Question

Case Study, Chapter 11, Pain Management Mr. Kim Li, a 54-year-old Asian American male, is postoperative day 3 after an abdominal aortic aneurysm (AAA) repair. The client and his family have lived in the United States all of their lives and speak English fluently. The 7-inch midline abdominal incision is open to air with staples well approximated, no redness, edema, or drainage present. VS: T,99o F; BP, 120/70 mm Hg; HR, 88 beats/minute; RR, 22 breaths/minute, shallow, and even. He rates his postoperative pain as a 10 and refuses to take pain medication. The nurse notes that the level of pain has increased over the days from a 6 to a 10, and the client has never taken the prescribed pain narcotic analgesic. Both the client and his wife believe that taking narcotics will lead to addiction. Until his pain goes away, he refuses to get out of bed or walk. His lungs are clear to auscultation but decreased in the bases bilaterally. The client grimaces when he tries to turn in bed and then returns quickly to the supine position. He can only reach halfway on the preoperative marking of the incentive spirometer (IS) when performing deep breathing, and he has a weak cough and moans despite splinting the incision. The nurse is concerned about the client's pain interfering with his ability to perform necessary postoperative care that will help prevent potential complications. (Learning Objective 18) a. What are the potential effects of poorly managed acute pain in this situation? b. What should the nurse do to dispel the client and wife's misconceptions regarding pain management so the client will be able to perform necessary postoperative care that will help prevent potential complications?

Answer 1

a. Potential effect of poorly managed acute pain in that patient situvation.

                       * Raise in blood pressure.

                       * Increase respiratory rate.

                       * Increase heart rate.

                       * Respiratory muscle tension.

                       * Nausea,vomitting.

                       * Fatigue.

                       * Headache.

                       * Increased pheripheral vascular resistance.

b.Nursing management to change patient and wife misconception regarding pain.

                    * Maintain soft voice during communication and explain that narcotics are just used

                      only for a short period of time and i will reduce its amount and eliminate completely

                       when your pain level come to low so it will not produce addiction.

                    * Educate the patient that Increase in pain level negatively affect your health and alter

                      the treatment process and result in systemic complications.

                    * Make arrangement for patient to talk to physician about his doubts regarding the medication.