Postoperative pain assessment: A review of nursing practices at Tygerberg Academic Hospital

Dippenaar, Petrus Johannes (2018)

Thesis

ENGLISH ABSTRACT: Pain is a complex, subjective, physical and emotional experience with large individual variation. Murray et al has estimated a prevalence of 62% of severe postoperative pain in Tygerberg Academic Hospital Surgical Wards (TAHSW). Efficient pain management stems from accurate pain assessment. Cultural influences and level of education determines patients’ willingness and ability to disclose the pain experience, as well as the health care provider’s ability to accurately assess it. Nurses with a greater level of training and experience tend to acknowledge self-report of pain to establish the existence of pain, but use objective parameters to determine intensity. Pain rating scales should be used to grade intensity of pain, as this is the easiest dimension to delineate. Acute pain has recently been regarded as the “fifth vital sign”, and routine assessment has created greater awareness of pain. Unfortunately, the lack of proper management protocols, has resulted in an increase in the inappropriate administration of opioid analgesics with an increased incidence of postoperative respiratory depression. Level of sedation secondary to opioid administration correlates with the risk of apnoea. Respiratory depression mostly occurs at night during the first 24 hours, due to lack of proper monitoring. Nurses need to be trained to recognise the danger signs of opioid induced respiratory depression.

AFRIKAANSE OPSOMMING: Pyn is ‘n ingewikkelde, subjektiewe, fisiese en emosionele ervaring met groot interpersoonlike verskeidenheid. Daar is ‘n baie hoë voorkoms van postoperatiewe pyn by Tygerberg Akademiese Hospitaal se Chirurgiese Sale (TAHSW), wat 62% nader. Effektiewe pynbeheer spruit uit akkurate assessering van pyn. Kultuurinvloede en vlak van opvoeding bepaal pasiënte se gewilligheid en vermoë om die pynervaring te weerlê, asook die gesondheidsorgwerker se vermoë om die gepaardgaande lyding na waarde te skat. Verpleegsters met hoër vlakke van opvoeding en ervaring erken die pasiënt se klagte van pyn, en kan sodoende die bestaan van pyn bewerkstellig, maar gebruik objektiewe maatreëls om die intensiteit te bepaal. Pynskale word gebruik om pynintensiteit te skat, want dit is die maklikste eienskap om te omskryf. Akute pyn was onlangs verhef tot die “vyfde vitale teken”, en roetine bepaling het ‘n groter bewustheid van pyn gekweek, en derhalwe pasiënthantering verbeter. Daar is ‘n baie hoë voorkoms van postoperatiewe asemnood vanweë opiaatgebruik. Diepte van sedasie stem noukeurig ooreen met risiko vir apnee. Die oorgrote meerderheid van asemnoodgebeure geskied snags, tydens die eerste 24 uur, vanweë gebrekkige monitering. Verpleegsters moet opgelei word om die gevaartekens van opiaat geïnduseerde asemnood te erken.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/108655
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