Symptom management Flashcards
What is required during the assessment for symptom management?
Remember the individual Holistic care What works for one will not necessarily work for another The nursing process Team work
Describe pain
“Pain is whatever the experiencing person says it is, existing whenever he/she says it does” (McCaffery 1972)
“An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (IASP 1986)
Describe the pain experienced by cancer patients.
In patients with cancer – pain is amongst the most prevalent symptom experienced, and the most distressing.
Caused by disease itself, treatments, related debility e.g. DVT, fungating wound; unrelated causes e.g.other underlying disease; psychosocial issues.
Cause often multifactorial requiring combinations of medication and/or other therapies.
Describe pain in non-malignant diseases
In patients with non-malignant disease – pain is also a common symptom
Cause is often multifactorial.
It has been suggested that patients with non-malignant disease experience their symptoms (including pain) for longer due to the slower nature of disease progression.
What are the different types of pain?
Nociceptive Somatic Visceral Neuropathic Complex regional pain syndromes
What are pain characteristics?
Acute Chronic Incident pain Breakthrough pain End of dose failure pain Intensity
Describe some barriers to pain management
Health Care Professional barriers
System barriers
Patient/family barriers
Societal barriers
What are adjuvants analgesics?
Any drug that’s primary use is not pain control, but has an analgesic effect
Antidepressants, anticonvulsants, corticosteroids, topicals, antivirals, antibiotics, bisphosphonates, anticholinergics, muscle relaxants, benzodiazepines
Adjuvants methods of treatment
Primary Therapy Anesthetic techniques Neurosurgical procedures Physiotherapy Relaxation techniques Acupuncture Behavioural therapy TENS
What systems can opioids affect?
Central nervous system GI Urinary Muscles Intolerance/hypersensitivity
Methadone
Synthetic opioid analgesic Maybe used as an alternative to morphine Potency Dosing Side effects Routes of administration
Selecting a starting opioid dose
The starting dose for opioid treatment is merely an estimate
Should be regular + prn doses of short acting opioid
When a starting dose is given it is titrated up or down according to patient response
Once pain is stable or controlled switch to most convenient dosing ie long-acting form ( +prn)
An equianalgesic chart should be used
Consider factors that may influence dosing
Long acting preparations
When using long acting preparations, pain should be first controlled with short acting opioid for 24-48 hours
Once controlled the patient can be switched to long acting q 12 hours(divide 24 hour dose by 2)
Continue the q 1 h prns
