Pain and Neoplasm Flashcards
ABC’s of Pain Assessment
A- ask about pain regularly
B- believe the patient and family in their reports of pain and what relieves it
C- choose pain control options appropriate for the patient, family, and setting
D- deliver interventions in a timely, logical, and coordinated fashion
E- empower patients and families
E- enable them to control their course to the greatest extent
PQRST
Mnemonic that can be used every time pain is being assessed
When everyone uses the same assessment techniques and tools assessments are more consistent and accurate
P- Precipitating and Palliative Factors
Aggravating and alleviating factors
What makes the pain better, what makes the pain worse?
Positioning - walking, sitting, standing, turning and repositioning (are they moaning when moved)?
Time of day
What does the pain interfere with?
What are the patient’s expectations?
Q- Quality of Pain
Description
What does the pain feel like?
Use the patient’s own words
Don’t rush the patient, they often need a few minutes to determine a description
Aching, stabbing, burning, tingling, dull, heavy, pinching, sharp, pins and needles, shooting, throbbing
R- Radiating
Where is the pain?
Does the pain radiate or travel?
S - Severity
Quantitive measure of pain
Use an appropriate scale to evaluate pain
Patients rating of pain, not caregivers perception
What is your pain now, what is the worst/ best it gets?
Type of scale used is dependent on patients cognitive status
T- Temporal/ Time
Pattern of the pain
Is there a time of day the pain is better or worse
How long have you had pain
Is the pain constant or intermittent
Is pain associated with a specific activity
What does the pain interfere with
Treatment
Cool compresses
Comfort measures
Behavioural techniques
Transcutaneous electric nerves stimulation (TENS)
Acupuncture
Analgesics
NSAIDs
Narcotics
Nerve Blocks
Surgery - cordotomy, neurectomy, sympathectomy, rhizotomy
Complementary therapy - acupuncture, biofeedback, hypnotism, relaxation, distraction, cutaneous stimulation
Treatment for chronic pain
Focuses on reducing or eliminating patient’s pain while improving or at least stabilizing
Attempt’s to reduce patient’s needs for medications
The WHO 3-step Analgesic Ladder
Pain -> Nonopioid analgesic ≠ Adjuvant therapy (Pain persisting or increasing) -> Opioid for mild to moderate pain \+ Nonopioid analgesic ≠ Adjuvant therapy (Pain persisting or increasing) -> Opioid for moderate to severe pain Nonopioid analgesic ≠ Adjuvant therapy (Freedom from pain)
Psychological Manifestations Characteristic of Cancer
Stress Grief Guilt Fear and anxiety Powerlessness Isolation Concern for body image Sexual dysfunction
ACS Goals of Medical Treatment
To eliminate the tumour or malignant cells
To prevent metastasis
To reduce cellular growth and tumour burden
To promote functional abilities and provide pain relief to those whose disease does not respond to treatment
Cancer Treatment
Surgery Chemotherapy Radiation - Internal radiation - External radiation Biotherapy or immunotherapy Bone marrow transplant Complementary therapies
Cancer Treatment
Multidisciplinary approach: nutritional counselling, physiotherapy, assistance with other problem
It may be curative, palliative, or prophylactic
Team
Surgeon Surgical oncologist Radiologist Pathologist Medical oncologist Oncology nurse Registered dietician Family doctor Oncology pharmacist Oncology social worker or psychologist Plastic surgeon Palliative care nurse
