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What is a potential gastrointestinal side effect of opioid use?
What is a potential gastrointestinal side effect of opioid use?
What is the primary use of anticonvulsants like gabapentin?
What is the primary use of anticonvulsants like gabapentin?
What is the name of the antidepressant medication commonly used for pain management?
What is the name of the antidepressant medication commonly used for pain management?
What is the purpose of using co-analgesic agents?
What is the purpose of using co-analgesic agents?
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What is the name of the medication patch that can be applied directly to the skin for localized pain relief?
What is the name of the medication patch that can be applied directly to the skin for localized pain relief?
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What is the recommended approach when using NSAIDs in elderly patients?
What is the recommended approach when using NSAIDs in elderly patients?
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What is a non-pharmacological nursing implementation for pain management?
What is a non-pharmacological nursing implementation for pain management?
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What is a consideration when initiating opioid use in elderly patients?
What is a consideration when initiating opioid use in elderly patients?
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What is the recommended approach for managing severe pain in elderly patients?
What is the recommended approach for managing severe pain in elderly patients?
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What is a potential side effect of opioids that can lead to a sensation of itchiness on the skin?
What is a potential side effect of opioids that can lead to a sensation of itchiness on the skin?
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Study Notes
Pain Management
- The Nurse Practice Act (1997) emphasizes the RN's role in ensuring patient comfort and managing pain as a nursing function.
- The BRN (Board of Registered Nursing) adopted a pain management policy for RN practice and curriculum guidelines for nursing programs.
Joint Commission Pain Standards
- Identify pain assessment and management as an organizational priority.
- Conduct quality improvement projects.
Pain Definition
- Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.
- It is a personal and subjective experience, with the patient's report being the most reliable indicator of pain.
- Pain is a common reason for seeking healthcare.
Harmful Effects of Unrelieved Pain
- Endocrine: Increased cortisol, ADH, and epinephrine.
- Metabolic: Hyperglycemia, insulin resistance.
- Cardiovascular: Increased heart rate, blood pressure, and cardiac workload.
- Respiratory: Atelectasis, hypoxia, decreased cough.
- GU: Decreased urine output, fluid overload, hypokalemia.
- GI: Decreased gastric and bowel motility (constipation).
- Musculoskeletal: Muscle spasm, fatigue.
- Cognitive: Decreased cognition, mental confusion.
- Immune: Depression of immune response.
- Developmental: Increased behavioral and physiologic response to pain, addictive behavior.
- Future pain: Debilitating chronic pain syndrome, phantom pain.
- Quality of life: Sleeplessness, anxiety, fear, hopelessness, increased thoughts of suicide.
Types of Pain (Duration)
- Acute pain: Short duration, resulting from tissue damage (surgery, trauma, burns).
- Chronic pain: Persistent pain that can last a lifetime, continuous or intermittent.
- Breakthrough pain: Chronic pain with intense acute exacerbations.
Categories of Pain (Pathology)
- Nociceptive pain: Caused by tissue injury.
- Neuropathic pain: Caused by damage to the peripheral or central nervous system.
- Mixed pain: Combination of nociceptive and neuropathic pain.
Nociception Process
- Transduction: Involves nociceptors, releasing prostaglandins, enhancing pain signals.
- Transmission: Glutamate carries pain signals to the spinal cord and brain.
- Perception: The brain processes and interprets pain signals.
- Modulation: Neurochemicals in the spinal cord and brain regulate pain signals.
Transduction and Analgesic Agents
- Acetaminophen, ibuprofen, local anesthetics, and anticonvulsants are examples of analgesic agents.
Transmission
- A-delta fibers: Responsible for detecting thermal and mechanical injuries, quickly transmitting pain signals.
- C fibers: Slower in conducting impulses, responding to mechanical, thermal, and chemical stimuli.
Perception
- Involves higher brain structures, associated with awareness, emotions, and drives.
- Nonpharmacologic therapies and distraction can help alleviate pain.
Modulation
- Pain modulation occurs throughout the body, involving the use of different chemicals to control pain information.
- Includes serotonin, norepinephrine, and other neurochemicals.
Neuropathic Pain
- Caused by a problem with the nerves that sense touch and pain.
- Can occur without physical injury or inflammation.
- Involves peripheral and central mechanisms.
Gate Control Theory of Pain
- Explains how pain signals are processed by the nervous system.
- Involves two types of nerve fibers: small and large.
- Large nerve fibers act as a "gate" to regulate pain signal transmission.
Factors Affecting the Pain Experience
- Cultural and ethnicity variables.
- Family, biological sex, gender, and age.
- Religious beliefs and spirituality.
- Environment and support people.
- Anxiety and other stressors.
- Past pain experience.
Components of Pain Assessment
- Self-report: Most reliable measure of pain.
- SOCRATES (site, onset, character, radiates, associated system, time/duration, exacerbating, severity).
Assessing Intensity
- Pain scales: Numeric Rating Scale (NRS), Wong-Baker FACES Pain Rating Scale, Faces Pain Scale–Revised (FPS-R), Verbal Descriptor Scale (VDS), and Visual Analog Scale (VAS).
Hierarchy of Pain Measures
- Attempt to obtain self-report.
- Consider the patient's condition.
- Observe behaviors.
- Evaluate physiologic indicators.
- Conduct an analgesic trial.
Pain Management in Specific Populations
- Nonverbal patients: Use the Hierarchy of Pain Measures.
- Young children or individuals who are unable to communicate: Use FLACC.
- Patients with advanced dementia: Use PAINAD.
- Patients in critical care units: Use CPOT.
Reassessing Pain
- Regularly reassess pain to evaluate treatment effectiveness.
- Depends on the stability of the patient and timing of peak effect of medication.
- Titration (adjusting) medication.
Pharmacological Management
- PCA: Patient Controlled Analgesia, an interactive method of pain management.
- Closely monitor sedation and respiratory status.
Analgesic Medications
- Nonopioids: Decrease pain by inhibiting cyclo-oxygenase.
- Opioids: Act on the CNS to inhibit activity of ascending nociceptive pathways.
- Local anesthetics: Block nerve conduction.
Opioid Analgesic Agents
- Mu agonists: Directly activate the mu receptors in the brain and spinal cord.
- Agonist-antagonists: Partially activate certain opioid receptors while blocking others.
- Antagonists: Block the effects of other opioids.
Safe Use of Opioids
- Individualized treatment plan.
- Route of administration.
- Titration (adjusting the dose).
- Equianalgesia (comparing the strength of different opioids).
- Physical dependence and tolerance.
- Withdrawal symptoms.
Substance Use Disorder (SUD)
- Chronic and treatable neurological disease.
- Impaired control over substance use.
- Compulsive use.
- Continued use despite harm.
- Craving for the substance.
Opioid-Induced Hyperalgesia (OIH)
- Increasing doses of an opioid result in increasing sensitivity to pain.
Co-analgesic Agents
- Local anesthetics.
- Anticonvulsants.
- Antidepressants.
- Ketamine.
Nursing Implementations
- Distraction.
- Humor.
- Music.
- Mindfulness practice.
- Cutaneous stimulation.
- Acupuncture and dry needling.
- Hypnosis.
- Biofeedback.
- Healing/therapeutic touch.
- Animal-assisted intervention.
Pain Management in the Elderly
- Use acetaminophen for mild to moderate pain.
- Use NSAIDs when other treatments have failed.
- Progress to opioids for severe pain.
- Consider adjuvants that address depression and neuropathic pain.
- Consider the use of legal cannabis.
- Sensitive to agents that produce sedation and CNS effects.
- Initiate with low dose and titrate slowly.
- Increased risk for NSAID-induced GI toxicity.
- Acetaminophen preferred for mild pain.
- Opioid dose should be reduced 25% to 50%.
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Description
This quiz covers the legal and ethical responsibilities of registered nurses in managing patient pain, including the Nurse Practice Act of 1997 and the BRN's pain management policy.
