Geri-Finals - PAIN in the ELDERLY Flashcards
PAIN
“Pain is whatever the patient says it is, existing whenever he/she says it does”
~ McCaffery
Cultural Aspects of Pain
– Depends on culture, elderly shows their pain in different ways
Acute Pain VS Chronic/Persisting Pain:
ACUTE PAIN
- temporary, sudden onset, often localized, short duration, identified cause
- SNS activation, usually controlled by analgesic meds.
- Could be due to trauma or an acute medical or orthopedic problem
- an exacerbation of pain associated with chronic medical problem such as cancer or other illness
Chronic/Persisting Pain
- no time frame, not always identifiable cause, often unresponsive to conventional therapy;
- multiple manifestations (physical, psychological, social, spiritual)
Chronic/Persisting Pain:
a) Nonmalignant
b) Malignant
a) Nonmalignant
- - intractable
- - the most common pain in elders
- - Ex. back pain
b) malignant
- - Ex. Cancer
Pain Management
Health Care professionals must:
- Recognize and treat pain properly
- Make information about interventions readily available (Ex. pre-medicate pt. before doing an activity that causes pain)
- Inform patients of intent to provide analgesic care, and that they will not be addicted to the pain meds.
- Define policies for analgesic technology
- Monitor and improve quality of pain management – evaluation
Underestimated Pain of the Elderlies
- 45-80% of nursing home residents report pain that is often left untreated. Pain is strongly associated with depression and can result in decreased socialization, impaired ambulation and increased healthcare utilization and costs.
- Older adults tend to minimize or not report their pain or are unable to due to sensory and or cognitive impairments.
- A significant barrier in treating pain in older adults is inadequate pain assessment.
- Therefore, a proactive, consistent approach must be taken to screen and assess older adults for persistent pain.
PAIN Assessment Tool for Elderly
1) Numeric Rating Scale (NRS)
2) Verbal Descriptor Scale (VDS)
3) Faces Pain Scale-Revised (FPS-R)
1) Numeric Rating Scale (NRS)
- - for cognitively intact patients
- - asks a patient to rate their pain by assigning a numerical value with zero indicating no pain and 10 representing the worst pain imaginable.
2) Verbal Descriptor Scale (VDS)
- - asks the patient to describe their pain from “no pain” to “pain as bad as it could be.”
3) Faces Pain Scale-Revised (FPS-R)
- - for cognitively impaired patients
- - asks patients to describe their pain according to a facial expression that corresponds with their pain.
Pain Classification
1) Nocioceptive
2) Neuropathic
3) Idiopathic Pain
1) Nocioceptive:
- - caused by damage to somatic or visceral tissue (usually receptive to common pain meds and non-pharm interventions)
a) SOMATIC–nerve receptors originating in skin or close to body surface (bone, joint, muscle, skin, connective tissue)
b) VISCERAL–from body organs. Dull and poorly localized (intestine, bladder)
2) Neuropathic
– pathophysiological process of PNS or CNS; damage to nerve cells or spinal cord processing
– Ex. postherpetic or trigeminal neuralgia, poststroke or postamputation pain, diabetic neuropathy, radiculopathies (spinal stenosis)
– Described as stabbing, tingling, burning, shooting
Responds less well to usual analgesics, helped by ANTIDEPRESSANTS and ANTICONVULSANTS *
3) Idiopathic Pain
- - could be a recurrent HA
Pain Assessment
- Analgesic history
- Screen for cognitive impairment
- Functional assessment (if interferes w/ ADL)
- Intensity, frequency, quality, location, aggravating (what makes it worse) and alleviating (what makes it better) factors
- Pain Rating Scale
- Adapting assessment for cognitively impaired and nonverbal patients (don’t forget caregiver report)
Patient’s participation in managing their pain
Ex. Asking what level of pain the patient want his/her pain to go down to:
– means RN is including the pt. in the goal and treatment of their pain
Pain Interventions
- Use combination of pharmacologic and nonpharmacologic strategies (music, distraction, meditation, etc.)
- Multidisciplinary approach
- Evaluate effectiveness of all therapies
- Manage side effects
- Include patient and family teaching
- Analgesics: (non-narcotic and non-narcotics)
- Adjuvant medications (antidepressants, anticonvulsants)
Adverse effects of opioids
- Respiratory depression (highest risk for opiate naïve patients)
- Sedation
- Impaired cognition
- N and V
- Constipation ** we don’t want bec this leads to fecal impaction → perforation → infection (peritonitis)
- CNS hyperactivity ** CNS stimulants can have different effect on elderly (sometimes opposite effect)
- Delirium
Contraindicated Opioids for Elderly
Meperidine (Demerol)
→ is absolutely contraindicated !!
→ metabolites produce confusion, psychotic behavior, possibly seizure
Other Contraindicated Opioids for Elderly:
- Pentazocine (Talwin),
- tramadol (Ultram),
- methadone
Tolerance
Tolerance:
- A given dose has a decreased effect with a decreased duration of effect. This is a characteristic of opioid analgesics.
- Tolerance occurs to analgesic effects, sedation, respiratory depression
Physical Dependence
Physical Dependence:
- Altered physiologic state produced by repeated administration of an opiate drug.
- Continued drug administration is required to prevent withdrawal.
S/S of Withdrawal:
- confusion
- ↑ HR, ↑RR, ↑ BP, ↑ T, N/V, anxiety, some gets restrained
- teach not to suddenly stop – need to taper
