Main Concerns for Patients Undergoing Cardiovascular Surgery Essay

The day after the surgery was just as bad as the day of the surgery. I was wheel chaired out of the hospital, and I felt tired, groggy, exhausted, and overall just terrible. On the car ride home my heart was hurting a lot and I was having a lot of irregular issues with my heart. I was having more panic and anxiety attacks. The incision wounds partly reopened so that was really scary. This experience changed me quite a bit and not in a good way. It was one of the worst experiences in my life. It has made me constantly worry about my heart and health. I have really bad anxiety when it comes to my heart. Or anything for that matter. I am always worrying about my heart. This experience changed the way I felt about surgery and what people go through. I dislike surgery so

The pre-operative stage is an important phase in patient’s surgery process. This is the time where the patients is experiencing a lot of anxiety issues and have questions regarding the impending procedure. To help ensure good patient outcomes, it is imperative to provide complete preoperative instructions and discharge instructions (Allison & George, 2014). It is the nurses’ duty to safe guard and protects the patient’s welfare during the surgical experience. Effective preoperative preparation is known to enhance postoperative pain management and recovery. Health professionals need to be cognizant of the contextual factors that influence patients’ preoperative experiences and give context appropriate care (Aziato & Adejumo, 2014).

Every patients main concern when going to a hospital is to get a surgery to fix a problem that they have, or to receive prescriptions for illnesses and diseases. But a factor most probably are not worried about when they go to a hospital is how they are being treated. Doctors already have a difficult task to perform, but overcrowding the hospitals will cause them to be busy and possibly conduct their job with out the amount of care that is required. Giving out prescriptions in a hospital could also be effected. Patients vital medicine could be mixed up with someone else’s and cause even more harm.

Keywords: intensive care, patient scenario, clinical practicum, pathophysiology, disease processes, interventions, diagnoses, assessments, health prevention, promotion, health outcomes

In cardiothoracic surgical patients, an incidence of as high as 16-46% has been reported8. This is related to a number of factors that can be encountered during surgery. Mechanical factors like manipulating the heart, pain and sympathetic stimulation can all induce POAF. It can also be related to systemic inflammatory processes, hypotension, hypoxia, anemia and metabolic alterations. These situations can all be expected during anaesthesia. Volatile agents used during anaesthesia may also have antifibrillatory action8.

Despite recent advances in information regarding perioperative care, postoperative pain continues to go undermanaged. Postoperative pain is the pain patients experience after a surgical procedure. According to Gan, 80% of all people who undergo surgeries experience postoperative pain, and 75% of them rate their pain at a moderate, severe, or extreme level (as cited by Cooney, 2016). Furthermore, inadequately managed pain can lead to patient dissatisfaction, decreased patient outcomes, and overall higher cost of care (Penprase, Brunetto, Dahmani, Forthoffer & Kapoor, 2015). In order to provide higher quality pain management,

As a result of delayed treatment, patients are more likely to experience unanticipated intensive care (ICU) admissions as well as increased lengths of stay, cardiac arrest, and death (McGaughey et al., 2007).

Chronic, acute, somatic and oncologic are all types pain - each with their own symptoms, reliefs, and evaluations. As pain has been explored, we have learned more about it; however, it remains an anomaly. In the postoperative setting, nurses are the first line of pain management. Their assessments of the patient’s pain, including questions and scaling is imperative when dosing medications and evaluating the patient. Studies continue to determine that healthcare providers undertreat and mismanage pain control and assessment. According, to the American Society of Interventional Pain Physicians, “80% to 90% of physicians have had no formal training in prescribing controlled substances, and only five out of one hundred thirty-three medical schools in the U.S. have required courses on pain management” (Glowacki, p. 37). The American Nurse Credentialing Center reported that “as of 2013, only one thousand six hundred seventy two registered nurses in the U.S. were certified in pain management” (Glowacki, p. 37). According to the CDC, about 50% of postoperative patients report unrelieved pain (Centers for Disease Control and Prevention, 2013). Effective postoperative pain control is necessary for successful care and treatment. Inadequate relief of postoperative pain can contribute to postoperative complications such as atelectasis, deep vein thrombosis, and delayed wound healing (Francis &

when pain scores were greater than 5 on a 0-10 pain scale scoring system. In addition to

The management of postoperative pain has received much interest nowadays. The intensity of postoperative pain depends on many factors such as type and duration of the surgery, type of anesthesia and analgesia used, and the patient’s mental and emotional status (11).

Pain can be categorised as either acute pain or chronic pain. Acute pain is short lasting and will commonly subside once healing has taken place (Mac Lellan 2006). It is often a sudden onset and usually lasts less than 6 months. The main example of acute pain would be the pain experienced post surgery. Chronic pain on the other hand is a prolonged and persistent pain that remains long after the normal healing process of 3- 6 months. A common example of such a pain would be chronic back pain (Mac Lellan 2006). For the purpose of this assignment, the management of acute pain post surgery will be discussed with reference to a particular scenario, which followed the care and pain management given to a patient post appendectomy.

In the professional setting, knowing the patient through his or her diagnosis, name, history of present illness, laboratory results or reason for staying in the hospital only contributes to the manner of physical care of the patient. However, recognizing the patient 's spiritual needs such as emotional support, mental positivity, and intellectual understanding of his or her situation gives a better assessment, as well as a trusting relationship between the nurse and the patient, as per personal experience. In the ward, it is evident that most of the staff nurses spend their time doing documentations, preparing medications, following-up laboratory requests, as well as reading through the patients ' charts to affirm the physician 's order. Throughout the duration of our shifts as student nurses, I see that the most that the staff nurses get to be conversant with the patient is when certain procedures (such as feeding through nasogastric tube, taking

Depending on the acuity of the pain, the patient’s pain threshold and current level of recovery; can be a great determinant as to which pain relieving medication that the doctor may prescribe and the nurse will initiate to give. A part of the nursing assessment of pain management, is to weigh up both the subjective and objective data to determine the severity of the pain the patient is experiencing and which medications that are charted, are most appropriate for the situation. This is especially the case in post-surgery, where as an exemplar Morphine may be the medication of choice, however if the symptomatic complaints are more mild than Ibuprofen or Paracetamol may

Inadequately managed pain can lead to adverse physical and psychological patient outcomes for patients. Continuous, unrelieved pain can suppress the immune system and result in postsurgical infection and poor wound healing. Sympathetic activation can have negative effects on the cardiovascular, gastrointestinal, and renal systems, predisposing patients to adverse events such as cardiac ischemia and ileus. Pain control is importance to nursing care, unrelieved pain reduces patient mobility, resulting in complications such as deep vein thrombosis, pulmonary embolus, and pneumonia.

Working as a team in the perioperative care of the patient is essential in managing surgical pain. In perioperative journey, the team should ensure that every role is agreed to get the best care as possible until the patient is discharge (Audit Commission 1997). The treatment should favour patients’ own needs. McQuay and colleagues mentioned the level of pain relief is achieved when choosing the safest and simplest techniques. Also, by using WHO Analgesic Ladder, the nurse or ODP will determine the appropriate analgesics from mild pain to severe pain. The method of analgesia and combination of other techniques should control the overall pain. And lastly, the patient should receive postoperative nausea medication to prevent