Managing Pain in the Surgical Patient[在手术病人的疼痛管理](PPT-73).ppt

1 Managing Pain in the Surgical Patient  LUCILLE LUTZ, RN, MSN, APRNBC CLINICAL NURSE SPECIALIST PAIN MANAGEMENT Objectives Discuss preop pain assessment Discuss intraop pain management Discuss postop pain management Background Acute Pain Immediate Serves as a warning Easier to treat (generally) Has an end (generally) Background Chronic Pain Lasts longer than 3-6 months Serves no purpose Cannot identify a cause Can lead to pain behaviors Very difficult to treat Pain Conduction Injury triggers release of bio-chemicals Inflammation takes place Stimulation of nerve fibers Bio-chemicals causes pain impulses to begin Pain Perception Impulse is sent to the brain via ascending tracts in spinal cord Neurotransmitters released by C fibers (substance P) Message to the brain (Thalamus) Sends message down descending pathway= pain response Why Pain Control Persistent acute postoperative pain: Decreases the body’s physiologic reserves May exacerbate co-morbid conditions (e.g.) increase risk of MI in patients with CAD Contributes to pulmonary complications. Impairs rehabilitation and functional outcome May lead to development of chronic pain syndromes and long-term disability. Increases hospital stay and the cost of patient care Decreases patient satisfaction. Metabolic Stress Response Surgical insult results in post op pain Increased circulating catecholamines Resulting in tachycardia and hypertension Leading to increased cardiac work Resulting in increased myocardial oxygen consumption Cardiovascular ↑ HR, ↑ BP, ↑ SVR, altered regional blood flow, ↑CMO2, ↑ DVT Respiratory: – ↓ VL (atelectasis), ↓ cough (sputum retention) – hypoxemia and infection Gastrointestinal: – ↓ gastric and bowel motility, nausea, vomiting ? Genitourinary: urinary retention ? Neuroendocrine: ↑ catabolic hormones – ↑ blood glucose, Na + H20 retention Musculoskeletal: Muscle spasm, immobility (↑ DVT) Psychological: fear, anxiety, insomnia ? Chronic pain Pre Op Assessme