Pain Management - 356

Describe how nurses' ensure effective pain management

A: Ask about pain regularly. Assess pain systematically. B: Believe the patient and family in their report of pain and what relieves it. C: Choose pain control options appropriate for the patient, family, and setting. D: Deliver interventions in a timely, logical, and coordinated fashion. E: Empower patients and their families. Enable them to control their course to the greatest extent possible.

List the nursing principles for administering analgesics

Know the patient's response Select proper medications when more than one is ordered Know accurate dosage Assess right time and interval for administration

Nursing Principals for Administering Analgesics: Assess Right Time and Interval for Administration

• Administer analgesics as soon as pain occurs and before it increases in severity. • An ATC administration schedule is usually best. • Give analgesics before pain-producing procedures or activities. • Know the average duration of action for a drug and the time of administration so the peak effect occurs when the pain is most intense. • Use extended-release opioid formulations to treat chronic pain. • Avoid stopping opioids abruptly in patients who are opioid tolerant. ATC, Around the clock; GI, gastrointestinal; NSAIDs, nonsteroidal antiinflammatory drugs.

Nursing Principals for Administering Analgesics: Know the patient's response

• Determine whether patient has allergies. • Know whether patient is at risk for using NSAIDs (e.g., history of GI bleeding or renal insufficiency) or opioids (e.g., history of obstructive or central sleep apnea). • Identify previous doses and routes of analgesic administration to avoid undertreatment. • Determine whether the patient obtained relief. • Ask whether a nonopioid was as effective as an opioid.

Nursing Principals for Administering Analgesics: Know Accurate Dosage

• Recall that 4 g is considered the maximum 24-hour dosage for acetaminophen and acetylsalicylic acid (ASA); 3200 mg for ibuprofen. • Adjust doses as appropriate for children and older patients. • Large doses of opioids are acceptable in opioid-tolerant patients but not in opioid-naive patients. • When titrating opioid, it is important to titrate to effect or to uncontrollable side effects.

Nursing Principals for Administering Analgesics: Select Proper Medications When More Than One Is Ordered

• Use nonopioid analgesics or opioid combination drugs for mild-to-moderate pain. • Give opioids with nonopioids to provide a multimodal analgesia approach. • Avoid using multiple opioids with the same duration and mechanism of action. • Intravenous medications act more quickly and usually relieve severe, acute pain within 1 hour; whereas oral medications take as long as 2 hours to relieve pain. • Avoid intramuscular analgesics, especially in older adults. • Use an opioid with a nonopioid analgesic for severe pain because such combinations treat pain peripherally and centrally. • For chronic pain give sustained-release oral formulations ATC.