Assessing Pain

• What is pain?• Do you believe that “perception is reality”?• What are EB clinical practice guidelines??• What if client non-verbal, or you do not

speak the same language?• Pain vs suffering

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Assessing Pain• Location• Intensity• Quality• Onset, duration & recurrence• Manner of expressing pain• Precipitating factors• Alleviating factors• Effects on ADL (C&DB, ambulating)

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INS Standards of Practice, 2011The nurse shall:• be competent in the care of patients receiving PCA. • have knowledge of the appropriate drugs used with

PCA, including: – pharmacokinetics and equianalgesic dosing– contraindications, side effects and their

management– appropriate administration modalities– anticipated outcomes.

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INS Standards of Practice, 2011

• The patient and caregiver shall be educated in the use of PCA.

• The patient’s and caregiver’s comprehension and ability to comply with procedures shall be evaluated and documented prior to, and on initiation of therapy.

• The use of infusion devices shall adhere to manufacturers’ directions for use.

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Definitions

• Anesthesia • Analgesia

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Equianalgesia

• “approximately equal analgesia”• Used when switching from 1 pain med or

route to another– Standard: Morphine, 10 mg IM/IV or

30 mg po–Chart: Craven, p. 1202, Table 44-3

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Patient Controlled Analgesia

• Self-delivery of narcotics• Goal: constant plasma level• IV, SQ, epidural• Acute or chronic pain• Philosophy of care

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Patient Criteria

• Alert• Able to comprehend instructions • Physically able to push button• Acute or chronic pain• No allergy to medication ordered

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Advantages

• Pump infuser can be used – get pain med quicker• Shown to be safe and effective• Patient more relaxed when have more control• Analgesia more effective when serum level

constant• Postop patients can avoid peak & trough• Patients shown to ambulate sooner after

abdominal surgery.• Better pain control= better able C&DB

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Potential Side Effects (opioids)

• Oversedation• Hypotension • Respiratory depression• Urinary retention• Nausea/vomiting• Constipation• pruritus

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Factors that reduce patient safety

• Improper patient selection• Pump problems• Programming errors– Standards require 2nd signature on

initiation• “PCA by proxy”

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Parts to PCA order

1. Name of drug2. Concentration (mg/ml) of drug3. Loading dose (Bolus)4. Mode

• Continuous infusion (Basal)• PCA (patient activated)• Combination

5. PCA dose6. lockout interval (Delay)7. Hour limit (1 or 4 hour limit)

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Equipment

• PCA pump• Key• PCA tubing• Syringe/cassette of medication• Patent, running IV

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Teaching

• Teach before procedure• Button • Can't overdose (lockout)• Family/friends should not operate• Report to you if ineffective

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Teaching• Report side effects • Goals of therapy• Return demonstration

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Assessment

• Pain level • Sedation level• Respiratory rate• Other side effects • History of attempt/injections

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Ineffective Pain Management

• First: look at history• Pain r/t ineffective medication– Is there a titration order?

• Pain r/t knowledge deficit

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Documentation

• Q 4 h• Assessment• # attempts / # injections• Amount of drug infused• Amount of drug in syringe

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