Pain Management Strategies for Acute Patients: Effective Approaches and Techniques

Acute Patient Assessment

Emergency Departments are dynamic healthcare settings in which time and effectiveness pose significant challenges to the delivery of the necessary level of care. Unlike other hospital wards, where nurses will have more opportunities to efficiently conduct patient assessments, acute settings require appropriate time management skills in addition to assessing and observing patients according to the established rules of practice.

In the current assignment, the role of a nurse in conducting the assessments of acutely ill patients admitted to Emergency Departments will be analysed. This goal can be achieved through following several steps. First, it is essential to provide a description of professional nursing experience regarding the care for a specific patient at a certain time in practice. Second, the undertaken evaluations will be discussed in relation to the appropriate physiology measures, and the break-down of the performed ABCDE assessment will be presented. Lastly, the management of the chosen patient by the nurse will be critically discussed to find positive and negative aspects of the efficiency and the quality of administered care.

Nursing Experience: An Appendicitis Patient

Acute appendicitis is almost the most common conditions with which patients are admitted to Emergency Departments (ED). In my practice as a nurse in an ED, I was responsible for assessing a patient who showed insignificant signs of appendicitis but experienced enough discomfort to refer to a care provider. The patient, Ms. J, was a 25-year-old woman who reported having frequent abdominal pains for a week. Her manifestations of appendicitis were not evident and were hard to diagnose, especially due to the occurrence of 20% of normal appendix being removed during appendicectomies.

According to Burton-Shepherd (2014), the symptoms of appendicitis can have a variety of diagnoses; however, failing to spot the condition can lead to a range of serious consequences. The first sign of appendicitis is the dull pain located in the navel or the upper abdomen. This pain becomes sharper when it travels to the lower right part of the abdomen. The complexity of the sign is associated with the fact that the pain can also be present in the upper abdomen, rectum, or in the back. Nausea, vomiting and fever that accompany pain also point to possible appendicitis. In some cases, patients can report difficulties and pain during urination, diarrhoea or constipation accompanied by gas, or inability to pass gas.

The patient, Ms. J, admitted to the Emergency Department did not have a fever, nor did she report any nausea or vomiting. Over the past several days, she has been experiencing dull and sometimes severe pain in the lower right abdomen (quadrant), the back, as well as sometimes in the lower left quadrant (Maxton & Butterworth 2018). Her appetite did not differ from usual habits; however, she did experience difficulties passing gas and constipation.

An important sign to mention is that the pain sometimes transferred to the ovarian area, which made the patient suspect cysts. When she referred to her gynaecologist with the complaints about the pain, she was advised to visit the ER for suspected appendicitis because her ovaries were healthy. Critically, these symptoms point to the high possibility of appendicitis, and it was my responsibility as a nurse to prevent the exasperation of the pain symptoms, administer pain medication if needed, as well as to conduct a set of assessments to allow the department to proceed with a surgical intervention to address appendicitis.

Assessments Undertaken with the Patient

In reference to underpinning physiology, the assessment performed with the patient had to identify the existing obstruction of the appendiceal orifice (Jones & Deppen 2018). Prior to conducting a physical examination of the patient, the nurse performed a CT scan to increase the accuracy of the diagnosis. This assessment was necessary to implement because Ms. J’s symptoms were not evident enough. The nurse consulted a CT specialist on the findings of the scan, which revealed an enlarged appendix (8 mm in diameter), the thickening of the appendiceal wall (2.5 mm) and the enhancement of the appendiceal wall (Jones & Deppen 2018).

To ensure that the patient had appendicitis, the physical assessment was performed. The most likely physical finding of appendicitis is associated with the tenderness of the abdomen, which takes place in the majority of instances (95% of acute cases of the condition). It was expected that the patient would find the lateral decubitus position with the flexion of the hip as the most comfortable since the pain would reduce and cause less pain. Overall, the abdomen would be soft with tenderness localised at and around the McBurney’s point (Figure 1). The test r