Description

During my placement at the acute surgical ward, I came across a patient who I will name Mr. Jones. When I arrived at the ward, the senior nurse briefed us about the cases on the ward. I learnt that Mr. Jones was admitted to the surgical ward with severe abdominal pain and he has been diagnosed with small intestinal obstruction and is being managed pre-operative for surgical intervention.

While attending to the patients in the ward under the supervision of my mentor, Mr. Jones called out to me that he is in severe pain. Walking up to him, I noticed the agony and pain he was in. Once he had my attention he was screaming and berating me that he is in terrible pain and that he need more painkillers. I approached Mr. Jones and introduced myself with the aim of building an initial and good rapport with him. I was so petrified with the signs and the way he communicated with me in such a way that really expressed he was in severe pain. I assured Mr. Jones that I will have a word with a qualified nurse and will be back. I walked up to my mentor and ask that Mr. Jones would need some painkillers as he is in severe pain.

I was very surprised when my mentor said to me “okay, where is Mr. Jones drug chart”? And to my utmost surprise, instead of getting a cocktail of painkillers for Mr. Jones, she was asking several questions. How do you know that he is in such severe pain as you have just described to me? Have you asked him with the trust policy of pain scale? What type of painkillers has been given to Mr. Jones and for how long ago were these given to him? She went on and on and I felt embarrassed. I was unable to answer any of the questions she has asked. I guess I must have been overwhelmed with sympathy rather than empathy for the patient. I went to bring Mr. Jones’ drug chart and my mentor explained to me that from his drug chart recordings, he is on oral morphine 10mg 4 hourly and the last dosage was given in just an hour ago.

Feeling

My first feeling was that this patient could be in severe pain and there is a need to administer some form of strong analgesics. Pain may not be totally objective but subjective according to Braun et al (2003), they went on to further point out that included in pain are emotional as well as personal experiences. My mentor showed me that Mr. Jones is on 10mg oral morphine four hourly and that he may need a new review by the doctor so as to reassess his pain.

Evaluation

This being my first encounter of meeting a patient with acute pain, I have so much to learn and gain about acute pain management. I was involved in most of the management of Mr. Jones.  I learnt according to Mr. Jones past medical history that he was first admitted into the hospital in September 2009 for hernia repair and discharged home. He is now being treated for small intestinal obstruction which is one of the side effects of adhesions which could result from hernia repair. I asked the qualified nurse series of question and she informed me that caring for patients with intestinal obstruction require a lot of nursing skills.

After re-assessment by the resident doctor that responded to the summon, M. Jones morphine was increased to 20 mg, 4 hourly in titrated doses so as to minimize the effect of euphoria and unwanted effects.

Analysis

Despite the fact that Mr. Jones has had a surgery to repair his hernia a year earlier and is about to undergo another one shortly, he was in very good spirit. The whole process from when I came into the ward and Mr. Jones called out to me that he is in severe pain till now has all been eventful and educating at the same time.

Under the supervision of my mentor, I actively participated in the monitoring of Mr. Jones vital signs. In addition to recording the temperature, I was involved in the monitoring of the fluid and electrolyte balance. Fluid balance was monitored hourly as one of the senior sisters explain to me the importance of a maintaining its balance.

Conclusion

I feel that the whole process involved in the management of Mr. Jones preoperative acute pain went smoothly. Being my first placement in the surgical ward I asked several questions and mentor and senior nurses were on hand to explain and in some instances demonstrate this out. But what else could I have done or what could I have done differently? Well, from the first time I went to meet the patient and then relaying the patient concern to my mentor, I should have looked at the patient’s drug chart rather than being overwhelmed by self-pity. All documentation with regard to the patients’ management is on the patients’ record and it is vital that I look at this.

Action Plan

To increase the effectiveness of nursing interventions and to improve the management of pain, the use of pain assessment tools for acute pain has to be followed such as verbal description scales which are based on numerically ranked words such as none mild, moderately severe and very severe for assessing both pain intensity and response to analgesia. Numerical Rating Scales this is easily used as a verbal scale of 0-10 indicating no pain on one extremity of the line and 10 indicating severe pain at the other extremity. Uncontrolled pain can lead to increased anxiety, fear, sleeplessness and muscle tension which further exacerbate pain.  I also learnt that there is a psychological aspect to pain. My nurse-patient relationship really helped in this area.  I hope to increase my nurse-patient relationship and how to deal with acute cases. This will be a goal I will be aiming at in my next placement through discussion with my mentor and further research.

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