Biomedical subjects

K A Puntillo

Publications and source records attributed to K A Puntillo.

5 recordsLinked to original sources

PubMed1995

Pain, pain relief and accuracy of their recall after cardiac surgery.

This study investigated how much pain and pain relief cardiac surgery patients experience in Intensive Care Units (ICUs), and the accuracy of their recall later, during hospital recovery. Thirty-nine patients completed the first interview in the ICU, and 31 of them answered recall questions later. The worst pain patients experienced in the ICU was moderately high, and patients reported 65% pain relief from analgesics administered. In general, patients' later recalled ICU pain was less severe and recalled pain relief from pain medications was greater than what they had reported when in the ICU. A substantial number of patients were unable to rate the effects of analgesics because they did not remember being mediated. One gender difference was noted: women recollected having a higher "worst pain" in ICU than men. Although recall of ICU pain is less than accurate, ICU cardiac surgical patients have episodes of substantial pain. Despite advances in pain management, patients report that pain relief is frequently incomplete and that they do not remember receiving analgesics. A more proactive approach to pain management by health care professionals, which includes informing patients when they are receiving analgesics, may help to improve pain relief in cardiac surgical patients.

Adult↗

PubMed1994

Dimensions of procedural pain and its analgesic management in critically ill surgical patients.

BACKGROUND AND PURPOSE: Many critically ill patients undergo endotracheal suctioning and chest tube removal procedures, yet little documentation of associated pain exists. Therefore, a study was conducted to (1) compare the magnitude and dimensions of pain associated with endotracheal suctioning and chest tube removal in intubated and nonintubated patients and (2) correlate preprocedural analgesic administration and pain magnitude. METHODS: Multiple dimensions of pain (ie, intensity, extent, sensation, and affect) were measured after postoperative cardiovascular surgery patients underwent endotracheal suctioning (N = 45) or chest tube removal (N = 35). Preprocedural analgesics and intubation status during pain assessments were noted. RESULTS: Patients reported lower pain intensity with endotracheal suctioning (mean, 4.9 on a 0-10 numerical rating scale) than with chest tube removal (mean, 6.6). Pain extent, sensation, and affect scores were relatively low for endotracheal suctioning and chest tube removal. Similar words such as "tender," "sharp," and "heavy" were used to describe both procedures; however, more patients described their response to chest tube removal as "fearful." Intubated patients had different pain experiences than extubated patients. Patients received little analgesic premedication, and correlations were low and nonsignificant between amount of medication received and pain magnitude. CONCLUSIONS: Patients were able to communicate extensive information about procedural pain, even when intubated. Endotracheal suctioning and chest tube removal were both painful; yet, there was little preparatory analgesic management of the pain. Research is needed to investigate a variety of pharmacological and nonpharmacological interventions for pain related to endotracheal suctioning and chest tube removal.

Adult↗

PubMed1990

Pain experiences of intensive care unit patients.

The purpose of this study was to describe various dimensions of the pain experiences of intensive care unit (ICU) patients. A purposive, primarily surgical sample of 24 ICU patients from two hospitals was interviewed after transfer from ICU. All but one patient remembered their ICU stay. Although this and six other patients had no recall of pain, 63% of the sample rated their pain as being moderate to severe in intensity. In a subgroup of nine patients having cardiac surgery, mean morphine sulfate administration during the first three postoperative days was 14 mg/day. This group of patients reported a lack of total pain relief from analgesics. Patients also described various sources of their pain, difficulties they had in communicating their pain, and nonpharmacologic methods that helped relieve their pain. Results of this study clearly indicate that not only pain but its communication and treatment were significant problems for a substantial portion of this ICU sample. Further descriptive and experimental research of pain characteristics and treatment practices for ICU patients is urgently needed. Improvements in nursing practice that result from such research may make a substantial difference in the comfort and well-being of critically ill patients.

Adult↗

PubMed1988

The phenomenon of pain and critical care nursing.

Pain is a multidimensional, complex experience. Critically ill patients are particularly vulnerable to pain. Patients in a critical care environment often have difficulty communicating their pain, and their pain may be aggravated by fear and anxiety. Indeed, their response to pain may compromise recovery. Although the significance of pain has been cited in literature, there is a dearth of research regarding pain in the critically ill. Such future research, as well as practice interventions, should be based on an understanding of pain psychophysiology. This article presents an in-depth review of pain mechanisms, including a discussion of pain modulation by the endogenous opioid system. Also reviewed are various pain theories contributing to our knowledge of pain. Finally, methods of pain measurement and treatment are outlined, and their appropriateness to critical care is evaluated. Although knowledge about pain mechanisms, measurement, and therapies has expanded, many issues remain unexplained. This article poses questions regarding pain in critically ill patients and presents specific areas for future nursing research.

Critical Care↗

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