Med-Surg · chapter 27 · Postoperative Care
Postoperative Pain Management
The 13 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 3 practice questions with the reasoning.
Key points
Pain assessment baseline
To create a baseline for developing a successful plan, the nurse must understand key information about a patient’s pain experience, including the location and quality of the pain and any aggravating or alleviating factors.
Subjective pain report
The first tasks of the pain assessment entail developing effective communication with patients and ascertaining their subjective experience of pain. An important consideration is that the expression of pain is subjective and should not be judged by the nurse to be different than what the patient claims it is.
Surgical site assessment
Nurses must carefully consider specifics of the surgical procedure when assessing a patient’s pain, while examining surgical sites for signs of inflammation or swelling that could worsen postoperative pain.
Pain triggers and relief
Furthermore, nurses investigate potential factors that exacerbate or relieve postoperative pain such as patient movement or changes to body position. This continuous assessment allows for the development of personalized pain management plans tailored to each patient’s unique needs and responses in the recovery phase.
Culture and pain communication
Culture shapes how individuals communicate and display pain and may also affect health-care providers’ assessments and interpretations of patients’ pain, affecting the accuracy of pain assessments and decision-making regarding treatment decisions.
Pharmacological choices
Pharmacological interventions are a primary approach, employing various analgesic medications such as opioids and nonopioids. Medication choices depend upon several factors, including type of surgery performed and patient medical history.
Regional anesthesia relief
Regional anesthesia techniques like epidural analgesia and peripheral nerve blocks offer targeted pain relief by temporarily impeding pain signals at specific spinal sites.
PACU opioid analgesics
During the PACU phase, IV narcotic analgesics are very effective for acute pain. Typical opioids used in PACU settings include fentanyl, hydromorphone, morphine, oxycodone, oxymorphone, and tramadol (Mayo Clinic, 2024).
PCA monitoring
The nurse is responsible for regularly monitoring the PCA for proper functioning.
Multimodal medication approach
By employing a multimodal approach, health-care providers hope to maximize pain relief while simultaneously minimizing any potential adverse side effects linked with any single class of medication.
Discharge pain criteria
IV pain medication should not be administered prior to discharge because the patient must be monitored for signs of respiratory depression. Manageable pain control is a criterion for discharge (Certain et al., 2022).
Nonpharmacological orders
Nonpharmacological pain management strategies form an integral component of holistic health care both within hospital settings and as self-care practices in daily life at home. While in the hospital, a provider’s order needs to be obtained before these modalities may be applied.
Pain and mobility
Painful conditions may restrict mobility and discourage patients from engaging in necessary physical activities and rehabilitation exercises that would support restoration of function and strength, further impeding healing efforts.
Terms to know
- Postoperative pain management
- Postoperative pain management is an integral aspect of patient care, comprising various strategies designed to mitigate discomfort and promote recovery.
- numeric pain scale
- The numeric pain scale is used most often, having the patient rate their current pain on a scale of 0–10 with zero being no pain and ten being the worst pain they have ever felt.
- patient-controlled analgesia (PCA) system
- A patient-controlled analgesia (PCA) system is a method of pain management that allows the patient to push a button that administers the prescribed medication via an IV site.
- Pharmacological interventions
- Pharmacological interventions are a primary approach, employing various analgesic medications such as opioids and nonopioids.
- Adjuvant medications
- Adjuvant medications work by modulating nerve signals, making them effective treatments for neuropathies like neuropathic pain conditions.
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
The graded version needs JavaScript. Every question is below anyway, with the answer and why.
Every question here, with the answer
At 09:00 in the PACU, a patient reports pain of 8/10 while resting quietly without crying. Which entry best documents this assessment?
- Patient reports pain 8/10; resting quietly without crying.
- Pain severity unconfirmed because observed behavior does not match the reported 8/10.
- Mild postoperative pain; patient remains quiet despite reporting 8/10.
- Patient reports pain 8/10; score considered unreliable because the patient appears comfortable.
Answer: Patient reports pain 8/10; resting quietly without crying.
The correct entry preserves the patient's subjective pain report while separately describing observed behavior. The other entries downgrade, withhold acceptance of, or discredit the reported severity because the patient is quiet, although outward expression does not determine pain intensity.
At 11:00, you have documented a postoperative patient's pain score as 6/10. The record lists a prescribed analgesic but does not describe the pain or the patient's response to treatment. Which actions should you take to complete the baseline pain assessment documentation? Select all that apply.
- Ask the patient where the pain is located and how it feels, then record the responses.
- Identify the surgical incision as the pain location based on the procedure performed.
- List the prescribed analgesic as an alleviating factor based on the medication order.
- Ask whether movement or position changes worsen the pain, then document the response.
- Ask what helps relieve the pain, then document the factors the patient identifies.
Answer: Ask the patient where the pain is located and how it feels, then record the responses., Ask whether movement or position changes worsen the pain, then document the response., Ask what helps relieve the pain, then document the factors the patient identifies.
The baseline assessment should establish the patient's pain location, quality, and aggravating or alleviating factors. The surgical procedure alone does not establish where the patient actually hurts, and an analgesic order alone does not establish that the medication has relieved the pain.
At 15:00, a hospitalized postoperative patient requests heat/cold therapy for pain. There is no provider order for this modality. Which plan should you document?
- Use heat/cold therapy under the patient's existing order for postoperative analgesic medication.
- Offer heat/cold therapy as a comfort measure, then request an order if the patient reports benefit.
- Obtain a provider's order before applying heat/cold therapy.
- Begin heat/cold therapy at the patient's request and notify the provider at the next update.
Answer: Obtain a provider's order before applying heat/cold therapy.
The section requires a provider's order before applying these nonpharmacological modalities in the hospital. A patient's request or an analgesic medication order does not satisfy that requirement, and obtaining an order or notifying the provider afterward reverses the required sequence.
Where every quote comes from
Section 27.2 Postoperative Pain Management of Medical-Surgical Nursing by Christy Bowen, Bridget Carey, Jessica Palozie, Maren Reinholdt, OpenStax, 2024. Read the whole section free at openstax.org.
The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.