Pain Case study

How is fatigue related to pain?
Fatigue often heightens the perception of pain & impairs coping skills
How is quality of pain described?
Descriptive terms, such as burning/itching/searing/crushing/stabbing
What is a common behavioral response to pain?
Frequent guarding ( protecting the painful area)
If pain and anxiety are identified as priority problems, what action must the nurse implement?
Continue interview because more assessment is needed to determine etiology of anxiety
“Acute pain r/t strain on muscles with movement” is the nursing diagnosis. What is the best goal?
Client reports pain as 1 on 0-10 scale

Rationale: acute injuries, always want to decrease pain

Before implementing actions, what must the RN do first?
Discuss plan of care with client to seek their input
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What are some common interventions for pain?
NSAIDS, alternate heat & cold application, back exercises
acetaminophen ( Tylenol) is best known as a what?
Anti-pyretic ( fever) & analgesic, but NOT AN NSAID
ASA is associated with what in children?
Reye’s Syndrome ( therefore, avoid ASA in children)
Usage of heat
Dry/moist, promotes muscle relaxation & relief caused by stiffness or spasm
When should cold be applied?
As prescribed, 20-30 minutes at a time
What instruction is important for the nurse to provide about cold application?
Remove if skin appears reddened before Rx time period passes
Why does skin become reddened after prolonged exposure to cold?
Cold causes vasoconstriction, but after prolonged exposure “reflex vasodilation” occurs
“Reflex vasodilation”
Restores adequate blood flow to an area after prolonged exposure to cold
TENS
Transcutaneous Electrical Nerve Stimulation
What is TENS
A type of cutaneous stimulation, where electrodes attach to a battery-operated unit to stimulate the skin and underlying tissues near localized pain area
What instruction should the nurse apply about using a TENS unit?
1. Use conductor pads/gel to ensure safe conduction and reduce injury to the client

2. Clean/dry the skin so electrodes can adhere

Purpose of TENS
can decrease clients need for analgesics if used correctly
When using a Scheduled drug, the RN knows what about these?
High abuse potential
ketorolac ( Toradol) is what classification of drug?
NSAID & the only one given IV
What site would you choose for an IM injection in a person who is thin?
Ventroglueal
For the Ventroglueal site, what landmark do you identify?
Greater Trochanter
Once the needle is inserted for an IM, what is the next action?
Insert the medication SLOWLY into muscle mass
Purpose of guided imagery
Decreases awareness to pain & allows patient to use all senses
Steps to progressive relaxation
1. Establish a regular breathing pattern
2. Ask patient to locate area where they feel muscle tension
3. Tense muscle fully
4. Relax muscle fully
Purpose of progressive relaxation
in time, client will be able to relax muscle without first tensing them more fully
Name some non-pharmacologic pain relief methods:
1. Acupressure
2. Music
3. Distraction
4. Biofeedback
5. Self-hypnosis
Purpose of non-pharmacologic pain medications
Assist with pain management and provide client with sense of control
When is teaching to a patient advised?
Pre-op, because they are awake, alert and not experiencing post-op acute pain
PCA
Patient Controlled Analgesic, also called a “demand dose” given by the patient
If patient is not using PCA, what does this likely indicate?
Pain is decreased or controlled via other measures
Hydrocodone + acetaminophen =
Vicodin
Hydrocodone + acetaminophen have a ___ effect
Synergistic
Purpose of combining non-opioid ( acetaminophen) with an opioid
A lower dose of the opioid can be given while providing effective analgesia
Morphine & hydrocodone/acetaminophen are classified as
Opioid analgesic ( analgesics that are CNS depressants)
Opioid analgesics can cause what major symptom?
Constipation
What is the best Rx for an opiod analgesic?
docusate sodium ( Colace)
If two RN’s are talking about a patient in the hallway, what ethical principle does this violate?
Confidentiality ( hallway talk violates patient privacy)
If you hear two RN’s talking about a patient, what role do you take on as the RN?
Patient advocate
Veracity
truthfulness
Fidelity
commitment to keep one’s word
Teleology
“ends justify the means”

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