Pain management-pharmacological and non-pharmacological treatment and evaluation
non-pharmacological pain and management strategies
COGNITIVE-BEHAVIORAL MEASURES: changing the way a client perceives pain, and physical approaches to improve comfort CUTANEOUS (SKIN) STIMULATION: (TENS) transcutaneous electrical nerve stimulation, heat, cold, therapeutic touch, and massage >interruption of path pathways >cold for inflammation >heat to increase blood flow and reduce stiffness DISTRACTION: >ambulation, deep breathing, visitors, TV, games, prayer, and music >decreased attention to the presence of pain can decrease perceived pain level RELAXATION: >meditation, yoga, and progressive muscle relaxation IMAGERY: >focusing on pleasant thought to divert focus >requires an ability to concentrate ACUPUNCTURE and ACUPRESURE: >stimulating subQ tissues at specific points usuing needles (acupuncture) or the digits (acupressure) REDUCTION OF PAIN STIMULI: >in the enviroinment ELEVATION OF EDEMATOUS EXTREMITIES: >promotes venous return and decreases swelling
non-opioids
acetaminophen, NSAIDS, including salicylates (ASA) >no more than 4 g/day for pts. with healthy liver >monitor for salicylates for tinnitus, vertigo, and decreased hearing acuity. >prevent gastric upset by admin. the med with food or antacids >monitor bleeding with long-term NSAID use
adjuvant analgesics
enhance the effects of non-opioids, help alleviate other manifestations that aggravate pain (depression, seizures, inflammation), and are useful for treating neuropathic pain. ANTICONVULSANTS: >carbamazepine, gabapentin ANTIANXIETY agents: >diazepam, lorazepam TRYCYCLIC ANTIDEPRESSANTS: >amitriptyline, nortriptyline ANESTHETICS: >infusional lidocaine ANTIHISTAMINE: >hydroxyzine GLUCOCORTICOIDS: >dexamethasome ANTIEMETICS: >ondansetron BISPHOSPHONATES and CALCITONIN: >for bone pain
Opioids
morphine sulfate, fentanyl, and codeine, are appropriate for treating moderate to severe pain (post op, MI, Cancer) >parenteral fastest route- relief for short-term acute pain >oral better for chronic, no fluctuating pain MONITOR: Sedation: changes is LOC (sedation precedes respiratory depression) Respiratory depression: rate prior to and following admin. of opioids (especially opioid naive) If necessary, slowly admin. diluted naloxone to reverse effects until client can deep breathe with a RR of at least 8/min. Orthostatic hypotension: advise client to sit or lie down if lightheadedness or dizziness occurs Urinary retention: I & O, assess for distension, administer bethanechol, and catheterize. Nausea/vomiting: admin. antiemetics, advise cliets to lie still and move slowly, and eliminate odors Constipation: use preventative approach (monitoring BM, fluids, fiber intake, exercise, stool softeners, stimulant laxatives, enemas)
pharmacological Intervention- 3 classes are:
non-opioids, opioids, and adjuvants