The following 4 questions pertain to this case study:

Exhibits

In PACU, many assessments and interventions are done simultaneously. However, the most critical, high-priority assessment is:

Choice A: Bradypnea

Bradypnea, or slow breathing, is not typically associated with inadequate pain control. It is more often related to the effects of certain medications, such as opioids, or underlying respiratory conditions. Inadequate pain control is more likely to cause increased respiratory rate (tachypnea) rather than decreased.

Choice B: Irritability

This is a correct answer. Irritability can be a sign of inadequate pain control. Pain can cause significant discomfort and distress, leading to changes in mood and behavior. Patients who are in pain may become irritable, anxious, or agitated.

Choice C: Tachycardia

This is another correct answer. Tachycardia, or an increased heart rate, can be a physiological response to pain. When a patient is in pain, the body’s stress response is activated, leading to the release of stress hormones like adrenaline, which can increase heart rate.

Choice D: Hypoglycemia

Hypoglycemia, or low blood sugar, is not directly related to pain control. It is more commonly associated with diabetes management, fasting, or certain medications. While it is important to monitor blood sugar levels, hypoglycemia is not a typical indicator of inadequate pain control.

Choice E: Poor cough effort

This is a correct answer. Poor cough effort can indicate inadequate pain control, especially after chest surgery. Pain can make it difficult for patients to take deep breaths or cough effectively, which is essential for preventing respiratory complications such as pneumonia.

Choice F: Drowsiness

Drowsiness is not typically a sign of inadequate pain control. It is more often a side effect of pain medications, particularly opioids. While it is important to monitor for excessive sedation, drowsiness alone does not indicate that pain is not being adequately managed.

Choice G: Refusal to participate in physical therapy

This is the final correct answer. Refusal to participate in physical therapy can be a sign of inadequate pain control. Pain can make movement and physical activity difficult and uncomfortable, leading patients to avoid necessary rehabilitation exercises. Effective pain management is crucial for encouraging participation in physical therapy and promoting recovery.

Choice A: Agency policy

While agency policy provides guidelines for reassessment intervals, it is not the primary factor in determining the specific time frame for reassessing a patient’s pain level. Policies serve as a general framework, but individual patient needs and clinical judgment should guide the reassessment timing.

Choice B: Type of intervention

This is a correct answer. The type of pain management intervention used significantly influences the reassessment time frame. For example, after administering intravenous pain medication, reassessment should occur sooner compared to oral medications due to the faster onset of action. Different interventions have varying durations of effectiveness, necessitating tailored reassessment intervals.

Choice C: Pain severity

This is another correct answer. The severity of the patient’s pain is a crucial factor in determining reassessment timing. Patients experiencing severe pain may require more frequent reassessments to ensure that pain management strategies are effective and to make timely adjustments if needed.

Choice D: If family members are present in the patient’s room

The presence of family members in the patient’s room is not a primary factor in determining the reassessment time frame. While family members can provide valuable support and information, the focus should remain on the patient’s clinical needs and the effectiveness of pain management interventions.

Choice E: The patient’s psychosocial condition

This is a correct answer. The patient’s psychosocial condition, including their emotional and mental state, can impact their perception of pain and response to pain management. Patients with anxiety, depression, or other psychosocial issues may require more frequent reassessments to address both physical and emotional aspects of pain.

Choice F: Risks for adverse effects

This is also a correct answer. The potential for adverse effects from pain management interventions necessitates careful monitoring and timely reassessment. For instance, opioids carry risks of respiratory depression and sedation, requiring close observation and frequent reassessment to ensure patient safety.

Choice G: Workload of the nurse

While the nurse’s workload can influence the practical aspects of care delivery, it should not dictate the reassessment time frame. Patient needs and clinical priorities should guide reassessment intervals, with workload management being a secondary consideration.

Choice H: The patient’s physical condition

This is the final correct answer. The patient’s overall physical condition, including comorbidities and current health status, affects their response to pain management and the need for reassessment. Patients with complex medical conditions may require more frequent monitoring to ensure effective pain control and to promptly address any complications.