The purpose of this descriptive study was to evaluate, through clinical testing, the interrater reliability and concurrent validity of the Interchange of Gases Assessment Tool (IGAST) for monitoring the respiratory status of patients in the Postanesthesia Care Unit. The IGAST was used to assess the respiratory status of 20 patients over three time periods (60 data samples). Findings indicated that interrater reliability of the IGAST was acceptable for clinical use in the PACU. The IGAST received a mean interrater reliability rating of 98% in the PACU setting. Results of the mean dimension scores supported the patients' readiness for discharge. Chart audit revealed that the IGAST had concurrent validity since charted information and rated IGAST items were congruent. Further findings suggested that nurses using the IGAST document the respiratory status of patients more completely and more consistently than nurses using narrative documentation.

Sammanfattning                        Postoperativ smärtbehandling är otillräcklig trots ökad kunskap i smärtfysiologi och utvecklandet av nya farmakologiska riktlinjer. Obehandlad postoperativ smärta kan leda till komplikationer som fördröjd mobilisering, djup ventrombos, lungemboli, hjärtinfarkt, stroke och lunginflammation, vilka leder till ett ökat lidande för patienten både fysiskt och psykiskt samt ökade kostnader för samhället. Anestesisjuksköterskan lägger grunden för den postoperativa smärtbehandlingen före och under anestesin och ska arbeta preventivt för att patientens smärtbehandling ska vara tillräcklig. Syftet med studien var att belysa anestesisjuksköterskans strategier för att förebygga patientens postoperativa smärta efter generell anestesi. Semistrukturerade intervjuer genomfördes med fyra anestesisjuksköterskor på ett västsvenskt sjukhus och analyserades med kvalitativ innehållsanalys. Anestesisjuksköterskorna strävade efter att ge en individuell smärtbehandling till patienterna. Känslan som skapades vid det preoperativa mötet med patienten, typen av ingrepp, samt användandet av andra smärtbehandlingsmetoder påverkade planeringen av de intravenösa analgetikadoserna peroperativt. Genom att använda multimodal smärtbehandlingsmetod till patienter som opereras i generell anestesi skulle postoperativ smärta kunna förebyggas och bidra till minskat lidande för patienterna samt snabbare postoperativ återhämtning. Även vårdtiderna kan förkortas vilket kan leda till en samhällsekonomisk vinst. / Abstract                                      The management of postoperative pain is insufficient despite increased knowledge of the physiology of pain and the development of new pharmacological guidelines. Postoperative pain left untreated can lead to delayed mobilization and secondary complications such as deep venous thrombosis, pulmonary embolism, cardiac infarction, stroke and pneumonia. The outcome is increased mental and physical disability for the patient and increased costs for the society. The nurse anesthesist has a crucial role in postoperative pain management before and during anesthesia and needs to work preventively to secure sufficient analgesia for the patient. The aim of this study was to enlighten the nurse anesthesist’s strategies to prevent postoperative pain after general anesthesia. Semi-structured interviews with four nurse anesthetists at a hospital in the Southwest of Sweden were analyzed with qualitative content analysis. The nurse anesthesists strived to individualize pain management. The effect of the atmosphere created at the preoperative meeting with the patient, the character of the planned procedure and the usage of other methods of pain management all affected peroperative planning of dosage of intravenous analgesics. By using multimodality analgesia in patients who have surgery under general anesthesia postoperative pain could be prevented and hence contribute to reduced patient disability and faster postoperative recovery.  Furthermore, the in-hospital care time can be reduced which could mean socioeconomic benefits.

Uma das manifestações mais comuns em sala de recuperação anestésica é a náusea, geralmente associada à anestesia. Além do aspecto subjetivo do desconforto, os pacientes que não apresentam melhora desse sintoma podem ter alta retardada, tanto da sala de recuperação anestésica quanto hospitalar. Como conseqüências, temos a demora do retorno às funções normais, a elevação dos custos hospitalares e um menor grau de satisfação do paciente. O objetivo do presente estudo foi realizar uma análise crítica das evidências disponíveis na literatura sobre os fatores relacionados e características definidoras do diagnóstico de enfermagem náusea, no período pós-operatório imediato, por meio de uma revisão integrativa. No desenvolvimento deste estudo, utilizaram-se como fonte de levantamento de dados quatro base de dados: Lilacs, Pubmed, Cinahl e Cochrane - Revisões Sistemáticas, e a amostra constituiu-se de 31 estudos. A análise das publicações selecionadas demonstrou que as náuseas e vômitos no período pós-operatório são considerados eventos relacionados e, na maioria das vezes, avaliados como um evento único. Os fatores relacionados identificados, de acordo com a freqüência de aparecimento e nível de evidência, foram: sexo feminino, não fumante, história prévia de náuseas e vômitos no pós-operatório, história de náusea associada ao movimento, idade, tipo de cirurgia, uso de opióides no trans e pós-operatório, uso de anestésicos voláteis e administração de óxido nitroso. Em relação às características definidoras evidenciamos nos estudos analisados: palidez, taquicardia, aumento na salivação, transpiração, sensação de calor e frio, rubor, consciência do impulso do vômito, tonturas, bradicardia, dilatação pupilar, variações na pressão arterial, respiração profunda, rápida e irregular. A importância de aperfeiçoar e legitimar os elementos que fazem parte da Taxonomia II da NANDA (2006) está em possibilitar aos profissionais enfermeiros que atuam em centro cirúrgico e recuperação pós-anestésica o planejamento da assistência de enfermagem ao paciente nos três períodos da experiência cirúrgica, visando à minimização das complicações no pósoperatório e promover uma reabilitação mais rápida e tranqüila. / Nausea is one of the most common adverse events in the pots-anesthesia recovery room. It is usually associated to anesthesia. Besides the subjective aspect it can be very distressing for patients. The patients who are suffering from nausea and do show any improvement at all may have a late discharge from both the post-anesthesia recovery room and the hospital. The delayed return to normal functions, the high hospital costs, and the lower degree of the patient\'s satisfaction are some of the consequences. The aim of the present study was to perform a critical analysis of the available evidences in the literature about the related factors and the defining characteristics of nursing diagnosis nausea over the immediate postoperative period by means of an integrative review. During the development of this study systematic reviews and four databases for data collection were used: Lilacs, Pubmed, Cinahl, and Cochrane. From the screened reports, 31 of those were potentially relevant for the purpose of this study. The analysis of the retrieved studies showed that vomiting and nausea in the postoperative period are considered to be closely related and most of the time no distinction can be made between nausea and vomiting. The identified factors related according to the rate of appearance and evidence level were the following: female gender, non-smoking, prior history of vomiting and nausea in the postoperative period, history of nausea associated to motion, age, type of surgery, opioid use in a trans- and a postoperative period, use of volatile anesthetics, and nitrous oxide administration. In relation to the defining characteristics we highlighted the following: pallor, tachycardia, an increased secretion of saliva (sialorrhea, salivation), and perspiration, sensation of cold and heat, blush, awareness of the vomiting impulse, dizziness, bradycardia, pupillary dilation, arterial blood pressure changes, deep, fast, and irregular breathing. The importance to improve and to validate the NANDA\'s Taxonomy II (2006) elements is to enable the registered nurses, who work at surgery centers and anesthesia recovery rooms, to plan the nursing care for the patient in the 3-period of surgical experience aiming at to minimizing the complications in the postoperative period and to stimulate a fast and an undisturbed rehabilitation.

No description available.

Aim: The aim of the study was to evaluate the differences in postoperative pain, nausea and time of discharge in children 3-12 years old after undergoing Tonsillectomy (TE) or Tonsillotomy (TT) at the post anaesthetic care unit (PACU), children’s ward and at home.  Background: TE involves risk of bleeding, severe postoperative pain and nausea. TT is a less invasive method with lower risk of bleeding and postoperative pain and nausea according to performed studies. Method: A prospective, comparative follow-up study design. Eighty-seven children from December 2008 until April 2009 in the ages 3-12 undergoing TE or TT participated. Visual analogue scale (VAS) was used for children’s pain and nausea assessments. Result/Findings: Significantly fewer children operated on by the TT assessed postoperative pain ≥ 3 according to the VAS than children operated on by the TE in both the PACU and the children’s ward. A significant difference of postoperative nausea was only present during the care at the PACU and children’s ward with fewer TT children that assessed nausea VAS ≥ 3. The time of postoperative care was shorter among the TT children in both the PACU and the children’s ward. Postoperative pain and pain related difficulties in eating after discharge was significantly more present among the TE children compared to the TT children. Conclusion: The results of our study indicated that TT is a more favourable alternative than TE in children.

Syfte: Syftet med denna studie var att jämföra graden av smärta och illamående hos två patientgrupper inom ortopedi som smärtlindrades med tablett Dolcontin/Depolan/Morfin eller tablett Oxycontin/Oxynorm postoperativt dag 0, 1 och 2. Syftet var även att undersöka vilka riskfaktorer enligt Apfel Risk Score som kan påverka grad av illamående samt att undersöka om en korrelation fanns mellan preoperativ information och incidensen av postoperativt illamående och kräkning (PONV). Metod: En komparativ studie med kvantitativ ansats. Data samlades in genom två olika enkäter, varav en enkät fylldes i av patienterna och en enkät av sjuksköterskorna. 48 patienter inkluderades i studien, 24 per substans. Både kvinnor och män som genomgått elektiva knä- eller höftarteroplastikoperationer deltog i studien och de var mellan 31-77 år. Mätinstrumentet som sjuksköterskorna använde sig av för att skatta smärta och illamående var visuell analog skala (VAS). Data analyserades i Statistic Package for the Social Science (SPSS) 10.1 med x2-test, oberoende t-test samt Mann-Whitney U-test. Resultat: Resultatet i studien visade att inte fanns någon signifikant skillnad gällande smärta och de två substanserna. Det fanns en signifikant skillnad gällande illamående och de två substanserna. Inget signifikant samband påvisades mellan illamående och riskfaktorerna i Apfel Risk Score. Det fanns heller inget signifikant samband mellan incidensen av PONV och patientens upplevelse av att ha fått noggrann information preoperativt. Slutsats: Då dokumentationen av smärta och illamående enligt VAS på sjuksköterskeenkäterna var bristfällig, kan inga säkra slutsatser dras. Mer forsknings krävs således inom detta område. / Aim: The aim of this study was to compare the rating of pain and nausea in two groups of patients in orthopedics that was pain relieved with tablet Dolcontin/Depolan/Morphine or tablet Oxycontin/Oxynorm postoperative day 0, 1 and 2. The aim was also to investigate the risk factors according to Apfel Risk Score that may affect the degree of nausea and to investigate whether a correlation existed between preoperative information and the incidence of postoperative nausea and vomiting (PONV). Method: A comparative study with quantitative approach. Data were collected through two different questionnaires, one that was filled out by the patients and the other questionnaire by the nurses. The study included 48 patients, 24 per substance. Both men and women, between 31-77 years old, who would undergo elective knee or hip replacement surgery, participated in the study. The measuring instrument that the nurses used to estimate the pain and nausea were visual analogue scale (VAS). Data were analyzed in the Statistic Package for the Social Science (SPSS) 10.1 with the x2-test, independent t-test and Mann-Whitney U-test. Results: The results of the study showed that there was no significant difference regarding pain and the two compounds. There was a significant difference regarding nausea and the two compounds. No significant correlation was found between nausea and the risk factors in the Apfel Risk Score. There was no significant correlation between the incidence of PONV and patient experience of receiving accurate information preoperatively. Conclusion: As the documentation of pain and nausea according to VAS on the nursing surveys were poor, no firm conclusions can be drawn. Further studies are necessary to confirm the results of this study.

In der prospektiven Untersuchung bekommen 50 Patienten ein intraoperativ inseriertes ON-Q® PainBuster® Kathetersystem. Patienten der Verumgruppe erhalten über 72 Stunden postoperativ Ropivacain 0,375 % über das lokale Wundkathetersystem mit einer Flussrate von 5 ml/h, Patienten der Placebogruppe zum Vergleich Natriumchloridlösung 0,9 %. Als Basisanalgesie werden alle Patienten mittels eines oralen Nicht-opioid Analgetikum und intravenösem Piritramid therapiert. Im postoperativen Verlauf von 5 Tagen werden die visuell analoge Schmerzskala bei unterschiedlichen Aktivitäten und der Bedarf von intravenös applizierten Piritramid über die PCA-Pumpe als Ergebnisse evaluiert. Diese Ergebnisse werden mit den aktuellen Analagesieverfahren im Rahmen der Thorax- und Kardiochirurgie verglichen und diskutiert. Mögliche Alternativen werden abschließend aufgezeigt.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Uppsala : Univ., 2004. / Härtill 4 uppsatser.

Diss. (sammanfattning) Linköping : Univ., 2003. / Härtill 5 uppsatser.