Pain Management

Pain is a _______

Undertreatment of pain can lead to→

How to know if pain improving?

What do we need to report?

Direct Measurement (whatever the pt says)

depression (chronic) and anxiety (acute)

chart pain rating before med/therapy and 30 min after

Side effects, extreme drowsiness, management of pain

Pain Assessment Tools: PQRST

1. Provokes: causes? aleviates? treatments?

2. Quality: how does it feel? Effect on function? Accompanying symptoms?

3. Radiates: Where is it and does it radiate?

4. Severity: on a scale of 0-10

5. swhen did it start? constant? last? often?

Pain Assessment Tools

1. FACES Scale

2. Visual Analog Scale

3. PAINAD Scale; what do we look for?

4. Behavior Pain Rating scale; what do we look for?

1. characters of faces; small children

2. scale on a picture; older

3. alhezmiers; Breathing, no talking, expression, body language, consolability

4. cant voice/point; no talking, expression, upper limb movement, guarding, restlessness, complaiance with vent

1. Nursing Interventions for Pain Management: Key questions

1. Major surgery? Vital signs? Pain rating? Orders for pain meds?

Pharmacologic Pain Options

1. Non-opioids

2. Opioids

3. Adjuvent (work with pain meds; NOT pain meds)

1. NSAIDs (ibuprofen), Salicylates (asprin), Acetaminphen (tylenol), Pregabalin

2. Morphine, Fentanyl, Oxycodone, Hydromorphone, Codeine

3. Steroids (inflammation), Antiemetics, Anxiolytics, Anticonvulsants (spasms), Antihistamine

Strategies for Effective Pain Management

1. Proactive approach:

2. instruct patient to report….

3. Common schedules; Ketorolac, IV tylenol

1. give analgesics before pain becomes too severe (6 out of 10)

2. report developing or recurrent pain and not wait until pain is severe for PRN meds

3. 6-8 hours… 4-6 hours

Pharmacologic Pain Options: PCA pump

1. Whats in it?

2. Loading Dose:

3. Demand dose:

4. Lockout interval:

5. If patient presses button during lockout interval→

1. IV Opioid; Patient controlled analgesia pump

2. inital dose

3. dose given when patient presses the button

4. time between doses to prevent overdose

5. no dose is given

PCA Pump Documentation

1. Assessment:

2. Is its important we chart their response and how their pain is being managed. Why?

3. Education:

4. Safety checks;

1. Monitor pain, sedation, RR, VS

2. Because these are strong opioids ( depressed)

3. teach how to use button and emphasize ONLY patient can press button

4. Pump settings correct, another nurse help sign off, change vial, discontinue pump

Opioid

1. Frequent Complications:

2. High risk:

3. Sedation levels:

1. Sedation, depression, retention, constipation, Falls (orthostatic hypotension)

2. Older, Obesity, naive, smoker, pulmonary/cardiac conditions, post surgical (abd)

3. Alert and awake → slightly drowsy but easily aroused → drowsy, arousable, drifts off to sleep during convo → no response to stimulation/sternal rub

Hot & Cold Therapy

Cold therapy:

1. BV effect:

2. Used in the first 24-48 hours for….

3. Cold compress….

4. No longer than …..

Heat therapy:

5. BV effect:

6. Helps reduce…

7. Great for»>

8. No longer than…

reduces inflammation/swelling/numbs

1. vasoconstriction (lower fluid/bleeding)

2. sprains, bruises, post-surgery, strains

3. needs to be wrapped in a towel

4. 30 min

relaxes muscles and joints

1. vasodilation (reduce stiffness)

2. muscle spasms and chronic pain

3. arthritis, tension, tight muscles, circulation

4. 30 min

Hot and cold therapy considerations

1. Do NOT use heat if→

2. Do NOT use cold on →

3. Assess→

1. swelling, open wounds, redness, or burns

2. poor circulation

3. sensation/skin before and after (pulse, warmth, numb)