Capital care Review Of Pain Management

  Please use the following information for the next four questions… Mrs. Watson, an 87 year-old woman, lives with her husband Mr. Watson in a suite at Canterbury Court, an assisted living residence affiliated with the Capital Care Home Care program.  They have been living at the residence for the last three years ever since Mrs. Watson could no longer care for her husband who requires a wheel chair.  Mrs. Watson has osteoporosis and some difficulty ‘getting around’.  She is otherwise healthy, cognitively aware, and usually in good spirits.  She is happy living at the residence with her husband even if they are no longer at their old home in the country. You are a member of the Watson’s interdisciplinary health team.  When you arrive at their room this morning you notice Mrs. Watson is fidgeting, withdrawn, has not touched her breakfast, and wants to go back to sleep. True or False: All of these signs indicate Mrs. Watson is in pain. 

• True

• False

Which of the following drug classes are considered as Adjuvant Drugs (Co-Analgesics) for pain therapy?

• Anti-depressants

• Anti-convulsants

• Muscle Relaxants

• Membrane-Stabilizing Agents

• All of the Above

PainAD is used only for residents who are non-verbal with advanced dementia.

• True

• False

Because of the widespread effects of Mr. Jones' disease, proper _____________ in his bed, wheelchair or couch will be necessary to maximize his comfort, thereby helping to reduce his pain.

According to the Capital Care policy manual on pain management, when should residents be observed and questioned for the presence of pain?

• A) During each shift by Health Care Workers

• B) Every time vital signs are taken

• C) Prior to helping the resident to the bathroom

• D) Both A & B

According to the Continuing Care Pain Assessment Tool, each resident should be asked to rate his/her pain using both the ______________ and ______________ scales.

Mrs. Watson is cooperative and eager to help you assess her back pain.  You find it easiest to use the numeric rating scale and verbal rating scale because Mrs. Watson is cognitively aware and capable of describing her pain.Numeric Rating Scale (NMR)Mrs. Watson describes her pain this morning as distressing and a 7 on the NMR.What scale could you use if Mrs. Watson was non-verbal or had severe dementia?

Please use the following information for the next four (4) questions:Mr. Jones is a client who has been living on your unit for the past two years.  He has been diagnosed with rheumatoid arthritis (RA) and experiences frequent flare-ups.  Although he is on medication to manage his systemic symptoms, he has been complaining of increasing pain and difficulty in using his hands to complete his activities of daily living.As a member of Mr. Jones' interdisciplinary team, you might recommend which of the following interventions to help relieve the pressure he is experiencing in his hand and wrist joints:

• Pastoral Care

• Sensory Stimulation

• Referral to a Recreation Therapy program

• A splint

Mrs. Lawson comes into the clinic complaining of severe nerve pain in her hands and feet related to her diabetes. She has suffered from similar pain before, but has not previously taken any medication for it. She says that the pain is worsening, and describes it as being "shooting, sudden, and recurring."  What might be the most effective treatment for Mrs. Lawson's neuropathic pain?

• Amitriptyline

• Gabapentin

• Phenytoin

• B and C only

• All of the Above

Use the following information to answer the next 2 questions: Mr. Kennedy's arthritis pain has been worsening over the past year. Previously, he says he has not taken much for his arthritis other than daily ibuprofen. He says that the doctor mentioned that maybe he should start on something else to help with the pain, such as codeine.  Mr. Kennedy explains that he has taken codeine once- 10 years ago when he fell and broke his leg, but had major problems with constipation and stomach upset while he was taking the codeine. He mentions that even the ibuprofen bothers his stomach sometimes. Mr. Kennedy says that he heard something about a patch that could be used to treat his pain, and he is wondering if perhaps a patch might be better for him, so he avoid having more stomach problems. True or False: Mr. Kennedy should be started on a transdermal slow-release opioid patch (Fentanyl) immediately in order to treat his arthritis pain, and avoid the negative GI side effects associated with oral opiate treatment.

• True

• False

Mr. Jones' rheumatoid arthritis has been progressing over the past year and now affects most of his joints.  During a flare-up, Mr. Jones' joints become excessively swollen which not only causes him pain but makes it difficult for him to get around the centre.True or False: Compression and acupuncture are two interventions that can specifically help to reduce edema.

• True

• False

Mrs. Watson sighs and explains that her back has been 'acting up' lately and this morning it feels especially painful.As a competent member of the healthcare team you recognize the need to assess Mrs. Watson’s level of pain.  You remember this assessment is your responsibility and that there are many consequences for a patient with persistent pain. Which of the following are consequences of persistent pain?

• Depression

• Anxiety

• Decreased Socialization

• Suicide

• Increased healthcare utilization and cost

• All of the above

• A, B, and C only

• A, B, C, and E (Not D)

As stated in the Capital Care poilcy manual on pain management, it is the responsibility of the HCA to monitor the effectiveness of the exisiting pain interventions.

• True

• False

If Mr. Kennedy is started on an oral codeine therapy, which of the following side effects should he be monitored for potential toxicity?

• Nausea

• Decreased sensitivity to touch

• Excessive Salivation

• Hyperactivity

• Pruritis / Itching

• Hallucination

• Diarrhea

• Myoclonus

While Mr. Jones is living in the centre, his pain can fluctuate from week to week, depending on his current symptoms.  Use the space below to list some of the non-pharmacological interventions that you can use to educate Mr. Jones so that he can learn how to self-manage and minimize the pain he experiences on a day to day basis.

According to the Verbal Pain Rating scale, identify the words (6) that are used to assess and measure the resident's pain; starting with no pain at all.