NUR 102 Fundamental

Suggestive Reading:
Potter and Perry, Fundamentals of Nursing, 6th ed, chpt. 43, pp1051-1084.
Potter and Perry, Fundamentals of Nursing, 6th ed., chpt. 36, pp 771-785.
Potter and Perry, Fundamentals of Nursing, 6th ed., Chpt. 30,pp 471-484.

Objectives:
Define terms associated with pain management
Identify techniques used in pain management
Apply the nursing process to pain management
Explain the application of the nursing process in pain management

According to the World Health Organization, “On any given day, 3 million people
suffer unrelieved pain that could be relieved”

Pain
An unpleasant sensory or emotional experience associated with actual or potential
tissue damage
Subjective, personal and private everyone perceives pain differently. It is very
multidimensional.
Multidimensional phenomenon
Cognitive pt. beliefs about pain.
Sensory each person’s perception of pain
Physiological transmission of nerve stimuli to the brain.
behavioral behaviors related to the pain.
affective emotions associated with pain
The client is the best authority on their pain experience.

Nurses roles and responsibilities in pain management legally and ethically obligated
to help relieve and intervene in pain.
Assessment where is the pain, character (sharp, throbbing, etc…), onset (acute,
chronic), what causes the pain, Duration of pain, intensity (1-10).
Implementations/Intervention
Evaluation

Assessment
Pain character, onset, location, duration, and intensity

Pain Scales
Numerical scales- (1-10)
Visual Analogs have patient to draw a line to their pain level.
Wong Baker scale or Riker scale faces, have pt point to face that relates to their
pain

Nursing Diagnosis:
Ineffective coping related to acute pain may be used for post op pt.
Impaired physical mobility related to ….. may be good for arthritic pt

Spiritual distress related to chronic pain may be verbalized by pt.

Interventions

Administration of analgesics Tylenol, motrin, hydrocodone.

Non-pharmacological pain relief methods heat/cold, message, PT

Alternative therapies accupunture, meditation.

Acute pain management

Analgesics
Non-steroidal Anti-inflammatory drugs
Opioids
Adjuvants drugs that are not necessarily meant for pain management, but
when taken w/ other analgesics they aid in pain management.

Non-Steroidal Anti-inflammatory drugs (NSAIDS)

Mild to moderate pain

Do not suppress the CNS if taken for a long period of time they will cause GI upset,
bleeds, and ulcers. May have to take protonix or other med to counter act GI
effects.
Musculoskeletal discomfort gout, arthritis
Examples- Anaprox, Naprosyn, Toradol

Opioids Analgesics traditionally called narcotics..

Moderate to severe pain Usually used post-op

Depression of the CNS especially Respiratory
Side effects include nausea and vomiting, constipation, and altered mental status
Examples- Demerol, Morphine, Lortab prolonged use can lead to tolerance and/or
psychological or physiological dependence (addiction).
Can be administered: IV, PO, and IM

Adjuvants Analgesics

Medication with analgesic properties that were not originally developed to relieve
pain
Mild to moderate pain
Combined with analgesic to enhance pain control
Examples: Amitriptyline, Neurontin

PCA analgesic patient controlled analgesic. Used post-op and with pt that have
terminal diagnosis. Connected to IV line. Morphine, Demerol, Phentinal.
Anesthesiologist will order loading dose, dosage amount, lockout time frame, and
four hour limit. Goal is to maintain med level in plasma.
Can have families that try to make pt better and end up getting too much narcotic
in pt. Wake pt up get to breathe deep and give Narcan.

Monitor pt for usage. Monitor vs, especially resp. Monitor IV sight for infiltration.
Make sure PCA is functioning properly.

Epidural Analgesic Block

Acute postoperative pain, labor and delivery, and chronic pain make sure pt
remains in same position, and holds still while being administered.
Short or long term therapy

Nursing strategies
Maintain an intravenous access at all times
Neurological checks every 4 hours while epidural catheter is in place
Monitor for signs of vital signs especially for respiratory depression
Watch for and notify anesthesia of a temperature > 101º F

Continuous Epidural/PCEA

Patient Controlled Epidural Analgesia (PCEA)

Nursing Strategies
Maintain IV access
Neuro check Q4hrs
Monitor VS***Resp
Monitor/Assess Epidural cath and site
No other sedatives or analgesic
Patient education

Chronic Pain

Cancer or non-cancer diseases

Management challenging
Combination of pharmacological/nonpharmcological therapies
Barriers affecting treatment a lot of nurses have biases, may label as drug seeker.
Remember that pt is entitled to their perception of pain; try not to label.

Management of Chronic Pain

-Massage DO NOT MASSAGE LEGS B/C OF RISK OF BLOOD CLOTS

Safe and effective way to produce relaxation and decrease pain
3-5minutes to aid in sleep and comfort

-Transcutaneous electrical nerve stimulation (TENS)

 Stimulation of the skin with a mild electrical current passed through external
electrodes
Provides a tingling sensation which aid in relieving pain

-Relaxation therapy: Meditation, Yoga, Progressive relaxation exercise, Distraction,

Music Therapy, Guided Imagery, Biofeedback, Behavioral therapy
-Relaxation Reduces muscle tension and pain

Benefits-effective in treating migraine, TMJ, abdominal pain

Limitations- compliance to adherence to treatment regimen, uncover unresolved
issues

-Acupuncture: Traditional Chinese medicine. Stimulation of certain points on the by

inserting a special needle to modify the perception of pain.

Effective- migraine headache, low back pain, whiplash

Pain management in children

Have difficulties understanding and verbalizing pain

Associate pain with experience that occur in various situations
Distraction

Pain management in elderly

Unreported pain
Chronic illnesses
Fear addiction or injury

Palliative care
Defined as the care which involves prevention, relief, reduction, or soothing of
symptoms of disease or disorders without effecting a cure
Terminal illness

Evaluation
The effectiveness of the analgesics and the side effects
The future of Pain Management
Research
Pain Clinics-Alabama Pain Center
Hospices

Questions