Free Nursing Dissertations - The Overall Analgesic Dose Is Shown To Be Lower If Given This Way Rather Than
The overall analgesic dose is shown to be lower if given this way rather than on a PRN basis. (Campbell FA et al. 2001)
The interpretation of pain is extremely subjective and dependent on the patient’s state of psychological arousal, it is a vital part of nursing post op. management to keep the patient calm and composed as far as possible, to help with pain control. (Svensson I et al. 2000)
Other considerations
Other medication may well also be written up on a PRN basis. There may be an element of nausea if morphine based analgesia has been used. Anti emetics such as metoclopramide or prochlorperazine can be used either orally, if the patient is not actually vomiting, or either IM. or by suppository if they are. Vomiting and nausea are particularly distressing symptoms and should be controlled if at all possible.
O2 saturation should be monitored at least until stable with a subnasal cannula in place if the saturation level is below XXXXXXX. (Client note: I have purposely left this blank as different units have different protocols you will need to fill in yours). The O2 saturation will initially, inevitably, be lower than normal by virtue of the recent anaesthetic. Not only will the anaesthetic gasses displace Oxygen from the haemoglobin but also the respiratory effort will be reduced until the patient has fully recovered. There may also be an element of mucous collection in the respiratory tract from when the patient was intubated which may take a while to clear.
In general terms, readings higher than 95% are considered to be acceptable and those below 90% suggest a degree of oxygen desaturation which is unacceptable. The nurse should bear in mind that these readings are not absolute and may need to be higher if there is a degree of anaemia (possibly due to post op. blood loss) (Rutherford KA 1989)
Routine nursing observation of temperature, pulse and blood pressure should initially be carried out at least every 15 mins, progressively increasing in interval up to 4 hrly. depending on the stability of the readings. The length of time that this continues is a matter of discretion or ward policy but should certainly be continued until there is no doubt that the patient‘s condition has completely stabilised (Client note: again I would suggest that you put in your particular unit’s protocols) It is a common and routine misconception that the duty of care actually stops at taking the readings. The nurse should always be aware of emerging patterns in these readings. (Yura H et al. 1998).
Progressive rise in temperature can indicate impending infection or heamatoma formation. Rising pule rate and dropping BP can indicate occult blood loss. Rising BP can suggest over replacement of fluids or renal problems.
Dissertations - Free Nursing Dissertations
