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Nursing 171 > NURS 171 Week 11: Pain > Flashcards

NURS 171 Week 11: Pain Flashcards

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1
Q

Pain

A
  • unpleasant sensory, emotional experience
  • subjective experience
  • can not be measured objectively
  • can interfere with quality of life, interfere with activities of daily living
  • destructive to both patient and family
  • can be a warning sign
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2
Q

How can Pain be Classified?

A
  • by region of the body involved
  • cause
  • duration
  • pattern of occurrence/ quality
  • intensity
  • time since onset
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3
Q

Origin of Pain

A

site where pain is felt, not necessarily the source of pain

  • cutaneous/superficial
  • visceral
  • deep somatic
  • radiating
  • referred
  • phantom
  • psychogenic
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4
Q

Origin of Pain: Cutaneous/ Superficial

A

arises in the skin or subcutaneous tissue

  • ex: hot object/ paper cut
  • significant short term pain
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5
Q

Origin of Pain: Visceral

A

(organs)

  • stimulation of deep internal pain receptors
  • most often in abdomen cavity, cranium, or thorax
  • pain may vary from local, achy, discomfort to more widespread, intermittent and crampy pain
  • ex: menstrual cramps, bowel disorders, and organ cancers
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6
Q

Origin of Pain: Deep Somatic

A

(deep tissue)

  • ligaments, tendons, nerves, blood vessels, and bones
  • more diffuse than cutaneous pain and lasts longer
  • ex: fracture/ sprain, arthritis, bone cancer
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7
Q

Origin of Pain: Radiating

A
  • starts at the origin
  • extends to other locations
  • ex: severe sore throat may extend to ears and head
  • ex: GERD: chest pain
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8
Q

Origin of Pain: Referred

A

occurs in area distant from original site

-ex: MI–> down arm or across back

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9
Q

Origin of Pain: Phantom

A

perceived to originate from area that has been surgically removed

  • after a limb has been removed, the nerve endings that remain, transmit to the brain that the body part still has pain, even though it has been removed
    ex: amputated limbs: burning, itching, and deep pain
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10
Q

Origin of Pain: Psychogenic

A

believed to arise from the mind

  • perceived pain though no physical cause can be identified
  • when no medical reason can be found for the pain (is it real, or is it in the mind?)
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11
Q

Causes of Pain

A
  • nociceptive

- neuropathic

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12
Q

Nociceptive

A

-pain receptors are stimulated
>visceral (organs)
>somatic (tissues + bones)
-most common type
-pain receptors (nociceptors are stimulated)
-noxious, thermal, chemical, or mechanical stimuli
-trauma, surgery, or inflammation
“aching”
-visceral (organs) and somatic (tissues and bones)

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13
Q

Neuropathic

A

nerves are injured

  • complex and often chronic
  • injury to one or more nerves
  • repeated transmission of pain signals even in absence of painful stimuli
  • nerve injury: poorly controlled diabetes, stroke, tumor, alcoholism, amputation, viral infection (shingles, HIV, AIDS)
  • medications can trigger nerve injuries
  • burning, numbness, itching and pins and needles or prickling pain
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14
Q

Duration of Pain

A
  • acute
  • chronic
  • intractable
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15
Q

Duration of Pain: Acute

A

short duration/ rapid onset

  • varies in intensity
  • may last up to 6 months
  • injury or surgery
  • “protective” indicates potential or actual tissue damage
  • usually disappears as tissue heals
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16
Q

Duration of Pain: Chronic

A

pain that has lasted 3 to 6 months or longer

  • often interferes with activities of daily living
  • related to a progressive disorder or with no current tissue injury such as neuropathic pain
  • may experience periods of remission or exacerbation
  • often viewed as insignificant by family + care providers
  • patients may withdrawal, have depression, anger, frustration, and dependence
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17
Q

Duration of Pain: Intractable

A

chronic and highly resistant to relief

  • frustrating
  • multi-modal pain therapy
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18
Q

Quality of Pain: Described by Patients

A
  • sharp
  • dull
  • aching
  • throbbing
  • stabbing
  • burning
  • ripping
  • searing
  • tingling
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19
Q

Quality of Pain: Length

A
  • Episodic
  • Intermittent
  • Constant
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20
Q

Quality of Pain: Intensity

A
  • mild
  • distracting
  • moderate
  • severe
  • intolerable
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21
Q

What Happens When Someone Has Pain? Transduction

A

activation of nociceptors by stimuli

  • activated by perception of mechanical, thermal, or chemical stimuli
  • chemicals (bradykinin, histamine, prostaglandins) released: Bradykinins cause inflamed, red, swollen, tender
  • Mechanical: trauma
  • Thermal: extreme heat or cold
  • Chemical: acid (like lemon juice) on open skin or tissue ischemia
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22
Q

Bradykinin

A

cause inflamed, red, swollen, tender

  • inflammation is most frequent cause of pain
  • released during transduction (when someone has pain)
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23
Q

What Happens When Someone Has Pain? Transmission

A
  • conduction of pain message to spinal cord

- pain transmission involves chemicals called neurotransmitters

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24
Q

Transmission

A

peripheral nerves carry pain message to dorsal horn of spinal cord
-A Delta Fibers: myelinated fast pain impulses: acute, focused mechanical + thermal stimuli; bumped knee
-C Fibers: smaller unmyelinated fibers transmit slow pain impulses
>dull, diffuse pain impulses travel at a slow rate
>mechanical, thermal, and chemical stimuli
>lingering ache

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25
Q

Transmission: A Delta Fibers

A

myelinated fast pain impulses

  • acute, focused mechanical and thermal stimuli
    ex: bumped knee
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26
Q

Transmission: C Fibers

A

smaller, unmyelinated fibers transmit slow pain impulses

  • dull, diffuse pain impulses travel at a slow rate
  • mechanical, thermal, and chemical stimuli
  • lingering ache
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27
Q

Pain Perception

A

recognizing and defining pain in frontal cortex

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28
Q

Pain Threshold

A

brain recognizes and defines stimulus as pain

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29
Q

Pain Tolerance

A

duration or intensity of pain a person can endure

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30
Q

Pain Modulation

A

changing pain perception by facilitating or inhibiting pain signals

  • Endogenous Analgesia System
  • Gate Control Theory
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31
Q

Pain Modulation: The Endogenous Analgesia System

A

neurons in the brain-stem activate descending nerve fibers that conduct impulses back to the spinal cord

  • impulses trigger release of endogenous opioids and other substances to block pain impulse
  • can be stimulated by various pain medications and non pharmacological measures
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32
Q

Endogenous Opioids

A

naturally occurring analgesic neurotransmitters

  • inhibit the transmission of pain impulses
  • bind to opiate receptor sites in the central and peripheral nervous system
  • 4 receptor sites: Mu, Kappa, Delta, Sigma
  • each site has a different affinity for various pain medications
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33
Q

4 Receptor Sites Endogenous Opioids Bind To

A

-Mu
-Kappa
-Delta
-Sigma
each site has a different affinity for various pain medications

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34
Q

The Gate Control Theory

A

pain impulses can be influenced/ controlled at the spinal level

  • theory: block the “gate” with a non noxious stimulation and block the perception of pain
  • asserts that non-painful input closes the “gates” to painful input which prevents pain sensation from traveling to the CNS
  • stimulation by non noxious input is able to suppress pain
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35
Q

The Gate Control Theory: Two Types of Fibers

A
  • those that produce pain

- those that inhibit pain

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36
Q

Examples for Gate-Control Theory

A

-TENS unit
-mediation
-exercise
-relation
-laughter
(compete with C fibers and block the gate)

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37
Q

What Factors Influence Pain?

A
  • emotions
  • developmental stage
  • sociocultural factors
  • communication skills
  • cognitive impairments
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38
Q

Factors Influence Pain? Emotion: Fear

A
  • is illness or injury life threatening?
  • progressive pain intolerable?
  • judged as weak if complain?
  • addictive?
  • fears can prolong or increase patients pain
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39
Q

Factors Influence Pain? Emotions: Confusion + Helplessness

A
  • role guilt

- when alone may experience loneliness or even a sense of abandonment

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40
Q

Factors Influence Pain? Emotions: Anxiety + Depression

A
  • anxiety + depression are common in people who are ill or hospitalized
  • anxiety associated with acute pain
  • anticipation of pain may trigger anxiety
  • waiting for surgery or procedure
  • depression most often linked with chronic pain, especially intractable pain
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41
Q

Factors Influence Pain? Emotions: Previous Pain Experience

A
  • previous pain experience affect emotions
  • previous numerous painful experiences can lead to more anxiety and more sensitivity to pain
  • if previous pain was controlled are less anxious and trust in pain relief
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42
Q

Factors Influence Pain? Emotions

A

-fear
-confusion + helplessness
-anxiety + depression
-previous pain experience
-illness and pain trigger emotional reactions
-emotional reactions exacerbate pain
-pain is usually a combination of physical + emotions
Interventions: relieve feelings of fear + helplessness, reflective listening, gentle touch, pain medication

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43
Q

Factors Influence Pain? Emotions: Interventions

A
  • relieve feelings of fear + helplessness
  • reflective listening
  • gentle touch
  • pain medication
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44
Q

Older Adults Vs Pain Influence

A
  • 50% or greater experience pain
  • may be unable to report because of cognitive impairment
  • nonverbal cues: grimacing, rapid blinking, withdrawal, labored breathing, altered gait or decreased activity
  • some have mental confusion or collapse
  • some lead to social isolation, depression, sleep disturbances, and mobility related problems
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45
Q

Nonverbal cues for Pain

A
  • grimacing
  • rapid blinking
  • withdrawal
  • labored breathing
  • altered gait
  • decreased activity
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46
Q

What Factors Influence Pain? Sociocultural Factors

A

we learn behaviors associated with pain through interactions with family and social support group

  • ex: minimizing pain or expression pain often tied to culture
  • crying, moaning, silence, brave, smiling at polite nurse
  • do not assume
  • culture sensitivity
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47
Q

Factors Influence Pain? Communication Skills

A

-challenges: stroke, dementia, intubation, or limited command of language
-watch for behavioral cues (nonverbal):
>decreased activity, grimacing, frowning, crying, moaning, irritability

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48
Q

Factors Influence Pain? Cognitive Impairments

A

Indicators:

  • Facial expressions (sad, frightened, rapid blinking)
  • Vocalizations (noisy breathing, profanity, verbally abusive)
  • Changes in Physical Activity (fidgeting, pacing, rocking, disruptive behavior)
  • Changes in Routine (refusing food, difficulty sleeping)
  • Mental Status Changes (increased confusion)
  • Physiological Cues (elevated vital signs)
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49
Q

Pain Responses

A
  • Sympathetic Response
  • Parasympathetic Response
  • Behavioral Response
  • Psychological Response
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50
Q

Pain Response: Sympathetic Response

A

(acute pain)

  • increased alertness
  • dilated pupils
  • increased heart rate and force
  • increased respiratory rate
  • increased systolic blood pressure
  • rapid speech
  • pallor
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51
Q

Pain Response: Parasympathetic

A

(Deep or Prolonged Pain)

  • changeable breathing pattern
  • constricted pupils
  • decreased pulse rate
  • decreased systolic blood pressure with symptoms: feeling faint, possible syncope
  • slow, monotonous speech
  • withdrawal
52
Q

Pain Response: Behavioral Responses

A
  • agitation
  • crying
  • facial grimacing
  • guarding of the painful area
  • moaning
  • withdrawing from painful stimuli
53
Q

Pain Response: Psychological

A
  • anger
  • anxiety
  • depression
  • exhaustion
  • fear
  • hopelessness
  • irritability
54
Q

How Does the Body React to Unrelieved Pain? Endocrine

A

hormones released that affect carbohydrate, protein and fat metabolism, hyperglycemia and poor glucose use

55
Q

How Does the Body React to Unrelieved Pain? Cardiovascular

A
  • increased Heart Rate
  • increased Blood Pressure
  • Increased Cardiac Workload
  • increased Oxygen Demand
  • Hyper-coagulation (excessive blood clotting)
56
Q

How Does the Body React to Unrelieved Pain? Musculoskeletal

A
  • impaired muscle function
  • fatigue
  • impaired mobility (immobility)
57
Q

How Does the Body React to Unrelieved Pain? Respiratory

A

-shallow breathing that can lead to pneumonia and atelectasis and under ventilation

58
Q

How Does the Body React to Unrelieved Pain? Genitourinary

A

affects release of hormones that can lead to

  • decreased urinary output
  • fluid retention (fluid overload)
  • urinary retention
  • hypokalemia
  • hypertension
  • increased cardiac output
59
Q

How Does the Body React to Unrelieved Pain? Gastrointestinal

A

intestinal secretions and smooth muscle tone increases and gastric emptying and motility decrease
-decreased gastric motility

60
Q

Pain Assessment

A
  • comprehensive pain history and assessment
  • pain location and quality
  • pain intensity
  • aggravating and alleviating factors
  • time and duration
  • pain relief
  • pain relief expectations
  • ADLs affected?
  • mobility
  • depression? substance abuse?
61
Q

Pain, the Fifth Vital Sign

A

Goal: to assess pain on a regular and ongoing bases

-accept clients pain assessment

62
Q

Pain Treatment

A
  • prescribed analgesic
  • non pharmacological options
  • consider risk of dependency, abuse + addiction
  • assess pain before medication administration and after (relief?)
63
Q

Assessing Pain: Focused Assessment

A

-obtaining a complete pain history: patient self report (onset, location, aggravating + alleviating factors)
-use pain scales
-change of condition
-need for more aggressive pain management
(increase in pain may indicate change in condition or a need for more aggressive pain management)
-Nonverbal signs of pain:
>physiological (vital signs)
>behavioral (withdrawal, guarding, moaning, agitation)
>psychological (fear, anxiety, irritability)

64
Q

Pain Scales

A
  • Visual Analogue Scale (VAS)
  • Numeric Rating Scale (NRS)
  • Simple Descriptor Scale
  • Wong-Baker Faces Pain Rating Scale
65
Q

Words Commonly Used to Describe Pain Across Cultures

A
  • pain
  • hurt
  • ache
66
Q

Non-verbal Signs of Pain

A
  • facial expression
  • posture
  • body position
  • changes in vital signs
  • may not be acting like they are in pain
  • use interpreter if different language is spoken
  • treat underlying depression
67
Q

Planning Outcomes

A

Goal: prevent, reduce, or eliminate pain

68
Q

Planning Interventions

A
  • control pain with least invasive/ most effective method
  • include non-pharmacologic methods
  • care depends on cause of pain (acute/chronic)
  • actively listen to self report of pain
  • provide analgesics promptly
  • assess responses to analgesics + non-pharmacological measures including level of sedation (30 to 60 minutes after administration)
  • manage side effects
  • reduce anxiety and fear by including patient in pain management plan
  • consult with healthcare provider for complex pain management issues
  • alter treatment if not adequately relieved
  • delegate appropriate strategies to nursing assistant personnel (NAP)
69
Q

Pain Management Strategies

A
  • reposition using pillows for support
  • back rub or massage
  • quiet/ dark room for sleep
  • reduce clutter in patients room
  • mouth care
  • soft music
  • using distraction
70
Q

Non-pharmacological Measures Complimentary Therapy

A 
-Based on "Gate Control Theory"
>TENS unit
>PENS unit
>Spinal Cord Stimulator
-acupuncture
-acupressure
-use of heat + cold
-contralateral stimulation
-immobilization
-massage such as effleurage; slow guided strokes
-myofasical release of overused or injured muscles + nerves
71
Q

Non-pharmacological Measures Complimentary Theory Based on “Gate Control Theory”

A
  • TENS
  • PENS
  • Spinal Cord Stimulator
72
Q

TENS Unit

A

transcutaneous electrical nerve stimulator

  • electrodes, connecting wire, and stimulator
  • pads directly on painful area
  • stimulates delta A fibers
  • can be worn intermittently or longer periods of time
  • complimentary therapy based on “gate control theory”
73
Q

PENS Unit

A

Percutaneous electrical stimulation

  • placed through the skin
  • stimulates peripheral sensory nerves
  • effective in short term/ acute and chronic pain management
  • complimentary therapy based on “Gate Control Theory”
74
Q

Non-pharmacological Measures Complimentary Therapy

A
  • acupuncture
  • acupressure
  • use of heat + cold
  • contralateral stimulation
  • immobilization
  • massage such as effleurage; slow, long guided strokes
  • myofasical release of overused or injured muscles + nerves
75
Q

Cognitive-Behavioral Interventions

A
  • distraction
  • relaxation techniques
  • guided imagery
  • diaphragmatic breathing
  • hypnosis
  • therapeutic touch
  • humor
  • expressive writing
  • animal assisted therapy
76
Q

Cognitive-Behavior Therapy: Distractions

A
  • Visual: watch TV
  • Tactile: massage, hugging favorite toy, holding loved one, stroking pet
  • Intellectual: crossword puzzle, game
  • Auditory: music therapy
  • Olfactory: soothing smells with aromatherapy
77
Q

Pharmacological Pain Relief Measures

A
  • analgesics
  • non-opioid analgesics
  • opioid analgesics
78
Q

Pharmacological Pain Relief Measures: Analgesics

A
  • non-opioids
  • adjuvants
  • opioids
  • analgesics work best if given before pain becomes too severe
  • administer next dose before last dose wears off
  • consider around the clock dosing
79
Q

Non-opioid Analgesics

A

mild to moderate pain that is acute or chronic

  • NSAIDs: Ibuprofen, naproxen, aspirin
  • Acetaminophen (Tylenol)
  • often compounded with opioids to allow for lower dose of opioid
80
Q

Opioid Analgesics

A
  • includes IV, IM, transdermal, and epidural forms
  • client-controlled analgesia pump
  • natural and synthetic compounds that relieve pain
  • work by binding with pain receptor sites to block pain impulses (mu, delta, kappa, sigma)
  • Mu most effective in relieving pain
  • no maximum daily dose for Mu agonists
  • Mu: codeine, morphine, hydrocodone, hydromorphone, fentanyl, methadone, oxycodone
81
Q

Mu

A

pain receptor site

  • most effective in relieving pain
  • no maximum daily dose for Mu agonists
  • Mu: codeine, morphine, hydrocodone, hydromorphone, fentanyl, methadone, oxycodone
82
Q

NSAIDs

A
  • largest group of non-opioid analgesics
  • act primarily in peripheral tissues
  • interfere with production of prostaglandins
83
Q

Prostaglandins

A
  • sensitize pain receptors

- involved with inflammation

84
Q

NSAIDs Side Effects

A
  • gastric irritation
  • gastric bleeding
  • kidney toxicity, hypertension, and heart failure in older adults with certain NSAIDs
85
Q

NSAIDs Interventions

A
  • administer low dose
  • administer with food
  • administer enteric coated pills
86
Q

Acetaminophen

A

-non-opioid analgesic
-very little anti-inflammatory effect
-fewer side effects
-“safest”
-can cause liver toxicity
(recommended dose maximum is 4000 mg a day)

87
Q

Adjuvant Analgesics

A
  • may be used as a primary therapy for mild pain
  • in conjunction with opioids for moderate to severe pain
  • reduce the amount of opioids needed
  • frequently used in managing neuropathic pain
88
Q

Adjuvant Analgesics Medications

A
  • anticonvulsants
  • antidepressants
  • local anesthetics
  • topic agents (lidocaine)
  • psycho-stimulants
  • muscle relaxants
  • neuroleptics
  • corticosteroids
89
Q

Adjuvant Analgesics Medications: Psycho-stimulants

A

produces a temporary increase in psycho-motor activity or temporary improvement in physical function or mental processes or both
-caffeine, nicotine, amphetamines, methamphetamine, ecstasy, cocaine, and methylphenidate

90
Q

Opioid Analgesics: Agonist-Antagonist

A
  • another group of opioids
  • stimulate some opioid receptors but block others
  • for moderate to sever acute pain
  • should not be given to patients taking Mu agonist (morphine)
91
Q

Opioid Analgesics Patient Misconceptions

A
  • respiratory depression
  • tolerance
  • physical dependence
  • psychological dependence
92
Q

Opioid Misconception: Respiratory Depression

A

can be treated with naloxone, an opioid antagonist

93
Q

Opioid Misconception: Tolerance

A

can occur but increasing the dose or changing the route of administration can correct the problem
-there is no ceiling on the analgesic affects of opioids

94
Q

Opioid Misconception: Physical Dependence

A

leads to withdrawal symptoms when the drug is removed abruptly

95
Q

Opioid Misconceptions: Psychological Dependence

A

commonly called addiction, occurs in less than 1% of patients even after long term prescribed use of opioids for pain

96
Q

Opioid Analgesics: Screening for Abuse

A
  • patients with tendency for abuse can become addicted

- healthcare professions needs to screen for drug, alcohol use and history

97
Q

Opioid Side Effects

A

-drowsiness
-nausea, vomiting
-constipation
>Large Doses can lead to: respiratory depression, hypotension
>Assess before Administering: level of alertness, respiratory status

98
Q

Opioid Analgesics: Large Doses Can Lead To

A

-respiratory depression
-hypotension
>assess before administering: level of alertness, respiratory status

99
Q

Other Side Effects of Opioids

A
  • difficulty with urination
  • dry mouth
  • sweating
  • tachycardia
  • palpitations
  • bradycardia
  • rashes
  • urticaria (hives)
  • Pruritis (itching)
100
Q

Other Assessments for Opioids

A
  • paradoxical reactions (increased pain)

- sedation (some sedation is to be expected)

101
Q

Richmond Agitation- Sedation Scale

A

Sedation Rating Scale

  • combative
  • very agitated
  • agitated
  • restless
  • alert and calm
  • drowsy
  • light sedation
  • moderate sedation
  • deep sedation
  • unarousable
102
Q

Routes of Administration for Opioids

A
  • use safest and least invasive rout
  • patient controlled analgesic (PCA) (allows patient to self administration for pain relief)
  • oral
  • parenteral
  • epidural
  • subcutaneous
  • intravenous
103
Q

PCA (patient controlled analgesic)

A
  • includes infusion pump, syringe, IV tubing, and a hand held trigger
  • programmed by nurse
  • dosing to manage patients pain effectively
  • most have a maximum dose allowed for given period of time
104
Q

Opioid Analgesic Routes: Oral

A
  • convenient and safe
  • produces steady and analgesic levels
  • mild to severe pain
105
Q

Opioid Analgesic Route: Transdermal

A
  • applied to skin
  • delivers continuous release of drug for up to 72 hours
  • febrile patients will have increased absorption
  • does not provide immediate relief
  • proper disposal
106
Q

Opioid Analgesic Route: Subcutaneous

A
  • used for intermittent injections and continuous administration of opioids
  • absorption and distribution vary according to site
107
Q

Opioid Analgesic Route: IM

A
  • not preferred route

- sterile abscesses and fibrotic tissue can result

108
Q

Opioid Route: IV

A
  • produces immediate pain relief
  • desirable for acute and escalating pain
  • short term therapy in hospital setting
  • in home setting for patients with cancer and other pain situations where oral intake is not tolerable
  • requires venous access
109
Q

Opioid Routes: Epidural (or intraspinal)

A
  • delivery of analgesia
  • requires placement of a catheter in the subarachnoid, epidural or intrathecal space
  • risk of infection, hematoma, and nerve damage as well as dural puncture
110
Q

Chemical Pain Relief Measures

A
  • regional anesthesia
  • local anesthesia
  • topical anesthesia
111
Q

Chemical Pain Relief Measures: Regional Anesthesia

A

anesthetic agent injected into or around the nerve that supplies sensation to a specific part of the body used in surgery, childbirth, and long-term pain management

  • nerve blocks
  • epidural injection
112
Q

Chemical Pain Relief Measures: Local Anesthesia

A

short or long acting

-injection of local anesthetics into body tissue

113
Q

Chemical Pain Relief Measures: Topical Anesthesia

A

applying an agent directly to the skin, mucous membranes, wounds, or burns
-absorbed quickly and provides relief for mild to moderate pain

114
Q

Surgical Interruption of Pain Conduction Pathways

A
  • Cordotomy
  • Rhizotomy
  • Neurectomy
  • Sympathectomy
115
Q

Cordotomy

A

interrupts pain and temperature sensation

116
Q

Rhizotomy

A

interrupts anterior or posterior nerve route that is located between the ganglion and the cord

117
Q

Neurectomy

A

used to eliminate intractable localized pain

118
Q

Sympathectomy

A

severs the paths to the sympathetic division of the autonomic nervous system

119
Q

Misconceptions that interfere with pain management: perceptions of the patients

A
  • pain is a sign of weakness
  • part of aging
  • no pain, no gain
  • fears of addiction
120
Q

Misconceptions that interfere with pain management: perceptions of caregivers

A
  • others in the same situation do not have pain
  • no obvious physical cause
  • concerns for drug seeking behavior and addiction
121
Q

Managing Pain In Older Adults

A
  • many take multiple medications–> drug interactions
  • drug distribution is altered due to changes in blood flow to organs, protein binding, and difference in body composition
  • at risk for under-treatment of pain due to concern about confusion + sedation by caregivers
  • may not communicate about pain effectively
  • both unmanaged pain + pain medication can increase risk of falling
122
Q

Managing Post-Operative Pain

A
  • use pain assessment tool
  • individualize plan
  • use a variety of analgesic and non-pharmacological techniques
  • administer around the clock dosing
  • monitor for side effects of analgesics
123
Q

Managing Pain in Patients with Substance Abuse or Active Addiction

A

-physical dependence + addiction not the same
>addiction is psychological dependence (compulsive use with self destructive behaviors o obtain drug)
-nurse should remain non judgmental

124
Q

Be Aware of the Following Behaviors and Consult Pain Management Specialist With Patients with Substance Abuse

A
  • repeated requests for injections
  • refusal to try oral medications
  • doctor shopping
  • pharmacy shopping
125
Q

Evaluation

A
  • compare finding with expected outcome
  • determine whether pain management strategy is effective
  • reassess patients pain regularly

Nursing 171 (38 decks)

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