Pain Management
C. Calzolari
2014
What is Pain?
Why Do We Experience Pain?
It is protective. How?
It is a signal. What?
Cause of Pain
Nociceptive pain(pain receptors) – most common. Respond to stimulation.Visceral – organs , linings of cavitiesSomatic – Skin, muscles, bones, connective
tissue
Neuropathic pain – complex and often chronic.
Classification of Pain
AcuteCan Identify CauseTemporaryActivates SNS - BP, HR, RR, more blood to brain, dilates pupils
Classification of Pain
ChronicLonger Duration – lasts beyond healing phaseInterferes with ADLsRemissions & exacerbationsStimulates PNS - or normal Vital SignsAffective Responses
Classification of Pain
IntractableChronic
Resistant to pain relief
Multi-Disciplinary Approach
Descriptions of Pain
Based on site, cause, duration and quality.
Site of Pain
Cutaneous or superficial pain
Visceral pain
Deep somatic pain
Radiating pain
Referred pain
Phantom pain
Psychogenic pain
Take the Vocabulary Quiz
Application
How would you classify the pain that the following patients are experiencing?
● A patient with metastatic cancer
A patient with back pain that was the result of an automobile injury a year ago
A patient with a broken leg
Quality of Pain
Only the patient can describe the quality of their pain. They may use words such as:
Sharp Dull Throbbing Stabbing Burning Ripping Tingling Intermittent Constant Mild Intense Severe
Factors Which Influence Pain
EmotionsDevelopmental StageCommunication ImpairmentsPain ThresholdCulture
Factors Which Influence Pain
Emotions: Anxiety Fear Guilt Anger Helplessness Exhaustion Irritability Depression
Factors Which Influence Pain
Developmental Stage:Infants and childrenAdultsOlder Adults
Factors Which Influence Pain
Communication Impairment: Those who have had a CVA, speak another language
or are cognitively impaired. You will need to observe nonverbal cues for pain.
Facial expressions Vocalizations Changes in physical activity Change in vital signs Change in routines Mental status changes
Factors Which Influence Pain
Culture:Involves the patient’s expression of pain,
the family’s response to the situation and the nurse’s attitude.
William & Hopper: Box 10.2 – page 143-144
Factors Which Influence Pain
Pain Threshold: The point at which the receptors in the frontal
cortex recognizes and defines a stimulus as pain.
Varies from person to person.
Pain Tolerance: The duration or intensity of pain that a person
is willing to endure.
Pharmacological Pain Relief Measures
Analgesics Nonopioids – acetaminophen, salicylates,
NSAIDS and COX -2 inhibitors
Opioids - morphine, codeine, hydromorphone, methadone, meperdine, oxycodone, sublimaze patch
Analgesics
Routes of Administration
Oral – preferred routeNasalTransdermalRectalSubcutaneousIntramuscular – least preferredIntravenousPCA – patient controlled analgesiaIntraspinal analgesics
Adverse Affects of Pain Medications
Nonopioids – GIB, inhibition of platelet aggregation, renal insufficiency, hypersensitive reactions in persons with asthma, liver necrosis with OD of Tylenol.
Opioids – respiratory depression, hypotension, drowsiness, constipation, nausea, vomiting, constricted pupils.
Analgesic Adjuvants
These medications may potentiate the effects of opioids or nonopioids.
Examples: steroids, benzodiazepines, tricyclic antidepressants, and anticonvulsants.
Able to use less opioid doses when used with these adjuvants.
Antidote
Narcan (naloxone)- counteracts the effect of opioids.
Interpreting MD Orders
Morphine Sulfate 2 mg. IM q 4 hours prn for surgical pain.
Percocet one tab po q 6 hours prn for foot pain
Duragesic patch 25mcg/hr transdermal q 72 hours at 0800.
Oxycontin 20 mg. po BIDOxyIR 5 mg. po q 6 hours prn for
breakthrough pain
Evaluation
Always re-assess your patient after administering pain medications.
At what time interval?
Special Considerations
The Elderly
The Person with Substance Abuse or Addiction
Unrelieved Pain
Nonpharmacological Pain Relief Measures
Cutaneous StimulationTENS – Trancutaneous Electrical Nerve
StimulatorAcupunctureAcupressureMassageHot and Cold TX
Transelectrical Nerve Stimulation
TENS
Acupuncture
Acupressure
Based on the same principles as acupuncture, (but using pressure instead of needles), acupressure works by stimulating specific reflex points located along the lines of energy which run through the body, called meridians.
Massage
Hot & Cold Therapies
Nonpharmacological Pain Relief Measures
Surgery
Immobilization Splints, slings, braces
Cognitive-Behavioral Interventions Distraction Relaxation Techniques Guided Imagery Hypnosis Therapeutic Touch Humor
Guided Imagery
start the day meditation - guided imagery – YouTube
Guided Imagery - Bubble Release - YouTube
REIKI
Biofeedback
Biofeedback Session Demo – YouTube
http://www.youtube.com/watch?v=a53LA7aL2Og
The Nursing Process
Lets Start With You, as a student nurse and health care providers.
The HCW’s Perception of Pain
What are some myths associated with pain management that you have witnessed in the healthcare setting?
Nursing Process: Collect Data
The fifth vital sign.Accept the patient’s report of pain.Obtain a pain history.Perform a physical assessment.Observe for nonverbal indicators of pain.Use WHAT”S UP format and pain
scales.
WHAT”S UP?
W here is the pain? H ow does the pain feel? A ggravating & alleviating factors. T iming. S everity. U seful other data. P erception.
Pain Scales
Visual Analog Scale
Numerical Rating Scale
The Wong-Baker FACES pain Rating Scale
Analgesic Administration
Use resources to check on purposes and actions of pharmacological agents
Reconcile & maintain MAR +/or Patient’s list of medications.
Identify patient’s allergies and intervene as appropriate.
Identify a contraindication to administration of a prescribed medication.
Acetaminophen Caution and Guidance
Planning
Use data collected to plan action with patient’s input.
Teach patient to use pain scales.Set goals for acceptable pain levels.Example: you will ask your patient who is in
pain, “What is an acceptable level of pain for you after we have helped you relieve your pain?”
“What has helped in the past to relieve your pain?”
Drug Calculations
Nursing Diagnoses
Nursing Diagnosis: Pain, acute or chronic,
Impaired Comfort
Others: Self-Care Deficit, Impaired Mobility, Sleep Deprivation, Ineffective Airway Clearance, Ineffective Coping.
Interventions
Apply therapies for comfort.Use alternative/complementary therapies for pain
management.Administer pain medication as prescribed.Identify patient expected response to pain
medication. Reinforce client teaching on possible effects of
medication.
Follow rights of medication administration.
Maintain medication safety practice. Follow protocol for handling controlled
substances.Monitor patient use of medication over
time.Maintain pain control devices.
Evaluation
Monitor and document patient’s response to pharmacological and non – pharmacological interventions.
Notify primary healthcare provider of actual/potential adverse effects of pain medications.
Explain the protocol for withholding pain medication if patient experiences an adverse reaction.
Discuss actions used in the event of adverse reactions with the use of opioids.
Role Playing & Case Scenarios
Utilize your Medication Research cards and The Joint Commission Handout, “SpeakUP” to perform these excercises.
Top Related