Transcript Pain - Quia
Pharmacology In Pain Management Pain • What is Pain? • Nursing Assessment • Pain Medication Administration – Documentation – Follow up • NANDA Macroscopic Anatomy: CNS / PNS Anatomy and Physiology Microscopic Anatomy Microscopic Anatomy: The Neuron Microscopic Anatomy: The Synapse Types of Receptors • Mechanocetors • Nociceptors • Thermoreceptos Types of Pain • Nociceptive • Inflammatory • Neuropathic Pharmacology Nonopioid Analgesics: Salicylates and Nonsalicylates Salicylates • Drugs derived from salicyclic acid 11 Salicylates: Actions and Uses • Fever • Pain – Inhibit production of prostaglandins • Anticoagulant 12 Salicylates: Adverse Reactions • GI • Systemic (allergic) 13 Salicylates: Contraindications and Precautions • • • • • • • Chickenpox Influenza Known Allergy Hepatic and Renal Disease Hypoprothrombonemia Vitamin K deficiency Gastric Ulcers 14 Nonsalicylates: Actions and Uses –No anti-inflammatory action –Pain –Fever 15 Nonsalicylates: Action and Uses • Useful for patients with: – aspirin allergy – bleeding disorders – receiving anticoagulant therapy – recent minor surgical procedures 16 Nonsalicylates: Adverse Reactions • Adverse reactions • Overdose 17 Nonsalicylates: Contraindications and Precautions • Known Allergy • Used cautiously in patients: –With severe or recurrent pain or high or continued fever –during pregnancy and lactation 18 Nursing Process: Nursing Diagnosis and Planning • Nursing Diagnosis • Expected Outcome 19 Nursing Process: Implementation • Promoting an optimal response to therapy: –Avoid salicylates 1 week before or after any surgery –Observe for adverse drug reactions –Observe for signs of salicylism (toxicity) 20 Nursing Process: Implementation • asa with full glass of water – With meals • acetaminophen with full glass of water – With or Without meals • S/S of Overdose 21 Nursing Process: Implementation • Notify MD if no relief or new type/source of pain or fever • Assess stool for color 22 Nursing Process: Implementation • Tinnitus or Hearing Loss – D/C immediately – Notify MD – Return to normal function after medication is D/C 23 NSAID: Actions and Uses • COX 1 and COX 2 Inhibitors • Fever • Pain 24 NSAIDs: Adverse Reactions • • • • • • • • GI Cardiovascular CNS Renal Sensory Hematologic Integumentary Metabolic and Endocrine 25 NSAIDs: Contraindications • Known Allergy – Cross Sensitivity • Third trimester of pregnancy and lactation • Ibuprofen • Celecoxib • Renal or Hepatic Disease • GI Bleeding, CVA 26 NSAIDs: Interactions • • • • • • • Anticoagulants Lithium Cyclosporine Hydantoins Diuretics Antihypertensives Acetamainophen 27 Nursing Process: Nursing Diagnoses • Nursing Diagnosis • Expected Outcome 28 Nursing Process: Implementation –Administer with food, milk, or antacids –Several weeks of treatment: Full therapeutic response 29 Nursing Process: Implementation • Educating the patient and family –Take correctly even if symptoms are relieved • Maintain schedule –Several Days for Therapeutic Effect to Start –Develop teaching plan: Appropriate prolonged use of the drug 30 Introduction to Opioid Analgesics • Controlled substances • Do not change tissues where pain originates • Change patient’s perception of pain • Treat pain centrally in the brain 31 Opioid Analgesics • • • • Opiates Morphine Heroin Synthetic opioids 32 Opioid Analgesics: Actions • CNS Cells • Receptors • Agonist and Agonist-Antagonist 33 Opioid Analgesics: Uses • • • • • Treat pain Manage opiate dependence Decrease anxiety Support anesthesia adjunct Promote obstetrical analgesia – Administered intrathecally/epidurally 34 Routes • PO • IM • IV – PCA • Transdermal Opioid Analgesics: Adverse Reactions • • • • • • • CNS Respiratory GI Cardiovascular Genitourinary Allergic Reaction Localized and Other Reactions 36 Opioid Analgesics: Contraindications • • • • • • • Known Allergy Respiratory Increased ICP Renal or Hepatic Disease Acute Ulcerative Colitis Convulsive Disorders Pregnancy, Labor or Lactation 37 Opioid Analgesics: Precautions • • • • • • • Elderly Patients Opioid Naïve Patients Biliary Surgery Undiagnosed Abdominal Pain Hypoxia SVT Prostatic Hypertrophy 38 Opioid Analgesics: Interactions • • • • • • • Alcohol Antihystamines Antidepressants Sedatives Opioid Agonist-Antagonist Barbituates Passion Flower (Herbal) 39 Nursing Process: Assessment • Vitals – Notice Respirations • Details of Pain • Use Your Judgment – Snowed Patient • Stool Consistency, Frequency and Color – Especially if opiate is used for diarrheal control 40 Nursing Process • Nursing Diagnosis • Expected Outcomes 41 Nursing Process: Implementation • Chronic Pain – MSO4 – CR Form – Long Acting Form – Combination Drugs 42 Nursing Process: Implementation • Epidural Pain Management 43 Monitoring • • • • Respirations Significant Change in Pulse Significant Change in BP Pediatric Patients – Cardiac Monitor when available 44 Opioid Dependence • Methadone • Prevention of Desire 45 Opioid (Narcotic) Antagonists • Actions –Antagonist: Competes for opiate receptor sites –Reverses all effects, pain will return –No opioid: Antagonist has no drug activity 46 Opioid (Narcotic) Antagonists • Uses • Adverse Reactions • Contraindications 47 Assessment – Monitor: Blood pressure, pulse, and respiratory rate at frequent intervals, vital signs every 5-15 minutes after patient responsive – Adverse drug reactions: Notify primary health care provider – Continue to monitor vital signs until effects of opioid wear off • Nursing Alert –Repeated dose needed if results from initial dose unsatisfactory –Duration of close patient observation depends on response to opioid antagonist 49 Nursing Process: Planning and Implementation • Planning –Return to normal respiratory rate, rhythm, depth, adequate ventilation of body, continued pain relief • Implementation: Promoting an Optimal Response to Therapy –Naloxone: Used in postanesthesia recovery unit –Balance pain relief 50 • Impaired Spontaneous Ventilation – naloxone (Narcan) 51 • Nursing Alert – Slow IV push: Somnolence abates • Acute Pain – Assess pain and begin to treat pain again, review circumstances that led to use of antagonist, educate family, monitor fluid intake and output 52 Introduction to Anesthesia and Types of Anesthesia • Induced by various drugs to bring about partial or complete loss of sensation • Types of anesthesia: –Local anesthesia –General anesthesia • Anesthesiologist –Trained physician to administer anesthesia 53 • Local Anesthesia • Regional Anesthesia 54 Preparing Patient for Local Anesthesia • Take patient’s allergy history • Prepare the area to be anesthetized: –Cleaning the area with antiseptic, shaving the area –Require fasting • May administer intravenous sedative 55 Administering Local Anesthesia • Mixed with epinephrine to cause local vasoconstriction • Epinephrine contraindicated when used on an extremity 56 Nursing Responsibilities when Caring for Patient Receiving Local Anesthesia • Applying dressing to the appropriate surgical area • Observe area for bleeding, oozing, other problems after administration 57 Preanesthetic Drugs: Uses • Decrease in anxiety • Decrease in Secretions • Decrease N/V 58 Nursing Responsibilities • Describe preoperative and postoperative interventions • Demonstrates, describes and explains postoperative patient activities • Pain Management 59 General Anesthesia • The choice of anesthetic drug depends on: –General physical condition of the patient –Area, organ, system being operated on –Anticipated length of the surgical procedure 60 Drugs used for General Anesthesia • Barbiturates and similar agents • Benzodiazepines • Gases and volatile liquids • Opioids • Skeletal Muscle Relaxants 61 Stages of General Anesthesia • • • • Stage 1- analgesia Stage 2- delirium Stage 3- surgical analgesia Stage 4- respiratory paralysis 62 Nursing Responsibilities • Preanesthesia • Postanesthesia 63 Conscious Sedation • Nursing Considerations Case Study I • • • • • • • • • Martha Matthews is a 34-year-old African American woman. Mrs. Matthews was admitted to the hospital 2 days ago with a venous thromboembolism. She is being discharged from the hospital today on Coumadin (warfarin) 5 mg every day. She tells the nurse she often takes Ecotrin for headaches. Discussion: 1. What should the nurse tell Mrs. Matthews about the use of Ecotrin with Coumadin (warfarin)? 2. What should the nurse recommend Mrs. Matthews take for her headaches? 3. What should the nurse tell Mrs. Matthews about the medication recommended for her headaches? Case Study II • • • • • • • • • James Smith is a 55-year-old Caucasian man. He presents to the physician’s office today complaining of pain in his knees and hips. He has hypertension, diabetes, and generalized anxiety disorder. His medications include lisinopril 20 mg every day, metformin ER 500 mg twice a day, and aspirin 81 mg every day. He has tried acetaminophen in the past to treat his joint pain, but with little relief. The physician diagnoses him with osteoarthritis and writes him a prescription for ibuprofen 800 mg every 8 hours as needed for pain. The physician has asked you, the nurse, to bring Mr. Smith the prescription. Discussion: 1. What should the nurse tell Mr. Smith about taking the ibuprofen with his other medications? 2. How should the nurse advise Mr. Smith to take his ibuprofen? 3. What side effect should the nurse discuss with Mr. Smith about his ibuprofen? Case Study III • Janice Wiggins is a 45-year-old African American woman. She is in the hospital for an elective hysterectomy. She is to receive morphine via a patient-controlled analgesia pump postoperatively. • • Discussion: • • 1. How should the nurse instruct Mrs. Wiggins to use the pump during preoperative teaching? • • 2. After the surgery what information should be included in the nurse’s ongoing assessment and how often should the assessments be completed? • • 3. What situations should be immediately reported to the physician? Case Study IV • Jeffrey Smith is a 17-year-old Caucasian boy who is driven to the emergency department after he collapsed at a party. After examining the patient and talking to others at the party, the physician suspects Mr. Smith has overdosed on oxycodone. • Discussion: • 1. The physician orders naloxone (Narcan) 0.2 mg IV at 2minute intervals. The emergency department has 1-mg/mL vials of naloxone. How many milliliters will the nurse administer per dose? • 2. Before administering naloxone (Narcan) to Mr. Smith what should be included in the nurse’s preadministration assessment? • 3. During the third dose Mr. Smith vomits; how should the nurse handle this situation? Case Study V • • • • • • • • • James Jones is a 29-year-old Caucasian man who is admitted to the hospital to undergo surgery to repair a torn anterior cruciate ligament on his left knee. He has no chronic medical conditions and is in good health. His only medication is Lortab 5/500 mg, and he is allergic to penicillin. Discussion: 1. As the preoperative nurse what are your responsibilities to Mr. Jones? 2. As part of preanesthesia the physician has ordered for Mr. Jones to receive midazolam (Versed) 5 mg 45 minutes before surgery. Midazolam is available in a 1-mg/mL vial. How much would you need to prepare to administer to the patient? 3. Mr. Jones’s surgery is successful. He is now admitted to the postanesthesia care unit, and you are the nurse assigned to care for him. What are your postoperative responsibilities to Mr. Jones? Pain Brochures • Student Presentations Respiratory Brochures 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Codeine Tessalon Pearles Mucomyst Robitussin Benadryl Zyrtec Allegra Claritin Sudafed Afrin 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. Proventil Theophylline Atrovent Spiriva Flovent Symbicort Adviar Pumicort Neo-Synephrine QVAR Respiratory Brochures • Minimum of 3 References – – – – • • • • • • • • Scholarly Drug Book Must be one Pharmacology Book Must be one APA Format Trade and Generic Names Typical Dosages Uses Classification Special Considerations Warning Signs of Overdose/Sensitivity Contraindications Warnings about Possible Interactions • Each Group is Responsible for TWO Drug Brochures • Due 9-24 at 0800 • Email or Drop Box