ألم ما بعد الجراحة ورفض المسكّن

Nurse: Good morning Mr Brooks, I'm your nurse today. How are you feeling this morning?

Patient: Morning. Not great, to be honest. I'm very sore and I don't feel like moving much.

Nurse: I'd like to understand your pain. Could you tell me what it's like, especially when you sit up?

Patient: It's pretty bad when I sit up. It makes me want to stay completely still.

Nurse: Where exactly is the pain, and how bad is it right now out of ten?

Patient: It's around my tummy, where the operation was. When I sit up, it's about seven out of ten.

Nurse: Does it stop you taking deep breaths, coughing or moving around?

Patient: Yes, I'm taking small breaths because deep ones hurt. Coughing sounds awful, and I don't want to move much either.

Nurse: I noticed you haven't wanted the oxycodone. Can you help me understand why?

Patient: I just didn't want it. I've felt uneasy about it, so I said no each time.

Nurse: What worries you most about taking stronger pain medicine?

Patient: I'm worried it's too strong, and that I might get hooked on it. That's what's been on my mind.

Nurse: Many people worry about strong pain medicines, so I'm glad you told me. I won't push you; I'd like to hear your concerns and answer them.

Patient: Thanks, I appreciate that. I don't want to become dependent on it. That's what really bothers me.

Nurse: Let's go through what worries you, and I can check with the team about anything I can't answer. You'll stay in control of what you take.

Patient: Okay, that's a relief. I'd like to know more, and it helps that I'd stay in charge of what I take.

Nurse: Good pain control lets you breathe deeply, cough and walk. That helps prevent chest infections and blood clots after surgery. When pain stops you moving or breathing deeply, those risks go up. Does that make sense?

Patient: I hadn't thought of it that way. So the pain is stopping me from helping myself get better. Yes, that makes sense.

Nurse: Your plan includes regular paracetamol, oxycodone when you need it, and regular laxatives. Taking pain relief before physiotherapy helps it work while you walk. Shall we plan the timing so you're ready?

Patient: Okay. Taking it before the physio makes sense. Yes, let's work out the timing so I'm not caught out.

Nurse: So you'll take your regular paracetamol, and we'll discuss oxycodone before the physiotherapist comes so it has time to work. Please tell me if pain stays high or the plan isn't working.

Patient: Alright, I'll take the paracetamol, and we'll talk about the oxycodone before the physio comes. I'll tell you if the pain stays bad.

Nurse: Can you tell me in your own words what we've agreed? Is there anything else you'd like to ask before the physio arrives?

Patient: So I take the paracetamol regularly, we talk about oxycodone before the physio comes, and I tell you if it's not working. No more questions, thanks.