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Chapter 05:
Relieving Pain and Providing
Comfort
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Factors That Contribute to Pain in the
Critically Ill Patient
See Box 5-1.
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The Most Painful and the Least Painful
Procedures in Intensive Care
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Preparing Your Patient for a Procedure
That Could be Painful
• Provide patient education on the procedure, explaining
the procedure from a patient’s perspective.
• Provide pain medication as ordered and wait to start the
procedure until the medication has taken effect.
• Provide medications to decrease anxiety as ordered.
• Provide ongoing assessment of pain and sedation level
during the procedure and repeat medications as needed.
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Benefits of Effective Pain Relief
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Addiction, Tolerance, and Dependence
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National Guidelines and Standards for
Pain Management
See Table 5-4.
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Websites Pertaining to Pain Management
See Table 5-5.
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Common Diagnoses for Patients in Pain
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General Guidelines for Nursing
Interventions for the Patient in Pain
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Nonopioid Analgesics Commonly Used in
Critical Care
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Commonly Used Opioid Analgesics
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Why Meperidine Should Not Be
Administered to Critically Ill Patients
See Box 5-4.
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Nonpharmacological Interventions
• Modify the environment to promote relaxation and rest
• Provide distraction through activities of interest to the
patient
• Relaxation techniques
• Therapeutic touch
• Massage of hands, feet, or shoulders
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Instructions Regarding Quieting Reflex
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Question
Which of the following statements about providing an
appropriate analgesic for a high-risk critically ill client is
correct?
A. Meperidine is the most potent opioid of choice to use.
B. National experts consider hydromorphone to be
dangerous and don’t recommend it.
C. Morphine sulfate is a preferred opioid to be given
intravenously.
D. Older patients are less sensitive to opioids.
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Answer
C. Morphine sulfate is a preferred opioid to be given
intravenously.
Rationale: Morphine, fentanyl, and hydromorphone are
recommended by national standards to be given IV to
critically ill patients who need an opioid analgesic.
Meperidine is the least potent opioid; national guidelines
consider the drug to be dangerous in the critically ill
population and do not recommend giving it. Older
patients are more sensitive to opioid analgesics because
as the body ages it takes longer for a drug to be
metabolized and excreted from the body.
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Question
After taking an opioid, a client has increased drowsiness,
urinary retention, and 10 respirations/minute. The nurse
should recommend which of the following?
A. Decrease the opioid dose.
B. Add an NSAID to the regimen.
C. Provide reduced doses around the clock and avoid giving
the opioid prn.
D. All of the above.
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Answer
D. All of the above.
Rationale: Side effects of opioid analgesics are managed by
reducing the opioid dose and by adding an NSAID as an
adjunct. Opioid analgesics work best if given around the
clock so that there is a steady blood level of the drug in
the system; giving the opioid prn causes a fluctuation in
the levels of the drug, increasing the risk for sedation
and respiratory depression.
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Question
Which of the following statements about pain is correct?
A. Acute pain has a sudden onset and no identified cause
and resolves quickly with treatment.
B. Acute pain has an identified cause and resolves within a
given time frame.
C. Chronic pain has a quick onset and an identified cause
and is compounded by acute pain.
D. Chronic pain has a definite cause and lasts for a short
period, after which it resolves completely.
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Answer
B. Acute pain has an identified cause and resolves within a
given time frame.
Rationale: According to Prevost, “acute pain has an
identified cause and will resolve in a given time frame.”
According to Prevost, chronic pain may last for an
indefinite period and is difficult to treat fully.
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