Post-operative readmissions occasioned by abdominal pain are a common occurrence for acute cholecystitis patients who have undergone surgery. While these trends have continuously been eminent if healthcare, research studies have not addressed the primary concerns as to how to eliminate or reduce these cases to acceptable levels (White, 2005). Pain management in post-operative care forms the backbone of effective outcomes. Thus, a situation that leads to continued pain during this period is a matter of concern not just to the patient but also to the physician. Apart from leading to further complications, such cases of readmission have associated costs and that place a significant burden to the patient. On the other hand, the emotional turmoil the patient undergoes from a recurring pain or illness after surgery could potentially harm their all-round well-being (Bennet, Squire and Brookoff, 2008).
Among Hispanic females above the age of 2o years, acute cholecystitis is significantly predominant. In particular, gender and lifestyle are regarded as influencing factors in the prevalence of acute cholecystitis. Similarly, cases of readmission resulting from this illness tend to grow within this risk group. Ethnic influences that are more or less related to social or economic settings offer another perspective of viewing this illness.
While several suggestions have been provided as effective post-operative care practices for these patients, research is yet to indicate the outcome efficacy and thus, only relying on assumptions. According to White (2005), these assumptions tend to avoid unearthing the primary issues that influence acute cholecystitis in an individual. For instance, pregnant mothers have a higher chance of contracting acute cholecystitis due to physiologic changes within the body. Similarly, post-operative care for such mothers cannot be handled in a similar manner as would be of an elderly patient. The realization of individual-based care in offering post-operative care for patients with acute cholecystitis after surgery is critical to determining the best practice.
In the diagnosis of post-operative readmissions and pain management, there is a general assumption that acute cholecystitis patients who have undergone surgery are more likely to present related complications related to the primary illness. This is, usually, not the case. The diversity of patient characteristics (gender, age, lifestyle and physiologic) may prove that the complication in post-op varies significantly with that presented at pre-operative stage (Bennet, Squire and Brookoff, 2008).
As such, the choice of a post-operative therapy or procedure should be influenced by a repeated examination of the patient and their history. Fever and pain are the moist reported cases during this stage and should not be presumed or diagnosed as a referred illness from the acute cholecystitis surgery. A detailed differential diagnosis should thus be taken by the clinician to eliminate the least possible influencing factors. From this point, then it becomes possible to determine among the higher likelihoods which post-operative strategy would suit the higher likelihood events. More than just medication, a holistic approach is critical to ensuring the well-being and fast recovery of the patient (White, 2005).
After a surgical procedure for Acute Cholecystitis either involving open cholecystectomy or laparoscopic abdominal, pain becomes one of the chief post-op complications that occur (Kum, Goh, Isaac, Tekant and Ngoi, 1994). As a way to relieve this pain, patients are put under a narcotic/opioid-based method of relieving abdominal pain. However, the use of this approach has proved in ineffective in preventing post-op re-hospitalizations or re-occurrence of pain. Use of narcotics exacerbates the post-op conditions of the patient due to side effects, leading to even more severe complications. Although the narcotics are effective in relieving abdominal pains, the side-effects that accompany the use of narcotics beat the logic of administering or prescribing narcotics.
Therefore, an educational and interventional gap exist in terms of adequately preventing re-occurrence of pain or re-admission and fostering quick healing and resumption to normal life. Among the severe effects of narcotics as a method of pain management include; sleepiness, low breathing rate, constipation, nausea, skin rash and difficulty during urination. Apparently, these side effects make the patient uncomfortable and may compromise the healing process. Along the same line, use of narcotics is only limited to physical complications such as pain that occur after surgery and ignore other non-physical complications such as emotional disturbances (Bennett, Squire and Brookoff, 2008). Health encompasses not only physical well-being but also mental well-being. Physical recuperation majorly relies on the mental status of the patient and agreeably, this is a gap that lies in the narcotics as a pain management strategy fails to address. The nurse has a role to use patient's resources economically to enhance improved patient outcomes, as well as financial outcomes. As a minority group, the Hispanic majorly consist the low to middle-income class and as such financial burdens associated with re-hospitalizations should be avoided at whatever cost.
As a solution to this gap, there is the need to adopt a holistic approach that apart from reducing abdominal also addresses the mental well-being of the patient. A non-medicine pain management strategy proves to be an effective approach in not only reducing pain but also fostering mental stability among patients with Acute Cholecystitis, who have undergone a surgical process (White, 2005). This intervention takes in behavioral-based methods of alleviating pain such as the use of distracters. For instance, instead of using narcotics to alleviate pain, the patient may use distracters such as listening to music to divert his/her attention away from the pain. On the other hand, guided imagery may come in handy in terms of reducing post-op emotions of self-sympathy and despair that affect the patient mental state. Guided imagery may involve a deep exhalation and inhalation accompanied by images comforting images such as viewing one’s self in a beautiful place (White, 2005). This technique helps in countering unpleasant emotions and feelings. Other non-medicine techniques may involve exerting pressure on the abdomen, say, using a pillow when coughing to prevent abdominal pain that accompanies coughing for post-op patients.
Bennett, D. S., Squire, P., & Brookoff, D. (2008). Opioids and the Treatment of Chronic Pain. Pain and Chemical Dependency, 367.
Kum, C. K., Goh, P. M. Y., Isaac, J. R., Tekant, Y., & Ngoi, S. S. (1994). Laparoscopic cholecystectomy for acute cholecystitis. British journal of surgery, 81(11), 1651-1654.
White, P. F. (2005). The changing role of non-opioid analgesic techniques in the management of postoperative pain. Anesthesia & Analgesia, 101(5S), S5-S22.