Nurses Role in PACU

Question: Describe about the Nurses Role in PACU. Answer: Efficient pain management techniques are essential components in the delivery of quality patient care. Nurses play a significant role in facilitating this by employing a broad range of innovative and acquired mechanisms which are geared towards allaying patients pain. A typical setting where these techniques are exemplified is the post-anesthesia care unit (PACU) where patients are placed temporarily after a major surgery. Nurses perform some roles to facilitate pain reduction. Firstly, according to Kastrup, Seeling, Barthel, Bloch, Spies, Scheller Braun (2012), nurses conduct various assessments to establish the point of emanation of the pain and any factor that might be associated with it. This entails allowing patients to depict areas of tenderness besides describing its nature. This allows selection of appropriate pain-relieving interventions and utilizing them beside prioritizing the major areas of concern. For those patients who may not be in a position to verbalize their pain, unnecessary movements or discomfort are be used to analyze whether the patient has any pain. Secondly, they play a role in the safe administration of non-opioid analgesics to counter reception of pain. Currently, opioid medications for pain management are supposed to be administered as adjunctive analgesics (Kastrup, et al. 2012). Following surgery, sensory pathways are triggered to transmit pain impulses from the altered tissues to the nervous system which culminates the situation. Drugs such as acetaminophen are effective in the quick curbing of the pain. Employing physical techniques such as massage and repositioning as part of the non-pharmacological ways of approaching pain is another technique that is used in PACU by nurses. This is geared towards altering the patients physiological processes. Massage not only increases blood supply to the altered tissues but also reduces pain reception. Reposition aids in relieving pressure on the affected tissues besides facilitating a sufficient blood flow (Kastrup et al. 2012). A patients reaction to this techniques should dictate whether they are efficient or alternative means should be employed. In addition, a nurse ought to collaborate with other care providers in order to ascertain the point of emanation of the pain. Mutual decision-making facilitates effective management of the pain. For instance, the anesthetist can be consulted on the possible side effects of using some drugs while the patient is in the process of from anesthesia. Establishing an empathetic relationship with the patient facilitates the creation of a therapeutic environment which ultimately aids in the elimination of pain. The patient finds it easy to report any episodes of pain thus allowing the nurse to intervene before deterioration. A nurse should not depict sympathy no matter how painful the tenderness is unless it is done in order to change the mindset of the patient. Employing cognitive techniques such as encouraging the patient to meditate about a certain subject makes him be distracted as his focus deviates away from the pain (Sibille, Kindler, Glover, Gonzalez, Staud, Riley Fillingim, 2011). Progressive monitoring of the general condition of the patients should also be prioritized as it gives a trend of what the prognosis of the pain or condition might be. Older patients are likely to be prone to diseases, unlike young people. This affects the pharmacokinetic changes that are usually associated with opioid usages. The elderly are more sensitive to them when compared to the younger age groups. They have a higher level of unbound and active substances besides having slightly different drug redistribution (Ganter, Michael, Blumenthal, Stephan, Du?bendorfer, Seraina, Brunnschweiler, Simone, Hofer, Tim, Klaghofer, Richard, Zollinger, Andreas Christoph, 2014). An increase in age facilitates protraction redistribution of opioids to the liver which results in prolonged metabolism and an increase in duration of the effects. Opioids such as propofal and ketamine increase the risks of acquiring diseases such as delirium when administered in doses that dont resonate well with the age group of the patient. Advance in age declines the number of neurons in the body reduces due to auto regulation and hence their pain reception is less pronounced than in young people. This facilitates the use of lower doses because efficacy is still achieved with the small doses. Moreover, administration of a dose similar to all age groups is likely to predispose the elderly to respiratory distress. Therefore, vulnerability to respiratory distress is increased with advancement in age. Weight affects the ratio of adipose tissue to the lean mass of the body. Lean body mass is employed in determining the dosage of the opioid medications (Faraj, Vegesna, Mudali, Khairay, Nissar, Alfarhan Sabir, 2012). Different weights ultimately lead to different cardiac output which affects the rate of distribution of the drugs. Patients with more weight are given much attention because they are vulnerable to respiratory distress if advanced dosages are administered to them. Lighter patients have a reduced cardiac output hence redistribution of the drugs is not pronounced like in patients with bigger weights. This necessitates the use of slightly higher doses in them. References Faraj, J. H., Vegesna, A. R., Murali, I. N., Khairy, M. A., Nissar, S., Alfarhan, M., Sabir, K., ... Go, T. (January 01, 2012). Survey and management of anesthesia-related complications in PACU.Qatar Medical Journal,2012,2, 64-70. Ganter, Michael T, Blumenthal, Stephan, Du?bendorfer, Seraina, Brunnschweiler, Simone, Hofer, Tim, Klaghofer, Richard, Zollinger, Andreas, ... Hofer, Christoph K. (2014).The length of stay in the post-anaesthesia care unit correlates with pain intensity, nausea and vomiting on arrival. (info:doi/10.1186/s13741-014-0010-8.) BioMed Central. Kastrup, Marc, Seeling k, Matthes, Barthel, Stefan, Bloch, Andy, le Claire, Marie, Spies, Was Claudia, Scheller, Matthias, Braun, Jan. (2012).Effects of intensivist coverage in the post-anaesthesia care unit on surgical patients' case mix and characteristics of the intensive care unit. (BioMed Central Ltd.) BioMed Central Ltd. Kastrup, M., Seeling, M.J, Barthel, S., Bloch, A., le, C. M., Spies, C., Scheller, M. Braun, J. (January 01, 2012). Effects of intensivist coverage in the post-anaesthesia care unit on surgical patients' case management and characteristics of the intensive care unit.Critical Care (London, England),16,4.) Sibille, K. T., Kindler, L. S. L., Glover, T. L., Gonzalez, R. D., Staud, R., Riley, I. I. I. J. L., Fillingim, R. B. (July 01, 2011). Individual Differences in Morphine and Butorphanol Analgesia: A Laboratory Pain Study.Pain Medicine,12,7, 1076-1085.