Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses
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J. Perianesth. Nurs. · Feb 2008
ReviewAssessment, physiological monitoring, and consequences of inadequately treated acute pain.
Postoperative pain is a major health care issue. Several factors have contributed to inadequate postoperative pain control, including a lack of understanding of preemptive pain management strategies, mistaken beliefs and expectations of patients, inconsistencies in pain assessment practices, use of as-needed analgesics that patients must request, and lack of analgesic regimens that account for inter-individual differences and requirements. ⋯ To effectively manage postoperative pain, nurses must be able to adequately assess pain severity in diverse patient populations, understand how to monitor physiological changes associated with pain and its treatment, be prepared to address the psychosocial experiences accompanying pain, and know the consequences of inadequate analgesia. It is important for nurses to be aware of relevant research and evidence-based guidelines that are available to guide pain assessments and patient-monitoring practices.
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J. Perianesth. Nurs. · Feb 2008
Family-centered care in the pediatric post anesthesia care unit: changing practice to promote parental visitation.
Although parental visitation in the PACU is the standard of care in a few institutions, it is surprisingly not a standard of care at most. Parental presence in the PACU at The Children's Hospital of Philadelphia (CHOP) was historically inconsistent and limited. ⋯ Through education, multidisciplinary collaboration, ongoing support, and dissemination of data, parental visitation in the PACU increased from 44% in January 2004 to 90% in January 2007. This report addresses parental visitation in the PACU, as well as quality improvement strategies to promote this valuable family-centered practice.
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New approaches to the management of acute perioperative pain have focused on ways to improve the risk/benefit profile of various analgesics, enhance the consistency of pain control, address interpatient differences in responses to pain and treatments, and avoid periods of ineffective pain relief (analgesic gaps). Although intravenous patient-controlled analgesia has been the "gold standard" for acute pain management, there are now more analgesic options and compelling data to support combinations of analgesics or multimodal therapy, timing of analgesic interventions, and the use of newer drug delivery systems. Maximizing pain control with preemptive analgesia and multimodal therapy, and the availability of transdermal fentanyl by iontophoresis and extended-release epidural morphine have expanded the armamentarium of effective options for perioperative pain control. This article explores emerging trends in acute pain therapy, and discusses their implications for improving patient care.
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Effective treatment of perioperative acute pain requires that information about the patient's goals for pain relief, previous history with analgesics, and type of surgical procedure is used to guide decisions about analgesic regimens. Analgesics are selected based on the location of surgery, degree of anticipated pain, and patient characteristics such as comorbidities, and routes of administration and dosing schedules are determined to maximize the effectiveness and safety of analgesia, while minimizing the potential for adverse events. ⋯ To accomplish this, nurses must have a thorough understanding of the pharmacology of analgesics. This article provides useful information for commonly used analgesics, primarily nonsteroidal antiinflammatory drugs (NSAIDs), opioids, and local anesthetics for control of acute postoperative pain.