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Post-Surgical Pain Management
Post-Surgical Pain Management
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Post-Surgical Pain Management
Introduction
Management of post-operative pain is an essential and important period compared to the surgical period. After the surgery, a patient tends to undergo different types of pains which are physical, emotional and cultural factors. Although the post-surgical management has no total assurance of working on all patience, it is essential. Most post-surgical caregivers don’t tend to pay attention to it. Activities such as exercises, deep breathing, splinting and moving around and good sleep are just but a few post-surgical which reduce the patients stress. In this study we are going to look at the problems after surgery, how to handle a post-surgical patient considering the health position of the patient and analysis of the patient information.
The Clinical Issues and Interventions
The post-surgical management method is guided by the patients’ health history and also the type of surgery underwent. Mrs. Wendy is a patient with abdominal pains and diarrhea whom after tests shows that she has a tumor in her colon and is scheduled for a surgery. She undergoes open right hemicolectonomy due to a colon growth. After the surgery she may experience the after surgical complications such as severe pain, Deep Vein Thrombosis (DVT) and wound or anastomosis dehiscence and paralytic ileus especially considering her health history of Asthma, Hypertension, Obstructive sleep apnoea and myocardial infection. During this post-surgical complications, a nurse should be able to take the right measures to ensure the patients fast recovery.
Under-treatment of pain in patient is one of the major problems identified among many surgical patients which lead to incomplete pain relive of post-operati0on pain (Topolovec-Vranic et al., 2010). This leads to delay in patient recovery and increase the suffering hence delay in hospital hence high unnecessary costs (Barr et al., 2013). According to the research done, some patients experience sever pain while others tend to experience moderate pain. Even after the post-surgical pain management it does not show much effectiveness to total pain relive. This has contributed to non-pharmacologic strategies to help the patients such as music and cold therapy which are fully medical integrated (Barr et al., 2013; Chou et al., 2016). The strategy to combine both medical and non-pharmacologic pain management adding splinting and sleeping has shown much effectiveness to acute pain.
During a research in the USA by the American Society for Pain Management (ASPMN), the committee found out that most nurses are able to employ the non-pharmacologic strategies like music and cold therapy on patients. Music in response has shown lower pain ratings (Liu and Petrini; 2015) as it did not work effectively in analgesia, post- operative complications or long hospital stay. Although it’s not very effective, it showed an association with ones perspective on pain control. This encouraged use of cold therapy also called cryotherapy which is the application of to the skin which is used to reduce edema and provides local analgesia to the surgical site. Combining music and cold therapy is a free-risk non-pharmacologic pain management strategy god to be adopted on the patient.
Splinting is also another effective non-pharmacologic method that is used on patients. This is the use of splinting device to support the incision by reducing stress by equalizing the pressure across the incision and allow comfort during position changes. It enables the patient to have easy time during deep breathing and coughing and while moving in bed or out of bed. Splitting devices can either be pillows, binders or other recommended devices by nurses although pillows are the common ones as they are specially designed to provide comfort at various incision areas especially abdominal incision. Deep breathing is also another non-pharmacologic strategy which has shown vast effectiveness. After chest or abdominal surgery, coughing and breathing are one of the affected natural tasks and painful. As deep breathing is one of the best after surgery recommendations, some tools may be adopted to make it easier for the patient to perform the task. Spirometer is one of the technical devices used to encourage deep breathing among surgical patients. Another device might be acapella which is recommended as per the patient’s condition and ability to take the deep breaths.
Deep Vein Thrombosis (DVT) is occurs often in deep veins of a patient legs or pelvic and the clot might cause pulmonary embolism (PE) if it travels to the heart (Dr. Hayley Willacy et al., 2020). A nurse taking care of a patient should be in a position to identify the symptoms of DVT on a patient for early diagnosis as its one of the post- surgical causes of death especially to patients with cancer, 60 years and above of age and smoking patients. Research show that the a very small percentage of around 15% are the ones who are able to be diagnosed with DVT on time and treated while others lose their lives before its known. Some of the symptoms are limb pain and tenderness along the line of deep veins, thigh or calf swelling, distension of superficial veins, high temperatures, skin discoloration and pitting oedema. Some similar signs can also be due to other causes like trauma, vacuities, cellulites, septic arthritis, compartment syndrome and others If ant of the signs are identified, the nurse should recommend for DVT tests for assurance on the patient and treatment commenced as per the results.
Wound or anastomosis dehiscence is a disorder when it comes to wound healing process. It can occur in a patient if she has certain complications or contributed by factors such as immunosuppressive therapy, radiotherapy, long term steroids, poor blood supply, malnutrition and vitamin deficiency and severe rheumatoid diseases. It does not commonly occur but it can cause mortality in patients. This disorder show 7-10 days after the surgery and is noticed by wound serosanguinous discharge and may affect the whole wound. Some of the complications may come hand in hand with this is condition are; infection of the wound inviting germs inside the wound and If noticed early, the infection can be treated using antibiotics, Osteomyelitis which attack the bone, gangrene which is loss of blood supply, periwound dermatitis around the tissue surrounding the wound, periwound edema and wound dehiscence. The nurse should immediately recommend for opiate analgesia, sterile dressing to the wound, fluid resuscitation or early return to theater for re-suture under general anesthesia.
Considering Mrs. Wendy’s health history and lifestyle, all this conditions have a likelihood of occurring at different times. The nurse should be watchful of any unusual signs of either of the above post-surgical complications and give the necessary recommendations. The exercises should also be upheld to minimize the risks involved and also assist in fast recovery of Mrs. Wendy and ensure that no harmful practice is taken by the patient like smoking and alcohol consumption during the recovery. Any medicines that may also have side effects on the wound or the patient condition should be avoided like steroids to assist in wound healing. The therapies should be administered on how effective they are to the patient and the most effective be recommend while in hospital example hourly exercise, regular deep breathing, movement in and out of bed often and cold therapy after a period of time. Blood circulation observation and air circulation are also critical observation areas.
Discharge Plan
The surgery done may take some time mostly 6 weeks to heal and some instructions are required to be followed to assist the healing process at home. You should look after the wound to avoid and infection which may lead to sever condition or even back to the theater if not careful, ensure you take stool softeners if prescribed by the surgeon. Pain relive medicines will be prescribed and its not necessarily you wait for severe pain to take them. Antibiotics will also be given to treat any infections if at all they occur. In terms of diet , follow any instructions given by the nutritionist starting with taking liquid foods fast and slowly going to hard foods. Incase of constipation, fiber may be added in your diet and stool softeners. A lot of fluids intake will be of much help but not alcohol. Ensure you take enough rest at all times and do not overstrain your muscles to avoid rupture. Avoid lifting heavy weights or any work involving the surgical area and do not take a dive shower until the wound is completely healed. Ensure you walk often and do the deep breathing excises and coughing and await instructions after your check up on when you can return to work.
Health Recommendation for Recovery
After discharge, lifestyle from usual to unusual happens. It might be permanent or temporary depending on the type of incision and also the risk involved if a certain lifestyle continuous or its not adapted. Some fun things like alcohol consumption and smoking are examples of a few lifestyles that are to be avoided during and possibly after recovery. Looking at the health history of Mrs. Wendy , some recommendations are made in order to facilitate her healing and ensure that no future occurrence of the same case is repeated. Some changes may cause discomfort but they are for the best of the patient. After recovery and total checkup, the doctor will further advice, as time goes by on which recommendations might be withdrawn. At first the lifestyle may also seem expensive and unmanageable due to a lot of dependency but its better to adthere to it for a while and solve long lasting complication.
During the healing period kindly do and avoid the following; Ensure the incision is kept clean and dry but do not touch the incision with soap or soapy water maybe the area around it, ensure you change the dressing minimum every 48 hours, ensure you do not pick, scratch or pull at the incision even when itchy, do not use oils or creams on the incision, ensure to avoid any negative medical information that are not confirmed medially or not approved by the doctor, ensure you do not engage in drinking or smoking during the healing process as it may lead to serious damage to the incision and your health in general. If you need to take any other drug please reach out to the doctor for approval first. Music is an effective way to settle the psychological effects of surgery, ensure you listen to soothing music which lifts ones spirit and create a positive notion in one’s mind.
Ensure you put on comfortable loose-fitting clothes, soft and comfy and avoid sleeping on the incision side but get a comfortable position. If any complications is experienced such as high fever, chest pains, pain and leg tenderness, nausea and vomiting, diarrhea for more than 3 days, dark coloring or bloody urine, bright red stool or dark. Swollen or skin rash or incision separation please reach out to the medical facility. Most importantly ensure you take proper care of your body no to trigger another disease or complication during the healing process. Follow the routine check-ups allocated without missing so as to know the progress of the incision and other health conditions. Kindly ensure you have someone to drive you around until your body recovers and also assist you in basic activities including bathing and wound incision dressing.
Further recommendations and instructions will be issued as the checkups and healing process continuous by the doctor and the nutritionists on diet and lifestyle
Conclusion
Surgical solution is commonly used to solve so many health issues in so many aspects. The procedure involved in each surgery depends on the health of the patient, the problem or condition of the patient and the age and other physical characteristics. A patient recovery fully depends on the nurse in charge keenness on the patient and the therapy strategies and also the patient’s observation to the prescriptions given during discharge. A patient’s mentality also matters a lot on the healing process; how well he/she is ready to adhere to the prescriptions and the mentality of the patient towards healing
References
Grosu, I., & De Kock, M. (2011). New concepts in acute pain management: strategies to prevent chronic postsurgical pain, opioid-induced hyperalgesia, and outcome measures. Anesthesiology clinics, 29(2), 311-327.
Joshi, G. P., & Kehlet, H. (2013). Procedure-specific pain management: the road to improve postsurgical pain management?. Anesthesiology, 118(4), 780-782.
Levy, N., Mills, P., & Rockett, M. (2019). Post-surgical pain management: time for a paradigm shift. British journal of anaesthesia, 123(2), e182-e186.
Macintyre, P. E., Loadsman, J. A., & Scott, D. A. (2011). Opioids, ventilation and acute pain management. Anaesthesia and intensive care, 39(4), 545-558.
Milotte, H. (2018). The Effect of a Therapeutic Pillow On Pain Following Nephrectomy: A Randomized Clinical Trial. Urologic Nursing, 38(3).
The Divine Command Theory, a review of two journals
Week One Journal
Reflection Prompt #1
The summary of the three of the ethical theories that are explained in Chapter 1 of Introduction to Business Ethics Fieser & Moseley (2012) include;
The Divine Command Theory (DCT) essentially teaches that a thing (i.e., action, behavior, choice, etc.) is good because God commands it to be done or evil because God forbids it from being done. Thus, to say that it is good to love our neighbors is semantically equivalent to saying God commands us to love our neighbors. Similarly, it is evil to commit murder because God forbids murder
Moral Objectivism: The view that what is right or wrong doesn’t depend on what anyone thinks is right or wrong. That is, the view that the ‘moral facts’ are like ‘physical’ facts in that what the facts are does not depend on what anyone thinks they are.
Objectivist theories tend to come in two sorts:
(i) Duty Based Theories (or Deontological Theories): Theories that claim that what determines whether an act is morally right or wrong is the kind of act it is.
E.g., Immanuel Kant (1724-1804) thought that all acts should be judged according to a rule he called the Categorical Imperative: “Act only according to that maxim [i.e., rule] whereby you can at the same time will that it become a universal law.” That is, he thought the only kind of act one should ever commit is one that could be willed to be a universal law.
(ii) Consequentialist Theories (or Teleological Theories): Theories that claim that what determines whether an act is right or wrong are its consequences.
3) Moral Relativism: The view that what is morally right or wrong depends on what someone thinks. (To which the claim that opinions vary substantially about right and wrong is usually added.) We can think of this position as coming in two flavors:
(a) Subjectivism: What is morally right or wrong for you depend on what you think is morally right or wrong, i.e., right or wrong is relative to the individual. The ‘moral facts’ may alter from person to person.
(b) Conventionalism: What is morally right or wrong depends on what the society we are dealing with thinks, i.e., morality depends on the conventions of the society we are concerned with. The ‘moral facts’ may alter from society to society.
How organizations would function were they to adopt those ethical principles
Much of morality in business falls under the rubric of honesty. Honesty means being in accord with reality. Honesty is basic to the structure of human relationships in virtually all contexts. Dishonesty is self-defeating because it involves being in conflict with realty. Morality in business involves objectively recognizing and dealing with customers, employees, creditors, stockholders, and others as autonomous rational individuals with their particular goals and desires. The trader principle should govern the course of all human interactions because voluntary value-for-value relationships are consonant with human nature (Brigley, 1995).
The above ethical philosophies can lead to the achievement of values. When one’s context is reduced to business, virtue theory contends that pursuing virtuous principles, strategies, and actions can result in firms realizing their values including their mission, purpose, profit potential, and other goals. Virtuous employees tend to carry out their roles in a competent manner that is congruent with the firm’s goals. Virtues are instrumental in allowing a person to act to gain values. When business people conform to Objectivist, they increase the likelihood of achieving their values and goals. Ethical philosophies stress the importance of each individual employee being able to make contributions of value. Valid virtue concepts are required to describe what it means to be an excellent director, leader, manager, or employee. To be successful, a business needs to espouse a set of virtues that are reality-based, non-contradictory, integrated, and comprehensive.
Reflection Prompt #2
The three of the punishments that corporations undergo when they have acted unethically (Fieser & Moseley, 2012) are;
1. Fines: This type of punishment is the most common. It is when a corporation breaks the law or an offense. It is then charged an amount of money that can be crippling as to serve a purpose to not do it again. When a corporation undergoes this type of punishment it serves a purpose to deter the company from acting unethically, but can also have several side effects.
2. Equity fine. This is fairly similar to the normal fine except it is shares of the company in question. It serves it purpose to give away market value which can be much more valuable than money. This in itself acts as a huge deterrent. This form of corporate punishment is not yet practiced in the United States, but the Scottish parliament has been debating legislation allowing equity fines.
3. Corporate Shaming. This type of punishment can be very severe. It is when a governing body requires the company in question to make a very public, embarrassing announcement. This can be extremely disastrous for not only the company but innocent workers. By doing this it will deter fellow companies that do not wish to lose reputation then eventually profits and revenue
The Three threats to running an ethical corporation according to Fieser & Moseley (2012) are:
The Profit Motive: This is when the motive of company to make profits could conflict with its sense of social responsibility. Organization stakeholders expect to see a return on their investments, and the corporate officers have a fiduciary duty to oblige them, to the point that the officers might neglect the interests of all other stakeholders.
Strategic misrepresentation, which is the intentional and systematic distortion or misstatement of facts for the purpose of gaining a financial advantage. Most executives are compelled from time to time to be deceptive when negotiating with dealers, labor unions, government officials, and even other departments within their own companies
Groupthink, which implies the practice of thinking or making decisions as a group in a manner, which discourages creativity or individual responsibility.
Finally, I think that there is no need for corporations to function by the same codes of morality that individual people in society have to abide by. This because unethical corporate behavior may be the responsibility of an unethical individual, but it often also reveals a company culture that is ethically lax. 33 Maintaining a positive ethical climate is always challenging, but it is especially complex for organizations with international activities. Different cultures and countries may have different standards of behavior, and managers have to decide when relativism is appropriate, rather than adherence to firm standards.
Prompt 3# Organizations
For-Profit Organization:
Enron
Not-For-Profit Organization
Red Cross
Reference
Brigley, S. (1995). Business ethics in context: Researching with case studies. Journal of Business Ethics, 14(3), 219. Retrieved from the ProQuest database.
Fieser, J. & Moseley, A. (2012). Introduction to business ethics. San Diego, CA: Bridgepoint Education, Inc
Some people see gentrification as a solution to many of the difficulties that older cities face.
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#2 Abstract
Some people see gentrification as a solution to many of the difficulties that older cities face. At the same time, many people are concerned about gentrification’s potential to evict low-income households. However, I have provided solid research about the scope of the problem which may help planners, legislators, and community-based groups. By investigating residence mobility among disadvantaged households in New York City throughout the 1990s, the study reported in this paper seeks to address this hole. We discovered that gentrification was related with delayed residence turnover among these households, rather than fast displacement. Normal succession appears to be accountable for changes in gentrifying districts in New York City, at least throughout the 1990s.
#3 Statement Of The Problem
Evaluating Gentrification Related To Neighborhood and City Health
“Gentrification a lift for everyone” was the headline of a 2005 article in USA Today (Newman & Wyly, 2006). This trend has sparked heated debate, with supporters and opponents split down the middle. One of the main arguments against this, as discussed by Professor Stephen Sheppard in his paper, ‘Why is Gentrification a Problem,’ is that low-income households who have spent years building a community with all of its complex social networks are forced to pack up and leave, either by choice or necessity. These residents are frequently unable to afford to stay in gentrified districts, and those that do may feel alienated from the community (Sheppard, 2012).
Professor J. Peter Byrne argues in his paper, “Two Cheers for Gentrification,” that an increase in the number of rich and well-educated citizens can only benefit cities. The fundamental reason for this is a growth in the number of residents with a lot of spare cash who may put it to good use in the city by paying taxes, buying local goods, and participating in local political processes. He goes on to say that the shortage of affordable housing, which is typically blamed on gentrification, is the result of the government’s incapacity to provide it. As a result, having wealthy people live and invest in the city will allow the government to support more affordable housing (Byrne, 2003).
Newman and Wyly began their investigation in their paper by examining displacement and its changes in New York City throughout the decade before the start of their research. They looked at information from the New York City Housing and Vacancy Survey, which is a three-year longitudinal study. Residents are polled on a variety of topics, including jobs, housing circumstances, and demographics. Newman and Wyly examined five previous years of surveys, filtering them to only include those that met their research criteria, which mostly included renters who had moved into their present residence since the previous study. They also looked at those who had relocated inside the city rather than those who had moved from other cities to acquire a better understanding of how gentrification affects intra-urban mobility.
The researchers subsequently conducted a second investigation, this time using an interpretivist approach. They did so by conducting a field study in neighborhoods inside the seven gentrifying sub-borough areas identified by Freeman and Braconi to acquire a deeper grasp of the changes brought about by this tendency within existing communities. This study went into greater detail into the numerous factors that drove residents of gentrifying districts to relocate.
The researchers used the second part of their study to identify two districts with little social change and to gain a deeper grasp of the lack of gentrification on the map and the ground. They gathered information through a variety of methods, including fieldwork, data generated from databases, archives, and secondary sources, and in-person interviews. Researchers wanted to acquire a better understanding of the causes of stalled gentrification and how they differ in different neighborhoods by using an interpretivist approach.
To strengthen the validity of their findings, all three of our researchers used two separate study approaches. Wyly and Newman utilized a mix of positivist and interpretivist methodologies to evaluate whether the census data supported their arguments that gentrification induced displacement and then to identify the precise reasons for these displacements. Their research, on the other hand, was not objective. The primary difference between Ley & Dobson’s technique with the one indicated above is that their research was conducted objectively, and as a result, their findings did not give strong evidence to back their statements.
Gentrification may result in displacement, which may be linked to increased bad health in non-gentrifying neighborhoods, lowering a city’s overall health. Second, the good health in gentrifying neighborhoods could simply be the result of the influx of more affluent, already healthier inhabitants. Gentrification has an impact on public health, especially in areas where certain communities are more vulnerable to the harmful effects of gentrification. According to studies, vulnerable populations have a shorter life expectancy, a higher cancer rate, a higher rate of birth deformities, a higher newborn mortality rate, and a higher prevalence of asthma, diabetes, and cardiovascular disease.
Annotated Bibliography
Diem, S., Holme, J. J., Edwards, W., Haynes, M., Epstein, E. (2019). Diversity for whom? Gentrification, demographic change, and the politics of school integration. Educational Policy, 33(1), 16–43.
This case study looked at how three New York City schools dealt with the effects of gentrification as student demographics changed. The conflicts, triumphs, and problems inherent in the school gentrification and integration process were examined using the conceptual framework of urban school leaders as cultural workers.
GD Johnson, M Checker, S Larson, (2021). A small area index of gentrification, applied to New York City. Department of Urban Studies, City University of New York
With application to New York City, this study gives a small-area indicator of the multifactorial process loosely referred to as gentrification (NYC). For NYC census tracts that are spatially normalized to the year 2010, the relative change of key input variables (median family income, median rent, and proportions of non-Hispanic white, 20–34-year-olds, and individuals with a 4-year college degree) was computed from 2000 to 2016.
Kenneth. A. Gould, TL Lewis, (2018). From Green Gentrification to Resilience Gentrification. City university of New York, Brooklyn.New York City’s once industrial waterfronts have been transformed into gentrified residential districts for the environmental class in the recent decade. To accomplish this, the city must clean and green these areas. This is referred to as green gentrification. It is headed by public officials and corporate investors who exploit underutilized environmental resources as part of the green growth machine.