Critical care nursing clinics of North America
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The assessment and management of a child's pain in the postoperative period remain a challenge to the PACU nurse. Assessment of pain in children is often difficult; ongoing clinical research in this area continues to expand knowledge of how to improve children's communication of their pain to caregivers. Many pain management strategies are available, both pharmacologic and nonpharmacologic, to ease pain and distress postoperatively. Through understanding and knowledge of pain, its assessment and its management, the PACU nurse contributes positively to the child's surgical experience.
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Sophisticated practice modalities, advances in technology, and the increase of sicker and older patients undergoing surgery mandate an expansion of all PACU nurses' skill and knowledge base. Invasive hemodynamic monitoring, as well as the quantitative assessment of cardiovascular function that it provides, is both feasible and necessary as an adjunct tool in today's PACU. Hemodynamic monitoring should be used only when a specific management decision is being considered and when the physician is committed to act on the data obtained. Once instituted, it is the nurse's responsibility to care for the patient safely and provide accurate and reliable data for collaborative assessment.
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This article has discussed the anatomy and physiology of the neuromuscular junction and excitation-contraction coupling. The pharmacokinetics and pharmacodynamics of various depolarizing and nondepolarizing neuromuscular blocking agents were presented. ⋯ Because the recovery room nurse is relied on for continuous assessment of the postoperative patient, it is imperative that the nurse have a comprehensive knowledge of intraoperative factors that relate to the patient's recovery. The recovery room nurse should be an expert in the assessment of postoperative patients.
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A wide variety of agents are available to the clinician for the treatment of pain. The selection of the agent or agents is based on the severity of the pain, the expected duration of the pain, the desired method of administration, types of side effects that will or will not be tolerable, and other patient-specific factors such as pre-existing disease states.
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The use of PCA for the treatment of pain is a valuable and growing practice. The technique for PCA initiation and management has been described. This mode of therapy should be in the therapeutic armamentarium of every clinician managing postoperative pain because PCA provides better analgesia than conventional IM or IV narcotic therapy and is generally associated with fewer side effects.