pain managements and meds Flashcards
why do we need to provide analgesia
it affects patients behaviour, appetite, welfare and their overall ehaling process (eg pain release stress hormones which delays healing) (pain-> slower healing)
secondary medical conditons can also arrise if oain is not adressed adaquately (eg from scratching thier incision site/ stress related disorders-hypertension)
why do they feel pain during surgery
tissue damage
how to prevent/ensure patient does not feel pain
pre empt the pain:
-know the procedure (long/short, more painful procedure-more analgesia) ,
- know your clinics protocol
prepare a good patient plan of care:
-include pre and post op analgesia.
-+/- intra-operative analgesia if its a long/major procedure (half life, need to top up)
when do we provide analgesia
- pre operative: usually part of the pre anesthetic protocol (eg methadone: some degree of anlgesic effect + sedative effect)
-administered preeptively (before they experince pain). - intraoperative analgesia: Analgesic drugs can be “topped up” during a surgical procedure, especially if it is a long or major procedure (half-life)
-Nerve blocks can also be performed, to reduce the amount of general anaesthesia used on a patient (nerve block adress localised pain relief, reduce amount og GA, less risk)
E.g., dental extractions - post operative analgesia: A pain management plan is usually in place after a surgical procedure, and it is tailored specifically to the patient (eg weight) and its associated procedure performed.
-Serves the vital purpose of rapidly altering the animal’s behaviour in order to avoid or minimize damage. (eg not putting wieght on injured leg)
-pain Stops when healing is complete= self-limiting.
-Varies in severity from mild to severe to excruciating.
- Symptoms can vary between individuals, but pain scale charts can help (sol to give us estimate of pain felt)
med usually given by injection- after surgery still may not be able to swallow, want them to get the full dose)m
guidelines of assing pain for post operative analgesia
same patient may hide their symtopms of pain
1.Observe the patient from afar in its bed/kennel, paying attention to its posture and demeanour (coming closer can cuase animal to hide pain) (observe for how they are sitting, how they are holding different parts of their body, tension)
2.Approach the patient and call its’ name. consider its’ response (looking from the corner of thier eye, vocalise)
3.Touch the patient, with caution, and assess its’ response (normal, aggressive-protective mechanism, flinching)
4.match oberservation to a published pain scale
pain score 0 behaviour cats and dogs
dog: comfrotable when resting
happy/content
not bothering would/surgery site
interesting/curious about surroundings
response to palpation: nontender of palpation to wound/surgery site/elsewhere
body tension: minimal
cat: content and quiet when unattended
confortable when resting
interested/curious about surrounding
for both: response to palpation: not bothered of palpation to wound/surgery site/elsewhere
body tension: minimal
pain scale 1 for dogs and cats
dog: content to slightly unsettiled to restlessness
-distracted easily by surroundings
response to stimulus: reacts to palpation of wound, surgery site/other body part by looking around,flinching or whimpering
cats: signs are often subtle and not easily detected in the hospital setting, more liekly to be detected at home by owners
-earliest signs at home: withrawal from surroundings/change in normal routine
-in hosp: content/slighly unsettled
-less interested in surroundings but will look around to see whats going on
response to palpation: may/not react to palpation of wound/surgery site
body tension: mild
pain scale 2 for cats and dogs
dogs:look uncomfortable when resting
-may whimper/cry, lick/rub wound/surgery site when unattended
-droopy ears/worried facial expression (arched eyebrows, darting eyes)
-relunctant to respond when beckoned
-not eager to interact with people/surroinds but will look around to see whats going on
respond to palpation: flinches/whimpers cries/guards/pulls away
cats: decrease responsiveness, seek solitude
-quiet, loss of brighness in eyes
-lays curled up or sits tucked up (all four feet under body, head held slighly lower than sholders, tail curled tightly around body with eyes partially/mostly closed
-hair coat appears fluffed up/rough
-may intensely groom painful/irritating area
decrease appetitle, not interested in food
response to palpation: responds aggresively or tries to escape if painful area is palpated/approached
-tolerates attention, may even perk up when petted as long as painful area is avoided
body tension:mild to moderate regresses anaglesic plan
pain scale 3 for cats and dogs
dogs: unsettled, crying, groaning, biting,chewing wound when unattended
-guards or protects wound of surgery site by altering weight distribution (limping, shifting body position)
-may be unwilling to move all/part of body
response to palpation: may be subtle (shifting eyes/increased rep rate) if dog is too painful to move/stoic
-may be dramatic such as sherp cry,growl,nite,bite threat, pulling away
cat: constantly yeowling, growling, hissing when unattended
0may bite/chew at wound, unlikely to move if left alone
response to palpation: grows/hisses at non-painful palpation
-reacts agressively to palpation, adamantly pulls away to avoif contact
body tension: mederate, regresses analgesic plan
pain scale 4 for dogs and cats
dogs: constantly groaning/screaming when unattended
-may chew/bite at wound/unliely to move
-potentially unresponsive to surroundings
-difficuit to distract from pain
response to palpation: criesat non painful palpation
may react agressively to palpation
cat: potentially unresponsivr/unaware of surroundings, diffiicuit to distract rom pain
receptive to care
respinse to palpation: may not response
may be rigid to avoid painful movement
pain tension: moderate to severe: may be rigif to avoid painful movement, regresses analgesic properlties
mode of pain relief treatment
Initial treatment is usually given by injection as this:
Ensures the patients gets the full dose of medication
Generally provides quicker analgesic effect.
Thereafter, analgesia can be provided either parenterally or orally (if hospitalised/discharged home)
what are common injectable pain medications, when are they used and contraindications
- drug class: NSAIDS (non steroidal anti inflammatory drugs)
purpose: pain relief and anti-inflammatory
carporfen (for dogs only) warnign for patients with GI/renal diease
meloxicam (for cats and dogs) warming for patients with GI, heaptic,renal diseases
mode of administration: sc, SID
- opiods: the same opidod drug given for pre-anesthesia can be given post-op too (eg premed is ace and methadone, methadone can be given 4-6hrs later-iv/im)
how to ensure drug is given continuoisly over a period of time
Besides administering analgesic drugs as separate doses given at specific timings (q6hrs, q3hrs, etc), they can be administered as constant rate infusions (CRIs).
-It might involve diluting the drugs with sterile saline/water and the drugs are administered directly into a patient’s vein (through an intravenous catheter), at a constant rate (e.g., 3ml/hr).
Common drugs used for CRIs: lignocaine, fentanyl, (opiod) ketamine, etc
what are common oral pain medications for outpatients, cleints to administer to their pets at home
Dispensed for outpatients, for clients to administer to their pets at home.
1.Non-steroidal anti-inflammatory drugs (NSAIDS)
Previous doses are usually given SC in the clinic
Eg. Meloxicam, caprofen, -coxibs (COX 2 inhibitors,type of NSAIDs)
2.Opioids
Previous doses are usually given IV/IM in the clinic
Eg. Buprenorphine, Tramadol (to be given tablet/patches for discharge)
when should meloxicam be given (tablet by woner) and why
after a meal if not can grt diarrhoea and vomitting (NSAIDs inhibit prostaglandins-> function is to protect lining of stomach)
what are the different drug categories
-OTC
-prescription only
-controlled drugs (class I-V)
what are OTC meds
-Medication that can be bought off the shelf.
-Does not require a prescription
-Mostly sold in veterinary clinics and/or pet shops.
-They generally have fewer side effects and are relatively safe to use.
E.g., eye drops, shampoo, antiparasitic medication (other then heartworm-included antiparsites)
-However, heartworm preventatives should NOT be bought OTC (e.g., Heartgard, Interceptor).
-Requires a negative heartworm test before commencing heartworm prevention.
-It is important to emphasise to clients that antiparasitic medications must be given consistently every month, without a lapse (Many parasites, like fleas, ticks, and heartworms, have life stages that can be interrupted effectively within a month, if not given consitenctly.)
prescription only drugs
-Dispensed in veterinary clinics, after a consultation with a patient.
-Usually involve medications that are dispensed specifically for the patient, for a specific diagnosed medical condition.
-If a clinic does not have a medication in stock, a prescription may be written for the pet.
-++Only a licensed veterinarian can issue a prescription
-Can be purchased at pharmacies or other veterinary clinics.
information about drug during dispensing that needs to be educated to cleint by vet tech
-Purpose of the medication for the medical condition (imp of giving med)
-dose and formulation (how many, tablet form)
Administration route (e.g. oral, topical, suppository)
Side effects of the medications (see this then stop med, call hosp)
Duration of treatment (how long med it given for)
what are common side effects of drugs
-gastrointestinal upset (vomitting, dairrhoea)
-excessive salivation
-allergic rxn (lump, bump, redness of skin)
-liver/kidney damage
-letheragy/ behaviour change
i they call up with these symptoms: ask how long it has been going on for, come in or not?
