6-C I. Managing Pain Nursing Interventions Flashcards Preview

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Flashcards in 6-C I. Managing Pain Nursing Interventions Deck (16):
1

oral

contraindicated with nausea and vomiting

assess response to therapy 1 hour after administration

slow-release preparations available: may require additional analgesic at initiation of therapy and for breakthrough pain

2

intramuscular

assess response to therapy 30 minutes after administration

avoid these methods with hypothermia and vasoconstriction

3

subcutaneous

assess response to therapy 30 to 60 minutes after initiating therapy

well-suited for clients with cancer

requires ambulatory infusion pump

easier to establish steady-state blood level

4

epidural and intrathecal

assess response to therapy 15 to 45 minutes after initiating therapy

itching can be severe

risk of hematoma, infection, meningitis

effective management of severe pain without central nervous system depression

agents: preservative-free opioids and local anesthetics via PCA or implantable pump

5

patient-controlled analgesia (PCA)

assess response to therapy 15 to 30 minutes after initiating therapy

client controls dosing
client prevented from overdosing with lock-out: establishes maximum frequency of dosing
client and family teaching: intended for client only control

used with oral, IV, subcutaneous, and epidural administration

dose frequently includes a basal rate: client activates PCA for on-demand dose
typical basal rate of morphine sulfate: of 2-5 mg/hour
typical on-demand dose of morphine sulfate: 0.5-2 mg every 10 minutes
provides a steadier analgesic blood level
pump set-up requires specially trained personnel; controls are behind a locked panel

may start equianalgesic oral opioids 30 minutes to 1 hour before discontinuing depending on the drugs involved

6

transdermal


assess response to therapy 1 to 2 hours after initiating therapy

difficult to adjust dosage

agents: fentanyl and morphine

increased absorption with febrile clients

used in chronic and severe pain syndromes

monitor for respiratory depression and skin irritation

remove old patch and cleanse area before applying new patch

7

intravenous

assess response to therapy 15 to 30 minutes after therapy

given by direct bolus

short-term pain management for moderate to severe pain

high risk of CNS depression especially respiratory depression

8

Nursing Interventions - opioid analgesics

establish baseline data and monitor respiratory rate, blood pressure, bowel pattern, platelets, neurologic status, allergy

accurately time doses to prevent overdose; reverse effects with antidote naloxone

keep emergency equipment immediately available

counteract adverse effects
administer antiemetic for nausea
administer antipruritic for pruritus
prevent constipation with fluid, fiber, ambulation since stool softeners usually ineffective

transition client from IV, IM dosing to oral dosing with equianalgesic doses

client teaching
ask for help when getting up
report rash, dyspnea, inadequate pain management
establish bowel habits, take with food to avoid nausea
take only as directed, do not exceed recommended dose
AVOID
alcohol, CNS depressants, antihistamines
herbal remedies including chamomile and kava
driving, making important decisions, and dangerous activity

9

equianalgesic conversions

Switching a client from one opioid analgesic to another should be based on an equianalgesic conversions to give the client similar pain relief.

For example: 10 mg of a parenteral dose of morphine sulfate is equivalent to 30 mg PO.

Another example: conversion ratio of oral morphine to transdermal fentanyl is approximately 2:1 so 60 mg/day of oral morphine sulfate is equianalgesic to 25 micrograms/hour of transdermal fentanyl.

10

Nursing Interventions - opioid agonist-antagonists

screen clients for previous use of opioids

11

Nursing Interventions - opioid antagonists

establish baseline data and monitor airway, respiratory rate, SaO2, blood pressure, heart rate and rhythm, pain intensity

provide information to client

administer with emergency equipment nearby

collaborate with provider for pain management

12

Nursing Interventions - synthetic diphenylheptane derivative

establish baseline data and monitor renal and liver enzyme tests

assess and monitor pain, vital signs, airway, level of consciousness, pupil reaction to light

opioid intoxication: lack of analgesic effect, clinical indicators of withdrawal

client teaching
report neurologic changes, allergic reactions
avoid CNS depressants, alcohol for 24 hours after administration
change positions slowly; do not drive or engage in dangerous activity

13

nursing interventions - non-opioid analgesics

establish baseline data and monitor liver enzyme tests, creatinine, complete blood count

assess and monitor pain, temperature, urine output, neurologic status

client teaching
AVOID alcohol
may crush or cut tablets
do not exceed recommended dose
AVOID over-the-counter medications containing acetaminophen
report nausea, vomiting, abdominal pain

14

nursing interventions - anti-migraine headache agents

Triptan

establish baseline data and monitor renal and liver enzyme tests

assess and monitor pain and associated findings, blood pressure, ECG, neurologic status

screen clients for cardiovascular or neurovascular history, drugs containing ergotamine

client teaching
AVOID triggers: foods containing tyramine , sulfites
report chest pain, worsening symptoms, paresthesia, flushing
AVOID pregnancy
do not crush tablets
remain in calm environment, away from noise, light

15

nursing interventions - anti-migraine headache agents

ergot derivatives

establish baseline data and monitor renal and liver enzyme tests

assess and monitor pain, associated findings, neurologic status including blurred vision, blood pressure, heart rate

treat overdose with vasodilators, heparin, and dextran

client teaching
ways to control, avoid or eliminate trigger factors
relaxation techniques
AVOID alcohol and over-the-counter drugs

16

nursing intervention:

Lidocaine

capsaicin topical

Lidocaine cream must be applied 1 hour before pain is anticipated as in a procedure


wear gloves to apply, rub into skin until cream is transparent
wash hands following application
client teaching: burning increases through heat, sweating, humidity, and clothing