GERIA - WEEK 6 (MIDTERMS)

Pain

Common negative sensation experienced by all human beings during process of living

Acute pain

occurs from: Time limited illness, medical procedures, recent event such as trauma or surgery.

Chronic pain

continuous pain over a prolonged period of time. Affects 1 in 5 persons over 65. (Depression can exacerbate pain levels)

Assessment

- Baseline vital signs

- Ability to walk, stand, or move about in bed

- Appetite and eating patterns

- Sleep patterns

- Cognitive function and mood

Nonverbal signs of pain

- Grimacing

- Moaning

- Guarded movements

- Sad facial expression

- Verbal outbursts

Relaxed

Neutral, no muscle tension

Tensed

Forehead wrinkling, lowering of eyebrows, tightly closed eyelids, elevation of mouth corners

Grimace

Forehead wrinkling, lowering of eyebrows, strongly tightly closed eyelids, elevation of mouth corners

Measurement of pain

- Subjectively according to the patient's self-report

- Through careful observation

- Additional behaviors: Sad or frightened facial expressions, noisy breathing, tense body language, repeated nighttime awakening

Mild pain (1-3)

you feel some pain or discomfort but can COMPLETE most activities

Moderate and Severe pain (4-6)

The pain makes it difficult to concentrate and may interfere with the ability to do certain normal activities such as reading, watching TV, and having phone conversations

Very severe pain (7-9)

The pain is quite intense and is causing to avoid or limit physical activity. Cannot concentrate on anything except PAIN.

Worst pain possible (10)

worst pain imaginable

Pain management

- Relieve both acute and chronic pain

- Uses both pharmacological and non pharmacological techniques

- Minimize side effects

Opioid Analgesics

Older patients are generally more sensitive to opioid analgesics, start low go slow.

Adjuvant drugs

Relieve discomfort, potentiate the effect of the pain medication, decrease dosage of opioid required for adequate pain control, reduce side effects associated with higher doses of opioids.

Medications used as adjuvants

- Antidepressants

- Topical analgesics

- Anti-anxiety medications

Chronic pain

oral dosing is preferred route, most effective when it is administered around the clock, long-acting or sustained- release forms of medication improve control.

Acute pain

Breakthrough pain relief should be available, IV or IM is preferred route, patient control analgesia(PCA) is less effective in elderly and especially those who are cognitively impaired.

Non-pharmacological

- Pain education programs

- Socialization or recreational therapies (movies, art therapy, therapeutic use of music)

- Behavior modification (imagery, hypnosis, relaxation)

- Physical therapy (massage, ultra-sound, exercise, and hot or cold packs)

- Neuro stimulation (acupuncture, transcutaneous nerve stimulation)

Types of pain

- Neuropathic pain

- Nociceptive pain

Neuropathic pain

Brain , nerves are damaged , deep and severe , burning electrical tingling sensation , difficult to relieve

Neuropathic pain

Treatment : Anticonvulsants , Antidepressants, Opioids, Surgical intervention for uncontrolled pain

Nociceptive pain

Tissue inflammation or damaged tissue

Nociceptive pain

Treatment : Acetaminophen , NSAIDS , Opioids as last choice

Types of care

- Palliative care

- Hospice care

Palliative care

highly structured system for delivery of care , supportive care during the dying and bereavement process emphasizes

Palliative care

quality of life living a full life up until moment of death

Palliative care settings

Hospitals outpatient clinic long- term care facilities home

Hospice care

focus on the whole person :

- Mind Body Spirit

- Support and care :Patients Family and Caregivers

- Multidisciplinary team of professional caregivers

- Nurse -manages pain and control symptoms , assesses patient and family's ability to cope , identifies available resources for care of patient, recognizes patient's wishes assures support system are in place

Hospice care

last phase (6months) of incurable disease live as fully and comfortably as possible

Hospice care settings

Hospital; home health agencies with homecare hospice . Home; nursing home or other long-term care settings