Pain Directives Flashcards
What two drugs can be administered for the adult pain standing order?
Morphine or fentanyl
What are the conditions for fentanyl in the adult pain medical directive?
The patient must be:
Equal to or greater than 18
Unaltered
Normotensive
What are the conditions for morphine in the adult pain medical directive?
The patient must be:
Equal to or greater than 18
Unaltered
Norm ostensible
What are the contraindications to fentanyl in the adult pain medical directive?
Allergy or sensitivity to fentanyl
Injury to the head, chest, abdomen or pelvis
SBP drops by 1/3 or more of its original value
What are the contraindications for Morphine in the adult pain medical directive?
Allergy or sensitivity to morphine
Injury to the head, chest, abdomen or pelvis
SBP that drops by 1/3 or more of its initial value
What is the dosing of Fentanyl in the adult pain medical directive?
25-50 mcg fentanyl IV q 5 minutes to a maximum of 4 doses.
Max single dose 50 mcg
What is the dosing for morphine in the adult pain medical directive?
2-5 mg morphine IV q 5 minutes to a max of 4 doses.
Max single dose of 5 mg
What is the adult pain medical directive?
The patient must be in severe pain AND have an isolated hip or extremity fracture or dislocation, major burns, current history of cancer related pain, or renal colic with prior history or acute musculoskeletal back strain or ongoing pacing.
Must be 18 or older, unaltered and normotensive
Must have no allergy or sensitivity to morphine or fentanyl. No injury to the head, chest, abdomen or pelvis. Bp can’t drop by 1/3 or more
Fentanyl 25-50 mcg q 5 min max 4 doses. Or
Morphine 2-5 q 5 min max 4 doses
What are the indications for the paediatric pain medical directive?
Severe pain AND isolated hip or extremity fracture or dislocation OR major burns OR current history of cancer related pain.
What are the conditions for the pedi attic pain medical directive?
Less than 18 years old
Unaltered
HR more than 60/min (61 and up)
Age related normotensive
What are the contraindications to morphine in the paediatric pain medical directive?
Allergy or sensitivity
Injury to the head, chest, abdomen or pelvis
SBP drops by 1/3 or more of initial value
What do you have to do before administering morphine in the paediatric pain medical directive?
Patch
What is the dosing of morphine in the paediatric pain medical directive?
0.05 mg/kg ( to a max of 3 mg)
IV or SC
Q 5 minutes
Max 2 doses
In what ways can you administer fentanyl or morphine in the adult pain standing order?
IV only
How can you administer morphine in the paediatric pain standing order?
IV or SC
But….. Since it is a patch consider asking for IN
What are the indications for the analgesia medical directive? (Auxiliary directive)
Isolated hip OR extremity trauma
AND
Pain
What two drugs can be administered for the analgesia medical directive?
Tylenol and Advil
What are the conditions of administering Tylenol for the analgesia medical directive?
18 and older
Unaltered
What are the conditions of administering Advil for the analgesia medical directive?
18 to 49 years of age. (Equal to or greater than 18 and less than 50)
Unaltered
What are the contraindications for Tylenol in the analgesia medical directive?
Tylenol use within the past 4 hours Allergy or sensitivity to Tylenol Signs or symptoms of intoxication Active vomiting Major burns HX of liver disease
What are the contraindications for Advil in the analgesia medical directive?
Advil or NSAID use within the previous 6 hrs Allergy or sensitivity to ASA or NSAID's Active vomiting Current active bleeding Major burns HX of peptic ulcer disease or GI bleed Pregnant HX of cardiovascular disease Asthmatic ( unless prior use of ASA or other NSAID) CVA or TBILISI in the previous 24 hrs
What is the dosing for Tylenol in the analgesia medical directive?
One dose of 960-1000 mg
Max dose 1000mg
What is the dosing for Advil in the analgesia medical directive?
One dose of 400mg
Max dose 400
What are the clinical considerations for Advil and Tylenol in the Analgesia medical directive?
Whenever possible administer Advil and Tylenol together
This does not replace the core pain medical directive and this directive can be used in conjunctive with the pain medical directive
What is the analgesia medical directive?
For isolated hip or extremity trauma and pain Patient must be 18 or older for Tylenol and between 18 and 49 for Advil Patient must be unaltered Tylenol: Must not have had Tylenol in past 4 hrs No allergy or sensitivity to drug No s/s intoxication No active vomiting No major burns No HX liver disease
Advil:
No Advil or NSAID in past 6 hrs
No allergy or sensitivity to ASA or NSAID’s
No active vomiting
No current active bleeding
No major burns
No HX of peptic ulcer disease or GI bleed
Not pregnant
No HX cardiovascular disease
Not asthmatic (unless prior use of ASA or NSAID)
No CVA or TBI in past 24 hrs
Dosing
Tylenol 960-1000mg X11
Advil 400 mg X1
Give both together if poss
Can also use with morphine/ fentanyl
What are the indications for the moderate to severe pain medical directive (auxiliary)?
Moderate to severe pain
AND
Isolated hip or extremity trauma OR major burns OR current history of cancer related pain OR renal colic with prior history OR patients with acute musculoskeletal back pain
What are the conditions for ketorolac for the moderate to severe pain medical directive (auxiliary)?
Between 18 and 49 years old
Unaltered
Normotensive
Patient must remain NPO or is unable to take oral medications
What are the contraindications for ketorolac?
NSAID or Advil use in past 6 hrs Allergy or sensitivity to ASA or NSAIDs Pt is on anticoagulant therapy Current active bleeding CVA or TBI in the past 24 hrs Asthmatic (unless prior use of ASA or other NSAID) Pregnant Known renal impairment
What is the dosing of ketorolac?
30 mg IM/IV
MAX 1 dose
What are the clinical considerations for ketorolac?
This directive may be used in conjunction with the core directive for pain (morphine/fentanyl)
What are the indications for the adult pain medical directive?
Severe pain
AND
Isolated hip or extremity fractures or dislocations OR major burns OR current history of cancer related pain OR renal colic with prior history OR patients with acute musculoskeletal back strain OR ongoing transcutaneous pacing
