The first problem in relation to Annabelle’s surgical repair of her patent ductus arteriosis (PDA) is her pain. Acute pain begins suddenly and is often sharp in quality, caused by injury or damaging stimuli. Surgery causes tissue damage and cell destruction which releases pain producing substances such as prostaglandins, serotonin and lactic acid. They then (delete this) initiate the nociceptive impulses and release catecholamine’s from the medulla of the adrenal gland which then changes vital signs according to Craft, J., Gordon, C.,Tiziani, A.,(2011). It will increase respiration, heart rate and blood pressure REF Anna belle has increased respirations of 48. Observations which indicate responses to pain include:- her high respiratory rate of ??? which should be 30 for her age (Hockenberry, Marilyn J, Wilson, David, Wong,Donna L. (2009), combined with her other data such as pulling away while trying to inspect the dressing, with her eyes shut tightly and her brows drawn together in a frown. Her mouth is also opened and square shaped and according to, Baulch, I. (2010). The first intervention for Annabelle is pain relief with the administration of IV morphine, associated with her surgery. Morphine belongs to the pharmacological group of opioids that act by binding to the opioid receptors in the central nervous system, inhibiting the effective transmission of painful stimuli (S. Lundeberg, T. Lundeberg, 2013).The exogenous opioid morphine, mimics the action of naturally occurring opioids such as endorphins, enkephalins and dynorphins acting on the same receptors decreasing pain according to Craft, J., Gordon, C.,Tiziani, A.,(2011). It is important to provide pain relief for Annabelle’s pain because it will prevent optimal respiration as pain leads to decreased muscle movement in the thorax and abdominal area leading to decreased tidal volume, alveolar ventilation, vital capacity and functional residual capacity. This sentence is a little long – try rewording again. This is a concern for Annabelle as her respirations are out of normal range. This can then lead to the inability to cough and clear secretions and increases the risk for further complications such as pneumonia and atelectasis which can be life threatening, indicating the high level of importance to get Annabelle’s pain under control Nett, M. P., M.D. (2010). Pain can also result in systematic overactivity, which leads to increases in heart rate, peripheral resistance, blood pressure and cardiac output. This increases cardiac demand and myocardial oxygen consumption decreasing the oxygen to the tissues, making it life threatening and delaying wound healing (F., Lavonia, (2013). In Annabelle’s case, because of the surgery and the characteristics of pain, morphine delivered intravenously would be the most appropriate in decreasing Annabelle’s pain, although there are some issues that should be considered before implementing this intervention, as stated by Smith N; Schub T (2013). This is because Morphine will depress respirations and is the most serious complication according to A Somogyi1, D Barratt J Coller, (2007). Any significant change calls for increased vigilance which makes monitoring and assessing vital and a priority. As morphine is a sedative it may have an adverse effect of drowsiness which may result in difficulties in feeding for Annabelle, (Ellis, J., Martelli, B., Lamontage, C., Pascuet, E., Taillerfer, L., Gaboury, I., & Vaillancourt, R. (2011). As morphine is a schedule 8 drug, appropriate procedures must be followed, such as the 6 rights of medication and assuring all documentation is recorded and Annabelle is closely monitored (Smith N; Schub T (2013).
The second intervention for Annabelle’s pain associated with the PDA repair is to use non pharmacological techniques. Pain is associated with fear anxiety and stress which are undesirable for all patients. A number of non-pharmacological techniques such as superficial massage, relaxation,
