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PAIN Management San Diego Service Area. San Diego The PAIN Problem  Most common reason for medical appointments in the U.S.  50 million people affected.

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Presentation on theme: "PAIN Management San Diego Service Area. San Diego The PAIN Problem  Most common reason for medical appointments in the U.S.  50 million people affected."— Presentation transcript:

1 PAIN Management San Diego Service Area

2 San Diego The PAIN Problem  Most common reason for medical appointments in the U.S.  50 million people affected by pain  1 out of 3 people affected by pain  140 million visits annually  $120 billion in annual health costs  Pain affects quality of life  Patient’s fear addiction to treatment meds  Healthcare provider’s fear treating malingering patients. Our GOAL is to manage the patient’s PAIN effectively!

3 San Diego Patient’s Rights  Be believed when pain is reported  Have pain relief  Be told how much pain to expect & how long it will last  Have pain prevented & controlled when it occurs  Be asked acceptable level of pain  Rate pain using appropriate scales  Develop a pain plan with the doctor & care delivery staff  Know the risks, benefits & side effects of treatments  Know what alternative pain treatments may be available  Ask for changes in treatments if pain persists  Receive pain medication in a timely manner  Include family & others in decision making about pain management  Considerate, respectful care, & made to be comfortable  Given respect for personal values & beliefs  Receive information about the pain causes & prevention  Refuse, accept, or suggest pharmacological or non- pharmacological interventions

4 San Diego Pain, the Fifth Vital Sign Once the patient has been assessed and a pain management plan has been designed, pain should be monitored and recorded routinely at least as often as other vital signs Pain assessment should include: Use of an appropriate, approved pain scale Ask about location, quality, intensity, duration, aggravating, and alleviating factors, acceptable level of pain or pain score goal. Reassessment should occur after treatment for pain

5 San Diego Barriers to Pain Management Multiple barriers to pain management have been identified, such as inadequate knowledge of pain management, poor assessment of pain, patients' reluctance to report pain, and the low priority given to pain management. Research shows that when nurses do not obtain pain ratings from patients, they are likely to underestimate pain, especially moderate to severe pain. Education needs to address the relevance of the nurse's personal opinion of the patient's pain versus the need to record and act on what the patient says about their pain We need to be aware of the need for cultural sensitivity and understand that patients may be in severe pain but not “look like” they are. (Mc Caffrey, 2000)

6 San Diego At Risk Populations for Under Treatment of Pain Patients with history of addiction or alcohol abuse Nonverbal (intubated, unconscious) Cognitively impaired Elderly Neonates, infants, children Ethnic, racial minorities

7 San Diego Numeric Pain Scale No Pain Unbearable Pain For use in adults, adolescents & cognitively-appropriate pediatric patients No PainWORST Pain Mild Pain [ 1,2,3 ] Moderate Pain [ 4,5,6 ] Severe Pain [ 7,8,9,10 ] May use FACES Scale if patient has difficulty with use of numeric scale Distressing Pain

8 San Diego Numeric Pain Scale - Spanish No me Duele No Aguanto el Dolor Dolor Leve [ 1,2,3 ] Dolor Moderado [ 4,5,6 ] Dolor Furte [ 7,8,9,10 ] El Dolor me Mortifica For use in adults, adolescents & cognitively-appropriate pediatric patients May use FACES Scale if patient has difficulty with use of numeric scale

9 San Diego Wong-Baker FACES Pain Rating Scale Spanish English

10 San Diego Pharmacological Pain Management Non-opioid Analgesics (1-3 or mild pain) Examples include: Acetaminophen and nonsteroidal antinflammatory drugs such as Ibuprofen. Weak Opiod analgesics (4-6 or moderate pain) Example: Codeine Strong Opiod analgesics (7 or above, severe pain) Examples: Morphine, Dilaudid Adjuvant Medications: Drugs with indications other than pain which may be analgesic in specific circumstances. Examples include: Decadron, antidepressants, anticonvulsants, Alpha-2-Adrenergic Agonists (Clonidine), muscle relaxants (Baclofen)

11 San Diego FLACC Pain Rating Scale For infants to 7 years of age CategoryScoring 012 F ace No particular expressionOccasional grimace or frownFrequent-constant quiver or smilewithdrawn, disinterested chin, clenched jaw L egs Normal position, relaxed Uneasy, restless, tense Kicking or legs drawn up A ctivity Lying quietly, normal Squirming, shifting back & Arched, rigid or jerking position, moves easily forth, tense C ry No cry (awake or asleep) Moans or whimpers; Crying steadily, screams, occasional complaint sobs; frequent complaint C onsolabilty Content, relaxed Reassured by occasional Difficult to console or touching, hugging, or being comfort talked to, distractible

12 San Diego N-PASS N eonatal P ain, A gitation, & S edation S cale Premature Pain Assessment + 3 if < 28 weeks gestation/corrected age + 2 if weeks gestation/corrected age + 1 if weeks gestation/corrected age

13 San Diego Non-verbal Pain Scale Not validated but useful tool for pt’s who cannot communicate Procedure 1.Assess pt. according to each 5 observation categories 2.Assign points according to criteria 3.Total the points 4.Apply point total to the 0-10 numeric scale 5.Reassess frequently to compare scores & determine changes in pain level

14 San Diego Non-verbal Pain Scale Used in Health Connect for Documentation Movement 0 = Positive response to interaction and touch 1 = Startling, guarding, generalized tension 2 = Thrashing, restless squirming Position 0 = Restful position, joints relaxed, hands open 1 = Finger curled, initial resistance to position change 2 = Clenched fists, knees pulled up, strong resistance to positioning Facial Cues 0 = Placid expression, smile, relaxed jaw 1 = Frown, fearful expression, brow lowering 2 = Scowling, clenched jaw, stern look Emotion 0 = Pleasant, serene, cooperative, sleeping 1 = Uncooperative, anxious, confused 2 = Irritable, combative Verbal Cues 0 = Agreeable responses, humming, singing to self, quiet 1 = Moaning, groaning, monotone, muttering 2 = Screeching, screaming, crying

15 San Diego RASS Sedation Scale Richmond Agitation Sedation Scale used in Health Connect Use PASS Score of Procedural Sedation Observe Pt. 1.Alert, restless, agitated ( ) 2.Not alert, state pt’s name, ask to “open eyes & look at me” a.Pt. awakens w/eyes open & contact ( -1 ) b.Pt. awakens w/eyes open & contact unsustained ( -2 ) c.Pt. has movement in response to voice but not eye contact ( -3 ) 3.No response to verbal, physically stimulate pt. a.Pt. has movement ( -4 ) b.Pt. has no response ( -5 ) Score TermDescription +4 Combative Overly combative, violent, immediate danger to staff +3 Very Agitated Pulls or removes tubes, catheters; aggressive +2 Agitated Frequent non-purposeful movement, fights ventilator +1 Restless Anxious, movements not aggressive 0 Alert & Calm -1 Drowsy Not fully alert, has sustained awakening (eye-opening/contact) to voice > 10 secs -2 Light Sedation Briefly awakens w/eye contact to voice < 10 sec -3 Moderate Movement or eye opening to voice Sedation (no eye contact) -4 Deep Sedation No response to voice, movement or eye opening to physical stimulation -5 Unarousable No response to voice or physical stimulation


17 San Diego Pain Management Competency Post Test 1. Your patient reports that they are still experiencing moderate to severe pain even though they are taking the maximum dose/frequency prescribed by the physician. What is an appropriate nursing action? A. Encourage the patient to “wait and let the medicine take effect” B. Perform a thorough pain assessment and communicate and collaborate findings with the physician C. Assume the patient is displaying drug seeking behaviors 2. A 45-year-old man arrives in the Outpatient Treatment Center. He is unable to adequately verbalize information requested. You need to assess his pain. What pain assessment scale(s) would be best to use? Choose any that could be used. A. Faces B Numeric C. N-PASS D. None of the above

18 San Diego Pain Management Competency Post Test 3. Patient rights include: relief or control of pain, to be asked about acceptable level of pain, to know the risks, benefits, and side effects of pain control measures, and to have respect for personal values and beliefs. A. True B. False 4. When completing a pain assessment or reassessment, approved pain scales appropriate for the patient must be used. A. True B. False 5. Once a pain control measure is given, further assessment is not needed. A. True B. False

19 San Diego Pain Management Competency Post Test 6. Which of the following are validated and approved pain scales? Select all that apply. A Numeric B. Wong-Baker Faces C. FLACC D. 0-5 Pediatric Faces E. N-PASS 7. A night shift RN notices that an infant is crying more than usual, and wants to assess the newborn’s pain. The RN would use the FLACC pain scale for assessment. A. True B. False

20 San Diego Pain Management Competency Post Test 8. Populations at risk for under management of their pain: A. Elderly B. History of drug/alcohol abuse C. Neonate D. Cognitively impaired E. Nonverbal F. All of the above 9. Patients and their caregivers must be provided education about the following: A. Pain scales B. How to control pain C. Consequences of uncontrolled pain D. Various pain control measures and potential side effects E. All of the above

21 San Diego Pain Management Competency Post Test 10. Which of the following best describes the “5th Vital Sign” initiative? A. Pain should be assessed at least five times a day B. Pain should be assessed after other vital signs C. Pain is the least important vital sign D. Pain information should be recorded at least as frequently as other vital signs 11. If a pain control measure is given and a re-assessment is completed but not documented, it really doesn’t matter. A. True B. False 12. Failure to ask patients about their pain and accepting and acting on the patient’s reports of pain is probably the most common cause of unresolved treatable pain. A. True B. False

22 San Diego Pain Management Competency Post Test 13. A 14-year-old male admitted for ambulatory surgery at one of our clinics does not need pain assessment. A. True B. False 14. Assessment of pain must include location, quality, intensity, duration, aggravating and alleviating factors, and one other item. What is that item? Acceptable level of pain or pain goal 15. Which of the following statements is true regarding opioid therapy? A. Pain at a level of five or above on a 10-point scale is treatable by opioid agents B Intensive opioid therapy remains an end-of-live therapy for severe chronic pain C. Intensive opioid therapy is limited largely to cancer pain D. Opioid therapy for non-cancer pain exposes the clinician ti regulatory sanction

23 San Diego Pain Management Competency Post Test 16. A 35-year-old male patient with testicular cancer is joking and playing cards with his roommate. When assessed by the pain management nurse, the patient rates his pain as a seven on a numeric pain rating scale of 0 to 10. The nurse concludes that the patient's behavior: A. is an emotional reaction to the anticipated pain. B. is in anticipation of future pain. C. is more indicative of the need for pain medication than the pain rating. D. may be in conflict with the pain rating, and accepts the report of pain 17. The pain management nurse notices a male patient grimacing as he moves from the bed to a chair. The patient tells the nurse that he is not experiencing any pain. The nurse's response is to: A. clarify the patient's report by reviewing the patient's nonverbal behavior B. confronting the patient's denial of pain C. obtaining an order for pain medication D. supporting the patient's stoic behavior

24 San Diego Pain Management Competency Post Test 18. When teaching a 65-year-old patient to use a pain scale, a pain management nurse anticipates that: A. additional time is needed for the patient to process the information B. older adults are unable to use pain scales reliably C. the Pain Assessment in Advanced Dementia Scale is appropriate for the patient D. the patient's family is included in the education sessions 19. Patients should be encouraged to establish an acceptable level of pain score or pain relief score goal. A. True B. False

25 San Diego Pain Management Competency Post Test 20. A 75-year-old female patient comes to the oncology clinic for management of chronic cancer pain. The patient has been prescribed morphine sulfate (MS Contin), 30 mg, every 12 hours. The patient states that she is taking the medicine only when the pain becomes severe because of her husband's concern about addiction. The pain management nurse responds: A. “It is okay to continue doing what you are doing.” B. “The risk of developing addiction when taking opioids for pain is very low.” C. “We need to consider other alternatives for managing your pain.” D. “You must take the medication as prescribed, regardless of your husband‘s concerns.”

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