Transcript Ch. 17-Drugs Used to Manage Painx

Chapter 17
Drugs Used
To
Manage Pain
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pain means to: ache, hurt or be sore
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pain is subjective (you cannot see, hear, touch or
smell pain, must rely on what person says)
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differs from person to person, you must believe the
person
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pain is a warning sign from the body, means there is
tissue damage
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often pain causes person to seek health care
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there are different types of pain:
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acute pain:
felt suddenly from injury, disease, trauma or surgery
tissue damage present
lasts a short time, usually less than 6 months
lessens with healing
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chronic pain:
lasts longer than 6 months
pain is constant or off and on
no longer tissue damage
remains long after healing
common causes: arthritis, cancer
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different types of pain continued….
 radiating pain:
 felt at site of tissue damage and in nearby areas
 example: heart attack pain is felt in chest, jaw, shoulder
 phantom pain:
 felt in a body part that is no longer there
 example: person with amputated leg feels leg pain
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Many factors affect reactions to pain:
 past experience:
severity of pain, it’s cause, how long it lasted, and if relief
occurred all affect the persons current response to pain.
Knowing what to expect can help or hinder how person
handles pain
 anxiety:
pain and anxiety are related, pain can cause anxiety.
Anxiety increases how much pain the person feels.
Reducing anxiety lessens pain. Example: Letting person
know ahead of time to expect pain post-surgery, but that
there will be drugs for pain relief may help reduce
anxiety and therefore reduce the amount of pain felt
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factors affecting reactions to pain continued..
 rest and sleep:
both restore energy, reduce body demands and the body
can repair itself. Lack of rest and sleep affects thinking
and coping with daily life. Sleep and rest needs increase
with injury/illness. Pain seems worse when tired or
restless. Also tend to focus on pain when tired
 attention:
the more one thinks about pain the worse it seems. Pain
seems worse at night when activity is less and it is quiet.
When unable to sleep the person has time to think
about the pain
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factors affecting reactions to pain continued..
 personal and family duties:
Pain is often ignored when there are children to care for.
Some people go to work with pain. Others deny pain if
serious illness is feared. Illness can interfere with jobs,
school, caring for others
 the value or meaning of pain:
To some pain is a sign of weakness. May indicate serious
illness and need for painful tests/treatments, therefore
pain is ignored or denied. Sometimes pain gives pleasure.
For some people pain means not having to work or
assume daily routines. Pain can be used to avoid certain
people or things.
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factors affecting reactions to pain continued..
 support from others:
dealing with pain often easier when family and friends
offer comfort/support. The use of touch by a valued
person is very comforting. Dealing with pain alone can
increase anxiety, person has more time to think about
the pain
 culture:
Culture can affect pain responses, some cultures are
stoic when it comes to pain (show no reaction). Other
cultures show strong verbal and non-verbal reactions to
pain. Non-english speaking persons may have problems
describing pain. Someone should be available to help
interpret person’s needs.
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factors affecting reactions to pain continued..
 illness:
some diseases cause decreased pain sensation. CNS
disorders may not allow person to feel pain, or it may
not feel severe. Person at risk for undetected disease or
injury. If pain is not felt person will not know to seek
health care.
 age:
children may not understand pain, they know it feels bad
but have fewer experiences with pain. They do not know
what to expect or how to relieve pain. They rely on
adults to help. Adults must be alert to behaviors and
situations that signal pain.
You must rely on what the person tells you about their pain
 Promptly report any info you collect about pain
 Write down exactly what the person says
 Nurse needs following info to assess pain:
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 location: where is pain, have them point, ask if anywhere else
 onset and duration: when did it start, how long has it lasted
 intensity: mild, moderate, severe, ask them to rate on scale of 1-10, or
use Wong-Baker Faces Pain Rating Scale (17-2 pg. 224). Ask person
to pick the face that best describes how they feel.
 factors causing pain: (precipitating factors) moving, turning, coughing,
ask what person was doing before pain started and when it started
 factors affecting pain: what makes pain better and worse
 vital signs: take vitals, increases will often occur with acute pain, may
be normal with chronic pain
 description: ask them to describe the pain, if they cannot offer them
some words such as:
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aching
crushing
knife-like
sharp
stabbing
-burning
-dull
- piercing
- sore
- throbbing
-cramping
-gnawing
- pressure
- squeezing
- vise-like
Signs and Symptoms of Pain
(17-2 pg. 224)
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Body Responses:
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Behaviors:
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appetite changes
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crying
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dizziness
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gasping
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nausea
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grimacing
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numbness
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groaning
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increase in vitals
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grunting
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skin: pale
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holding the affected body part
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sleep: difficulty
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irritability
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sweating (diaphoresis)
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moaning
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tingling
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changes in mood
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vomiting
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positioning: refusing to move
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weakness
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quietness
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restlessness
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rubbing
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screaming
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speech: slow or rapid/quiet or loud
Pain Management
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analgesic: drug that relieves pain
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goals of pain management:
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relieve intensity of pain and how long person is in pain
prevent pain from becoming chronic
prevent suffering and disability associated with pain
prevent psychologic and socio-economic consequences
from inadequate pain management
- control side effects from pain management
- improve persons ability to perform activities of daily
living to optimal level
pain is transmitted from site of pain to the brain
 pain receptors are first stimulated at site of damage
 neurotransmitters send nerve impulses from the damaged
site to the spinal cord
 impulses travel up spinal cord to brain
 opiate receptors within CNS control pain
 when opiates stimulate these receptors the pain sensation is
blocked
 opiate: a drug that contains opium, derived from opium or
has similar activity to opium.
 opium: milky substance from unripe poppy seeds
 when cells are damaged other chemicals are released that
stimulate pain receptors, other drugs block such chemicals
and stop pain
 most drugs for pain management are given PRN, the nurse
decides when a PRN drug is needed
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Opiate Agents
opiates are derived from opium and include
morphine and heroine
 opiate agonists: group of semi-synthetic or
synthetic drugs that can relieve severe pain
without loss of consciousness
 synthetic: substance that is made, not naturally
occurring
 semi-synthetic: natural substance that has
partially been altered by chemicals
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Opiate Agents continued….
Opiate agonists stimulate opiate receptors in the CNS and
cause the following:
◦ analgesia
◦ respiratory depression
◦ cough reflex suppression
◦ drowsiness
◦ sedation
◦ mental clouding
◦ euphoria (exaggerated feeling or state of physical or mental
well-being)
◦ nausea and vomiting
Opiate Agents continued….
opiate agents are used:
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relieve acute or chronic moderate to severe pain
pain from acute injury, surgery, renal or biliary colic,
MI and cancer
pre-operative sedation
supplement anesthesia
reduce anxiety in persons with acute pulmonary
edema
Opiate Agents continued….
- most opiate agonists can produce addiction (after 3-6 weeks of
continuous use)
- considered a controlled substance
- Signs and Symptoms of opiate withdrawals:
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restlessness
perspiration
goose-flesh
tears
runny nose
dilated pupils
muscle spasms
pain
cramps
(muscle/abdominal)
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flashes: hot and cold
insomnia
nausea
vomiting
diarrhea
severe sneezing
vital signs: increased
temp, heart rate,
respiratory rate, blood
pressure
Opiate Agents continued….
Assisting With the Nursing Process
-Opiate agonists are given PRN for pain relief
-Some uses they may be ordered STAT (at once) ie: MI for pulmonary edema
-Could also be a one-time order ie: pre-op sedation
Assessment: observe the persons speech pattern, degree of alertness and
orientation to person, time and place. Measure vital signs, if respirations are below
12/minute tell nurse immediately. Ask person to rate pain. Check medication
administration record (MAR) for when person last received analgesic
Planning: available for subcutaneous, intramuscular or IV injection.You do NOT give
drugs by these routes
Implementation: see table 17-1 (p. 225-226) for “Initial Adult Dose”
Evaluation: report and record:
- lightheadedness, dizziness, sedation, nausea, vomiting, sweating: tend to occur with
first dose, supine position helps to reduce these symptoms, provide for safety
- confusion, disorientation: observe person’s alertness and orientation to person time
and place. Provide for safety
- orthostatic hypotension: provide for safety, measure BP, do not allow person to sit up
- constipation: may occur from continued use, follow care plan re: food/liquids, give
stool softeners or laxative as ordered
-respiratory depression: if respirations are below 12/minute tell nurse immediately, also
observe depth of respirations, if shallow breathing tell nurse immediately
- urinary retention: measure intake/output, meds can cause urine retention. Ask about
problems with urinating, follow care plan to promote urination
- excess use or abuse: always report complaints of pain or drug requests to nurse
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Salicylates: most commonly used analgesics for slightmoderate pain.
◦ Drugs inhibit prostaglandin(PG) production.
◦ PGs are fatty acids that cause various responses:
 Analgesic effect: Salicylates inhibit formation of PGs affecting pain receptors
 Anti-inflammatory effect: salicylates inhibit PGs that produce
signs/symptoms of inflammation (redness, swelling, and warmth)
 Anti-pyretic effect: given to reduce fever
See table 17-2 (pg. 227) for salicylates
Salicylates:
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Aspirin:
- inhibits platelet activity, platelets needed for blood clotting.
aspirin is used to:
reduce risk of transient, ischemic attacks or stroke in men
reduce risk of MI in person with previous MI or unstable angina
Assisting With Nursing Process:
Assessment: observe the persons speech pattern, degree of alertness and orientation
to person, time and place. Measure vital signs. Ask person to rate pain. Check (MAR)
for when person last received ordered drug
Planning: see 17-2 for “Dose Forms”
Implementation: see table 17-2 (p. 227) for “Uses and Adult Dosages” and for
“Maximum Daily Dose”
Evaluation: report and record:
- stomach irritation: give with food or milk or with large amounts of water, if antacids
are ordered they are give 1 hour later
- GI bleeding: vomitus that looks like coffee grounds, red vomitus and black or tarry
stools are signs of GI bleeding. Test stools for occult blood as directed by nurse/care
plan
- tinnitus (ringing of ears), impaired hearing, dimmed vision, sweating, fever, lethargy,
dizziness, confusion, nausea, vomiting: signal salicylate toxicity
Non-steroidal Anti-inflammatory Drugs (NSAIDs)
- known as aspirin-like drugs
- prostaglandin inhibitors
- used to reduce pain, inflammation, fever
- tend to have less side effects that salicylates, there is a risk
however of MI, stroke, GI bleeds from NSAIDs
Assisting With Nursing Process:
Assessment: observe the persons speech pattern, degree of alertness and orientation to person,
time and place. Measure vital signs. Ask person to rate pain.
Planning: see 17-3 (p. 229-230) for “Dose Forms”
Implementation: see table 17-3 (p. 229-230) for “Uses and Adult Dosages” and for “Maximum
Daily Dose”
Evaluation: report and record:
- stomach irritation: give with food or milk
- constipation: follow care plan for fluid intake and diet, give stool softeners or laxatives as ordered
- dizziness or drowsiness: provide for safety
- GI bleeding: vomitus that looks like coffee grounds, red vomitus and black or tarry stools
are signs of GI bleeding.Test stools for occult blood as directed by nurse/care plan
- confusion: observe persons alertness and orientation to person, place and time. Provide for
safety
- rash, hives, itching: may signal an allergic reaction, tell nurse at once
- decreased urine output, red or smoky-colored urine: signal kidney problems
- anorexia, nausea, vomiting, jaundice: may signal liver toxicity
- sore throat, fever, jaundice, weakness: may signal changes in red/white blood cells
Other analgesic agents:
acetaminophen (Tylenol, Datril,Tempra):
- synthetic non-opiate analgesic
- anti-pyretic
- no anti-inflammatory activity
Assisting With the Nursing Process
Assessment: Measure vital signs. Ask person to rate pain. Check MAR for
when person last received ordered drug
Planning: see pg. 232 for “Dose Forms”
Implementation: see p. 232 for “Uses and Adult Dosages” and for
“Maximum Daily Dose”
Evaluation: report and record:
- stomach irritation: give with food or milk, or large amounts of water
- anorexia, nausea, vomiting, low blood pressure, drowsiness,
confusion, abdominal pain, jaundice: signal liver toxicity
Other analgesic agents:
propoxyphene (Darvon)
- synthetic opiate agonist, used to relieve mild to moderate pain from muscle
cramps, pre-menstrual cramps, minor surgery and trauma, and headache
Assisting With the Nursing Process
Assessment: Observe person’s speech pattern, degree of alertness and
orientation to person, time and place. Measure vital signs. Measure
intake/output. Ask person to rate pain.
Planning: see pg. 233 for “Dose Forms”
Implementation: usual adult dose 65mg capsules or 100 mg tablets, every 4
hours, PRN
Evaluation: report and record:
- stomach irritation: give with food or milk
- sedation or dizziness: sedation is usually mild, tends to resolve, provide for
safety
- excess use or abuse: always report complaints of pain or drug requests to
the nurse at once
- rash: may signal allergic reaction, tell nurse at once. Do not give next dose
unless approved by nurse
Other analgesic agents:
pentazocine (Talwin)
- opiate partial agonist
- if person has not received opiate agonists this is an effective analgesic
- effect is similar to morphine when used within first few weeks of therapy
- tolerance can develop with prolonged use
- used for short-term relief (up to 3 weeks) of moderate to severe pain
Assisting With the Nursing Process
Assessment: Observe person’s speech pattern, degree of alertness and orientation to
person, time and place. Measure vital signs. Ask person to rate pain.
Planning: oral dose form 50mg tablets
Implementation: usual adult oral dose is 50-100mg every 3-4 hours
Evaluation: report and record:
- clamminess, dizziness, sedation, nausea, vomiting, dry-mouth, sweating: tend to occur
with first dose, supine position helps these symptoms, provide for safety
- constipation: may occur with continued use, follow care plan
- confusion, disorientation, hallucinations: provide for safety
- respiratory depression: tell nurse if respiratory rate is 12 per minute or less, also tell
nurse if person has shallow breathing
- excess use or abuse: always report complaints of pain or drug requests to nurse at
once