6-C I. Managing Pain Nursing Interventions Flashcards
oral
contraindicated with nausea and vomiting
assess response to therapy 1 hour after administration
slow-release preparations available: may require additional analgesic at initiation of therapy and for breakthrough pain
intramuscular
assess response to therapy 30 minutes after administration
avoid these methods with hypothermia and vasoconstriction
subcutaneous
assess response to therapy 30 to 60 minutes after initiating therapy
well-suited for clients with cancer
requires ambulatory infusion pump
easier to establish steady-state blood level
epidural and intrathecal
assess response to therapy 15 to 45 minutes after initiating therapy
itching can be severe
risk of hematoma, infection, meningitis
effective management of severe pain without central nervous system depression
agents: preservative-free opioids and local anesthetics via PCA or implantable pump
patient-controlled analgesia (PCA)
assess response to therapy 15 to 30 minutes after initiating therapy
client controls dosing
client prevented from overdosing with lock-out: establishes maximum frequency of dosing
client and family teaching: intended for client only control
used with oral, IV, subcutaneous, and epidural administration
dose frequently includes a basal rate: client activates PCA for on-demand dose
typical basal rate of morphine sulfate: of 2-5 mg/hour
typical on-demand dose of morphine sulfate: 0.5-2 mg every 10 minutes
provides a steadier analgesic blood level
pump set-up requires specially trained personnel; controls are behind a locked panel
may start equianalgesic oral opioids 30 minutes to 1 hour before discontinuing depending on the drugs involved
transdermal
assess response to therapy 1 to 2 hours after initiating therapy
difficult to adjust dosage
agents: fentanyl and morphine
increased absorption with febrile clients
used in chronic and severe pain syndromes
monitor for respiratory depression and skin irritation
remove old patch and cleanse area before applying new patch
intravenous
assess response to therapy 15 to 30 minutes after therapy
given by direct bolus
short-term pain management for moderate to severe pain
high risk of CNS depression especially respiratory depression
Nursing Interventions - opioid analgesics
establish baseline data and monitor respiratory rate, blood pressure, bowel pattern, platelets, neurologic status, allergy
accurately time doses to prevent overdose; reverse effects with antidote naloxone
keep emergency equipment immediately available
counteract adverse effects
administer antiemetic for nausea
administer antipruritic for pruritus
prevent constipation with fluid, fiber, ambulation since stool softeners usually ineffective
transition client from IV, IM dosing to oral dosing with equianalgesic doses
client teaching
ask for help when getting up
report rash, dyspnea, inadequate pain management
establish bowel habits, take with food to avoid nausea
take only as directed, do not exceed recommended dose
AVOID
alcohol, CNS depressants, antihistamines
herbal remedies including chamomile and kava
driving, making important decisions, and dangerous activity
equianalgesic conversions
Switching a client from one opioid analgesic to another should be based on an equianalgesic conversions to give the client similar pain relief.
For example: 10 mg of a parenteral dose of morphine sulfate is equivalent to 30 mg PO.
Another example: conversion ratio of oral morphine to transdermal fentanyl is approximately 2:1 so 60 mg/day of oral morphine sulfate is equianalgesic to 25 micrograms/hour of transdermal fentanyl.
Nursing Interventions - opioid agonist-antagonists
screen clients for previous use of opioids
Nursing Interventions - opioid antagonists
establish baseline data and monitor airway, respiratory rate, SaO2, blood pressure, heart rate and rhythm, pain intensity
provide information to client
administer with emergency equipment nearby
collaborate with provider for pain management
Nursing Interventions - synthetic diphenylheptane derivative
establish baseline data and monitor renal and liver enzyme tests
assess and monitor pain, vital signs, airway, level of consciousness, pupil reaction to light
opioid intoxication: lack of analgesic effect, clinical indicators of withdrawal
client teaching
report neurologic changes, allergic reactions
avoid CNS depressants, alcohol for 24 hours after administration
change positions slowly; do not drive or engage in dangerous activity
nursing interventions - non-opioid analgesics
establish baseline data and monitor liver enzyme tests, creatinine, complete blood count
assess and monitor pain, temperature, urine output, neurologic status
client teaching AVOID alcohol may crush or cut tablets do not exceed recommended dose AVOID over-the-counter medications containing acetaminophen report nausea, vomiting, abdominal pain
nursing interventions - anti-migraine headache agents
Triptan
establish baseline data and monitor renal and liver enzyme tests
assess and monitor pain and associated findings, blood pressure, ECG, neurologic status
screen clients for cardiovascular or neurovascular history, drugs containing ergotamine
client teaching
AVOID triggers: foods containing tyramine , sulfites
report chest pain, worsening symptoms, paresthesia, flushing
AVOID pregnancy
do not crush tablets
remain in calm environment, away from noise, light
nursing interventions - anti-migraine headache agents
ergot derivatives
establish baseline data and monitor renal and liver enzyme tests
assess and monitor pain, associated findings, neurologic status including blurred vision, blood pressure, heart rate
treat overdose with vasodilators, heparin, and dextran
client teaching
ways to control, avoid or eliminate trigger factors
relaxation techniques
AVOID alcohol and over-the-counter drugs
