Peri-op & Anaesthesia : Pain Assessment and Management Flashcards
Assessment of pain in a surgical patient:
give some causes
- hunger
- anxiety
- hypovolemia
- delirium
- infection
- hemorrhage.
Post: op pt complains of pain….what are signifiant clincial features if found to be worried about
- mild pyrexia is common in the 48 hours after a procedure
Be worried if:
* hypotension and tachycardia -> signs of shock, which may be caused by a post-operative bleed.
Clincial Assessment of pain: What is a way of subjectively assessing a patients pain?
- Ask the patient to grade their pain on a scale of mild, moderate, or severe; this can be assessed regularly as part of the nursing observations.
- Scale of 1-10 used too - use in judging effect of interventions
Clincial Assessment of pain: What are objective features of pain?
- tachycardia
- tachypnoea
- hypertension
- sweating
- flushing
An unwillingness to mobilise or agitation may be present in those that are less able to communicate their pain
Practical tip: when assessing a pts pain where/what should you ask the to do ? to assess how their pain is affecting their functionality
Each patient should be assessed when:
* mobile
* when taking a deep breath
* when in bed
- (a pain-free patient in bed may well be in severe pain when they walk to the toilet).
What are consequences of poor pain control?›
WHO pain ladder: examples of simple analgesics
- non-opiod
- paracetamol and/or NSAIDs (e.g ibuprofen or diclofenac).
How do NSAIDs work?
- by inhibiting the synthesis of prostaglandins
- thereby reducing the potential inflammatory response causing the pain.
- These anti-inflammatory properties mean such analgesics are often used in musculoskeletal conditions
Side effects of NSAIDS
(I-GRAB)
- Interactions with other medications (such as Warfarin)
- **Gastric ulceration **(consider adding a PPI when prescribing NSAIDs long-term)
- **Renal impairment **(use NSAIDs sparingly in those with poor renal function)
- **Asthma sensitivity **(triggers 10% of individuals with asthma)
- Bleeding risk (due to their effect on platelet function)
How many steps are there on the WHO ladder- give some examples of drugs at each step
There are three steps:
- Step 1: Non-opioid medications e.g. Paracetamol and NSAIDs
- Step 2: Weak opioids e.g. codeine and tramadol
- Step 3: Strong opioids e.g. morphine, oxycodone, fentanyl and buprenorphine
What are some examples of adjuvant pain medication? Indication?
- Can combine with drugs in pain ladder OR use separately for neuropathic pain
- Amitriptyline: Tricyclic Antidepressant
- Duloxetine - SNRI antidepressant
- Gabapentin – Calcium Channel blocker used to manage epilepsy and neuropathic pain
- Pregabalin – Calcium Channel blocker used to manage epilepsy and neuropathic pain
- Capsaicin cream (topical)
What is the mechanism of action of opiates ?
They work by activating opioid receptors (MOP u, DOP, and KOP), which are distributed throughout the central nervous system.
How do NSAIDs increase the bleeding risk of a pt?
Reduce platelet function (they stop prostacyclin which usually promotes platelets)
If you are worried of a patient having NSAIDs for a long time due to side effects, what can you prescribe alongside it?
PPI
Why do NSAIDs cause renal impairment?
- NSAIDs inhibit prostaglandins.
- Usually, prostaglandin cause vasodilation of the afferent arteriole of the kidney to help maintain GFR.
- When a pt takes NSAIDS, they inhibit this vasodilation.
- SO you get poor renal perfusion - and kidney is more unable to respond to a reduced GFR
Advantages and disadvantages of Patient controlled analgesia?
