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To deliver optimum patient care, what kind of skills and knowledge should nurses be equipped with?
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Answer 1.:– To deliver optimum patient care, nurses must be equipped with skills, knowledge and attitudes towards pain, pain assessment and management. These skills must be guided by best available evidences to prevent any type of harm to the patients. Pain assessment is an integral part of pain management (Hall-Lord, 2006). In the above case study, the patient complains of pain in his chest and neck. The complicacy of non-self-reporting pain, even though absent and as per patient self-reporting he is experiencing pain, there are certain challenges for a nurse to assess pain.
The patient condition shows no change from the previous status where he was recorded GCS 13 E3, V3 and M6. The above pain rating on GCS scale implies the patient responds to voice, uttering of words may be inappropriate and some abnormal flexion's can be observed on painful stimuli. But the motor response rating implies he is fine with the motor response as 6 demonstrates the patient obeys the normal orders (lankova, 2006). On contrary to this, the patient complains of consistent pain in his right side chest and back. These contradicting views self-reported and evidence based literature act as a challenge for the nurse to assess the pain for the patient.
In such cases, it is essential to apply the evidence based strategy than any other pain measuring scale. The following strategy will be maintained for obtaining data about Mr. Brown pain
-To get a self-report from the patient, which in the contemporary scenario behaves as the single most reliable factor to start with (Herr K, 2004) .
-Going through patient medical history for pain assessment forms another important part, since every small change at the physical level may induce pain at certain points (Wilson, 2007).
– Consideration of recently applied medical interventions since any procedures applied might be causing pain.
– Taking data from her wife, to understand the pathophysiology of pain, pain behavior (if she has previously seen such pain in his husband during hospital admission or home based treatment).
-At times physiologic conditions are underestimated, but they can be the least indicators for pain so this need to be evaluated in Mr. Brown case.
–Patient behavior at times provides valuable clues for pain identification such as changing positions, sitting positions can enumerate where the pain is occurring, frequency of pain and severity of pain (Pasero C, 2002).
So these strategies will be maintained to assess the pain in Mr. Brown.
Answer 2. :-There can be different reasons for back and chest pain- The pain can be due to infection in the pleura, which can result in rubbing of two linings of lungs inside and outside thus causing pain at different points at chest. The rationale is the pleura inflammation can be caused by pneumothorax, lungs collapse, and pneumonia, which has been already diagnosed in Mr. Brown.