who sets the standards for pain and pain management?
the joint commission
JC standards
rights of pts to assess and manage pain
assess pain in all pts
record assessment of pain and f/u
educate providers, pts and families
establish pain and med policies
include pt needs for Sx control in discharge planning
collect data to monitor effectivenes
types of pain
acute
chronic
cancer
acute pain
protective
identifiable cause
rapid onset
short duration
varied intensity
disappears with healing
chronic pain
extends beyond healing time becoming own disease
lacks identified pathology
VS no longer indicate pain
does not provide protective function
disrupts sleep and ADLs
Cancer pain
acute, chronic, or intermittent
related to tumor recurrence of treatments
who is the only one who knows whether pain is present and what the experience is like?
the pt
define pain
unpleasant subjective sensory and emotional experience associated with actual or potential disuse damage or described in terms of such damage
optimal pain management is the right of
every pt
carefully observe a pts behavior and nonverbal responses to pain when
when he/she is unable to self report
most effective pain management combines
pharm and non-pharm strategies
assess each pts
coping style, physical status, past experiences with pain, culture and ethnicity, expectations for pain relief, and emotional health to design and effective pain management
make sure care is
pt centered
culture can effect
how pain management can be handled
EBP for pain management
report behavioral changes
assess for causes/modifiers
use non opioids cautiously
consider rational for polyp harm
preemptive analgesia goal
individualized pain management plan
non opioids may have more serious SE than
opioids, esp in elderly
smaller doses of more meds is
rational poly pharmacy or multi mobile dosing- fewer SE and greater analgesia
we need to know pts
PMH
MEDS
therapies used
OTC meds
tolerance is not
an early sign of addiction
drug-drug interactions
often occur with multiple drug use in pts with chronic pain
most pts can function with a pain level
<3
first 24hrs on opioids req freq assessment of at least
q4hrs
who can press PCA pump med for pt
only the pt
when inflammation occurs,
protective mechanism and to establish tissue repair
infection caused by
microorganisms
not all inflammation is caused by
infection
inflammation signs
redness
swelling
pain
heat
loss of function
types of analgesia
non opioids
opioids
adjuvants
non-opiods
acetaminophen
NSAIDS
opiods
morphine
hydromorphone
oxycodone combination
adjuvants
anticonvulsants (gabapentin)
tricyclic antidepressants
corticosteroids
local anesthetics (lidocaine patch)
antihistamine (hydroxyzine)
most common classification of pain is by
duration
actue- mild, mod, severe, sudden,
chronic- prolongued duration
pain can also be classified by
origin
nociceptors are activated by noxious stimuli which can be
chemical
mechanical
thermal
in peripheral tissue
somatic pain
bones and muscles
visceral
organ pain
neuropathic pain
neural hypersensitivity
inj or disease of peripheral or central nervous system
neuropathic pain symptoms
burning, tingling, electrical pain with touch
common in DM
adjuvant meds used with opiods or non opioids are used at
lower dosages for decreased SE
aspirin precautions
decreases inflammation by inhibition of prostaglandins
anti platelet that decreases platelet aggregation in blood clotting
GI distress
not to be taken with other NSAIDS
S/S of overdose of NSAIDS including aspirin in pts
tinnitus, vertigo, bronchospasm
observe aspirin and ibuprofen pts for
S/S of bleeding
ibuprofen
reduces inflammation and fever
med hx r/t increases effects of phenytoin, sulfonamides, warfarin
may cause GI upset
not to be taken with other NSAIDS or alcohol
non-opiods treat
mild to mod pain
non-opioids are effective for
dull, throbbing pain, dysmenorrhea, inflammation, minor abrasions, muscular aches, arthritis
acetaminophen risk
hepatotoxicity
opiods treat
mod to severe pain
opioids cause
resp depression, euphoria and sedation, consitpation, hypotension
antitussive =
resp depression and cough
opioids are contraindicated in
head inj pts r/t increase ICP (hypoventialtion inc CO2 which vasodilates
morphine antidote
narcan
hydromorohone (dilaudid)
6x potency of morphine with less hypnotic effect and GI distress
combination drugs treat
mod to severe pain, decrease dependency risk
adjuvants
anticonvulsants (act on peripheral nerves in CNS)
antidepressants- SSRI, tricyclics (prevent re-uptake of serotonin)
corticosteroids (reduce nociceptive stimuli)
antidysrhythmics- mexiletine (block sodium channels)
local anesthetics- lidocaine patch (inte
opioid addition
when stopped suddenly-
withdrawal symptoms, rebound pain
withdrawal S/S
diarrhea
abd cramps
watery eyes
runny nose
nausea
restlessness
methadone treatment programs
replaces opioid with methadone which is less effective
rebound pain
increased previous pain
maintenance program is
same dose every day
weaning program is
less dose over time
opiod overdose
narcan
benzo overdose
remazicon
overdose pt gets
O2, suction, antidote
monitor overdose pts for
vitals, o2, LOC, tremors, convulsions,
vitals and LOC done every
15 min for first 2 hrs
assess overdose pt IV site every
shift
NARCAN assess for:
bp changes, tachycardia, dysrhythmias
Benzo antidote pt, assess for:
rash, hot flashes, dizziness, headaches, sweating, dry mouth, blurred vision,
non-pharm intervetions
physical measures
cognitive-behavioral
physical measures
cutaneous stimulation-
cold, heat or pressure
therapeutic touch
massage
vibration
transcutaneous electrical nerve stimulation
cognitive-behavioral interventions
complimentary medicine
distraction
imagery
hypnosis
magnet therapy
accupuncture
herbal remedies
whichever method of interventions, consider:
pain relief last as long as stimulation is present and outcomes are unpredictable
invasive pain techniques
interupt pain pathways when pain is debilitating or intractable (nerve block)
temp or permanent, outpt procedures