Post on 12-Jul-2015
LET’S DISCUSS
Pain assessment
Pain management
Palliative care
PAIN IS…
Physiologic
Psychologic
Behavioral
Social
Cultural
Religious
A Multifaceted Experience
Pain in the Elderly
Ability to cope may change
LossesSignificant other, friends, pets
Finances
Transportation
Driving
Multiple chronic illnesses
Unwanted relocation
Elderly Pain Barriers
Myth that pain is normal aging
Underestimation by clinicians
Overestimation of addiction rate
Overestimation of depressed
respiration
Lack of clinician education
Elderly Pain Barriers
Hearing, visual deficits
Cognitive impairment, depression
Financial constraints, accessibility
Underused pharmaceutical agentsFears of addiction
What other’s might think
Adverse side effects
Acute Pain
Unpleasant sensory or emotion
Whatever they say it is
Acute Pain identified with:
An event
A beginning and end
“Looks sick”
May present with changes in vitals, symptoms
Chronic Pain
Often exhausting experience
Physically, functionally,
psychologically
Pain becomes focus of treatment
Underlying condition chronic,
rarely resolved
Somatic Pain
Identified with:
Direct stimulation, receptors, muscles, bones
Usually localized
Soft tissue, bone pain:
Sharp, throbbing, aching
Muscle pain:
Cramping, gripping, clenching
Visceral Pain
Identified with:
Direct stimulation of
intact receptors in
deep visceral organs
like heart and lungs
Difficult to localize
Deep aching, cramping,
pressure or colicky
Neuropathic Pain
Identified with: Disordered function, Direct
damage to nerves, Difficult to treat
effectively
Peripheral Pain: Burning, Shooting
Spinal Cord Pain: Constant, Dull aching with
neurologic deficits
Central Nervous System Pain: Changes in vital
signs, nausea, vomiting, increased
intracranial pressure
Pain Assessment
Location, Onset, Duration Quality, Intensity Relationship to Activity &
Position Precipitating & Alleviating Associated Findings Life-style Factors: Function,
Appetite, Sleep, Socialization
Assessment of Pain
Standardized Pain
Assessment
Subjective Report
Severity, Intensity
Desired Outcome
Instruments: Numerical or
Verbal Descriptor, Visual Analog,
Vertical or Horizontal,
Pictorial Facial Expressions
Pain Management
Goals:Prevention of acute painControl of chronic painOptimizing functionImproving quality of lifeInterdisciplinary team
Effective Management
Requires the health care providers to be aware of personal biases surrounding pain and its
management
Non Pharmacological
Consider prior to pharmacological
Enhances management
Physical or Occupational Therapy
Transcutaneous electrical nerve stim
Biofeedback
Visual imagery
Non Pharmacological
Relaxation Yoga
Counter Irritation
Hydrotherapy
Psychotherapy
Magnetic Therapy
Nerve Blocks
Prayer
Meditation
Music
Activities
Heat
Cold
Massage
Pharmacological
World Health Organization
Stepwise Analgesic Ladder
Focus on
Proper selection, dosing, titration, and
administration of analgesics
Five concepts: by mouth, by the clock, by
the ladder, for the individual, with attention
to detail
Step 1
Mild pain 1 - 3 on a 10 point scale
Analgesics include:
Aspirin
Acetaminophen (Tylenol)
Nonsteroidal anti-inflammatory
drugs (Elderly need to be cautious)
Coanalgesics
Step 2
Moderate pain 4 - 6 on 10 point scale
Analgesics include:
Codeine
Hydrocodone
Oxycodone
Nonopioid analgesic
Coanalgesics
Step 3
Severe Pain 7 - 10 on a 10 point scale
Analgesics include:
Morphine
Oxycodone
Hydromorphone
Fentanyl
Nonopioid analgesics
Coanalgesics
The relief you need when you are experiencing serious medical illness
PALLIATIVE CARE
Patient
&
Family
Centered Care
Patient Population
Comprehensive Care
Inter-disciplinary
Team
Attention to relief of suffering
TimingQuality
Improve-ment
Communi-cation
Continuity of care across
settings
Equitable Access
Addressing regulatory
barriers
Palliative Components
Palliative Care Team
Clinical Team:
Physician
Nurse Practitioner
Physician Assistant
Nurse
Therapists, Dietician
Pharmacist
Psychosocial Team:
Social Worker
Case Manager
Psychologist
Chaplain
Grief Counselor
Child Life Specialist
Who Uses Palliative Care
People of all ages…
Life threatening
illness
Limiting injuries
from accidents or
other trauma
Congenital injuries
Dependent on life-sustaining treatments
Serious, life-threatening illness
Progressive chronic conditions
Palliative Care Indications
Uncontrolled
symptoms
Goals of care
Cardiac arrest
Advanced cancer
Multi-organ failure
Ventilation support
Hospice eligibility
Prolonged
hospitalization
Multiple
hospitalizations
Family distress
Reduce physical, emotional symptoms
Improve function and reduce disability
Integrating complimentary therapies
Coordinate with specialists, resources
Assist in making informed decisions
Palliation of suffering along with continued
treatment (no requirement to stop care)
Palliative Care Goals
Pain and symptom control
Avoid inappropriate prolongation of the
dying process
Achieve a sense of control
Relieve burdens on family
Strengthen relationships with loved ones
Singer, et al. (1999).
The Patient’s PerspectiveWhat Do Palliative Care
patients want?
ReferencesBrown, J. B.; Bedford, N. K.; White, S. J. (1999).
Gerontological Protocols for Nurse Practitioners.
Bruera, E. & Ahmed E. (2008). The MD Anderson
Supportive and Palliative Care Handbook.
End of Life Palliative/ Education Resource center:
www.eperc.mcw.edu/EPERC
www.hartfordign.org
www.ConsultGeriRN.org
Singer, et al. JAMA 1999;281(2):163-168.