Pain mgmt in EOL Flashcards
5 ways to assess pain in mild to mod cog impairment
- direct quesry
- caregiver report
- use terms sysnonymous with pain
- ask about present pain
- ask about and observe pain behaviors
3 verbal descriptor scales
- verbal descriptor scal
- present pain inventory
- faces scale
what is best assessment in mild to mod impariment
the one the PT can use
- use the same one and be consistent
3 direct observation in in severe cog. impariment
- facial expressions
- vocalizations
- body movement/guarding
how to assess in severe cog impairment
- no optimal pattern
- if reason for pain present, treat empirically
what is optimal endpoint for pain mgmt
- not NO pain
- acheives acceptable level of releif
- preserves function and alertness
- less SEs
5 principles of pain mgmt
- educate patient and family
- investigate wisely and effectively
- do not delay> treat immed
- use pain diary if possible
- use step wise approach to pain meds
2 main non opiods
- tylenol
2. NSAIDS
2 issues
- ceiling effect
2. may have issues with full doses for renal PTs etc
5 common myths about opiods that they rarely cause
- resp depression
- addiction in this pop
- sig. tolerance
- cause death
- nausea the requires quitting them
6 main opiods
- codeine and combos
- morphine
- hydromorphone
- oxycodone
- fentanyl
- methadone
2 that have a max dose
- oxycocet
- tylenol 1-4
both due to aceto
how to choose opiod
- past experience
- clincian comfort-
- certain conditions
3 not to use
- propoxyphene
- pentazocine
- demerol
2 less desired in liver failure and replacement
- codeine
- methadone
use: oxy, morphine, hydro, fentanyl
** what to avoid in renal failure and what to use
avoid - morphine - codeine - meperidine - oxy use (inactive metabolites) - fentanyl - methadone
5 non PO routes
- IV/SC
- transdermal (fentanyl)
- rectal
- microcapsule (for PEG and tube)
- liquids
3 principlies to follow
- tirrate dose to releif
- be aware of SE
- always consider adjuvant modalities
what is opiod conversion table
codeine - 100mg PO
morphine - 10mg PO = 5mg IV
oxy - 5mg PO
hydro - 2mgPO/1mgIV
what is breakthrough dose
dose available between regular doses
how much to give for breakthrough
q1h, prn
10-20% of daily dose or 50% of q4h dose
what is longer term condideration
if pain stable, give a longer acting form
- keep same breakthrough dose
how to titrate up
simply add up amount of daily dose and all breakthrough doses taken and this tell you how much to titrate up the daily dose
how to Tx consipation
- prevent rather than Tx
- Senna
- NOT fiber and bulking agents
meds for nausea
- halperidol
- prochlorperazine
NOT gravol
