Marissa Rose-Morris

Oct 15/15
3020 Reflective Journal 1
Today my patient was on dilauded through a PCA pump for pain control. The pt had had
a R hemicolectomy to correct their intussusception which was the main cause of their pain. The
surgery occurred on Oct 13, and their pain was decreasing. The pt had not used their PCA much
during the day and stated that their pain was better than the day before. This coupled with the
pts increased O2 sats (up from 80% in the morning to 90-94% in the late afternoon), had the
primary nurse making the decision to try to wean the pt off of the PCA. To do this, the nurse
took the pump button away and told the pt to use the call bell if they were in pain. The pt was
compliant in this instruction. Later in the shift when the pt needed to get up to use the toilet they
were in pain so was asked if they wanted to use the PCA, to which they responded yes. Other
than that one time, the pt had little pain and did not use the PCA again. The pt was able to walk
around the unit 3 times throughout the day with little pain.
I felt that this intervention was very effective for the pt. It seemed to have improved their
mood and reduced their drowsiness. I was happy for the pt as they were feeling better and in less
pain than the day before. When trying to assess the pts pain level they werent able to use the
VAS scale very accurately as they would first state that it only hurt when they had to get in or out
of bed then rate their pain at a 7/10 for just lying in bed. Her statements of pain fluctuated when
I spoke with her, although she would rate it a higher number she did not show any of the outward
signs of pain. This got to be rather confusing and made it so I would ask more questions in order
to get a better idea of her actual pain level.

I think that the pts pain was mostly controlled with little use of the PCA pump. They
were able to walk about the unit with little pain, and experienced tolerable pain when returning
to bed. Although using the VAS scale for pain assessment was not the most effective choice for
this pt, I was able to find other ways to gauge their pain level. I used the pts general attitude and
response to other questions such as: when does it hurt, where does it hurt, what kind of pain is it,
and would you consider it more of a 3 or a 5? Using these questions I was able to get a better
understanding of my pts pain level.
While a literature review by Coll, Ameen, and Mead (2004) found the VAS is effective in
assessing the sensory component of pain, it also found that more guidelines are needed to define
and measure pain properly. Looking into this article I find that I agree with them, especially
after my experiences today with this pt. While the VAS works well for most people, some pts
are unable to have a clear idea of what the numbers are. Even with defining the outer limits of
the scale, 0 being no pain at all and 10 being the worst pain imaginable, some pts do not have a
clear idea of what the numbers between mean.
Overall this experience helped me to better understand how it can be difficult to
determine a pain level in some pts. Since the pt was on a PCA pump and was trying to be
weaned off, it was important to know that the pts pain was controlled. If the pt is unclear with
their pain level, it is important to use alternative questions to gauge how much pain theyre in.

Reference
Coll, A. M., Ameen, J. R., & Mead, D. (2004). Postoperative pain assessment tools in day surgery:
literature review. Journal of advanced nursing, 46(2), 124-133.