Symptom Management Flashcards
(40 cards)
What are the key components of symptom management?
Physical symptoms; psychological well-being; and patient/family
Describe assessment as the key to symptom management:
- Remember the individual
- Holistic care
- What works for one will not necessarily work for another
- The nursing process
- Team work
What are the benefits of assessment tools?
- Aid to an overall assessment
- May provide a focus for symptom management
- Reliability/validity
- Appropriate/applicable
Who are common team members we use in symptom management?
- Social Worker
- Family
- Volunteers
- Palliative team
Describe the components of the FH Palliative Symptom Management Assessment tool:
- Onset
- Provoke – What makes it worse, better?
- Quality – What is it like? Sharp, ache
- Radiating – Do you expect any symptoms anywhere else?
- Severity – Use scale
- Treatment – What treatment have worked, what doesn’t?
- Understanding – Understanding of situation – how does that make them feel?
- Values – What is important to you? E.g. what’s your goal for symptom management? What about their family?
Describe the mild pain treatment of the analgesic ladder:
- Non-opioid
- +/- adjuvant
Describe the moderate pain treatment of the analgesic ladder:
- Weak opioid
- +/- non-opioid
- +/- adjuvant
Describe the moderate/severe pain treatment of the analgesic ladder:
- Done if pain persists/increases
- Strong opioid
- +/- non-opioid
- +/- adjuvant
What is pain?
- Pain is whatever the experiencing person says it is, existing whenever he/she says it does
- HOWEVER, this might not always be the case! Pain might not be what they it is because not everyone expresses their pain the same, some may conceal it, etc. We need a history of pain and the type they’ve experienced before.
- An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
- Can be caused by disease itself; treatments; related debility; unrelated causes; psycho-social issues; often multi factorial, requiring combinations of meds/other therapies
What is total pain?
Pain that encompasses physical, psychological, social, emotional, spiritual, and cultural - gives us a holistic image of pain!
What are the different types of pain?
- Nociceptive (somatic, visceral)
- Neuropathic
- Complex regional pain syndromes
What are characteristics of pain that we evaluate? (i.e. types of pain)
- Acute
- Chronic
- Incident pain
- Breakthrough pain
- End of dose failure pain
- Intensity
Describe acute pain:
increased heart rate, change in blood pressure, sweaty, increasing RR, facial grimacing (non-verbal), anxiety, distress
Describe chronic pain:
pain that persists after what we would anticipate has sorted – can have lots of psychological and social impacts
Describe incident pain:
Something occurs and pain occurs for the patient - e.g. patient needs to have surgery, an incident that is going to happen and we know is going to cause pain – ulcer on coccyx have to move them, you know it will cause pain; Predictable!
Describe breakthrough pain:
unpredictable; having baseline analgesics, breaks through the underlying pain management; ensuring someone has very appropriate pain meds is important
Describe end-of-dose failure pain:
pain coming back 2-3 hours before next dose; so many dose is not large enough; e.g. Patches
Describe intensity of pain:
subjective how the patient experiences they pain – the pain is what the patient says it is – can be related to personal experiences, etc.
What are barriers to pain management?
- HCP barriers (lack of education, fear of OD, lack of experience, stigma/bias/prejudice, hierarchy)
- System barriers(policy; communication within teams or hierarchy)
- Patient/family barriers (under-reporting d/t a number of reasons; fear of addiction; cultural reasons)
- Societal barriers (cultural; you must not act like that in public)
What are the 3B’s?
Bowels, Barfing and Breakthrough
What classes of drugs act as adjuvant analgesics?
- Anti-depressants
- Anti-convulsants
- Corticosteroids
- Topicals
- Antivirals
- Antibiotics
- Bisphosphonates
- Anticholinergics
- Muscle relaxants
- Benzodiazepines
What are some adjuvant methods of treatment? (for pain)
- Primary Therapy
- Anesthetic techniques
- Neurosurgical procedures
- Physiotherapy
- Relaxation techniques
- Acupuncture
- Behavioural therapy
- TENS
Why might we use parenteral drug therapy instead of oral?
- Oral issues (e.g. sores from chemo)
- Absorption issues
- N/V
- Bowel obstruction
- Swallowing difficulties
What are common adverse effects of opioids?
- CNS - Sleep, confused, hallucinations, decrease in RR
- GI – constipation (need to manage from onset)
- U – can increase muscle retention
- M – myoclonus can lead to full blown seizures
