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4 / 9

Pain Management

Page 4 of 9

8.

Patient and family education

  • I.

    Pharmacologic management of pain as dictated by the intensity of the patient's pain, along with RN assessment of pain, and the effectiveness of previous pain relief strategies to meet the objective of preventing:

    • 1.

      Mild pain

      • a.

        Scheduled and/or prn non-opioid analgesics are recommended, keeping in mind medication side effects (i.e., GI upset with NSAIDs) and manufacturer dose ranges (i.e. Acetominophen-not to exceed daily dose of 4000mg)

      • b.

        Consider adjuvant options.

    • 2.

      Moderate to severe pain: pharmacological treatment

      • a.

        When continuous pain is anticipated, a fixed-dose schedule (around the clock) is recommended.

      • b.

        A PRN order of a rapid onset analgesic may be necessary to control activity-related (breakthrough) pain.

      • c.

        To ensure opioids are safely administered, begin with a low dose and titrate to comfort.

      • d.

        Modification in analgesic administration is based upon effectiveness of the previous dose, including change in pain intensity, relief, and side effects experienced.

      • e.

        Patients respond differently to various opioid and nonopioid analgesics; therefore if one drug is not providing adequate pain relief, another in the same class may result in better pain control.

      • f.

        Consider adjuvant options.

3. Safe use of opioids: a. Because opioid-induced respiratory depression is preceded by an increasing level of sedation, sedation levels are monitored at regular intervals in patients receiving opioids. i. A history of sleep apnea and/or obesity increases the risk of enhanced sedative effects and those patients should be monitored more closely with pulse oximetry. ii. Sedation should be monitored for all opioid naive patients with moderate to severe pain when opioid dosing is initiated, and every two hours for 24 hours. iii. Sedation monitoring: I. Sleeping and easy to arouse: acceptable no action necessary; supplemental opioid may be given if necessary z

II. Awake and alert: acceptable no action necessary; supplemental opioid may be given if necessary z

III. Slightly drowsy, easily aroused: acceptable no action necessary; supplemental opioid may be given if necessary z

IV.

z z z Frequently drowsy, arousable, drifts off to sleep during conversation: unacceptable. Discuss with physician. Consider past sleep history and pain management, then consider as applicable decreasing opiod dose if respiratory rate < 12, heart rate <60, B/P < 100/60. Administer acetaminophen or an NSAID, if ordered and not contraindicated, to control pain. Monitor sedation and respiratory status closely.

V. Somnolent, minimal or no response to physical stimulation:

https://www.lucidoc.com/cgi/doc-gw.pl?ref=bch:10631/frame/DOCBODY

9/10/2010

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