John Wilkinson has a medical history his father had diabetes type 1 and his brother suffers from severe hypertension. He had been suffering from renal impairments for the past 4 years. Kidney Transplant was not an option then and his option was to have dialysis. John Wilkinson has got an arterial venous fistula that is 4 years old, Fistula is a vein and artery combined to form a bigger lumbar this is then used for heamodialysis. Heamo is blood and dialysis is when using a machine as a artificial kidney used to filter the blood stream and excrete waste products such as sodium (NA), potassium (K) AND excessive fluids such as water. The National Kidney Federation (2008)
John got admitted into hospital due to abdominal pain, intermitted claudicating in the legs and a temperature of 37.8 Celsius degrees. John was also admitted for a cadaveric kidney transplant. A cadaveric transplant is an organ from someone who died but donated it. (The National Kidney Federation (2008) He had a blood pressure of systolic of 170 and diastolic of 100. His skin felt sweaty ad clammy.
As stated in the introduction roper logon Tierney is used as a framework to provide the best care possible for the patient. The first activity of living the john has used was communication. Renal failure could bring up physical changes that affect the patient. John has stated to the nurses that he had abdominal pain.
Pain is “"an unpleasant sensory and emotional experience, associated with actual or potential tissue damage, or described in terms of such damage". Pain is not just a physical sensation it can also be an emotional experience and that should be treated as such; and pain is not always related with actual damage to the body’s tissue, it could be potential tissue. Pain could also be caused by a lesion or dysfunction in the nerves system. There might be no noxious stimulus which is causing the pain this is referred as Neuropathic pain. Neuropathic pain is divided into two it could be central or peritoneal. Central Neuropathic pain examples could be pain following a stroke or spinal injury and peritoneal. Neuropathic pain is pain following from limp amputation or diabetic neuropathy. (Association of the British Pharmaceutical Industry 2008)
Each and every body tissue is supplies with nerve receptors called Nociceptors. These special nerve receptors are there to detect any painful inducement for example severe heat. When the nerve detect a pain full inducement they will force off an impulse which travels back along the nerve fibre to the spinal cord, from there the pain travels to the part of the brain called Thalamus and then to the other parts of the brain. The pain indicates been received by the parts of the brain and this is important because they affect the way someone becomes aware of the pain. (Association of the British Pharmaceutical Industry 2008)
Pain assessment and management in the renal unit is an important aspect of care and requires careful considerations to ensure patients comfort and safety.
For nurses to assess the pain of john Wilkinson they would need to use a pain assessment tool. The pain assessment tool starts of with a scale from 1 to 10, were 1 is being discomfort and 10 being excruciating. (Appendix 1) John had told the nurses that the pain is severe. The pain assessment tool also shows a human body on were the patient could tell were the pain is and nurses marks the pain location. (Appendix 1) For the pain assessment to be more accurately a few questions are asked on the tool for example: “How and when did your pain begin”. (Appendix 1) John has been in a pain for a few hours. After nurses having assessed john‘s pain a plan must be carry out to provide the right care for John.
The plan was to provide some analgesia for the severe pain. John was started of with orally paracetamol 1 gram prescribed regularly by the doctors.
Nurses had also told john to tell the nurses about when his pain is easing, getting worse or no change. Nurses would have to carry out with the pain management until johns is no longer in pain. Hence from using the pain assessment tool nurses and other health care professionals can decide whether john needed any stronger analgesia. John had stated to the nurses that his pain has not changed because john finds his pain still being severe nurses have to make another plan. This plan involved in proving a stronger analgesia called Tramadol. Tramadol is giving intramuscular or intravenous and this would go straight to the location of the pain. (Dinesh. K Mehta 2008)
During medication round nurses would find out more about his pain and could also ask John’s partner to bring in water bottles for him, this could relieve the pain naturally. Another way is nurses could advice john to get into a fetal position; this would relax the stomach instantly and loose the muscles. The nurses would also refer john to the physiotherapy to find ways of easing the intermitted claudicating. This could loosen muscle cramps in his legs.
After John had his cadaveric kidney transplant. He had a PCAS. Patients control analgesia system institute which could only be admistered by himself. Docters, nurses or any other health care professional are not allowed to admister it. The analgesia was called morphine. Morphine must be admister very carefully. The side affects of morphine is nausea, vomiting and it could also depress the respiration of the patients. (Dinesh. K Mehta 2008)
A separate assessment is used to control the intake of morphine. John could have up to 100mg or more depending on how severe the pain is. It is automatically controlled john can have1milligram every 5 minutes and it goes on lock out for 5 minutes. The pain assessment also asses sickness or itchiness due to the morphine. John has told the nurses he was feeling sick, doctors had prescribed him cyclizine which is an antiemetic. (Dinesh. K Mehta 2008)
The advantages of both these pain assessments scales are that you can see if the pain is getting better or worse. These assessments can show other health care professionals such as doctors, special nurse management and the other health care professionals looking after John Wilkinson’s care. These assessments can also show the nurses if john needs to have other analgesia prescribed to reduce the pain.
The disadvantages of using both these pain assessments scale is that as a health care professionals you can never measure the pain of john accurately . The other disadvantage in using this scale is that you can never tell if the patient is lying because as a health care professional you have to trust the patient’s pain even if there faking it.