Pain vs. and Infection Prevention

Pain vs. and Infection Prevention

Part One

Cues indicating severe pain in the patient may include verbal cues where the patient describes their pain as “excruciating,” “unbearable,” or “the worst pain I’ve ever felt.” Non-verbal cues can also signal severe pain, such as facial grimacing, restlessness, agitation, or guarding the affected area. Vital signs like increased heart rate, elevated blood pressure, and rapid, shallow breathing can further indicate severe pain (Harrison et al., 2021).

Accurately measuring the patient’s pain level can be done using the Numeric Rating Scale (NRS). Here, the patient rates their pain on a scale from 0 to 10, with 0 being no pain and 10 being the worst possible pain. Descriptors like mild, moderate, severe, or unbearable can also assess pain levels accurately (Harrison et al., 2021).

Characteristics of the patient’s pain that would be appropriate to assess include the location of the pain (like hip area), the quality of the pain (such as sharp, dull, throbbing), the duration of the pain (such as constant, intermittent), and the exacerbating or relieving factors (such as movement, rest, medication) (Harrison et al., 2021).

Situational circumstances affecting an older adult’s pain perception include cognitive impairment, sensory deficits, comorbidities, and medications. Conditions like dementia or delirium can impact patients’ ability to communicate their pain effectively. Sensory deficits, such as hearing or vision impairments, can make it challenging for older adults to express pain or understand pain-related instructions (Harrison et al., 2021). Comorbidities like arthritis or diabetes can amplify pain perception due to inflammation or neuropathy. Also, certain medications, such as opioids or sedatives, can affect pain perception or mask pain symptoms.

Nonpharmacological measures that can effectively decrease pain include positioning and immobilization to reduce pressure on the affected area, cold or heat therapy to alleviate pain and reduce inflammation, distraction techniques like engaging in enjoyable activities, and relaxation techniques such as deep breathing exercises or guided imagery (Harrison et al., 2021).

Relaxation positively affects the patient’s pain by promoting a sense of calmness and reducing muscle tension. Relaxation techniques can help distract the patient from the pain, release endorphins, and enhance overall well-being (Harrison et al., 2021).

Part Two

To prevent infectious agents from being introduced during catheter insertion, the healthcare provider should first perform proper hand hygiene before the procedure. This involves thorough handwashing with soap and water or using an alcohol-based hand sanitiser. Second, the healthcare provider should wear appropriate personal protective equipment (PPE) such as gloves, a gown, and a mask (Aghdassi et al., 2020).

Potential reservoirs for an infection that could contaminate the catheter insertion include the patient’s flora. The patient’s skin and mucous membranes can harbour microorganisms, which, if introduced into the urinary tract during catheter insertion, can cause infection. Additionally, the healthcare environment itself can serve as a reservoir for infection (Aghdassi et al., 2020). Contaminated surfaces and equipment within the healthcare setting can be sources of infectious agents.

Correctly utilizing sterile technique impacts breaking the cycle of infection. The sterile technique involves maintaining a sterile field and using sterile equipment during the procedure. By adhering to sterile techniques, the healthcare provider minimizes the introduction of pathogens into the patient’s urinary tract (Aghdassi et al., 2020).

Violation of the sterile technique can introduce pathogens during the catheter insertion procedure. For example, pathogens can be introduced if non-sterile equipment or contaminated hands come into contact with the catheter or insertion site (Aghdassi et al., 2020). Improper handling or manipulation of the catheter or failure to maintain a sterile field can also lead to contamination and the introduction of infectious agents.

Several factors make the patient a susceptible host to infection. Age can play a role, as older adults may have a weakened immune system or underlying health conditions that compromise their ability to fight infections. Comorbidities like diabetes or immunodeficiency disorders can also increase susceptibility (Aghdassi et al., 2020). Additionally, any skin integrity breach, such as the catheter insertion site, provides an entry point for pathogens. The patient’s overall health status, previous exposure to infectious agents, and the presence of any indwelling medical devices, like urinary catheters, can further contribute to their susceptibility to infection (Aghdassi et al., 2020).

Part 3

Pertinent information from the new event includes 1) the patient’s headache report, rated six on a scale of 0-10, 2) the patient complained of dizziness; and 3) elevated blood pressure of 178/106 mmHg.

Based on the situation, measuring the patient’s vital signs more frequently than routine postoperative monitoring is appropriate. Considering the elevated blood pressure and symptoms of headache and dizziness, it would be advisable to measure the patient’s vital signs at least every 15-30 minutes until the blood pressure stabilizes or the symptoms resolve.

The first intervention upon the patient reporting these symptoms would be to assess their condition further and ensure their safety. This can be done by providing a calm environment, assisting the patient to a sitting or lying position, and closely monitoring their vital signs. It would be important to promptly notify the healthcare provider about the elevated blood pressure and symptoms, as further assessment and intervention may be required (Harrison et al., 2021). The rationale for this intervention is to ensure immediate patient safety and initiate appropriate management for the reported symptoms.

The patient’s pulse pressure can be calculated by subtracting the diastolic blood pressure (DBP) from the systolic blood pressure (SBP). In this case, the pulse pressure would be 178 mmHg (SBP) – 106 mmHg (DBP), which equals 72 mmHg.

Risk factors that could be contributing to the patient’s hypertension include postoperative pain and discomfort. Pain can increase blood pressure temporarily, especially if it is not adequately managed. Also, some medications, such as opioids or other analgesics, can cause temporary increases in blood pressure (Harrison et al., 2021). Stress and anxiety are another factor. The surgical experience and recovery process can be physically and emotionally stressful, leading to transient elevations in blood pressure. The patient may have had pre-existing hypertension, which, as Harrison et al. (2021) note, can be exacerbated by the stress of surgery and postoperative pain.

References

Aghdassi, S. J. S., Grisold, A., Wechsler-Fördös, A., Hansen, S., Bischoff, P., Behnke, M., & Gastmeier, P. (2020). Evaluating infection prevention and control programs in Austrian acute care hospitals using the WHO Infection Prevention and Control Assessment Framework. Antimicrobial Resistance & Infection Control, 9, 1-9. https://doi.org/10.1186/s13756-020-00761-2

Harrison, Z. L., Bumgardner, J. D., Fujiwara, T., Baker, D. L., & Jennings, J. A. (2021). In vitro evaluation of loaded chitosan membranes for pain relief and infection prevention. Journal of Biomedical Materials Research Part B: Applied Biomaterials, 109(11), 1735-1743. https://doi.org/10.1002/

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Week 1 Case study- Pain, VS and infection prevention
You are a nurse caring for a 73-year-old farmer who was brought to your emergency department via ambulance after he fell while caring for his chickens. The external rotation of his left foot indicates the high likelihood that he fractured his hip with the fall. He has returned from radiology after having his hip and pelvis radiographed. He is trying to be brave but is in significant pain. His initial dose of pain medication, while somewhat effective, does not make his pain tolerable.

Pain vs. and Infection Prevention

A. Which cues (assessment finding) would signal the presence of severe pain in your patient? B. How would you accurately measure his pain level?
C. What characteristics of his pain would be appropriate to assess?
D. Which situational circumstances can affect an older adult’s pain perception?
E. What nonpharmacologic measures can effectively decrease pain?
F. How could relaxation positively affect his pain?
As you prepare him for surgery, you note that the healthcare provider has ordered the insertion of a urinary catheter.
A. Outline measures you would take to prevent infectious agents from being introduced during his catheter insertion.
B. List potential reservoirs for infection that could contaminate this procedure.
C. How does correctly utilizing sterile technique impact the cycle of infection?
D. Describe how violation of sterile technique could introduce pathogens in this procedure.
E. Indicate the factors that would make your patient a susceptible host to infection.
The patient has had an uneventful recovery from the hip surgery. On day three postoperatively the patient requires only acetaminophen (Tylenol) for the pain. You answer his call light, and although he is pleasant,
he reports headache (rated 6 on a 0-to-10 scale) and dizziness, BP in 178/106.
A. Outline the pertinent information with this new event.
B. How often would you expect to measure the patient’s vital signs based on this situation?
C. What would be your first intervention upon her reporting symptoms? Include rationale.
D. What is the patient’s pulse pressure?
E. Describe risk factors that could be contributing to your patient’s hypertension.