Group Translation 9

Wanda, Stephanie, Erica, Jess, Sue, Dana, Leah

Pain in post-op patients - Sue
Pain is a subjective experience that is common amongst post-operative patients. Uncontrolled
pain affects patients in a variety of ways ranging from decreased appetite to irregular sleeping
patterns. Thus, pain management is vital for the healing process and to improve the overall
quality of life. My patient this past week was diagnosed with chronic abdominal pain. One of the
things I found to be interesting was the use of pharmacologic interventions only by the nurse. For
instance, I reported to the nurse that the patient's pain level was an 8 on the numeric scale of 1-10
after reassessing the pain. Her response was "O well there is nothing I can do, he can't get any
more drugs." He lacked any physical signs of acute pain and his vital signs were within the
normal range, however, I took it upon myself to employ non-pharmacologic measures to ensure
his comfort. After asking him questions regarding his likes and dislikes, we decided to turn on
the television so that he could listen to classical music. He also complained of feeling cold so I
layered him with extra blankets. An hour later, he reported that his pain level was now a 6/10 but
that was tolerable for him. Unfortunately, he often brushed the pain off and underreported it to
the nurse. Sue, it is great that you are able to implement non-pharmacologic methods to soothe
the patients pain. If you were the primary nurse in charge of this patient, how would you ensure
that this patient was receiving the appropriate medication needed to manage the patients pain?
Also, what barriers can you identify that would make this patient underreport his pain?
- Re: Pain in post-op patients Steph
Nice job girl! I have had similar experiences during clinical, where nurses mostly focus on
meds as an intervention for pain, and don't try things like positioning, distraction, and
breathing exercises. Honestly, I feel that the main reason this happens is lack of time (and
potentially lack of knowledge). Most days during clinical, the nurses have so many
responsibilities- from assessments, to meds, documentation, admissions, discharges, etc that
brainstorming non-pharm interventions with patients can probably seem very low on the totem
pole. Even though we as student nurses do not have the full responsibilities of a RN yet, we
can still contribute significantly to a patient's status by taking the time to do an assessment of
the patient's preferences, ask questions, and try out different interventions. I had a pt last week
that was dx with failure to thrive and anemia of chronic disease and she seemed to always
have some level of pain. However, watching Coach Carter and talking seemed to help a lot!
One other thing that I thought of regarding chronic pain is the adaptation patients make to this
state. As we discussed in class, patients with chronic pain may not exhibit the typical signs
that other patients without chronic pain do, such as grimacing, clenching fists, and
tachycardia. It may be harder to assess pain in these patients because of the lack of visual cues
and objective data, in addition to patients underreporting pain. We need to be vigilant in
providing pain assessments to this pt population and establish what is baseline for them, so we
know when it changes. Great thorough reasoning and analysis especially with patients with
chronic pain, Stephanie. There are some interesting points that you bring up. You are correct
in your summation about chronic pain, depression is also a concomitant finding (McCance et.

al, 2012). Do you believe that the care you provided maybe have had an impact on the
depression they may be experiencing? What are some ways that a nurse can organize him or
herself to provide a variety of pain management methods to a patient given the lack of time?
Why do you think a lack of knowledge about pain management still persists given the amount
of information and education given to nursing staff?
- Re: Pain in post-op patients - Erica
Two weeks ago, I had a patient who was in complete agony throughout my entire shift. She
was post-op for a laryngectomy due to supraglottic laryngeal cancer. She also had a
supraclavicular muscular flap reconstruction surgery to reconstruct her neck area. Since this
patient also had a tracheostomy, she could not talk to verbally communicate her pain, and
often refused to use the clipboard to write messages to us. Therefore, communicating with her
was very difficult, however, I could tell by her nonverbal expressions (facial grimacing,
crying) that she was in an extreme amount of pain and discomfort. It was heartbreaking,
because no intervention I tried to implement (such as repositioning, bringing more blankets
and pillows, etc) seemed to help. Like Shay said, my primary care nurse quickly resorted to
administering pain meds only and did not try any additional alternative non-pharmacological
interventions. As a result, my patient was sedated throughout most of the day. Come to find
out in lecture after this clinical shift that you don't want your patient to be sedated/sleeping all
day! I think this was a very difficult case because her pain was so terrible, and the only thing
that relieved it was her strong pain medication. Erica, sometimes patients such as the one that
you cared for can raise ethical issues. When do we as nurses do what is just and moral for
patients despite what theory tells us? There are instances where patients are kept sedate to
minimize discomfort, such as the ventilation patient. What ethical issues come to mind when
you think about the care of this patient? Why do you believe that this patient was hesitant to
write messages to communicate her needs? How do you think that care could be improved for
this patient?
- Re: Pain in post-op patients - Leah
Pain is the fifth vital sign, right?
It seems so obvious that pain will be one of the most prevalent symptoms in our hospitalized
patients, yet it is interesting, and fairly disturbing, how underappreciated it really is to the
healthcare team. I know this can largely be attributed to the system (like Steph alluded to) and
not the individuals since everyone is busy and applying pharmacologic solutions is the easiest
and fastest remedy, for which may be all they seemingly have time. It is also such a subjective
measure that it can be difficult and time consuming to really get at how debilitating someones
pain is and what is realistic in terms of pain management. I have heard mention of a pain
team, but I have no idea how accessible they are and if they are only reserved for serious,
unrelieved pain?
Furthermore, I know we are taught to believe what patients report to us, but it is clearly
culturally acceptable in our unit (at the very least) to label patients as drug seekers. In my
experience thus far this semester, two of my patients were verbally labeled as drug seekers
and dealt with as such. I felt like this was not a black and white issue, though. I could
understand the signs/cues that lead many to believe these assumptions, but it was clear from
even a basic assessment that there was still pain that needed to be addressed. Also, having
chronic illnesses with chronic pain often means we are forcing people to seek pain meds, yet

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if they are asking for them too much they are seekers. If I were either of my patients and
had chronic abdominal pain from pancreatic divisum or painful lymphedema in one of my legs
from possibly metastasized cancer, I would want pain medication and I would want it now.
Sure, if someone presents in the ER and is just asking for opioids without any assessment
indications of real pain that should raise some eyebrows, but pain hurts (right?!) whether you
crave drugs or not. Leah Youve brought up an excellent point about medications for pain
vs. medication for drug seekers. Why do you think that this idea is prevalent despite education
provided to health care professionals? How can a nurse ensure competent care when myths
about pain management persist?
- Re: Pain in post-op patients - Wanda
I totally agree with you Sue that as nurses we should always try to implement some nonpharmacological interventions to manage our patients pain. It is also very important to make
sure that we are treating our patients pain with medications if they are prescribed. This week
my patient was a 66 year old male that was admitted for a cystectomy he also have a history of
osteoarthritis. He was on PCA hydromorphone. The first time I assessed my patients pain he
reported it at 2- 3/10 I instructed him to use his PCA if he felt any pain. After re-evaluating he
still reported the pain at a 2-3/10. Throughout my shift my patient kept reporting his pain at
the same level. After checking the PCA with the nurse it was discovered that my patient was
purposely not medicating himself although he was showing signs of pain such as grimacing
and looking uncomfortable. After further exploration and talking to his wife I found out the
reason he was not hitting his PCA button is because the doctor told him that the opiod can
cause constipation and decrease bowel movement which will increase his hospital stay. I took
this opportunity to educate my patient and his family on pain medication. I thought them
about the importance of pain management especially since he has a history of osteoarthritis
and just had major abdominal surgery. I also clarify that yes the opiod medication can cause
constipation but we were already treating his constipation with a suppository. He stated his
understanding of pain management and hit his PCA button three before my shift was
over. Wanda, youve cited a very important aspect in nursing and that is our role as patient
educators. Most times, much of the adversities we find in our clinical practice can come from
misinformation. How can nurses ensure that the patients that we manage are getting the
clearest information to make informed decisions?
- Re: Pain in post-op patients Jess
Sue, I can totally relate to this post. I think it's a pretty common occurrence that
pharmacological interventions are typically a first-line defense for the nurses, especially on
days when things get extremely busy. I also took it upon myself for a few of my patients to ask
them if there was anything that I could do to distract them from the pain they were having.
While some patients were no-so interested in the idea, others were extremely receptive, saying
they enjoyed watching tv, reading magazines or doing crossword puzzles. These minor
activities that really took minimal time were really effective in distracting the patient from
pain that was hard to get rid of with strictly pharmacological interventions Jess, I think its
important to ask patients what methods of non pharmacological pain methods they prefer.
Asking a patient what their normal routines are at home will also give the nurse clues about
soothing pain in alternative ways, even when a patient expresses no interest in the idea of non-

pharmacologic methods.
- Re: Pain in post-op patients - Dana
Great post! In all of the patients that I've had so far at clinical, they have all had post-op pain.
By far, and up to yesterday, pharmacological interventions were the number 1 and only
method that the nurses were employing. However, my nurse and I yesterday really pushed the
non-pharmacological approach of heat therapy for a patient that was s/p TAH-BSO. The
patient was a little bit stubborn and reluctant to use her PCA pump as indicated despite
repeated reinforcement on the benefits of adequately controlled pain and the consequences of
inadequately controlled pain. So, we tried methods that the patient felt more comfortable with:
anything that didn't involve opioids. She responded very well to the heating pad and was more
willing to report her pain and talk about ways to reduce it once we weren't just pushing pain
meds on her.
I think Sue's and my experience both highlighted the benefits of non-pharmacological
therapies in conjunction with meds (of course!). Patients have very real concerns about using
opioids that, I think, we kind of brush off because we know that the easiest and generally most
effective way of managing pain (especially post-op pain) is through the use of pain
medications. It's important to keep in mind that some people just don't like drugs. Dana,
youve made a very important insight, some patients simply do not like taking medications for
pain and have no desire to take them. When assessments are performed on patients for pain,
we also should ask questions about how they treat pain when they are at home. This may give
the nurse insight into how to approach pain management with time constraints.

Group Members

Role

Grade with comments

Lead

97% Post is clearly defined, focused, and

supported. Contains specific example and details.
Applied class discussion to clinical situation

Stephanie

Contributor

97% - Able to connect content from classroom to

the clinical area. Demonstrates understanding of
various pain types and their associated assessment
and interventions

Erica

Contributor

97% - Able to connect classroom concepts with

clinical experience. Raised ethical questions about
pain management

Lea

Contributor

92% - Raised a controversial issue in nursing

practice however, needs specific and concise

Sue

example of understanding of concepts learned

Wanda

Contributor

95% - Posting contains pain assessment measures.

Demonstrated reflective participation and adds to
the discussion by addressing patient personal
preferences

Jess

Contributor

88% - Posting is consistent with the context of the

online discussion. Comments are relevant to lead
posting

Dana

Contributor

95% - Posting contains pain subjective and objective

assessment measures. Demonstrated reflective
participation and adds to the discussion by
addressing patient education

Overall comments:
Good job everybody! A common idea I read from everyones posts is that there is a heavy reliance on
medication for pain management. Putting yourself in the shoes of the primary nurse, how would you
implement non-pharmacologic methods of pain management for your patients? How would you
manage and organize your clinical day to ensure that both pharmacologic and non-pharmacologic
methods are used? Consider how differently you would manage pain for patients in regards to time
management, organization, and prioritization. Pain management brings up ethical issue in patient care
and nurses we also have to keep the idea of duty of beneficence in mind. Perhaps, one way to manage
non-pharmacological pain methods in tight time constraints would be to delegate tasks to assistive staff
if the task is within their scope of practice. In addition to completing patient pain assessments, consider
having a conversation with the patient about how they manage pain such as headaches at home. Also,
consider asking the patient how they manage stressful situations in their life as stress can enhance pain
perception. This can give the nurse insight into how the nurse can effectively manage pain at the
hospital.
Reference:
McCance, K.L., Huether, S.E., Brashers, V.L., Rote, N.S. (2010) Pathophysiology: The Biologic Basis for
Disease in Adults and Children. Mosby-Elsevier: Maryland Heights, Missouri

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