pain management ii
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TRANSCRIPT
Pain Management
What is pain?
One of the most common reasons people seek healthcare
One of the most widely under-treated health problems
Pathophysiology A sensation caused by some type of
noxious stimulation A pattern of responses that function to
protect the individual from harm Whatever the experiencing person says
it is whenever he says it does
Components of PainPhysical
Caused by some kind of noxious stimulant
EmotionalResults of combination of thoughts, feelings, and beliefs
BehavioralPattern of responses that function to protect the individual from further harm
Causes of PainCutaneous
Direct stimulation to skin (cut)
Somatic
From musculo-skeletal system (sprained muscle)
Visceral
Arising from hollow organs (appendicitis)
Neuropathic
Damage to nervous system
Referred
Pain arising from someplace else in body
Descriptions of pain
• Chronic: occurring over a long period of time
• Acute: sudden, brief onset
Visual Analog ScaleThis is a line 10 cm. long (about 4 inches) that
is divided into ten divisions. Patients are asked to show the amount of pain on a 1-10 scale.
Researchers say that patients cannot function with a scale with more than ten points.
PQRSTThis mnemonic is devised to show the
steps in pain assessment: Provoking factors Quality Region/Radiation Severity/Symptoms Timing
• Provoking factors include what caused the pain and what might be making it worse
• Quality questions refer to how the pain feels…let the patient tell but offer suggestions if necessary, like sharp, dull, throbbing, burning, etc.
• Region….have patient point to area that hurts
• Severity can be measured with the pain rating scales
• Symptoms may accompany the pain….nausea, vomiting, etc
• Timing refers to when the pain started, how long it lasts
Be aware
• Just because a patient cannot respond to pain doesn’t mean there is no pain
• Activities of daily living (ADLs) may be effected
• Neurological status will alter the response to pain
Pain Management
Management must be timely, individualized,and bring the pain to an acceptable level of tolerance
Pharmacologic interventions
Must be individualized
• Three main categories:– Non-opioids– Opioids– Adjuvants
Non-opioids: Acetominophen (Tylenol) Aspirin NSAIDs (Advil)
Opioids Weak Strong
Codeine Hydromorhone Oxycodone Morphine Vicodin Merperidine
Adjuvants Primary function is not pain relief but provide relief
May modify mood so patient feels better
Precautions to giving pain medications
• Medication choice may depend on practitioner’s preference, however:– Should not give two analgesics
from same class at same time– Must be aware of effects of
medications– Must watch for allergic reactions
Routes of medication administration
• Oral• Injection• Intravenous (includes PCA)• Epidural• Rectal• Topical
SEVERE PAIN: Keep giving mild pain medication and add a strong opioid such as morphine or Fentanyl
MODERATE PAIN:Keep giving mild pain medication and add a mild Opioid such as codeine
MILD PAIN:Aspirin, ibuprophenAcetominophen, naprosyn
WHO Pain Ladder
Concepts of WHO Pain Ladder
• By the mouth
• By the clock
• By the ladder
• For the individual
• With attention to detail
Placebos
Controversial use of an inactive substance to satisfy the demand for medication
Non-pharmacologic interventionsPain control without using medications• Alter the environment• Relaxation and guided imagery
– Meditation• Cutaneous stimulation
– Massage, acupressure, acupuncture, TENS
• Biofeedback• Therapeutic touch• Education
JCAHO Standards for Pain Management
• Address care at the end of life
• Assess and manage pain appropriately
• Assess pain in all patients
• Support safe medication ordering and administration
• Monitor patient during post-procedure period
• Rehabilitate for optimal level of function
• Educate about pain an managing pain• Plan for discharge continued care if
needed• Collect data to monitor performance
Nurses spend more time with patients than any other provider. They must stay informed in order to give the best care to their patients.
• References:– Falk. Kim Marie. Pain Management. National
Center of Continuing Education. Catalog 98 TX.
– http://www.fxbcenter.org/caring/painladder.html
– http://www.harcourthealth.com/Mosby/Wong/fyi_03.html