Pain Management and Legal/Ethical Responsibilities
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Questions and Answers

What is a potential gastrointestinal side effect of opioid use?

  • Constipation (correct)
  • Diarrhea
  • Nausea
  • Heartburn

    • What is the primary use of anticonvulsants like gabapentin?

  • Inducing anesthesia
  • Relieving itching
  • Treating seizures (correct)
  • Managing chronic pain

    • What is the name of the antidepressant medication commonly used for pain management?

  • Lidocaine
  • Duloxetine
  • Ketamine
  • Nortriptyline (correct)

    • What is the purpose of using co-analgesic agents?

    <p>To enhance the effectiveness of pain relievers</p> Signup and view all the answers

    What is the name of the medication patch that can be applied directly to the skin for localized pain relief?

    <p>Lidocaine patch 5%</p> Signup and view all the answers

    What is the recommended approach when using NSAIDs in elderly patients?

    <p>Use when other treatments have failed</p> Signup and view all the answers

    What is a non-pharmacological nursing implementation for pain management?

    <p>Providing animal-assisted intervention</p> Signup and view all the answers

    What is a consideration when initiating opioid use in elderly patients?

    <p>Titrating slowly</p> Signup and view all the answers

    What is the recommended approach for managing severe pain in elderly patients?

    <p>Progressing to opioids</p> Signup and view all the answers

    What is a potential side effect of opioids that can lead to a sensation of itchiness on the skin?

    <p>Pruritus</p> Signup and view all the answers

    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.

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