As nurses, we are used to being in control. We help manage our patient's medications, their diet, and activity. No matter where nurses work, we have to organize our day in order to get everything done. Much of the time we feel like we are barely keeping our heads above water. Nursing has changed so much over the years, and it feels like more responsibility is added all the time.
At some point, we will all find ourselves under the covers instead of standing at the bedside. It is unnerving to say the least. We must at that point put ourselves in the care of the nurses, nurse anesthetists, anesthesiologists, doctors, and surgeons. It makes me nauseous just thinking about it. Knowing so much can be a blessing and a curse at the same time. Personally, I don't announce that I'm a nurse, but they usually figure it out when I start asking questions or requesting certain things.
Very recently, I found myself under the covers. I felt like throwing up, crying, and running out the door in my lovely hospital gown. Things began running through my head, what if I die? Throw a clot? Stroke? Wake up on a ventilator in ICU? I have seen too many things happen. My husband sat in the chair next to my bed with no idea of what was going on in my head. I took a deep breath and reminded myself that I had prayed about this, and I had to put my trust in God.
My admitting nurse did a great job, and the nurse anesthetist and anesthesiologist made me feel taken care of and listened to. With a tendency for post op nausea, they gave me a scopolamine patch and marinol. The marinol was new to me for post op nausea and vomiting. Everything worked well, because I did not have any nausea or vomiting.
I don't remember PACU, but I do remember being rolled back to day surgery. I heard the nurse give report and then nothing. When you are in that space of waking up from anesthesia, you can go from sleeping to awake with severe pain. Any pain medications given at this point were probably given towards the beginning of the surgery and this is hours later, or one may have gotten pain medication in PACU. Anesthesia is pain blocking, but as it wears off, one can still have severe pain.
My husband took a picture of me when I first got back to day surgery and I was grimacing and crying in pain. As my head cleared, I looked around and saw that I had a blood pressure cuff on but it wasn't attached to anything, in fact, there was no monitor in the room. Not once was my pain level assessed or not one vital was taken. No temperature, B/P, heart rate, or pulse. I was flabbergasted. Someone came in the room and brought me a ginger ale and a cup of ice. They placed it on the bedside table at the end of the bed. I had no idea it was there. My husband helped me out of course, but what if he wasn't there?
Aside from the neglectful nursing, my point here that I am trying to make is that there seems to be a misconception about the post op period in regard to pain management. I remember when my mother-in-law had lumbar surgery. I was sitting in the chair just being there for her. She would wake up and cry out in pain, say a few words then drift off back to sleep. I told the nurse when she came in that she was in pain, and the nurse refused to give her anything because she had her eyes closed.
One thing I do know, is that once a pain level gets severe, it is really difficult to get under control. The period of waking up from anesthesia is often confused as the patient being comfortable. If the patient wakes up and cries, grimaces, any of the pain indicators, then they are having pain. If the patient's pain is well controlled initially, then they will recover faster. They will move more, eat better, therefore help to prevent surgery related sequela such as pneumonia.
Several years ago, I had another major surgery. For this one, I was admitted overnight on the orthopedic floor. I don't remember much about the day of surgery, but that night, I was more awake and beginning to shake off the effects of anesthesia. The nurse came in and I told him I was in a lot of pain. He replied in a very sarcastic manner that I had a pain pump, with the button on the left side of my bed. What!? I looked over and sure enough, there was the magic button. I began pushing that button until I felt better physically and emotionally.
I had no idea that the pain pump was available to me. Once again, it is forgotten that patients need to be assessed and reassessed. I feel that the nurse should have walked over to the bedside and put the pump in my hand and explained it to me, more than once if need be.
My whole point of writing this is to voice my experience with post op pain control. I feel that sometimes it can be inadequate due to the nurses' misconception of the role of anesthesia and pain control in post op care. Pay attention to nonverbal cues as well as when a patient complains of pain. Give pain med when appropriate, it will help the patient recover.
Has anyone else experienced this? Please share your experience.
