order to promote successful recovery, pain should be managed adequately. Nursing pain management goals should strive to relieve pain quickly and prevent its recurrence.  The use of nursing theories and evidence-based pain management techniques are fundamental in achieving this goal. 

Nursing theories act as a compass to guide nursing practice and help improve patient outcomes. Interestingly, the prescriptive middle-range pain management theory, such as “A Balance Between Analgesia and Side Effects”, can be beneficial to this patient. The three fundamental principles of this theory include multimodal intervention, attentive care, and patient participation. Education directly promotes and increase patient participation. Preoperative education has been proven to increase patient satisfaction and improve patient outcome. Education also decreases anxiety and allows the patient to participate in formulating a holistic plan of care.

When confronting pain, assessment is the first crucial step in creating an effective pain management plan. Once the patient arrives to the unit after surgery, establishing a baseline allows the nurse to formulate an individualized plan of care.  It is also essential for reevaluation, especially when determining if treatments are effective.  Pain cannot be measured or identified by diagnostic procedures. It is subjective, which makes self-reporting the most accurate indicator of pain. In the clinical setting, a numerical pain intensity scale or visual analog pain scales are often used. For non-verbal or sedated patients, the nurse should assess for the presence of pain by observing the patient’s body language, movements and changes in vital signs. Non-verbal pain behaviors may reveal what the patient is unable to communicate. 

Once pain is identified, multimodal interventions can be implemented. Multimodal interventions consist of systemic analgesics such as opioids, non-opioids, and adjuvants. The theory proposes that nurses use potent pain medication, and pharmacological and nonpharmacological adjuvants, to achieve a balance between analgesia and side effects (Peterson & Bredow, 2017). In this situation, this patient will be given intravenous morphine combined with intravenous acetaminophen, for pain control. Also, the patient will participate in nonpharmacological techniques such as relaxation, distraction and position change. The nurse should be attentive and observe the patient for adverse side effect and the overall effectiveness of treatment. 

A right hemicolectomy postoperative patient would benefit significantly from a conceptualize approach; such as the Theory of Unpleasant Symptoms (TOUS) for nausea. This theory implies that management of one symptom will contribute to the management of others (Peterson & Bredow, 2017). The TOUS theory incorporates three factors: the symptom, variables that influence the symptom experience and the effect of the symptom.

Nausea and vomiting are the most common reported postoperative complication. Since a hemicolectomy is a gastric procedure, the likelihood of experiencing nausea is greatly increased. To adequately treat nausea, assessment of nausea should be completed with a numerical rating scale on a 0-10 scale. Within the scale, 0 is indicative of no nausea and 10 indicates the worst possible nausea experienced. The assessment will also include measurements of presence, intensity, and frequency. Physiological, psychological and situational factors should be incorporated in the treatment of nausea. Prevention is imperative in reducing post-operative nausea. Nurses should be knowledgeable and anticipate symptoms before they happen. Antiemetics should be given with medications that are prone to induce nausea such as analgesics. Pain management is also important. Uncontrolled pain can increase the incidence of nausea. Situational factors such as the elimination of odorous materials and minimizing jerking movements can help alleviate nausea. After the implementation of these interventions, reassess the patient using the same scale to evaluate the effectiveness of treatment. 

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