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    Pain Management

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    Maica Lectana
    This document discusses pain management in geriatric nursing. It defines concepts like nociception and different types of pain including nociceptive, neuropathic, mixed, and idiopathic pain. It also outlines pharmacologic approaches to pain relief including acetaminophen, NSAIDs, and opioids as well as non-pharmacologic options. Palliative care aims to improve quality of life for those with life-limiting illnesses, while hospice care focuses on comfort for those with a life expectancy of 6 months or less.

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    Pain Management

    Uploaded by

    Maica Lectana
    35 views20 pages
    This document discusses pain management in geriatric nursing. It defines concepts like nociception and different types of pain including nociceptive, neuropathic, mixed, and idiopathic pain. It also outlines pharmacologic approaches to pain relief including acetaminophen, NSAIDs, and opioids as well as non-pharmacologic options. Palliative care aims to improve quality of life for those with life-limiting illnesses, while hospice care focuses on comfort for those with a life expectancy of 6 months or less.

    Original Title

    PAIN MANAGEMENT

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    This document discusses pain management in geriatric nursing. It defines concepts like nociception and different types of pain including nociceptive, neuropathic, mixed, and idiopathic pain. It also outlines pharmacologic approaches to pain relief including acetaminophen, NSAIDs, and opioids as well as non-pharmacologic options. Palliative care aims to improve quality of life for those with life-limiting illnesses, while hospice care focuses on comfort for those with a life expectancy of 6 months or less.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    35 views20 pages

    Pain Management

    Uploaded by

    Maica Lectana
    This document discusses pain management in geriatric nursing. It defines concepts like nociception and different types of pain including nociceptive, neuropathic, mixed, and idiopathic pain. It also outlines pharmacologic approaches to pain relief including acetaminophen, NSAIDs, and opioids as well as non-pharmacologic options. Palliative care aims to improve quality of life for those with life-limiting illnesses, while hospice care focuses on comfort for those with a life expectancy of 6 months or less.

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    PAIN

    MANAGEMENT
    GERIATRIC
    NURSING
    NOCICEPTION
    • “THE NEURAL PROCESSES OF
    ENCODING AND PROCESSING
    NOXIOUS STIMULI”
    • NOXIOUS STIMULI – AN
    ACTUALLY OR POTENTIALLY
    TISSUE DAMAGING EVENT
    PAIN
    • AN UNPLEASANT SENSORY AND
    EMOTIONAL EXPERIENCE WHICH
    WE PRIMARILY ASSOCIATE WITH
    TISSUE DAMAGE OR DESCRIBE IN
    TERMS OF SUCH DAMAGE, OR
    BOTH
    • ALWAYS SUBJECTIVE
    CLASSIFICATION OF
    PAIN

    • NOCICEPTIVE PAIN
    • NEUROPATHIC PAIN
    • MIXED PAIN
    • IDIOPATHIC PAIN
    • PHANTOM LIMB PAIN
    NOCICEPTIVE PAIN
    • PAIN THAT IS PROPORTIONATE
    TO THE DEGREE OF ACTUAL
    TISSUE DAMAGE
    • SERVES A PROTECTIVE
    FUNCTION
    • 2 TYPES
    • SOMATIC
    • VISCERAL
    NEUROPATHIC PAIN
    • ALSO KNOWN AS NEUROGENIC
    PAIN
    MIXED PAIN
    •NEUROPATHIC PAIN
    •NOCICEPTIVE PAIN
    •NOCICEPTIVE PAIN MAY
    COEXIST WITH A
    COMPONENT OF
    NEUROPATHIC PAIN
    IDIOPATHIC PAIN
    •NO UNDERLYING LESION
    FOUND YET, DESPITE
    INVESTIGATION
    •PAIN DISPROPORTIONATE TO
    THE DEGREE OF CLINICALLY
    DISCERNIBLE TISSUE INJURY
    PRESENTATION ACROSS
    PAIN STATES VARIES
    Neuropathic Pain
    Pain initiated or caused
    by a primary lesion or Mixed Pain Nociceptive Pain
    dysfunction Pain with Pain caused by injury to
    in the nervous system neuropathic and body tissues
    (either peripheral or nociceptive (musculoskeletal,
    central nervous components cutaneous or visceral)2
    system)1

    Examples Examples
    Peripheral Examples
    • Post-herpetic neuralgia • Pain due to
    • Trigeminal neuralgia • Low back pain
    with inflammation
    • Diabetic peripheral • Limb pain after a
    neuropathy radiculopathy
    • Cervical fracture
    • Post-surgical • Joint pain in
    neuropathy radiculopathy
    • Cancer pain osteoarthritis
    • Post-traumatic • Post-operative
    neuropathy • Carpal tunnel
    syndrome visceral pain
    Central
    PAIN RELIEF

    PHARMACOLOGIC

    NON-PHARMACOLOGIC
    PHARMACOLOGIC
    INTERVENTIONS

    • STEP APPROACH (0 – 10 SCALE)


    • STEP 1: MILD PAIN (0 – 3)
    • ACETAMINOPHEN (< 4,000 MG/DAY) &
    NSAIDS
    • STEP 2: MODERATE PAIN (4 – 6)
    • LOW-DOSE, SHORT-ACTING OPIOIDS WITH
    ACETAMINOPHEN & NSAIDS
    • STEP 3: SEVERE PAIN (7 – 10)
    • OPOIDS NOT USED IN COMBINATION WITH
    TYLENOL OR NSAIDS
    PHARMACOLOGIC
    INTERVENTIONS

    • ROUTE OF CHOICE: ORAL


    • IF PATIENT CANNOT SWALLOW:
    • SL, SUBQ, IV, RECTAL, TOPICAL
    • PRESCRIBE HALF A DOSE GIVEN TO
    YOUNGER CLIENTS: TO PREVENT
    ADVERSE REACTIONS
    • “START LOW & GO SLOW”
    PHARMACOLOGIC
    CONSIDERATIONS
    • ACETAMINOPHEN
    • LEVELS SHOULD NOT EXCEED
    4,000/DAY
    • WELL TOLERATED FOR LONG-TERM
    USE
    • FOR MUSCULOSKELETAL PAIN
    • NSAIDS
    • USE WITH CAUTION IN CLIENTS
    WITH ULCER DISEASES, AND CHF
    PHARMACOLOGIC
    CONSIDERATIONS

    • OPIOIDS
    • MODERATE TO SEVERE PAIN
    • START WITH SHORT HALF-LIFE
    (MORPHINE, HYDROMORPHONE,
    OXYCODONE) THEN LONGER HALF-LIFE
    (FENTANYL PATCH, METHODONE)
    • CONSTIPATING – CONCURRENT BOWEL
    PROGRAM IS ESSENTIAL
    • STIMULANT AND STOOL SOFTENER AT
    START OF THERAPY
    PHARMACOLOGIC
    CONSIDERATIONS
    • MORPHINE
    • “GOLD STANDARD”
    • MOST COMMONLY USED OPIOID
    • IF SEDATION OR CONFUSION
    DEVELOPS AFTER A FEW DAYS OF
    USE, SWITCH TO ANOTHER
    ANOTHER OPIOID
    • LONG-ACTING CAN ONLY BE USED
    AFTER A FEW DAYS OF TRIAL WITH
    SHORT-ACTING MORPHINE
    NON-PHARMACOLOGIC
    INTERVENTIONS
    •ACUPUNCTURE
    •TAI CHI/YOGA
    •GUIDED IMAGERY
    •BIOFEEDBACK
    •MUSIC THERAPY
    WONG-BAKER FACES PAIN
    RATING SCALE
    CARE OF THE DYING

    PALLIATIVE CARE
    HOSPICE CARE
    PALLIATIVE CARE
    • PHILOSOPHY – CARE FOR THOSE PERSONS
    WITH LIFE-LIMITING ILLNESSES WHO ARE NOT
    YET ELIGIBLE FOR HOSPICE CARE
    • COMPREHENSIVE MANAGEMENT OF THE
    PHYSICAL, PSYCHOLOGICAL, SOCIAL,
    SPIRITUAL AND EXISTENTIAL NEEDS OF
    PATIENTS
    • GOAL – ACHIEVE THE BEST POSSIBLE QUALITY
    OF LIFE FOR PATIENTS AND THEIR FAMILIES
    • CONTROL OF PAIN, PSYCHOLOGICAL, SOCIAL,
    AND SPIRITUAL PROBLEMS
    HOSPICE CARE
    • CREATED IN ORDER TO PROVIDE
    COMFORT AND DIGNITY AT END OF
    LIFE
    • ELIGIBILITY IS BASED ON A LIFE
    EXPECTANCY OF 6 MONTHS OR LESS
    IF AN ILLNESS RUNS ITS NORMAL
    COURSE

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