Dimitri Novak

Question 1

what is Dimitri’s related topic?

Answer 1

NEWS2/Pain & analgesics

Question 2

how old is Dimitri?

Answer 2

20 years old

Question 3

what department is he in?

Answer 3

surgical

Question 4

what procedure has dimitri had?

Answer 4

a laparoscopic appendectomy

LAP-A-RA-SCOPIC

APPEN-DEC-TOMY

Question 5

what did he receive during during this procedure?

Answer 5

general anesthetic

Question 6

what is his PMH?

Answer 6

• fit and well
• no known allergies (NKA)

Question 7

when did he last receive analgesia and what kind?

Answer 7

• 2hrs ago
• IV paracetmol 1G

Question 8

how was he upon returning to the ward post-op?

Answer 8

fully alert, no reports of pain, normaly obs

Question 9

does demitri have any wounds? if so, what are they like?

Answer 9

• yes
• he has three small wounds
• no strikethrough
• mepore dressings in situ

Question 10

what is dimitri’s complaint?

Answer 10

he is reporting pain

Question 11

difference between general and local anaesthetic?

Answer 11

local; small relevant area of the body is numbed whilst you remain fully conscious

general; medicine which makes you completely unconscious

Question 12

what does anaesthesia mean?

Answer 12

loss of sensation

Question 13

what are anaesthetics?

Answer 13

medicined which cause anaesthesia (loss of sensation)

Question 14

what side effect could impact demetri’s ability to score his pain?

Answer 14

• his general anaesthetic
• can impact concentration and cause confusion for a day or two
• this could mean using a pain scale hard to comprehend

Question 15

what impact can pain have on mental health?

Answer 15

• depression/low mood
• anxiety and distress

Question 16

what impact can pain have on heart rate?

Answer 16

pain can cause tachycardia, as acute pain induces a stress response from the body, e.g., a release of adrenaline from the adrenal glands

Question 17

Demitri’s obs upon returning to the ward were normal, so if they have now altered/deteriorated, what could have caused this?

Answer 17

• 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

Question 18

how long can a standard laparoscopic appendectomy take in surgery?

Answer 18

about 1hr

Question 19

steps to approaching someone in pain? 5 points?

Answer 19

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?

Question 20

what signs of inflammation could be presnet at dimitir’s surgical site?

Answer 20

• swelling (oedema)
• eythema (redness)
• warm periwound
• pain (bradykinin making sensory receptors/nocireceptors sensitive to pain stimuli)

Question 21

when can dimitri next have paracetamol?

Answer 21

• 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

Question 22

what is the link between pain and sympathetic NS?

Answer 22

• 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

Question 23

how will pain influence dimitri’s respirations?

Answer 23

• 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 %

Question 24

how will pain influence dimitri’s heart rate?

Answer 24

• rate and force of contraction will be increased as the heart’s SA node function will be accelerated

Question 25

how will pain influence dimitri’s pulse rate?

Answer 25

• 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

Question 26

how will pain influence Dimitri’s blood pressure?

Answer 26

• 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