Dimitri Novak Flashcards
what is Dimitri’s related topic?
NEWS2/Pain & analgesics
how old is Dimitri?
20 years old
what department is he in?
surgical
what procedure has dimitri had?
a laparoscopic appendectomy
LAP-A-RA-SCOPIC
APPEN-DEC-TOMY
what did he receive during during this procedure?
general anesthetic
what is his PMH?
- fit and well
- no known allergies (NKA)
when did he last receive analgesia and what kind?
- 2hrs ago
- IV paracetmol 1G
how was he upon returning to the ward post-op?
fully alert, no reports of pain, normaly obs
does demitri have any wounds? if so, what are they like?
- yes
- he has three small wounds
- no strikethrough
- mepore dressings in situ
what is dimitri’s complaint?
he is reporting pain
difference between general and local anaesthetic?
local; small relevant area of the body is numbed whilst you remain fully conscious
general; medicine which makes you completely unconscious
what does anaesthesia mean?
loss of sensation
what are anaesthetics?
medicined which cause anaesthesia (loss of sensation)
what side effect could impact demetri’s ability to score his pain?
- his general anaesthetic
- can impact concentration and cause confusion for a day or two
- this could mean using a pain scale hard to comprehend
what impact can pain have on mental health?
- depression/low mood
- anxiety and distress
what impact can pain have on heart rate?
pain can cause tachycardia, as acute pain induces a stress response from the body, e.g., a release of adrenaline from the adrenal glands
Demitri’s obs upon returning to the ward were normal, so if they have now altered/deteriorated, what could have caused this?
- most likely his pain from surgery in general
- possible pain from infection of surgical site; no strikethrough present but would assess periwound of dressing without removing for signs of infection
- no known allergies but would still consider allergic reaction to general anaesthetic
how long can a standard laparoscopic appendectomy take in surgery?
about 1hr
steps to approaching someone in pain? 5 points?
1.) determine cause and location of pain; visceral, neuropathic, somatic?
2.) assess amount of pain; scale 1-10, what makes it worse/better, what can help, e.g., pillow position?
3.) reassure & comfort pt, anxiety is known to make pain worse, actively listen ti pt
4.) administer appropriate and effective analgesia
5.) re-asses; to ensure chosen analgesia is actually working, pain is not worsening, is tolerance from pt presnet? any sid eeffects and what could help those?
what signs of inflammation could be presnet at dimitir’s surgical site?
- swelling (oedema)
- eythema (redness)
- warm periwound
- pain (bradykinin making sensory receptors/nocireceptors sensitive to pain stimuli)
when can dimitri next have paracetamol?
- dimitri last had 1G of IV paracetamol
- paracetamol can only be administered 1g every 4 hours, meaning dimitri can have no more paracetamol for another two hours, which I would inform him of
- i would inform him that I would check his kardex to see what other pain medications he can have, then alert my mentor of his pain
- i would then return to dimitri to let him know his nurse is aware of his need for analgesia, so he is not left wondering if i have forgotten
what is the link between pain and sympathetic NS?
- pain/distress/anxiety can trigger a stress response (or sympathetic NS stimulation).
- as a result, the hormones adrenaline (ephinephrine) and noradrenaline (norepinephrine) to be secreted from the adrenal glands
- these hormones act as neurotransmitters when they reach target organs, such as within the respiratory and cardiovascular systems
- through this effect, they increase and sustain the effects of the sympathetic NS; fast and quick action/response
how will pain influence dimitri’s respirations?
- the smooth muscle of his respiratory tract/airways, particularly his bronchioles, will dilate/relax via bronchodilation
- this will cause increased input of air into his lungs per each inhilation and therefore- TACHYPNEA
- O2 input & CO2 output will also be increased; meaning O2 saturations should be- NORMAL O2 SAT %
how will pain influence dimitri’s heart rate?
- rate and force of contraction will be increased as the heart’s SA node function will be accelerated
how will pain influence dimitri’s pulse rate?
- pulse rate = the sensation of the heart beat via a blood vessel over a bony prominence
- sympathetic stimulation accelerates SA node in heart and therefre heart beat
- therefore, pulse rate will be increased during exctreme pain= tachycardia
how will pain influence Dimitri’s blood pressure?
- his blood pressure will increase (hypertension)
- depsite widespread vasodilation as a result of sympathetic stimulation, the vascontriction to less vital areas of the body during a stress response, e.g., the GI tract and skin, have a more vast bed of blood vessels, having a more significant impact on systemic BP
