Pain Management
Mr. Will, a 67-year-old patient, is postoperative day 2 after a coronary artery bypass graft operation to revascularize his coronary arteries that were significantly blocked. He has a midline incision of his chest and a 7-inch incision on the inner aspect of his right thigh where a saphenous vein graft was harvested and used to vascularize the blocked coronary artery. The surgeon ordered Oxycodone 5 mg every 4 hours PRN for moderate pain and Oxycodone 10 mg every 4 hours PRN for severe pain.
Considering the patient’s age, what medication administration considerations should the nurse incorporate into the pain management plan and why?
What measures should the nurse provide the patient to prevent adverse effects of analgesic agents from occurring?
What nonpharmacologic pain management methods should the nurse teach to Mr. Will to assist with pain management? Pain Management
2. Mr. Rogers is 2 days postoperative of a thoracotomy for removal of a malignant mass in his left chest. His pain is being managed via an epidural catheter with morphine (an opioid analgesic). As the nurse assumes care of Mr. Rogers, he is alert and fully oriented, and states that his current pain is 2 on a 1-to-10 scale. His vital signs are 37.8 – 92 – 12, 138/82.
What are benefits of epidural versus systemic administration of opioids?
The nurse monitors Mr. Rogers’ respiratory status and vital signs every 2 hours. What is the rationale for these frequent assessments?
The nurse monitors Mr. Rogers for what other complications of epidural analgesia?
Mr. Rogers complains of a severe headache. What should the nurse do?
Mr. Rogers’ epidural morphine and decreased mobility increase his chances of constipation. What interventions should be included in his plan of care to minimize constipation?
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Types of Pain
Pain is a general term that describes any kind of unpleasant or uncomfortable sensation in the body.
There are many different types and causes of pain, and these can be grouped into eight different categories to help with pain management: Pain Management
Acute pain
Chronic pain
Breakthrough pain
Bone pain
Nerve pain
Phantom pain
Soft tissue pain
Referred pain.
Acute pain
This starts suddenly and only lasts for a short period (ie, minutes, hours, a couple of days, occasionally a month or two).
It is usually caused by a specific event or injury, such as:
A broken bone
A car crash or other type of accident
A fall
Burns or cuts
Dental work
Labor and childbirth
Surgery.
Chronic Pain
Chronic pain is pain that has persisted for longer than six months and is experienced most days. It may have originally started as acute pain, but the pain has continued long after the original injury or event has healed or resolved. Chronic pain can range from mild to severe and is associated with conditions such as: Pain Management
Arthritis
Back pain
Cancer
Circulation problems
Diabetes
Fibromyalgia
Headache.
Chronic pain can severely affect a person’s quality of life and prevent them from returning to work or participating in physical activity. In some people, it may lead to depression or social isolation.
Breakthrough Pain
Breakthrough pain is a sudden, short, sharp increase in pain that occurs in people who are already taking medications to relieve chronic pain caused by conditions such as arthritis, cancer, or fibromyalgia.
Breakthrough pain may also be called a pain flare and it may occur with exercise or physical activity, coughing, illness, stress, or during the period between pain medication doses. The pain level is often severe, but the location of the pain is usually the same as the person’s chronic pain. Pain Management
Bone Pain
This is a tenderness, aching or discomfort in one or more bones that is present during both exercise and rest.
Bone pain is commonly associated with conditions or diseases that affect the structure or function of bone, such as cancer, a fracture (broken bone), infection, leukemia, mineral deficiency, sickle cell anemia, or osteoporosis. Many pregnant women experience pelvic girdle pain.
Nerve Pain
Nerve pain is caused by nerve damage or inflammation. It is usually described as a sharp, shooting, burning or stabbing pain and may also be called neuralgia or neuropathic pain. Some people describe it as being like an electric shock and it is often worse at night.
Nerve pain can severely interfere with a person’s life and affect their sleep, work, and physical activity levels. They are often very sensitive to cold and may experience pain with even the slightest touch. Many people with chronic nerve pain also develop anxiety or depression. Pain Management
People with neuropathic pain are often very sensitive to touch or cold and can experience pain as a result of stimuli that would not normally be painful, such as brushing the skin.
Common causes of nerve pain include:
Alcoholism
An injury to the brain, a nerve, or the spinal cord
Cancer
Circulation problems
Diabetes
Herpes zoster (shingles)
Limb amputation
Multiple sclerosis
Stroke
Vitamin B12 deficiency.
Phantom Pain
Phantom pain is pain that feels like it is coming from a body part that is no longer there. It is common in people who have had a limb amputated, but is different from phantom limb sensation, which is usually painless Pain Management
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