Fundamentals: Pain Management and the Nursing Process

After having received 0.2 mg of naloxone intravenous push (IVP), a patient's respiratory rate and depth are within normal limits. The nurse now plans to implement which actions?

Assess patient's vital signs every 15 minutes for 2 hours. *Every 15 minutes for 2 hours following drug administration reassess patients who receive naloxone because the duration of the opioid may be longer than the duration of the naloxone, and respiratory depression may return.

An opioid-naïve patient is on naloxone for respiratory depression caused by methadone overdose. The nurse is instructed to reassess the patient every 15 minutes for 2 hours following drug administration. What is the reason behind the schedule of reassessment of the patient?

Duration of the action of naloxone is less than that of methadone. *The duration of action or half-life of naloxone is less than that of methadone. Therefore, recurrence of respiratory depression by the relatively long action of methadone can be prevented by reassessing the patient every 15 minutes for 2 hours after naloxone administration. Methadone has a greater half-life than naloxone. Therefore, the effect of methadone is more prolonged than that of naloxone. Naloxone is an opioid-antagonist drug. Naloxone does not act as an agonist to morphine after 2 hours. Opioid-naïve patients are patients who have not taken opioid medications for at least a week. Naloxone causes morphine withdrawal symptoms only in patients who are physically dependent on morphine, not the patients who are opioid naïve.

tolerance.

In patients with chronic pain, if the dose of the drug for pain relief needs to be increased over time to achieve the same effect,

radiating pain

Intermittent or constant pain that travels down or along a body part

The nurse advises a patient with neuropathic pain to undergo guided imagery therapy to alleviate pain. Which pharmacological treatment interventions would be beneficial to the patient for pain management?

Anticonvulsants Antidepressants *The nonpharmacological interventions that are usually recommended for pain relief in a patient with neuropathic pain include relaxation and guided imagery. This allows patients to alter affective-motivational and cognitive pain perception. The pharmacological pain management therapies that would be beneficial to a patient with neuropathic pain include anticonvulsants such as gabapentin and antidepressants such as nortriptyline. Gabapentin acts on the supraspinal region to stimulate noradrenaline-mediated descending inhibition to reduce neuropathic pain. Nortriptyline alleviates neuropathic pain by altering neurotransmitter levels.

The nurse notices that a patient has received oxycodone/acetaminophen (5/325), two tablets PO every 3 hours for the past 3 days. What concerns the nurse the most?

The amount of daily acetaminophen *The major adverse effect of acetaminophen is hepatotoxicity. The maximum 24-hour dose is 4 g. It is often combined with opioids (e.g., oxycodone) because it reduces the dose of opioid needed to achieve successful pain control.

Which pain characteristics might the nurse suspect in a patient with kidney stones?

The pain is in a part of the body separate from the source of pain. *Kidney stones cause groin pain, an example of referred pain, which occurs in a part of the body separate from the source of pain.

The electrocardiogram of an elderly male patient who had chest pain shows signs of myocardial infarction. What are the likely sites for referred pain for a male patient with myocardial infection?

When pathological changes in one part cause pain at a distant site on the body, then the pain is called referred pain. Pathological changes in the heart often cause referred pain in the jaw, left arm, and left shoulder,

Visual analogue scale (VAS)

assesses the pain level in the patient by rating the pain along a 10-centimeter line in 1-centimeter increments from no pain to unbearable pain.

Physical dependence

is a state in which the patient develops withdrawal symptoms upon stopping the drug abruptly.

Referred pain

is in a part of the body separate from the source of pain.

Superficial pain

is of short duration and is localized.

Oucher scale

requires the patient to look at six faces with different expressions and point at the face that best matches the pain he or she is experiencing.

Deep or visceral pain

results from the stimulation of internal organs.

Numeric rating scale (NRS)

the nurse asks the patient to choose a number to rate the level of pain.

verbal descriptor scale,

the nurse asks the patient to describe his or her feelings about the intensity of pain.

Addiction

the patient craves the drug and uses the drug compulsively despite knowing that it is harmfu

pseudoaddiction

the patient seeks many primary health care providers for pain medications to get adequate pain relief.