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  1. Factors affecting pain
    • Age/developmental stage
    • Gender
    • Culture
    • Meaning of pain
    • Previous experience
    • Attention
    • Anxiety
    • Fatigue
    • Coping style
    • Family and Social support
  2. Classification of pain
    • Superficial
    • Visceral
    • Somatic: bones/muscles
    • Radiating/referred
    • Phantom: pain from an abscent source, ie amputated
    • Psychogenic
  3. What is breakthru pain/
    Transitory exacerbation of pain that occurs on a background of otherwise stable pain in a patient receiving chronic opioid therapy. 
  4. what is nocioceptive pain
    • The process by which information about tissue damage is conveyed to the central nervous system (CNS). Exactly how painful stimuli is perceived as pain is unclear. 
    • There can be pain without nociception (e.g., phantom limb pain) and nociception without pain.
  5. 4 Processes of pain
    • 1) transduction: pain stimuli
    • 2) transmission: pain signals transfered to brain
    • 3) perception: signals interpreted as pain
    • 4) modulation: down reg of response. 
  6. Steps in pain management and assessment
    • Definition
    • Recognition
    • Assessment
    • Treatment
    • Monitoring
  7. Principles of pain assessment
    • Assess and reassess
    • Use methods appropriate to cognitive status & context 
    • Assess intensity, relief, mood & side effects
    • Use personal verbal report whenever possible 
    • Document  in a visible place
    • Expect accountability – staff, family, patient
    • Elevate importance of pain management
    • Engage patient & family/loved ones
  8. Roe of nurse in pain management
    • Requires effective patient advocacy that takes 
    • Time 
    • Patience 
    • Courage
    • Must establish:
    • Trust 
    • Rapport
    • And communicate, “I believe you are in pain”
    • Must identify pain and share information with health care team as well as family
  9. Attitudes of openness and availability
    • I want to discuss with you what  your pain means to you
    • I am willing to stay with you even if I fail to help control your pain
    • I f you cannot relate to me, I will try to find someone else for you. 
  10. Barriers and false beliefs
    • Belief that failure of the patient to express pain equates with the absence of pain
    • Patient fears
    • Belief by older adults that pain is an inevitable consequence of aging
    • Belief by the patient that caregivers know pain is present and are doing all they can to relieve it
    • Lack awareness on the part of the patient that effective pain management is their right
    • Fear that persistent use of PRN and IM medications will cause them addiction
    • Fear of medication side effects/addiction
    • Fear of being seen as a complainer
    • Fear the meaning of the pain
  11. Joint Commission
    says we MUST assess and treat
  12. Methods of assessing pain
    • Visual Analogue Scale (VAS)
    • Numeric Rating Scale (NRS)
    • Simple descriptor scale
    • Wong-Baker Faces Pain
    • Rating Scale
  13. What is your goal with pain management
    • To reach the pain number the pt states is tolerable. 
    • Is subjective.  
  14. Which pain assessment tool is best?
    • No single preferred assessment tool
    • Individualize the tool for your patients
    • Make sure the patient understands the scale
    • Use the same scale with each assessment
    • Familiarity with 2 tools is suggested
    • Education of staff vital
  15. FLACC scale
    • scored scale based on location and responses.
    • Face
    • Legs
    • Activity 
    • Cry
    • Consolability 
  16. Populations requiring special consideration
    • Inadequate pain assessment
    • Concommitent pain from another source
    • Better performance status
    • High expectations for optimal management
    • Old & Young
    • Allergies
    • Culture and traditions
    • History of substance abuse(ETOH or drug)
    • Chronic and preoperative pain history
    • High anxiety about post-operative problems 
  17. Nonverbal signs of pain in the elderly
    • Increased confusion
    • Decreased decision-making skills
    • Decreased communication 
    • Combative behavior
    • Impaired mobility 
  18. Goals of pain management
    • Establish a baseline
    • Define a cause 
    • Or not
    • Sometimes don’t know the cause
    • Select interventions
    • Evaluate response to treatment 
  19. Nonpharmacy pain intervensions
    • Cutaneous stimulation: 
    • Based on “gate control” theory
    • TENS-electrodes to override nerves. 
    • PENS
    • Acupuncture
    • Acupressure
    • Massage
    • Use of heat and cold
    • Contralateral stimulation
    • Distraction
    • Progressive muscle relaxation
    • Guided imagery
    • Hypnosis
    • Therapeutic touch
    • Humor
    • Journaling
  20. Postop pain management options
    • On-Q pump
    • Patient Controlled Analgesia (PCA)
    • Epidural
    • Regional Anesthesia
    • Oral Medications
    • Opiods
    • Nonopiods 
    • Adjuvants
  21. consequences of poorly treated pain
    • Gait Disturbances
    • Falls
    • Cognitive dysfunction 
    • Agitation or restlessness
    • Polypharmacy like use of 9 or more medications
    • Increased nursing time
  22. Chronic pain assessment in the elderly
    • Unreliable signs:
    • Hypertension
    • Tachycardia
    • Diaphoresis
    • Pupillary dilitation
    • Sleep cycle changes
    • Change in mood
    • Resisting care
    • Change in behavior
    • Changes in ROM/ADL’s 
  23. Pearls for elderly pain treatment
    • Routine not PRN dosing
    • Start low, go slow BUT GO!!!!
    • Least invasive route
    • Reassess frequently
    • “He who write the narcotic, writes the cathartic”
  24. Warning signs for drug seeking behaviors
    • Preference for short acting or bolus opioids
    • Reports that “nothing else helps”
    • Multiple Prescribers:Multiple Pharmacies
    • Noncompliance with other therapies
    • Continued use despite adverse effects
    • Loss of Control
    • Not taking prescribed meds
    • Repeatedly “running out” or “losing meds”
Card Set:
2012-07-02 03:24:30
FT3 Pain Management

Pain Management
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