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Acute Pain Management


Role of Nurses
Learning Objective

• Identify the unique role of nurses in


assessment and management of pain

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Critical Components - Nurse’s Role
on Pain Management
• Assessment of Pain – standardized pain scale based on
patient self report
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• Education of patient, families and staff


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• Proper intervention of treatment of pain


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• Documentation of pain assessment and


intervention

• Implementation of improvement of standards to QuickTime™ and a


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monitor pain management program


Documentation
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• Acute Post-operative Pain Management Order Sheet


– PCA-IV
– PCA-Epidural
– Analgesia Infusion Flow Sheet
Nurse Role: Knowledge Based
Practice
1. Knowledge of Self

2. Knowledge of Pain

3. Knowledge of the
Standard of Care
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• Barrier to achieving effective pain management may be


nurse’s:
– Individual experience
– Personal use of medications
– Family’s history or experience with substances for
pain control

NURSE MAY NOT ASSESS, EVALUATE OR


COMMUNICATE THE PATIENT’S PAIN LEVEL
EFFECTIVELY AND OBJECTIVELY
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1. Pain Assessment

2. Pharmacologic and Non- pharmacologic Intervention

3. Current pain management modalities and guidelines

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Analgesia Ladder for Post-operative Pain
Major surgery
 Thoracotomy
 Upper abdominal
 Knee surgery

“Moderate” surgery
 Hip replacement
 Hysterectomy
 Paracetamol/NSAID +
 Epidural L.A, opioid or combination
 Maxillofacial
 or systemic opioids (PCA)

Minor surgery  Paracetamol/NSAID +


 Inguinal hernia  wound infiltration with LA
 Varicose veins and/or
 Gyn. Lap,  Peripheral nerve block +
 systemic opioids (PCA)

 Paracetamol/NSAIDs/weak opioids
Wound infiltration with l.a. and/or
Peripheral nerve block Rawal,Reg Anes Pain Med,24:1:71,1999
Knowledge of Standard of
Care
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• Assessment and Reporting of Pain

• Development of pain management plan of care


involving patient and family

• Implementation of pain management strategies and


nursing interventions

• Evaluation of the strategies and interventions

• Documentation of interventions, patient’s response and


outcome

• Advocate for effective pain management


Basic Knowledge: What is Pain?
• Unpleasant sensory and emotional experiences associated
with an actual or potential tissue damage, or described in
terms of such damage.
IASP

* Subjective
* Self-Report
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Why do we need to control pain?
GIT/GUT
•Ileus, nausea, vomiting CARDIOVASCULAR
•Urinary retention, uterine inhibition • Increased plasma catecholamines
•Myocardial ischemia

RESPIRATORY
MUSCLE
•Atelectasis
Restless
Immobility •Pneumonia
PAIN •hypoxia

CNS
•Anxiety METABOLIC
•Depression •Increased catecholamines, cortisol
•Sleep disturbance • decreased insulin
Assessment of Pain QuickTime™ and a
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• Self-Report “The Gold Standard”


• One-dimensional Pain Scales
– Wong-Baker FACES Pain Rating Scale
– Verbal Rating Scale (VRS)
– Numerical Rating Scale (NRS)
– Visual Analogue Scale (VAS)

• Multidimensional Pain Scales


– Brief Pain Inventory
– McGill Pain Questionnaire

• Physiologic/Biologic Parameters
• Behavioral Observations
Patient & Family Education QuickTime™ and a
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• Presurgical (Preoperative)
– Teach the patient and the family members what to
expect about pain and pain management and how pain
is assessed
• Importance of ongoing assessments

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Patient & Family Education QuickTime™ and a
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• Presurgical (Preoperative)
– Patient should understand his/her own role in
managing pain
• Cooperation needed during assessment
• “staying on top of pain”
• Importance in communicating information about their status
of pain

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Patient & Family Education QuickTime™ and a
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• Presurgical (Preoperative)
– Provide written materials whenever possible

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Patient & Family Education QuickTime™ and a
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• Admission and Surgery (Intraoperative)


– Reinforce information about pain scales that was
provided to the patient during presurgical planning

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Patient & Family Education QuickTime™ and a
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• Admission and Surgery (Intraoperative)


– Topics to be discussed:
• Realistic and comfort-function goals
• Using pain scale
• Staying on top of pain management by alerting someone
if patient is present

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Patient & Family Education QuickTime™ and a
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• PACU (Postoperative)
– Reinforce the following points:
• The reality of postoperative pain
• Cooperate with anesthesia team
– Explain why frequent assessments are necessary
– Provide instruction on how to report pain
– Encourage communication
• Ineffective pain relief measures
• Increasing pain
• Pain other than surgical site QuickTime™ and a
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• Side effects of pain medications


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• Surgical Unit
– Teach the patient how pain will be assessed
– Explain the importance of managing pain in a
timely manner
– Explain to the patient that there are options
for breakthrough pain
– Make the patient aware of alternative
therapies
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Documentation
• Presurgical Planning
Clearly document the following:
– Patient’s comprehension of information
– Which pain scale was taught
– Screening for absence or presence of pain QuickTime™ and a
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– Pain management history


– Location, character, radiation,
onset/duration
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Documentation
• Admission and Surgery
– Pain score at regular intervals
– Pain intervention and response to the intervention

• PACU and Surgical Unit


– pain assessment on admission to PACU, at regular
interval and prior to transfer
– Interventions and response to interventions
Patient Controlled Analgesia

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PATIENT CONTROLLED ANALGESIA SHORTENS THE CYCLE OF PAIN