Kim Litwack

Practical points in theevaluation of postoperative fever

The finding of an elevated temperature in the PACU or ambulatory surgicalunit in and of itself is not the challenge facing either the patient or the nurse. The challenge is in the interpretation of the finding, the outcomes of the alterations in temperature, and the physiologic sequellae that accompany the elevation.

Predictors of chronic pain in traumatically injured hospitalized adult patients

It is unclear what causes chronic pain in traumatically injured hospitalized adults. A total of 101 patients admitted to a level 1 trauma center completed interviews during their inpatient stay and at 4 months, and data on biologic, psychologic, and sociologic variables were collected. Statistical analysis used hierarchical logistical regression,&khgr;2, and independent-samples t tests. Prevalence of chronic pain at 4 months was 79.2%. Those with chronic pain at 4 months had more posttraumatic stress disorder, anxiety, and depression. High initial pain score was the only significant predictor of chronic pain. Initial pain intensity predicts chronic pain.

''Knowing'' as the Foundation of Clinical Competence

EACH DAY, YOU TAKE CARE of patients by administering medications, performing assessments, planning interventions. Do you want to challenge yourself a bit? For each intervention, ask yourself questions: Why did you select the dose of pain medication that you did? What clues did you see that led you to know that your patient was getting into trouble? How didyou know to call the surgeon instead of the anesthesiologist? Where is the patient going after discharge from the PACUwhy there? So often, we get into routines. We follow rules. We follow procedures. We admit our patients, get reports, take vital signs, and follow written orders untilourpatientsreachourrequireddischargecriteria. At that point, we move our patient to either an ICU, postopunit,phase-tworecovery,orhome.Routines are good. Routines ensure continuity of care. Routinesensuresafetyaswefallintocomfortablebehaviors required in the care of postoperative patients. BUT.routines can also cause us to stop looking, to stop asking questions, to miss critical clues. Take, for example, the patient who is tachycardic postoperatively with a heart rate of 118 bpm. The textbooks say that a ‘‘normal heart rate’’ will be 60-100 beats/minute. The new nurse will know something is wrong. The more experienced nurse will know to look for the cause before deciding on an intervention. Experienced nurses know well that tachycardia may be a sign of pain. But tachycardia canalsobea signofhypoxemia.Our responses as experienced nurses will be very different if the cause is pain as opposed to hypoxemia. If we make the wrong choice and select an intravenous opioid as our treatment, and the cause is hypoxemia, our choice could have devastating consequences. Tachycardia may also be the result of shivering, vomiting, or hypovolemia. Each is treated very differently from hypoxemia and pain. So, back to the question.how do you know? To know is defined as ‘‘to perceive, or understand as fact or truth; to have established or fix in the mind or memory, to be aware of, to be acquainted with something by sight, experience or report and to understand from experience.’’ 1 With experience, you come ‘‘to know’’ the cause of the patient’s elevated heart rate and exactly what intervention is required.

Pain management in military trauma.

The wounded warrior requires immediate care, and at times, evacuation from injury. Care may be self-regulated, or may require more advanced care under the direction of medics or advanced practitioners, including physicians and surgeons. While survivability is the immediate priority, pain management has become a military initiative, recognizing that poor management of acute pain may lead to the development of chronic pain and post-traumatic stress disorder. This article reviews current initiatives used in current conflict situations, as well as those in continued care following initial stabilization.

The Expert and the Novice: A Tale of Two Authors

TWO AUTHORS GENEROUSLY consented to share their experiences in publishing manuscripts in the Journal of PeriAnesthesia Nursing (JOPAN). A novice and expert were purposely sought out to allow the reader to share in their journey. Exploring each author’s path in idea generation, rewards, challenges, satisfaction, and potential impact should hopefully allow the reader to experience the entire process.

Practical points in theassessment of the patient with pulmonary disease

The second in a series on perioperative assessment, this article focuses on the patient with preexisting pulmonary disease. For each disease presented, defining characteristics will be provided, including the cause and treatment. Most importantly, implications for nurses who care for these patients in a perioperative setting will also be provided.

Practical points for the patient with preexisting cardiac disease

As the first in a series, the purpose of this article is to discuss common preexisting cardiac diseases seen in patients presenting for surgery. Defining characteristics, pathophysiology, etiologies, and treatments are presented along with perioperative nursing implications.