I'm currently on a cardio placement on a surgical ward and have been treating a 31yo lady who had a history of non healing gastric and duodenal ulcers. Her condition worsened and she presented to her GP with haematemesis and upper quadrant pain. Nine days later she admitted to surgery for a distal gastrectomy and resection, followed the next day by an exploratory laproscopic evacuation of haematoma. This patient was handed over to me as someone who was extremely difficult to mobilise, due to a very low pain threshold.
On our first treatment she was 7 days post op and had only been mobilising 2-3 metres with an IV pole. When we arrived she was RIB, clearly bracing and just keeping as still as possible. It appeared that she had been lying in the position she had been left in for the last couple of hours. It took heaps of encouragement to finally get her up and walking, the whole process being filled with many tears and complaints of pain. The patient showed this kind of behaviour through all of the sessions and after discussing her condition with her, she revealed that she didnt feel that the surgery was at all necessary and she wished she hadnt had it. This appeared to be the reason why she wasnt coping well with the pain, because she felt she had made a poor decision in having the surgery at all. While I empathised with her, by the third day she was mobilising independantly. What I found from this situation is that, it is very difficult to understand pain from a patients point of view, it is so subjective and depends on so many different factors. This patient would probably have stayed in bed for months if we let her, but once she was moving her recover was very fast. The important thing was that we did mobilise her and use as much encouragement as we could to achieve a common goal
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2 comments:
Hey cass.
Great post.
Yeah i've noticed about different levels of pain. It is so hard to comprehend how much pain someone is in. It's even harder when our job is usually to get them up andw alking, which increases their pain. And i think you're right in setting goals with the patient.
I've had similar situations, where i've said to the patient that look at the long term goal, that you'll be going home sooner. That's always a motivator
Heya Cassy! Pain! its something so hard to make sense off because ppl are just so different and have such varying perceptions of it. I guess we have to keep in mind their limits as to how far to push them... and i agree... setting goals with pts based on their aims will definately motivate and be of some form of target to get them towards!
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