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Check the MARs and nurses’ notes for the past several days.
Ask the nurse educator to give an in-service about pain management.
Perform a complete pain assessment and history on the client.
Have a conference with the nurses responsible for the care of this client
Sensory
Affective
Sociocultural
Behavioral
Cognitive
Amitriptyline (Elavil)
Corticosteroids
Methylphenidate (Ritalin)
Lorazepam (Ativan)
A client with fibrolyalgia
A client with phantom limb pain
A client with progressive pancreatic cancer
A client with trigeminal neuralgia
Make a note in the nurse’s file and continue to observe clinical performance
Refer the new nurse to the in-service education department.
Quiz the nurse about knowledge of pain management
Give praise for the correct dose and time and discuss the deficits in charting.
Simple description pain intensity scale
0-10 numeric pain scale
Faces pain-rating scale
McGill-Melzack pain questionnaire
Treatment is based on client goals.
A multidisciplinary approach is needed.
The client must be believed about perceptions of own pain.
Drug side effects must be prevented and managed.
Intraspinal
Patient-controlled analgesia (PCA)
Intravenous (IV)
Sublingual
Administer smallest dose that provides relief with the fewest side effects.
Titrate upward until the client is pain free.
Titrate downwards to prevent toxicity.
Ensure that the drug is adequate to meet the client’s subjective needs.
Therapeutic touch
Use of heat and cold applications
Meditation
Transcutaneous electrical nerve stimulation (TENS)
An elderly chronic pain client with a hip fracture
A client with a heroin addiction and back pain
A young female client with advanced multiple myeloma
A child with an arm fracture and cystic fibrosis
Encourage expression of fears on past experiences
Provide accurate information about use of pain medication
Explain that addiction is unlikely among acute care clients.
Seek family assistance in resolving this problem.
Fever
Nausea
Diaphoresis
Abdominal cramps
Assist the client with preparation of a sitz bath.
Monitor the client for signs of discomfort while ambulating
Coach the client to deep breathe during painful procedures
Evaluate relief after applying a cold application.
Prepare the medication and hand it to the physician
Check the hospital policy regarding use of the placebo.
Follow a personal code of ethics and refuse to give it.
Contact the charge nurse for advice.
Closely assess for nonverbal signs such as grimacing or rocking.
Obtain baseline behavioral indicators from family members.
Look at the MAR and chart, to note the time of the last dose and response.
Give the maximum PRS dose within the minimum time frame for relief.
IV
IM or subcutaneous
Oral
Transdermal
PCA
Deliver the bolus dose per standing order.
Contact the physician to increase the dose.
Try non-pharmacological comfort measures.
Assess the pain for location, quality, and intensity.
Diversional therapy, such as playing cards or board games
Massage of back and neck with warmed lotion
Side-lying position with knees to chest and pillow against abdomen
Transcutaneous electrical nerve stimulation (TENS)
PRN at the client’s request
Prior to painful procedures
IV bolus after pain assessment
Around-the-clock
Potassium 3.6 mEq/L
Hematocrit 41%
PT 14 seconds
BUN 20 mg/dL
An anxious, chronic pain client who frequently uses the call button
A client second day post-op who needs pain medication prior to dressing changes
A client with HIV who reports headache and abdominal and pleuritic chest pain
A client who is being discharged with a surgically implanted catheter
“The doctor ordered the medicine to be given every 4 hours.”
“If the medication is given too frequently he could suffer ill effects.”
“Please tell him that I will be right there to check of him.”
“Let’s wait about 30-40 minutes. If there is no relief I’ll call the doctor.”
A client who needs pre-op teaching for use of a PCA pump
A client with a leg cast who needs neurologic checks and PRN hydrocodone
A client post-op toe amputation with diabetic neuropathic pain
A client with terminal cancer and severe pain who is refusing medication
Wait!
Here's an interesting quiz for you.