Critical Care Pain Management

Questions and Answers

What is the primary benefit of effective pain management in patients?

It enhances patient anxiety and discomfort.

It prolongs the time needed for patient assessments.

It improves patient care by reducing anxiety and discomfort. (correct)

It reduces the need for physical therapy.

When administering Morphine sulfate via IV, what is the correct dosage and frequency?

0.5-1 mg every 20 minutes.

2-5 mg every 5 minutes. (correct)

1-3 mg every 15 minutes.

5-10 mg every 10 minutes.

Which of the following actions should NOT be taken in managing a patient's pain?

Ignore the patient's comfort position if determined. (correct)

Reassure the patient to alleviate anxiety.

Assess the patient's level of pain using a reliable scale.

Reassess the patient's pain level after treatment.

Under what condition can pain medication be safely administered?

If the systolic BP is over 90 mmHg. Signup and view all the answers

If unable to establish IV access, what is an alternative method for administering Morphine?

Intramuscularly (IM) every 15 minutes. Signup and view all the answers

What is the role of Ondansetron (Zofran) in pain management?

To treat nausea and/or vomiting. Signup and view all the answers

Which pain management step is critical when transporting patients?

Pay special attention to pain management due to environmental changes. Signup and view all the answers

What is a primary feature of the Wong-Baker Faces Pain Rating Scale?

It uses a series of facial expressions to indicate pain levels. Signup and view all the answers

Which of the following statements about Fentanyl is correct?

It can be repeated one time in 5 minutes IV. Signup and view all the answers

In terms of pharmaceutical management of pain, what is a key consideration?

Regular monitoring of the patient's vital signs. Signup and view all the answers

What is the recommended action if a patient's condition remains unstable after administering 2 liters of Normal Saline?

Immediately administer blood products Signup and view all the answers

Which IV gauge is preferred for administering blood products in adults?

18 gauge Signup and view all the answers

What is the maximum time blood products can remain outside a 2-8 degrees Celsius environment before they must be discarded?

4 hours Signup and view all the answers

What must be documented at the completion of a blood transfusion?

The patient's response to blood product Signup and view all the answers

Which of the following is NOT required to be confirmed by two health care providers before blood product administration?

Patient's medical history Signup and view all the answers

What indicates that the infusion rate of blood products should be increased?

Completion of 30 minutes without any reactions Signup and view all the answers

In which situation should Furosemide be administered during blood transfusion?

After each unit for patients showing signs of CHF Signup and view all the answers

What is required in the event a transfusion reaction is noted during administration?

Stop the transfusion and remove all tubing Signup and view all the answers

What must be done if blood products are not used during transport?

Document the time and turn them in at the receiving facility Blood Bank Signup and view all the answers

What type of filter is mandated when administering blood products?

Leukocyte reduction filter Signup and view all the answers

What is the maximum dose of Fentanyl for patients with known renal failure?

50 mcg Signup and view all the answers

What is the correct administration protocol for Midazolam?

2.5-5 mg IV/IN/IM, may repeat in 5 minutes Signup and view all the answers

What must be verified before administering pain medications to a patient with unstable vital signs?

Allergy to the pharmaceutical agent Signup and view all the answers

Under what conditions should a patient with a head injury receive pain medication?

Only with a direct order from Medical Control Signup and view all the answers

When administering sedation, what must be done before using a paralytic agent?

Contact On Call Critical Care Medical Control Signup and view all the answers

What is the recommended dose of Lorazepam and its repeat frequency?

1-4 mg IV, may repeat every 15 minutes Signup and view all the answers

Which medication requires monitoring for respiratory status and readiness of a bag valve mask during administration?

Midazolam Signup and view all the answers

What is the flushing technique recommended for accessing a Central Venous Catheter?

Use pulsating technique and maintain pressure at the end of the flush Signup and view all the answers

What should be done if the CCT crew is unsure they can safely transport a patient?

Seek a restraint order for transport Signup and view all the answers

Study Notes

Pain Management Protocol

Pain is the most common complaint; effective control reduces anxiety and discomfort.
Assess pain using the Pain Assessment Scale (0-10) or Wong-Baker Faces Pain Rating Scale.
Position the patient for comfort and provide reassurance.
Consider treatment options like ice or splinting, reassessing pain after interventions.
Pain management includes pharmaceutical options, with medication guidelines based on systolic blood pressure (>90 mmHg).

Medication Administration Guidelines

Morphine Sulfate: 2-5 mg IV every 5 minutes; if IV access fails, 2-5 mg IM every 15 minutes.
Ondansetron (Zofran): 4 mg IV/IM for nausea, repeat in 15 minutes if needed.
Fentanyl: 50 mcg IV over 2 minutes, repeatable once; 50 mcg IM if IV access fails.
Hydromorphone: Administer 0.5-1 mg IV, repeat once.
Ketamine: 30 mg IV for patients over 15, after opioid administration.

Monitoring and Special Considerations

Monitor for respiratory depression and blood pressure after narcotic administration (check 5 mins post-dose).
Confirm no allergies to medications before administration; consult Medical Control for patients with head injuries or unstable vital signs.
In renal failure cases, reduce Fentanyl dose to 25 mcg.

Sedation Management

Address anxiety and confusion; attempt verbal reassurance first.
If sedation is necessary, choose appropriate sedative medications:
- Midazolam: 2.5-5 mg IV/IM, repeatable in 5 minutes.
- Lorazepam: 1-4 mg IV, repeat every 15 minutes.
- Diazepam: 2-10 mg IV/IM, repeat every 10 minutes.
- Propofol: Continuous IV infusion, titrate as needed (5-55 mcg/kg/min).

Restraint and Safety Measures

Seek restraint orders if patient safety is uncertain during transport.
Prepare for potential airway support; have bag valve mask ready.
Ketamine can be given at 1 mg/kg IV or 2 mg/kg IM if necessary.

Accessing and Using Medical Devices

Maintain aseptic technique when accessing Implanted Subcutaneous Ports or Central Venous Catheters.
Scrub injection caps with antiseptic, allow to dry before access.
Use single-use flush systems and flush vigorously to prevent reflux.

Blood Product Administration

Administer blood products urgently for cases of acute blood loss and clinical instability after 2 liters Normal Saline.
Evaluate patients for signs of shock such as low BP, tachycardia, and altered mental status.
Confirm baseline vital signs, review previous transfusion history, and ensure IV site patency before administering blood products.

Pre-Administration Checks

Verify blood products' temperature (2-8°C) and administration within 4 hours.
Dual verification of patient details, blood type, and product information by healthcare providers.

Infusion Management and Reaction Protocol

Start infusions slowly, monitoring closely for adverse reactions; rates can be increased after initial assessment.
If a reaction occurs, stop transfusion, conduct reassessment, and document all findings and actions taken.
Use appropriate filters and saline to support transfusion, documenting infusion details thoroughly.

Post-Infusion Care

Flush IV site with Normal Saline after completion of blood product administration.
Consider medications like Diphenhydramine for allergic reactions or Furosemide for signs of CHF after transfusion.

Documentation Requirements

Record blood product details, infusion start and end times, total volume infused, and the patient's response to the treatment.

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Description

Explore the essential concepts surrounding pain management in critical care settings through this quiz. Understanding the assessment of pain severity and relief strategies can significantly enhance patient comfort and care. Ideal for healthcare professionals involved in pain management.