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
Radiation
Used to kill, reduce size, decrease pain, or relieve obstruction
Adverse Effects
- Cell damage to blood vessels and skin
- GI effects
- Exudate in lungs
- Fistulas or necrosis of adjacent tissue
Chemotherapy
Bone marrow depression
Vomiting
Cell damage (hair loss)
Some can cause lung damage, blood vessel, and organ damage
Other Drugs
Hormones
Biologic Response Modifiers
Angiogenesis Inhibitor drugs
Analgesics
Nutrition - very important d/t vomiting and anorexia, sore mouth, loss of teeth, pain, fatigue, malabsorption d/t inflammation in GI tract
Prognosis - some have change and some do not
Assessment
Collect focused assessment data: Be alert for: Adverse effects of cancer treatments Infection or bleeding Decreased blood cell counts Psychosocial or spiritual distress
Diagnosis, Planning, and Implementing
Give psychologic support - Anxiety - Disturbed body image - Grieving Teach areas of knowledge deficit Monitor for risk for infection, injury, impaired tissue integrity Monitor nutrition Treat pain management
Evaluation
Monitor for exacerbation or remission of the disease process
Make changes in nursing care as indicated
Utilize interdisciplinary care and referrals as needed
Teaching for Discharge
Teach client to differentiate minor from serious problems
Teach client when to call for help
Oncological Emergencies
Pericardial effusion and neoplastic cardiac tamponade Superior vena cava syndrome Sepsis and septic shock Spinal cord compression Obstructive uropathy Hypercalcemia Hyperuricemia Tumor lysis syndrome
What is palliative care?
Support and comfort for individuals and families living with chronic or life-threatening illnesses
Focuses on:
- Relieving pain and other uncomfortable symptoms
- Helping families and friends involved in care giving
- Planning for chronic care and facing the end of life
Radiation Therapy (Palliative)
Radiation therapy is the medical use of ionizing radiation as part of cancer treatment to control malignant cells
Can be used for curative or adjuvant cancer treatment
Also used as palliative treatment such as pain management
Radiation therapy is commonly applied to the tumour, lymph nodes, or surrounding tissue
Chemotherapy (Palliative)
Chemotherapy is the use of chemical substances to treat disease - it refers primarily to cytotoxic drugs used to treat cancer - the chemo meds destroy cancer cells Side Effects: Nausea Anemia Immunosuppression Hair loss Weight loss
Complementary Therapies (Palliative)
Provide a positive and complementary role or enhancement of the various therapies when used in conjunction with traditional approaches Examples: Dietary Massage Therapeutic touch Relaxation
Key Elements of Palliative Nursing
Pain Management Symptom Management Cultural Considerations Spiritual Care Communication Grief, Loss, and Bereavement Preparation and Care at the time of death Achieving QOL at end of life
Pain Management
Mild to moderate pain - Acetaminophen; Codeine Severe pain - Morphine; Hydromorphone, Oxycodone; Transdermal Fentanyl; Methadone Adjuvant Analgesics - NSAIDs; Tricyclic antidepressants, anticonvulsants, steroids, oral local anesthetics Alternate routes - Oral; SC; rectal; transdermal; IV
Symptom Management: N/V
Causes: - Constipation/ bowel obstruction - Chemo - Radiation - Other meds Treatment: - Antiemetic (haloperidol, stemetil) - Odour control
Symptom Management: Constipation
Causes: - Opioids - Chemo - Radiation - Inactivity - Dehydration Treatment: - Laxatives used whenever opioids are prescribed - stimulant such as senna (Glysennid, Senokot), plus a softener such as decussate (Surfak, Colace) - Diet: fluids and fruits (prunes, figs, dates, etc.) - Mobility
Symptom Management: Anorexia/ Cachexia
Loss of appetite, poor food intake, weight loss
Causes:
- Medication (can cause nausea, bad taste in mouth)
- Pain
- Loss of appetite
Treatment:
- Improve nausea and appetite
- Dietitian to be involved to advise and optimize nutritional intake
Symptom Management: Dsypnea
Causes: - Pneumonia - Anemia - Pulmonary embolus - COPD, CHF - Positioning Treatment: - Oxygen - Opioids - Bronchodilators - Repositioning
Cultural Considerations
Culture - the learned, shared, and life way practices of a particular group that guides thinking, decisions, and actions in a patterned way
Focus on meeting the needs of each individual person and family, knowing they will experience their culture in their own unique way
Cultural Assessment
- Ascertain from the patient
- Perceptions (health, illness, death)
- Use of or belief in traditional remedies
- Role of family
Spiritual Care
Palliative Care aims to meet the psychological, social, spiritual, and practical needs of the individual and family
Spirituality has many facets - get to know the preferences r/t rituals, symbols, practices, gestures and meditation - make an attempt to meet these needs
Communication
What makes it difficult to talk about death and dying? Factors that make it difficult - Fear of own mortality - Denial - Language barriers - Lack of experience - Conflict within the family Factors making it easier - Being honest, genuine being "yourself" - Acceptance of the reality - Notion of "living until one dies" - Willingness to listen
Grief, Loss, and Bereavement
Grief
- Psychological, behavioural, social, and physical reactions to the loss of someone or something
Mourning
- The process by which people adapt to loss
Bereavement
- The period after a loss during which grief is experienced
Kubler - Ross Stages of grief
Preparation and Care at the Time of Death
Final hours of caring - Keep the dying person comfortable - Not dying alone Signs of dying process - Decreased LOC - Changes in body function
