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Discussion: Week 3 Pain can be very difficult to control in a critical care pati

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Discussion: Week 3
Pain can be very difficult to control in a critical care patient, and pain may be mistaken for anxiety or another condition. Mechanical, chemical, and thermal stimuli results in pain perception. The patient endorphins can also suppress pain.
Case Presentation
Jenny Alvers is a 38-year-old otherwise healthy female who has been admitted directly to the intensive care unit (ICU) after an automobile accident and emergency abdominal surgery. In addition to surgery, she has deep face, neck, and chest lacerations and contusions. Jenny is on a ventilator and somewhat disoriented and restless with elevated blood pressure and heart rate. She is unable to provide a report of pain, but based on her pathologic condition, the nurse assumes that Jenny has pain and consults with the surgeon about orders for a continuous IV opioid infusion. Knowing that Jenny will be subjected to painful procedures such as endotracheal suctioning and wound care during her stay in the ICU, the nurse also requests supplemental IV opioid doses to administer prophylactically. Jenny’s sister reported that Jenny has no allergies but experienced severe nausea when she was given IV morphine following an appendectomy 3 years ago. The surgeon prescribes an IV infusion of hydromorphone at a dosage appropriate for an adult with moderate to severe pain and supplemental IV hydromorphone bolus doses every hour as needed. Scheduled doses of IV acetaminophen and IV ibuprofen are also ordered.
The nurse suspects that Jenny’s restlessness could be related to unrelieved pain and therefore administers an IV hydromorphone loading dose before initiating the infusion. Infusions of IV ibuprofen followed by IV acetaminophen are also administered. An aqua pad circulating cool water is placed over Jenny’s chest to provide additional analgesia. The nurse reduces the external stimuli in the room as much as possible and provides Jenny with calm reassurance and orientation while caring for her. Within 45 minutes of these interventions, Jenny is no longer restless, her vital signs are within normal limits and stable, and she appears to be resting comfortably.
For this discussion question please address the following questions:
When a patient is intubated, how does a nurse assess a patient’s pain?
What is nociceptive pain and neuropathic pain? It is known that nociceptors do not adapt to pain, please describe why? What kind of pain do you think Jenny has?
What aspect of the critical care unit could cause pain? What can you do as a nurse to change some of these aspects? Besides the nursing interventions the nurse already provided to Jenny, what else could you do to decrease Jenny’s pain?

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