Week 7 - end

Nursing Management: Post-Operative Pain

Assessment:

• Use multidimensional pain assessment tools, such as the Brief Pain Inventory or McGill Pain Questionnaire, for comprehensive evaluation.

• Consider psychological factors influencing pain perception, such as anxiety, depression, or cultural attitudes.

• Observe for non-verbal cues in patients who are non-communicative (grimacing, restlessness, moaning).

Interventions:

1. Pharmacological Management:

   • Administer medications on a schedule to maintain consistent pain relief, rather than waiting for pain to intensify.

   • For severe pain, consider adjunct medications such as anticonvulsants (e.g., gabapentin) for neuropathic pain or muscle relaxants.

2. Regional Analgesia:

   • Use epidurals or peripheral nerve blocks if indicated. Ensure continuous monitoring for complications such as hypotension or numbness outside the targeted area.

3. Non-Pharmacological:

   • Implement Cognitive Behavioral Therapy (CBT) techniques to reduce pain-associated distress.

   • Employ distraction strategies such as TV, music, or engaging in light activities as tolerated.

Patient Education:

• Emphasize the importance of reporting pain early rather than enduring it.

• Discuss expected duration of pain and reassure patients regarding safe tapering of medications post-discharge.

Nursing Management: Post-Op Wound Assessment and Discharge Planning

Wound Assessment:

1. Daily Monitoring:

   • Document wound characteristics using the REEDA scale (Redness, Edema, Ecchymosis, Drainage, Approximation).

   • Check for excessive exudate or abnormal drainage.

2. Advanced Wound Care:

   • Assess for granulation tissue to gauge healing progress.

   • For surgical drains (e.g., JP, Hemovac), record daily output trends and notify if there’s a sudden increase or foul-smelling drainage.

Discharge Planning:

1. Wound Care Instructions:

   • Provide a detailed guide for dressing changes, including step-by-step photos or videos if literacy or language barriers exist.

   • Educate on normal versus abnormal healing signs, such as mild itching versus redness spreading beyond the wound edges.

2. Follow-Up Care:

   • Arrange for home health visits if the patient has limited mobility or cognitive challenges.

   • Ensure they have access to appropriate supplies (dressings, antiseptics).

Nursing Management of Hip and Knee Arthroplasty

Post-Operative Care:

1. Pain and Mobility Management:

   • Administer multimodal analgesia, including NSAIDs, opioids, and local anesthetics.

   • Encourage active participation in physical therapy starting the day after surgery to restore mobility and strength.

2. Preventing Complications:

   • Monitor for signs of joint dislocation in hip arthroplasty (e.g., severe pain, shortened leg, abnormal rotation).

   • Assess for post-operative anemia and consider transfusions if hemoglobin drops below acceptable levels.

Patient Education:

• Teach about assistive device use:

  • Hip: Avoid low chairs and twisting movements. Encourage the use of raised toilet seats.

  • Knee: Stress the importance of straightening the knee while seated and performing exercises like straight-leg raises.

• Explain the importance of infection prevention, such as prophylactic antibiotics before dental or invasive procedures.

Nursing Management and Care for Patients Undergoing Amputations

Pre-Operative Care:

1. Psychosocial Support:

   • Use therapeutic communication to explore fears about body image changes, loss of independence, or stigma.

   • Offer resources for meeting with peer mentors who have undergone similar procedures.

Post-Operative Care:

1. Residual Limb Care:

   • Inspect daily for redness, swelling, or skin breakdown.

   • Teach proper limb wrapping techniques using an elastic bandage to prevent edema and shape the residual limb for prosthetic fitting.

2. Complication Management:

   • Manage phantom limb pain with a combination of pharmacologic (tricyclic antidepressants, opioids) and non-pharmacologic (mirror therapy, acupuncture) methods.

Rehabilitation:

• Collaborate with the rehabilitation team to create a realistic prosthetic fitting timeline.

• Encourage upper body strengthening exercises to improve mobility with assistive devices.

Applying the Nursing Process: Fracture

Assessment:

• In addition to the 5 Ps of Neurovascular Assessment, include capillary refill time and skin temperature for distal circulation.

The 5 Ps:

1. Pain:

   • Assess for the presence, intensity, location, and type of pain (e.g., sharp, throbbing, or deep ache).

   • Consider: Is the pain disproportionate to the injury or unrelieved by medication? This could indicate compartment syndrome or other complications.

2. Pulse:

   • Check for the presence and quality of distal pulses in the affected limb (e.g., radial, dorsalis pedis).

   • Consider: A weak, absent, or thready pulse may indicate impaired arterial circulation. Use a Doppler if pulses are not palpable.

3. Pallor:

   • Observe skin color and compare to the unaffected limb.

   • Consider: Pale, white, or mottled skin suggests poor circulation, while cyanosis may indicate venous congestion or lack of oxygenated blood.

4. Paresthesia:

   • Ask about sensations like tingling, numbness, or burning in the affected area.

   • Consider: Abnormal sensations or loss of sensation may point to nerve compression or ischemia.

5. Paralysis:

   • Assess the ability to move the limb and individual digits actively.

   • Consider: Weakness or inability to move can indicate severe nerve or vascular impairment and requires urgent attention.

• Evaluate for systemic symptoms of fat embolism (e.g., respiratory distress, petechial rash on the chest or neck).

Interventions:

1. Immobilization and Alignment:

   • Use appropriate devices (splints, external fixators) to stabilize fractures.

   • For traction, ensure proper alignment and weight application, and prevent complications like pressure ulcers.

2. Nutrition:

   • Provide a high-protein, calcium-rich diet with supplements like Vitamin D to promote bone healing.

3. Complication Prevention:

   • Educate on cast care: Keep dry, report increased tightness, or signs of compartment syndrome (e.g., unrelieved pain, loss of pulse).

Applying the Nursing Process to GI Disorders

Assessment:

1. Detailed Symptom History:

   • Identify aggravating or relieving factors for pain.

   • Document stool characteristics (frequency, color, consistency, presence of blood or mucus).

2. Nutritional Status:

   • Assess for malnutrition, including weight loss or deficiencies (e.g., Vitamin B12 in Crohn’s).

Interventions:

1. Medications:

   • GERD: Administer proton pump inhibitors, antacids, or H2 blockers as prescribed.

   • Constipation: Recommend fiber supplements, stool softeners, or enemas if necessary.

   • Diarrhea: Monitor electrolytes and administer anti-motility agents like loperamide cautiously.

2. Dietary and Lifestyle Adjustments:

   • For IBS: Identify and eliminate food triggers (e.g., FODMAPs).

   • Educate on small, frequent meals to reduce gastric stress in peptic ulcer disease.

Complication Management:

• Monitor for perforation or hemorrhage in acute abdominal conditions and prepare for immediate intervention if suspected (e.g., guarding, rebound tenderness).

Patient Education:

• Stress adherence to prescribed diets, recognizing red-flag symptoms like severe abdominal pain, or significant changes in bowel habits.