Controlling Pain Before and After Surgery

December 13, 2009 by  
Filed under Education

1. Ask the doctor or nurse what to expect.

  • Will there be much pain after surgery?
  • Where will it occur?
  • How long is it likely to last?

Being prepared helps put you in control. You may want to write down your questions before you meet with your doctor or nurse.

2. Discuss the pain control options with your doctors and nurses. Be sure to:

  • Talk with your nurses and doctors about pain control methods that have worked well or not so well for you before.
  • Talk with your nurses and doctors about any concerns you may have about pain medicine.
  • Tell your doctors and nurses about any allergies to medicines you may have.
  • Ask about side effects that may occur with treatment.
  • Talk with your doctors and nurses about, the medicines you take for other health problems. The doctors and nurses need to know, because mixing some drugs with some pain medicines can cause problems.

3. Talk about the schedule for pain medicines in the hospital. Some people get pain medicines in the hospital only when they call the nurse to ask for them. Sometimes there are delays, and the pain gets worse while they wait. Today, two other ways to schedule pain medicines seem to give better results.

  • Giving the pain pills or shots at set times. Instead of waiting until pain breaks through, you receive medicine at set times during the day to keep the pain under control.
  • Patient controlled analgesia (PCA) may be available in your hospital. With PCA, you control when you get pain medicine. When you begin to feel pain, you press a button to inject the medicine through the intravenous (IV) tube in your vein.

For both ways, your nurses and doctors will ask you how the pain medicine is working and change the medicine, its dose, or its timing if you are still having pain.??Doctors such as??Angelo Cuzalina??say it is important to make sure you are open about this communication so you are not feeling more pain than needed.

4. Work with your doctors and nurses to make a pain control plan. You can use aform to begin planning for pain control with your nurses and doctors. They need your help to design the best plan for you. When your pain control plan is complete, use the form to write down what will happen. Refer to it after your operation. Then keep it as a record if you need surgery in the future.

After surgery
5. Take (or ask for) pain relief drugs when pain first begins.

  • Take action as soon as the pain starts.
  • If you know your pain will worsen when you start walking or doing breathing exercises, take pain medicine first. It’s harder to ease pain once it has taken hold. This is a key step in proper pain control.

6. Help the doctors and nurses “measure” your pain.

  • They may ask you to use a “pain scale”.
  • They may ask you to rate your pain on a scale of 0 to 10. Or you may choose a word from a list that best describes the pain.
  • You may also set a pain control goal (such as having no pain that’s worse than 2 on the scale).
  • Reporting your pain as a number helps the doctors and nurses know how well your treatment is working and whether to make any changes.

7. Tell the doctor or nurse about any pain that won’t go away.

  • Don’t worry about being a “bother.”
  • Pain can be a sign of problems with your operation.
  • The nurses and doctors want and need to know about it.

Stick with your pain control plan if it’s working. Your doctors and nurses can change the plan if your pain is not under control. You need to tell the nurses and doctors about your pain and how the pain control plan is working.

Tags: Sensory system, Patient safety and nursing, Nursing, Nociception, Pain

Open Heart Surgery – Your visit with the heart surgeon

December 8, 2009 by  
Filed under Education

Your heart will explain the results of your tests and why surgery is being recommended. He will also explain the surgical procedure and the results you can expect. He will tell you about the risks of having or not having the surgery, the benefits of having the surgery and any options you have in place of surgery. You must consider the balance of the risks you will be taking and the benefits you will receive. Don’t be afraid of offending the surgeon or embarrassing yourself by asking questions about anything you don’t understand. Remember, the more you know, the more you will become confident about your decision. The following is a list of questions to help you get started.

Questions to ask

These are basic questions to ask your surgeon. If you think of others, write them down and bring them with you to your visit. Go over the list with your spouse and family. Ask if they have other questions they would like to have answered. Before you leave the surgeon???s office, try to get all your questions answered. Be sure you understand everything clearly. If you think of questions after you leave, write them down and call your surgeon back.

  • How will the surgery improve my condition?
  • Tell me again what will happen during the surgery?
  • Will I need blood transfusions?
  • How long will the surgery last?
  • How long will I be in the intensive care unit (ICU or CCU)?
  • How much pain should I expect and how will it be controlled?
  • What will the scar look like?
  • What are the possible complications of surgery, and how likely are they to happen?
  • Can I recover completely from this surgery? If so, how long will it take?
  • How long will I be in the hospital?
  • How long will my recovery take after I am home?
  • What will I be able to do and not do during recovery?
  • Will I need special equipment when I get home?
  • When can I return to work?
  • If I choose not to have surgery, will I get worse or remain the same?
  • Is there an alternative treatment that does not involve surgery?
  • How long do I have to decide?
  • If I decide to have the surgery, how soon should I have it?

Making your decision

Once you have the information you need to consider all your options, you may be surprised that the best decision for you is becoming pretty clear. That doesn’t mean that it’s an easy decision to make, but at least it will be one you will feel good about and will know what to expect as a result of your decision.

Tags: surgeon, Evaluation methods, open heart surgery, Surgery, heart surgeon, Nursing

Choosing a Rehab Program

December 8, 2009 by  
Filed under Education

The doctor and other hospital staff will provide information and advice about rehabilitation programs, but the patient and family make the final choice. Hospital staff know the patient’s disabilities and medical condition.

They should also be familiar with the rehabilitation programs in the community and should be able to answer questions about them. The patient and family may have a preference about whether the patient lives at home or at a rehabilitation facility. They may have reasons for preferring one program over another. Their concerns are important and should be discussed with hospital staff.

Things To Consider When Choosing a Rehabilitation Program

  • Does the program provide the services the patient needs?
  • Does it match the patient’s abilities or is it too demanding or not demanding enough?
  • What kind of standing does it have in the community for the quality of the program?
  • Is it certified and does its staff have good credentials?
  • Is it located where family members can easily visit?
  • Does it actively involve the patient and family members in rehabilitation decisions?
  • Does it encourage family members to participate in some rehabilitation sessions and practice with the patient?
  • How well are its costs covered by insurance or Medicare?
  • If it is an outpatient or home program, is there someone living at home who can provide care?
  • If it is an outpatient program, is transportation available?

A person may start rehabilitation in one program and later transfer to another. For example, some patients who get tired quickly may start out in a less intense rehabilitation program. After they build up their strength, they are able to transfer to a more intense program.

When Rehabilitation Is Not Recommended
Some families and patients may be disappointed if the doctor does not recommend rehabilitation. However, a person may be unconscious or too disabled to benefit. For example, a person who is unable to learn may be better helped by maintenance care at home or in a nursing facility. A person who is, at first, too weak for rehabilitation may benefit from a gradual recovery period at home or in a nursing facility. This person can consider rehabilitation at a later time. It is important to remember that:

Hospital staff are responsible for helping plan the best way to care for the patient after discharge from acute care. They can also provide or arrange for needed social services and family education.

This is not the only chance to participate in rehabilitation. People who are too disabled at first may recover enough to enter rehabilitation later.

Tags: Healthcare in the United States, Healthcare, Geriatrics, Nursing home, Geriatric rehabilitation, Rehabilitation medicine, Stroke recovery, Nursing

Deciding on a Stroke Rehab Center

December 8, 2009 by  
Filed under Education

Some people do not need rehabilitation after a stroke because the stroke was mild or they have fully recovered. Others may be too disabled to participate. However, many patients can be helped by rehabilitation. Hospital staff will help the patient and family decide about rehabilitation and choose the right services or program.

Types of Rehabilitation Programs
There are several kinds of rehabilitation programs:

  • Hospital programs
  • These programs can be provided by special rehabilitation hospitals or by rehabilitation units in acute care hospitals. Complete rehabilitation services are available. The patient stays in the hospital during rehabilitation. An organized team of specially trained professionals provides the therapy. Hospital programs are usually more intense than other programs and require more effort from the patient
  • Nursing facility (nursing home) programs
  • As in hospital programs, the person stays at the facility during rehabilitation. Nursing facility programs are very different from each other, so it is important to get specific information about each one. Some provide a complete range of rehabilitation services; others provide only limited services
  • Outpatient programs
  • Outpatient programs allow a patient who lives at home to get a full range of services by visiting a hospital outpatient department, outpatient rehabilitation facility, or day hospital program
  • Home-based programs
  • The patient can live at home and receive rehabilitation services from visiting professionals. An important advantage of home programs is that patients learn skills in the same place where they will use them

Individual Rehabilitation Services
Many stroke survivors do not need a complete range of rehabilitation services. Instead, they may need an individual type of service, such as regular physical therapy or speech therapy. These services are available from outpatient and home care programs.

Paying for Rehabilitation
Medicare and many health insurance policies will help pay for rehabilitation. Medicare is the Federal health insurance program for Americans 65 years of age or over and for certain Americans with disabilities. It has two parts: hospital insurance (known as Part A) and supplementary medical insurance (known as Part B). Part A helps pay for home health care, hospice care, inpatient hospital care, and inpatient care in a skilled nursing facility. Part B helps pay for doctors’ services, outpatient hospital services, durable medical equipment, and a number of other medical services and supplies not covered by Part A. Social Security Administration offices across the country take applications for Medicare and provide general information about the program.

In some cases, Medicare will help pay for outpatient services from a Medicare-participating comprehensive outpatient rehabilitation facility. Covered services include physicians’ services; physical, speech, occupational, and respiratory therapies; counseling; and other related services. A stroke survivor must be referred by a physician who certifies that skilled rehabilitation services are needed.

Medicaid is a Federal program that is operated by the States, and each State decides who is eligible and the scope of health services offered. Medicaid provides health care coverage for some low-income people who cannot afford it. This includes people who are eligible because they are older, blind, or disabled, or certain people in families with dependent children.

These programs have certain restrictions and limitations, and coverage may stop as soon as the patient stops making progress. Therefore, it is important for patients and families to find out exactly what their insurance will cover. The hospital’s social service department can answer questions about insurance coverage and can help with financial planning.

Tags: outpatient hospital services, Medicare, health insurance policies, supplementary medical insurance, Health economics, hospital insurance, Medicaid, skilled rehabilitation services, Healthcare in the United States, Geriatrics

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