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The Fifth Vital

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Within this video was Mike Majlak. Mike always seemed to come across as the wise one, the guy with his head screwed on. The older guy in the group who has the experience and the know-how to guide this crazy train of fame whilst maintaining a level-head. The questionnaires were filled by the head nurse (63.0%), by the nurse supervisor (13.0%), by the supervisor anaesthesiologist (8.3%), by the head nurse advisor or nurse coordinator (6.5%), by the clinical director (4.6%), by the general nurse (2.8%) and by the chairman of the hospital board (1.9%). Pain is complex and by trying to box it into a vital sign may unwittingly diminish the importance of a comprehensive pain assessment. While the 5th vital sign helps to recognize a patient is in pain this information is not complete. What is necessary is that clinicians possess the foundational knowledge critical for untangling the contributors to pain and the knowledge of management options based on these contributors.

At NICHD’s 2018 “Menstruation: Science and Society” meeting, investigators were challenged to include menstrual status intheir research projects and to consider menstruation as a model for understanding other health issues, such as tissue loss and regeneration. Themes from this meeting, highlighted in a paper and accompanying editorial in the American Journal of Obstetrics and Gynecology, continue to resonate. Not only do health care professionals need continued education about pain management, but the public needs education as well. Nurses can help patients and their families achieve and maintain successful pain management through education. In this hospital, is there a regular evaluation of the quality of the pain records in the hospital charts? A person who is drug tolerant, however, does not experience withdrawal, even when the drug is stopped suddenly. Nurses who have little personal experience with pain may not appreciate the scope of painful conditions associated with diseases and medical or surgical interventions. They may expect patients with chronic pain to react similarly to those with acute pain. Nurses may assume that reactions to pain fall within a certain norm based on their own cultural values. The more that a patient’s response varies from these expected norms, the more likely that a nurse’s attitude toward the patient will be positively or negatively biased.Subsequently, I use a multistep process depending on the specifics of the microscope used to examine the smear: The main goal for the implementation of P5VS is to assess and manage undertreated pain, consequently reducing the patient’s suffering and its associated healthcare costs. Adequate pain assessment and control may also help to reduce surgical readmissions and emergency department visits after hospital discharge [ 5, 8, 9, 15]. However, some of the results in the literature are contradictory. A study found that routinely measuring pain intensity may not increase the quality of pain management [ 16]. However, this study was performed in a single clinic, and the pain was managed based only on its intensity scores. On the contrary, several studies demonstrated that after the proper implementation of P5VS, the number of patients reporting moderate to severe pain significantly decreased [ 8, 17– 19]. Nevertheless, introducing P5VS may not be enough if some principles of practice are not implemented, carried out and audited to effectively improve the patient’s health. A starting point would be to make pain assessment visible in hospital charts and to promote staff education on adequate pain assessment and prompt management, mainly during the postoperative period [ 2, 6– 9, 20]. The present investigation showed that almost all NHS hospitals provided the staff with pain education and written information, hopefully contributing to pain management improvement, as reported in internal audits. As a teenager Mike got caught up in the opioid epidemic that swept America. For nearly 10 years he struggled with drug addiction and many other issues. He eventually had no one left to believe in him except his mom. While all his friends were starting lives of their own, getting married, having kids, exceeding in life, Mike was basically at the lowest point he could go, living on the streets, with little to no money at the end of a very dark tunnel with a small light at the end of it. The story is very exciting and is told with many remarkable stories that leave you wondering after how he made it out of all these situations alive. Hernandez-Boussard T, Graham LA, Desai K, Wahl TS, Aucoin E, Richman JS, et al. The Fifth Vital Sign: Postoperative Pain Predicts 30-day Readmissions and Subsequent Emergency Department Visits. Ann Surg. 2017; 266( 3):516–24. doi: 10.1097/SLA.0000000000002372

The attitudes of health care professionals toward pain influence the way they perceive and interact with patients in pain. Without adequate assessment skills or knowledge of pain and analgesic therapy, they may not be able to understand their patients’ pain. Since pain is now routinely measured due to efforts of the VHA and JCAHO, the NRS is also asked of patients who are seeing physicians that have little to do with pain management on a day to day basis. So what is the role of pain assessment in these settings? There is not a simple answer, but it should be considered that assessing pain at every patient encounter may not be reasonable. Careful thought needs to go into the purpose of the pain assessment and what will be done with the pain assessment once the clinician receives it. This brings us full circle to the importance of provider education and management of pain. Tompkins DA, Hobelmann JG, Compton P. Providing chronic pain management in the "Fifth Vital Sign" Era: Historical and treatment perspectives on a modern-day medical dilemma. Drug Alcohol Depend. 2017; 173 Suppl 1:S11–S21. doi: 10.1016/j.drugalcdep.2016.12.002 It’s well worth a read. Knowing that no matter your upbringing or your situation you and you alone can change that. Your mentality and perseverance is put to the test to see you grow as a person and to further your ambitions. In response to mandates by The Joint Commission and other organizations, many hospitals and other health care agencies in the United States have interdisciplinary pain teams, also known as analgesia teams, who consult with staff and prescribers on how best to control the patient’s pain. The team typically consists of one or more nurses, pharmacists, case managers, and physicians. In larger facilities, pain teams may specialize by type of pain (e.g., cancer pain team). Although a large part of the team’s plan may center on drug therapy, this group also recommends nonpharmacologic measures as appropriate.Unable to escape the noose of addiction, he eventually lost the trust and support of everyone who had ever loved him.

The severity of postoperative pain may be a predictor of long-term pain. The use of preemptive analgesia is a technique designed to decrease pain in the postoperative period, decrease the requirements for a postoperative analgesic, prevent morbidity, and decrease hospital stay. Preemptive analgesia includes administering local anesthetics, opioids, and other drugs in the preoperative, intraoperative, and/or postoperative period. This intervention may inhibit changes in the spinal cord—changes that can lead to a central sensitization that results in chronic pain.Ahluwalia SC, Giannitrapani KF, Dobscha SK, Cromer R, Lorenz KA. "It Encourages Them to Complain": A Qualitative Study of the Unintended Consequences of Assessing Patient-Reported Pain. J Pain. 2018. doi: 10.1016/j.jpain.2017.12.270

Zhang H, Li N, Li Z, Li Y, Yu Y, Zhang L. Zhang H, et al. Front Pharmacol. 2022 May 3;13:898574. doi: 10.3389/fphar.2022.898574. eCollection 2022. Front Pharmacol. 2022. PMID: 35592413 Free PMC article. Review.Lellan KM. A chart audit reviewing the prescription and administration trends of analgesia and the documentation of pain, after surgery. J Adv Nurs. 1997; 26( 2):345–50. doi: 10.1046/j.1365-2648.1997.1997026345.x Develop a teaching plan for patients to include complementary and alternative therapies for pain management.

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