pain 2

cognitive strategies

• CBT reframes negative thoughts and behaviors

• Distraction — TV, virtual reality during procedures

• Relaxation, imagery, and music therapy

• No prescription needed — nurses can advocate

therapeutic touch

• Hands on or near the body to balance energy

• Studied in cancer and fibromyalgia pain

• May improve mood, nausea, anxiety, fatigue

• Evidence not yet sufficient as standard of care

opioids

PCA

• Basal rate plus a client-triggered bolus — common postoperatively

• Nurse obtains equipment and medication and sets up the pump

• Stand-alone or attached to an IV pump; can be used epidurally

• Educate client and family on safe use

epidural route

• Opioids (morphine, hydromorphone, fentanyl) or local anesthetics (lidocaine, bupivacaine)

• Nurse assists: consent, IV access, positioning, support

• After placement: monitor the site for infection, keep the dressing dry and intact

• Monitor vital signs and response

RN responsibilities

• In many facilities only the RN assesses vital signs, pain, sedation, and respiratory status

• Only RNs program and start the pump and verify settings

• Always verify agency policy

safety

• Most facilities require naloxone kept in the client’s room

• IV naloxone rapidly reverses opioid effects

• Effective respiratory monitoring, including capnography, reduces the need for it

nonopiods

adjuvalent and cannabis

acute

Chronic disease is managed, not cured — evaluate response continuously and escalate to the provider when relief falls short.

chronic

pain and opiod addiction

barriers

safety and monitoring

range orders

client education and evaluation