◦Dose adjustment based on assessment of analgesic effect versus side effects
◦Use the smallest dose to provide effective pain control with fewest side effects
}Documentation MUST address all areas of nursing process!
◦1100- c/o severe pain in left foot-rated 8/10- describes as throbbing & constant-onset ½ hr ago- states “it started when I got out of bed this morning and put my foot down”- left foot pink & warm to touch- pedal pulses =88 & equal B-homan’s sign neg- DTRs 2+ B.
◦(goal and nursing diagnosis implied & doesn’t need to be charted)
◦1110- Repositioned foot without relief-massaged foot without relief obtained
◦1120- medicated with Tylenol #3 2 tabs PO
◦1145- stated “I’m comfortable. My pain is much better now”- rated 2/10
Need for increased dose to maintain same degree of pain control
Not as common as once thought
Rotate drug if tolerance develops, as increasing dose could contribute to hyperalgesia (extreme sensitivity to pain)
Expected response to ongoing exposure to pharmacologic agents manifested by withdrawal syndrome when blood levels drop abruptly
To avoid withdrawal, drug should be tapered
Neurobiologic condition with drive to obtain and take substances for other than prescribed therapeutic value
Tolerance and physical dependence not indicators of addiction