A priority goal of the nursing pain assessment is to:

Choice A: Anesthetic agents and other drugs that were administered

This is a correct answer. Including information about the anesthetic agents and other drugs administered during surgery is crucial for the PACU nurse. This information helps in monitoring the patient’s recovery from anesthesia and managing any potential side effects or complications. Knowing the specific drugs used allows the PACU nurse to anticipate and address issues such as pain management, nausea, and allergic reactions.

Choice B: The patient’s relevant health history

This is another correct answer. The patient’s relevant health history provides essential context for the PACU nurse. It includes information about chronic conditions, allergies, previous surgeries, and any other factors that might affect the patient’s recovery. Understanding the patient’s health history helps the PACU nurse to tailor post-operative care to the patient’s specific needs and to be vigilant for any complications that might arise due to pre-existing conditions.

Choice C: The name of the surgical procedure

This is also a correct answer. Knowing the specific surgical procedure performed is vital for the PACU nurse. It helps in understanding the expected post-operative course, potential complications, and specific care requirements. For example, the care for a patient who underwent a cardiac surgery will differ significantly from the care for a patient who had an orthopedic procedure.

Choice D: Estimated blood loss during surgery

This is the final correct answer. Reporting the estimated blood loss during surgery is important for the PACU nurse to assess the patient’s hemodynamic status and to plan for any necessary interventions. Significant blood loss may require monitoring for signs of hypovolemia, administering fluids or blood products, and closely watching vital signs.

Choice A: Agency policy

While agency policy provides guidelines for reassessment intervals, it is not the primary factor in determining the specific time frame for reassessing a patient’s pain level. Policies serve as a general framework, but individual patient needs and clinical judgment should guide the reassessment timing.

Choice B: Type of intervention

This is a correct answer. The type of pain management intervention used significantly influences the reassessment time frame. For example, after administering intravenous pain medication, reassessment should occur sooner compared to oral medications due to the faster onset of action. Different interventions have varying durations of effectiveness, necessitating tailored reassessment intervals.

Choice C: Pain severity

This is another correct answer. The severity of the patient’s pain is a crucial factor in determining reassessment timing. Patients experiencing severe pain may require more frequent reassessments to ensure that pain management strategies are effective and to make timely adjustments if needed.

Choice D: If family members are present in the patient’s room

The presence of family members in the patient’s room is not a primary factor in determining the reassessment time frame. While family members can provide valuable support and information, the focus should remain on the patient’s clinical needs and the effectiveness of pain management interventions.

Choice E: The patient’s psychosocial condition

This is a correct answer. The patient’s psychosocial condition, including their emotional and mental state, can impact their perception of pain and response to pain management. Patients with anxiety, depression, or other psychosocial issues may require more frequent reassessments to address both physical and emotional aspects of pain.

Choice F: Risks for adverse effects

This is also a correct answer. The potential for adverse effects from pain management interventions necessitates careful monitoring and timely reassessment. For instance, opioids carry risks of respiratory depression and sedation, requiring close observation and frequent reassessment to ensure patient safety.

Choice G: Workload of the nurse

While the nurse’s workload can influence the practical aspects of care delivery, it should not dictate the reassessment time frame. Patient needs and clinical priorities should guide reassessment intervals, with workload management being a secondary consideration.

Choice H: The patient’s physical condition

This is the final correct answer. The patient’s overall physical condition, including comorbidities and current health status, affects their response to pain management and the need for reassessment. Patients with complex medical conditions may require more frequent monitoring to ensure effective pain control and to promptly address any complications.