07.07 Pain and Nonpharmacological Comfort Measures

Overview

  1. Pain
    1. Patient perspective
    2. Understanding pain
    3. Pain goals
    4. Managing pain

Nursing Points

General

  1. Patient perspective
    1. Pain is what the patient says it is
      1. Always subjective, even though it’s given a number
    2. Acute versus chronic
    3. Will be different between patients
  2. Understanding pain
    1. OLDCARTS vs PQRST
      1. OLDCARTS
        1. Onset
        2. Location
        3. Duration
        4. Character
        5. Alleviating or aggravating factors
        6. Radiation
        7. Timing
        8. Severity
      2. PQRST
        1. Provoking factors
        2. Quality
        3. Region or radiation
        4. Severity
        5. Time
    2. Nonverbal or physiologic responses
      1. Assess for grimacing, guarding or reacting
      2. Observe BP and heart rate
  3. Pain goals
    1. Nonpharmacologic response
    2. Cannot eliminate pain
      1. Reduce to manageable level
      2. Set realistic goals
  4. Managing pain
    1. Pain scales
      1. Use appropriate scale
    2. Escalating pain measures
      1. Use nonpharmacologic pain meds first,
      2. Nonopiate analgesics
      3. Oral opiates
      4. Injectable opiates
    3. De-escalating pain measures
      1. Patients can’t go home on IV pain meds
      2. Work to utilize non pharmacological pain measures

Nursing Concepts

  1. Comfort
  2. Patient-Centered Care
  3. Health Promotion
  4. Mobility

Patient Education

  1. Educate patient on realistic pain goals
  2. Educate patient on medication side effects
  3. Explain to patient benefits of nonpharmacologic pain efforts

Reference Links

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Video Transcript

In this lesson we’re going to talk about pain and non-pharmacological comfort measures.

When we look at our patients pain, we have to remember that it’s a subjective thing. So it’s something that the patient says that it is. And what we try to do is reconcile what they’re telling us they’re experiencing with something objective so that we can treat them. We’ll talk about how all that works a little bit later in this lesson, but what I want you to remember is it is what the patient experiences.

Pain can be acute, chronic, or both. So if it’s acute pain, it means that it’s been a relatively short time since they’ve had it, it can be really intense, and, it’s affecting almost every aspect of their life. Chronic pain doesn’t affect their life any less, but just remember that it’s been for a very, very long duration, and most of the time the qualities of that pain are much different than acute pain. And sometimes they can have both, meaning a patient that has chronic low back pain, and experiences a new back injury, can have both types.

Also, pain is going to be different for every patient. Some people tolerate a ton of pain, and some people can’t. What that means is that you’re going to have to key into what your patient’s telling you so you can manage their pain in the best way possible.

The best way to understand your patient’s pain is probably going to be to look at either these two mnemonics. I’m going to cover both of these briefly, but what I want you to understand is that in order to understand our patients pain better, we have to look at different aspects of pain from the patient’s point of view to really get a good idea as to what interventions are really going to work.

When we look at old carts, we’re going to look at onset so when did it start. Location, where does it hurt. Duration, how long does the pain last? Character, is the pain dull, or sharp, or aching, or throbbing? is there anything that you can do that makes it better or makes it worse? Radiation, does it go anywhere, does it spread out anywhere? Timing, is there a particular time of the day that it’s worse or better? And severity, which is how intense is it?

In the opqrst method you’re going to get a lot of the same things. so is there anything that makes it worse? Tell me the quality of it. Where does it start and does it spread anywhere? How severe or intense is it? Is there any time of day that’s better or worse?

As you can see, pain isn’t just a relative number. Pain is something that’s really complex, and we need to drive home that we really need more information, so that we can really help our patients out.

When we talk about pain management and goals, you need to tell your patient that you can’t take the pain away, but you’ll work with them to manage it. You want their pain to be tolerable so that they can get out of bed and do regular things. But set that expectation early so that you can work with them on it.

The other thing that you should focus on to our non-pharmacological interventions for pain management. So these are things like guided imagery or Massage, or aromatherapy, or pet therapy. Heat and Ice are often used for pain management. Put these things in your toolbox so that when you need to get them out you’ll have them available so that if your patient is having a pain breakthrough you can at least do something for them.

Now when you’re talking to your patient about pain, you need to make sure that you’re using the right pain scale. If you have a patient, who’s a pediatric, they may not be able to understand or comprehend the number scale, which is the one that we most commonly use for our adult patient. There’s lots of these different pain scales and there’s a really good cheatsheet with this lesson so go check that out.

But the thing that I really want to drive home here is that you should try to use your nonpharmacologic interventions first. If that doesn’t work for your patient, then you should move up in a stepwise fashion. For instance, if your patient has a migraine, jumping to the strongest IV opiate medication may actually not help their headache. Patients with migraines often complain about having the lights be too bright, or that noises make the pain worse. So consider turning out the lights and turning down the tv, that way you don’t have to jump to immediate medication.

If your patient isn’t responding to your nonpharmacologic interventions, then you can maybe try your analgesics like your NSAIDs, or some of the other non opiate medications. And then if that doesn’t work then you could step up to oral pain medications, and then if you have to go to your IV pain medications you can. Just know that once you reach that top-level, you really can’t go any higher.

The other thing that you should consider is how soon the drug actually kicks in and also what other treatments they may be doing. If you plan on doing a really painful dressing change in 10 minutes, and the only thing that you have available is an oral medication that will kick in for 30 minutes, your patient’s going to hurt. So just be considerate when you’re trying to plan care so that you really using the best medication possible.

The last thing I want to talk about de-escalating pain management. And what I mean is that your patient can’t stay on IV pain medications forever. So like I said in the beginning, you should set your expectations and goals for your patients so that you can say first thing in the morning hey they’re going to stop your pain pump, so we need to get you on some oral pain medications. That’s when you introduce the Pain Scale, that’s when you educate your patient, and that’s when you really start working towards managing your patients pain.

Our nursing concepts really focused on comfort and patient-centered care today. Also, we focused on health promotion for our patients through pain management.
Okay so let’s recap.

First off remember that your patients pain is what they say it is. It’s a totally subjective experience.

Pain is different for everybody, so be sure to ask them all the questions about what their pain is like.

Set realistic expectations for your patient, and remember that you can’t eliminate the pain, but you’re going to focus on managing it to something tolerable.

Try your nonpharmacologic methods first, And then step up to the big guns.

That’s our lesson for today. Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!

Read more

  • Question 1 of 10

A nurse is caring for a 12-month old child who is recovering from surgery. Which of the following principles should the nurse implement when managing pain in a patient who cannot communicate with words? Select all that apply.

  • Question 2 of 10

A nurse is caring for a patient who has cancer and has been suffering from pain. Which of the following describes breakthrough pain as experienced by a patient? Select all that apply.

  • Question 3 of 10

A patient in the hospital complains of a headache and asks for pain medication. The nurse may give either an opioid or non-opioid analgesic. Which of the following drugs are examples of non-opioid analgesics for mild to moderate pain? Select all that apply.

  • Question 4 of 10

A nurse is caring for a patient who uses a morphine PCA for pain control. The patient calls the nurse and says that the PCA does not seem to be working because he is still having significant pain. Which response from the nurse is most appropriate?

  • Question 5 of 10

A nurse is caring for a patient who has returned from the recovery room following surgery. The patient arrived to the floor with a PCA pump in place and orders for pain control. Which step would the nurse perform first?

  • Question 6 of 10

A nurse prepares a dose of medication that is a controlled substance to give to a patient for pain. When the nurse takes the medication into the room, the patient refuses it. What action of the nurse is most appropriate?

  • Question 7 of 10

A nurse is caring for a client with chronic pain and recommends relaxation therapy as part of pain management. How would relaxation therapy work in this situation?

  • Question 8 of 10

A nurse is utilizing the PQRST Pain Assessment method to determine if a patient is experiencing pain. Which questions would the nurse ask according to the P portion of the assessment? Select all that apply.

  • Question 9 of 10

A nurse has been ordered to give a patient an intravenous dose of an opioid pain medication following surgery. Which of the following describes a contraindication to using intravenous therapy? Select all that apply.

  • Question 10 of 10

A 50-year-old patient is recovering from abdominal surgery. He complains of pain that has been continuously rated at a 6 on a 0-10 scale despite the intervention of giving morphine Q4H PRN. Which implication must the nurse consider when controlling this patient’s pain?

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