Gero Module 3: Pain Management in Palliative Care

What is the most common adverse effect related to the use of acetaminophen?

Liver dysfunction

Physiological Dependence

Manifested by a withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood lvl of the drug, and/or administration of an antagonist, like naloxone

Constipation Process

1- Reduced peristalsis 2-Increased re- absorption of water

Addiction

A primary, chronic, neurobiological disease with genetic, psycho-social and environmental factors influencing its development and manifestations

Pediatric pain scale used from 2-7

FLACC

Chronic Pain

Persists for longer than 3-6 mos

Most opioids do not have a ceiling effect, T/F?

True

Physical/Biological Pain

What has caused the pain?

Tolerance

A state of adaptation in which exposure to a drug induces changes that result in diminution of one or more of the drugs effects of over time

You are performing a pain assessment on Matilda. Your assessment reveals that Matilda has pain rated as a 5 in her left hip that worsens with movement. She has been having this pain off and on for the last three years. Which of the following pain assessment components have you not addressed in your assessment?

Alleviating factors

During your assessment, you notice Robert, who has a diagnosis of dementia, rubbing his right shoulder. What should you do next?

Ask Robert if he is in pain.

Yolanda has osteoarthritis of the left knee for which she is receiving acetaminophen 1000mg every six hours. She rates her pain at a 4 every time you ask. What do you think an appropriate next step would be at this time?

Ask Yolanda what an acceptable pain score is for her.

Mr. T's wife tells the nurse she doesn't want him to take the morphine the doctor ordered for his cancer pain because she heard from a friend that he could stop breathing because of it. Your best response would be:

Breathing problems are rare when these medications are used as ordered.

Renal dysfunction

Can occur when patients are dehydrated, decrease GFR and cause tublular injury

Joey is a 3-month-old who has a serious illness and will probably die in the next few months. His mother is concerned that he looks like he is in pain whenever she has to change his diaper. Your best response to her is:

Can you explain to me what Joey looks like that makes you concerned he is in pain?

NSAID GI toxicity

GI toxicity through local and systemic effects, GI bleeds, gastric ulcers.

Neuropathic Pain

Generally due to damage to the nervous system

You are talking with the parents of a 2-year-old boy diagnosed with leukemia about pain management. Which statement indicates an understanding about pain management in children?

He needs to be assessed carefully so that he gets enough pain medication.

Spiritual Pain

How does the pain affect the person's spiritual well-being? Questioning god or higher power?

Addiction behaviors

Impaired control over drug use, compulsive use, continued use despite harm, craving

NSAID Action

Inhibit the cascade of inflammatory, inhibit prostoglandins by blacking cyclooxygenase

Platelet Aggregation

Inhibited by thus bleeding is a potential risk.

Psychological Pain

Is there a psychological component to the pain? Depression, anxiety?

Pruritus

Itiching

Acute Pain

Lasts less than 1-3 mo

Opioid antidote

Naloxone (narcan)

During your pain assessment, Randall describes his pain as a burning pain in his lower extremities. What type of pain does this describe?

Neuropathic pain

During your pain assessment, Lenora describes her pain as an aching and cramping pain in her lower abdomen. What type of pain does this usually describe?

Nociceptive pain

NSAIDs

Nonsteroidal anti-inflammatory drugs.

Physical Exam for pain

Observation, auscultate, palpation, percussion

Pain scale used for unconscious pts

PAIN-AD

John is admitted to the hospital for a pain crisis from his sickle cell disease. He usually takes morphine 30mg every 12 hours by mouth. He states his pain is a 10 on a 0-10 scale. You tell your colleague that his pain can't be that bad because he is watching television and talking on the phone. Which important principle of pain management are you violating?

Pain is a subjective experience and is what the patient reports it is.

Pain assessment questions

Quality of pain, what makes better, timing of the pain, have you ever take medication for pain, acceptable lvl of pain intensity, how has the pain affected your function

Adverse reactions to opioids

Respiratory depression, constipation, sedation, urinary retention, N/V, pruritus, myoclonus

Best assessment of pain

Self-report. Pain management requires a comprehensive assessment of the individual's pain

Mr. Johnson tells you that although the oral morphine prescription he just started for his cancer pain says to take one tablet every 12 hours, he has found that if he takes it every 6 hours, his pain is much less. What behavior does this represent?

Substance misuse

Substance Misuse

Taking medication for a purpose other than their intended use

Substance Abuse

Taking more medication than prescribed

You are teaching a patient how to take her new prescription for morphine, an opioid pain medication. Which of the following teaching statements reflects an understanding of potential adverse effects?

This medication causes constipation, so you need to take a laxative to prevent that.

Myoclonus

Twitching

Social Pain

Uncontrolled pain severely affects quality of life

Nociceptive Pain

Usually related to damage to bones, soft tissues or internal organs

Acetaminophen (tylenol)

non-opioid, analgesic & antipyretic, adverse effect is liver damagae

You are caring for Ms. P, a 55-year-old woman with cancer. She received pain medication less than two hours ago. A nursing assistant reports that Mrs. P is complaining of pain again. The nursing assistant says, "She can't be hurting as much as she says she is." What is the most appropriate response?

Pain is whatever the patient says it is. Let's assess her further.