Most trauma orthopedic special units in the United States receive patients with varied care depending on the type of injury, the degree of injury, patient orientation, and clinical and patient experience. Clinicians employ the usage of intravenous (IV) morphine and non-opioid oral medications to patients suffering from limb trauma such as a fractured femur, rib, sternal bruises, and multiple abrasions. This paper intends to examine the best pain management and pain control.
Initial Management and Pain Control
The initial management of pain in adults involves the admission of oral paracetamol for mild pain, oral paracetamol and codeine for moderate pain, and intravenous paracetamol enhanced with intravenous morphine. The mixture is titrated to a conclusion for severe pain. The case study requires the admission of a solution of titrated morphine mixed with paracetamol. Intravenous opioids are applicable for frail and the elder in the society, such persons must not be given non-steroidal anti-inflammatory drugs (NSAIDs).
Garg & Moudgil, (2019), argue that smoking significantly affects the musculoskeletal system, and thus inhibits the healing process during the treatment of bone fractures. Scientists suggest that nicotine impedes the healing process of fractures, suppresses the action of antioxidant properties of vitamin C and E, and makes the action of estrogen ineffective. It is appropriate to advise the client on the adverse effects of smoking during and after treatment to create awareness. Low bone density results in fracture risk. Biologists assert that bone biochemical makers can be found in urine and serum. According to Garg & Moudgil, 2019), the examination of the patient's urine would indicate vital factors that add to his bone quality and remodeling rate.
Thus, critical spectra nursing interventional action includes calling the physician to the patient's Nicotine patch and reporting the decreased output of urine with umber urine. It is also clinically right that the nurse to intervene in the patient's smoking history and this can be achieved by providing the patient with education about the effects of smoking because the patient should be recovering from anesthesia at this moment.
The Second Nursing Intervention Action
The second best course of action is to perform among the six steps includes the administration of 2mg Morphine injection via the intravenous (IV) route for severe pain that is reported as eight on the scale of 10. The signal recognized in the scenario includes the patient's scale value of 8, which denotes severe pain. The implication of the action is because after managing hypoxia, the nurse should make efforts to reduce the pain to a moderate level which should be 5 in the scale. In judging the hypothesis, Meissner et al. (2018), argued that if the patient assessment indicates a rating of between 7 and 10 on the NRS (Nurse Rating Scale) for pain, predominantly the postoperative patients, the score is interpreted as the worst intensity pain or severe pain. As a result, the nurse should administer morphine or a suitable opioid to relieve the pain, and in this case scenario, a goal of 5 (Shanthanna et al., 2019).
The situation further reveals that the patient's requirement for oxygen is higher, and this could be because the patient is experiencing severe pain. The main aim at the phase is thus to regulate the pain and significantly reduce the patient's need for the oxygen. Therefore, the nurse would be compelled to elevate regular and breakthrough dosages of morphine by approximately 25%, followed by titration of the doses after every one day (Borda, Charnay-Sonnek, Fonteyne, & Papaioannou, 2013).
The Third Best Nursing Action
The third best nursing action involves the administration of tetanus immunization. The recognized hint from the scenario consists of the fact that the patient has a fresh wound on his limb following the surgical procedure, and as such the hypothesis is that the patient is highly vulnerable to tetanus, which has been reported to be fatal even with expert management of wounds following a surgical procedure, and mostly due to infection by the organism Clostridium tetani (Tchuenkam et al., 2017). In judging the hypothesis, Tchuenkam et al. (2017) further noted that in addition to the condition resulting in fatalities, the clinical manifestations arise because of an exotoxin synthesized by an organism known as Clostridium tetani, which is a pathogen that penetrates via a skin opening and is independent of the depth and size of the wound, notably in postoperative patients.
Moreover, the recent research led by Sneha May (2018) noted the presentation of the infectious pathogen Clostridium tetanic in patients' stool, particularly in postoperative cases. As such, the patient must be managed with tetanus immunization based on the USA's recommended adult immunization schedule (Kim & Hunter, 2019). In responding to this intervention, the RN's (Registered Nurse) action plan should involve obtaining consent from the postoperative patient to administer the immunization (Garg & Moudgil, 2019), along with conducting a thorough background check of any potential drug allergic reactions before applying the tetanus immunization.
The Fourth Best Nursing Action
The fourth phase of intervention should involve bestowing efforts to relieve pain, and this should be done in the Electronic Order System (EOS). The very crucial cues in the scenario include organizing pain recorded at 8 and 10 of the evaluation scale. A resultant hypothesis should compel that before these actions are taken, a registered nurse (RN) should clearly define the pain management in the EOS to attain an optimal control while anticipating to carry out other crucial steps successfully.
Additionally, the surgical procedure has the potential to make the patient experience sever pain. As a result, the nurse should initiate a proper pain management scheme very fast before the PCA pump is disconnected. To ensure that this is successful, the nurse should critically define an adequate pain management plan. As far as the case is concerned, there is a need to incorporate two physician strategies. These include the discontinuation of the PCA as well as consulting pain management and the administration of morphine for severe pain.
According to Urban et al., the essential and significant workflow in the management of postoperative patients will only be successful if the implementation of a CPOE is well catered for and that the improvement of medication Turnaround time is adequately met (2015). Moreover, Urban et al. illustrated that the utilization of EOS results in the minimization of severe respiratory depression associated with a lack of implementing that involves CPOE for pain management along with a decrease of reported post adverse drug reactions of any type (2015). In support of these findings, the results of Urban et al. (2015) resonates well with the findings of Prewitt et al. (2013) that explains the significance of implementing an EOS program during the early phases when postoperative patients are taken care of to avoid any further complications.
As a result, it is appropriate to affirm that the best and the first procedure in the case is managed the pain through EOS which has been referred to as a Computerized Provider Order Entry for pain management (Alomi, 2017; Duncan, Smith, Maguire, & Stader III, 2019). From a clinical viewpoint, early initiation of pain management, particularly in postoperative patients, is extremely vital since it contributes to a phenomenon known as preemptive analgesia (Urban, Chiu, Wolfe & Magid, 2015). Urban et al. (2015). Furthermore, it is noted that RNs utilize preemptive analgesia and other relevant health care providers should minimize central sensitization along with regulating the wind-up phenomenon.
Final Stages of Pain Management and Control
The final aspect of patient management suffering from the bone structure as in the study case is to employ anti-embolism. The usage of anti-embolism is essential in executing a measured pressure at a diminishing gradient from the ankle towards the knee. This ensures an increase in blood flow and improves venous return.
The Incorrect Action
The nurse would have been involved in incorrect action that would comprise the decrease in the oxygen saturation levels of the patient. The defined symptom retrieved from the scenario constitutes reported oxygen level, including 94 % on the 4L Nasal Cannula. The implication here is that a patient that has been exposed to surgical processes involving the application of anesthesia or rather a patient who is recovering from anesthesia agent such as the patient in the scenario should be maintained on a SpO2 level of not less than 95 %. The evaluation of the hypotheses shows that any value below 95 % would signify hypoxia. But again, one of the actions in the nurse's decisions involves a further decrease of the oxyhemoglobin saturation of the patient, which can potentially lead to respiratory arrest (Sun et al., 2015).
Moreover, the RN needs to consider the fact that the patient's incapacity to a deep breath is the principal reason for the patient's readings of both CO2 and O2. One of the causes of impaired breathing, particularly in postoperative patients, includes agonizing pain. Therefore, the nurse must ensure the pain is controlled, which will improve the patient's breathing, thus optimizing his ABGs. Once the objective of enhancing the patient's ABGs is achieved, the patent's oxygen requirements would be minimized, and a state of wellbeing accomplished. Therefore, the collaborative checkpoint for this intervention includes improving the patient's ABGs by improving his breathing system. The monitoring and analysis of the ABGs are very significant to prevent severe complications that may emerge in the postoperative care phase. Studies have revealed that postoperative pulmonary complications, especially myocardial ischemia, which fundamentally takes place after two days as a result of the surgical process (Gonon et al., 2019).
The research led by Sun et al. (2015) discovered that hypoxemia is a prolonged and frequent amongst hospitalized cases recovering from non-cardiac surgical procedures. Sun and colleagues conducted a prospective blinded observational survey to determine the persistence and commonality of postoperative hypoxemia among 594 Cleveland Clinic and Juravinski Hospital (Sun et al., 2015). The authors unearthed that hypoxemia was widespread, with 37 % of the reported cases having a minimum of one example comprising oxyhemoglobin saturation levels of less than 90 %. The authors also found that the working nurses missed approximately 90 % of 'smoothed' episodes of hypoxemia, which included saturation levels of less than 90 % for a minimum of one hour (Sun et al., 2015).
It is very significant to acknowledge that any significant oxygen desaturation levels should be remedied to prevent the incident of anaphylaxis or respiratory arrest that may be dreadful to the patient. According to O'Driscoll, Howard, Earis, and Mak any noted prolonged substantial desaturation levels of oxyhemoglobin (SpO2<90%) must be addressed by supplemental to attain target SpO2 of between 94 and 98 % among postoperative patients (2017). Therefore the nurse in the present case scenario should correct any SpO2 of less than 90 %, maintain the levels at a range of between 94 and 98 % in addition to close and constant monitoring of the patient, preferably after every one-hour intervals.
Alomi, Y. A. (2017). National pharmacy pain management program at the ministry of health in Saudi Arabia. J Pharmacol Clin Res, 3(2), 1-7. Retrieved from: https://pdfs.semanticscholar.org/73d2/b6872a0d6cf95b8c3...
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