Assessing Pain What is pain Do you believe that perception is reality What are EB clinical practice guidelines What if client nonverbal or you do not speak the same language Pain vs suffering ID: 761829
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Assessing Pain What is pain?Do you believe that “perception is reality”?What are EB clinical practice guidelines??What if client non-verbal, or you do not speak the same language?Pain vs suffering 1
Assessing Pain LocationIntensityQualityOnset, duration & recurrenceManner of expressing painPrecipitating factors Alleviating factors Effects on ADL (C&DB, ambulating) 2
INS Standards of Practice, 2011 The nurse shall:be competent in the care of patients receiving PCA. have knowledge of the appropriate drugs used with PCA, including: pharmacokinetics and equianalgesic dosing contraindications , side effects and their managementappropriate administration modalitiesanticipated outcomes. 3
INS Standards of Practice, 2011 The patient and caregiver shall be educated in the use of PCA. The patient’s and caregiver’s comprehension and ability to comply with procedures shall be evaluated and documented prior to, and on initiation of therapy.The use of infusion devices shall adhere to manufacturers’ directions for use. 4
Definitions Anesthesia Analgesia 5
Equianalgesia “approximately equal analgesia”Used when switching from 1 pain med or route to anotherStandard: Morphine, 10 mg IM/IV or 30 mg po Chart: Craven, p. 1202, Table 44-3 6
Patient Controlled Analgesia Self-delivery of narcoticsGoal: constant plasma levelIV, SQ, epidural Acute or chronic pain Philosophy of care 7
Patient Criteria AlertAble to comprehend instructions Physically able to push button Acute or chronic pain No allergy to medication ordered 8
Advantages Pump infuser can be used – get pain med quickerShown to be safe and effectivePatient more relaxed when have more controlAnalgesia more effective when serum level constantPostop patients can avoid peak & trough Patients shown to ambulate sooner after abdominal surgery. Better pain control= better able C&DB 9
Potential Side Effects ( opioids) OversedationHypotension Respiratory depressionUrinary retentionNausea/vomiting Constipation pruritus 10
Factors that reduce patient safety Improper patient selectionPump problemsProgramming errorsStandards require 2nd signature on initiation “PCA by proxy” 11
Parts to PCA order Name of drugConcentration (mg/ml) of drug Loading dose (Bolus) Mode Continuous infusion (Basal) PCA (patient activated) Combination PCA dose lockout interval (Delay) Hour limit (1 or 4 hour limit) 12
Equipment PCA pumpKeyPCA tubingSyringe/cassette of medication Patent, running IV 13
Teaching Teach before procedureButton Can't overdose (lockout)Family/friends should not operate Report to you if ineffective 14
Teaching Report side effects Goals of therapyReturn demonstration 15
Assessment Pain level Sedation levelRespiratory rate Other side effects History of attempt/injections 16
Ineffective Pain Management First: look at historyPain r/t ineffective medicationIs there a titration order?Pain r/t knowledge deficit 17
Documentation Q 4 hAssessment# attempts / # injectionsAmount of drug infused Amount of drug in syringe 18