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会计学1ManagingPainintheSurgicalPatient在手术病人的疼痛管理
Objectives Discuss preop pain assessment Discuss intraop pain managementDiscuss postop pain management 第1页/共73页
BackgroundAcute Pain ImmediateServes as a warningEasier to treat (generally)Has an end (generally)第2页/共73页
BackgroundChronic PainLasts longer than 3-6 monthsServes no purposeCannot identify a causeCan lead to pain behaviorsVery difficult to treat第3页/共73页
Pain ConductionInjury triggers release of bio-chemicalsInflammation takes placeStimulation of nerve fibers Bio-chemicals causes pain impulses to begin第4页/共73页
Pain PerceptionImpulse 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 第5页/共73页
Why Pain ControlPersistent acute postoperative pain:Decreases the body’s physiologic reservesMay exacerbate co-morbid conditions (e.g.) increase risk of MI in patients with CADContributes to pulmonary complications.第6页/共73页
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.第7页/共73页
Metabolic Stress ResponseSurgical insult results in post op painIncreased circulating catecholaminesResulting in tachycardia and hypertensionLeading to increased cardiac workResulting in increased myocardial oxygen consumption第8页/共73页
Cardiovascular ↑ HR, ↑ BP, ↑ SVR, altered regional blood flow, ↑CMO2, ↑ DVTRespiratory:– ↓ VL (atelectasis), ↓ cough (sputum retention)– hypoxemia and infection第9页/共73页
Gastrointestinal:– ↓ gastric and bowel motility, nausea, vomiting? Genitourinary: urinary retention? Neuroendocrine: ↑ catabolic hormones– ↑ blood glucose, Na + H20 retention第10页/共73页
Musculoskeletal: Muscle spasm, immobility (↑ DVT) Psychological: fear, anxiety, insomnia? Chronic pain第11页/共73页
Pre Op AssessmentIndication for surgical procedureAllerg
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