Nursing Management of a Client with Post-op Pain Flashcards
What are the types of pain?
- Acute Post-op pain
- Chronic non-malignant pain
- Cancer-related pain
What factors influence pain that the nurse should be aware of?
- Past experiences with pain
- Anxiety level
- Culture
- Age
- Gender
- Expectations about pain relief
- Tolerance to medications
- Substance use
Nurse assessment of pain?
- The 5th vital sign
- Assessed every time vital signs are assessed
- Patients need to be involved in care decisions
- Patients have a right to appropriate pain assessment and management
- Pain is assessed in ALL patients
Assessment included..
- Location
- Intensity
- Timing
- Quality: how the pain feels to patient using their words
- Aggravating/alleviating factors
What are 4 pain assessment tools used by nurses?
- Numeric Rating Scale: rate pain on scale from 1 -10
- Wong-Baker FACES pain scale: six cartoon faces; can use for adults or children
- FLACC: for children; (face, legs, activity, consolability, crying)
- Visual Analog Scale (VAS): 10cm line with word anchors from no pain to worst pain
Pre-op pain assessment
- Educate patient about pain assessment methods and management
- Assess pain with vs on admission
Intraoperative pain Assessment
- Anesthesia management,
- vital signs especially pulse and BP
Post-op Pain Assessment
- phase 1 Immediately post-op (PACU) assess on arrival to PACU and throughout PACU stay,
- give IV pain meds
Phase 2 post-op (on unit) – assess on arrival to unit; reassessed depending on patient stability / hospital policy/protocol; may be done q10min if patient unstable or may be q4 or q8 when stable / 24 hrs post-op
Methods of pain management
IV via IV push or PCA
- Opioid analgesics like morphine, Dilaudid (hydromorphone), fentanyl
- IV acetaminophen(Ofirmev) (given over 15 minutes)
Oral
-Non-opioid: acetaminophen or NSAIDS
-Opioid: oxycodone (Percocet), hydrocodone (Vicodin)
Combinations of both
IM
- Nerve block
- Epidural
- Local anesthesia pump
- Rectal (rarely used) in some children
What is the onset, peak and duration of of both IV and PO first line Opioids?
Morphine:
- Onset: 30min(PO) 5min(IV)
- Peak: 1-2hr(PO) 20min(IV)
- Duration: 4-12hr(PO) 4-5hr(IV)
Fentanyl:
- Onset: 5-15min(OT) 1-2min(IV)
- Peak: 20-30min(OT)3-5min(IV)
- Duration: 2-5hr(OT) 1/2-1hr(IV)
Hydromorphone:
- onset: 15-30min(PO) 10-15min(IV)
- Peak: 1/2-1hr(PO) 15-30min(IV)
- Duration: 4-5hr(PO) 2-3hr(IV)
What adverse effects of opioids must the nurse be aware of?
- Constipation(assess bowel movement frequency)
- Nausea
- Vomiting
- Pruritus
- Hypotension
- Sedation
- Delirium
What alternative methods of pain management can be used besides Opioids?
Physical:
- Reposition the patient
- Ambulation
- Application of heat or cold
- Massage
Cognitive and behavioral:
- Relaxation breathing
- Imagery
- Music
- Distraction
- Communication
- encouragement
What are the pros and cons of PCA
Patient Controlled Analgesia: Pros -Provides optimum pain relief via IV infusion -Hope to have minimal side effects -Patient controlled -Better than IM injection -provides steady serum levels of medication -Easier C & DB -Early ambulation -Improved pain relief and shortened hospital stay Cons -Problem is major safety issues
How is the IV tubing for PCA set up and why?
-PCA is always “piggy backed” to a primary line because PCA tubing always has a clamp on the line
What is part of the nurse’s assessment of a patient on PCA?
Monitor
- Medication use
- Sedation levels
- Accuracy of prescription that is programmed into PCA pump
- Level of consciousness
- notify MD if patient is unexpectedly somnolent
- Vital signs and call MD if respirations <12
- Degree of pain relief and call MD if not effective
- Must know and adhere to agency policy/protocol
- Must document minimum of every 4 hours
What are the characteristics and settings of Patient Controlled Analgesia?
-Medication:Morphine, Fentanyl or Dilaudid
-Dose volume: 0.1-0.5mL each dose
-Loading Dose: initial volume or amount administered to raise serum levels into therapeutic range
-Lockout Interval: length of time in which additional dosing is not possible.
(0-99min)
-4 hour maximum: maximum dose allowed in a 4 hour period is (5-30mL)
