Page 5 of 9
unacceptable. Stop opioid. Notify physician. Slowly administer physician ordered dilute IV naloxone (0.4mg naloxone in 10 mL saline; 0.5 mL over 2-minute period)or call Rapid Response Administer acetaminophen or an NSAID, if ordered and not contraindicated, to control pain Monitor sedation and respiratory status closely. z z z z z
Non-pharmacologic Pain Management
Utilization of non-drug strategies is encouraged to alleviate pain. These techniques have minimal adverse events and pose little safety threats to patients. Strategies include:
Progressive muscle relaxation techniques
Music therapy (instrumental, rhythmic, 60-80 beats per minute; duration is typically 20-30 minutes (Wells, Pasero, McCaffrey, 2008)
Massage- systematic manipulation of soft tissues by manual or mechanical means; duration 5-20 minutes
Repositioning &/or splinting
Transcutaneous Electrical Nerve Stimulation (TENS) unit - with physician order
Distraction- DVD, television, visitors, etc.
Heat/cold therapy- Protect skin when applying heat or cold.
cold therapy has been found to improve pain, range of motion, and function in patients undergoing orthopedic surgeries (Wells, et.al, 2008) Heat (over a 5 day period improved pain intensity and function for patients with low back pain (Wells, et.al., 2008)
Patient teaching should include as applicable such topics as:
The patient’s right to controlled pain
His/her responsibility to give an accurate subjective assessment and report pain on a numerical or happy face scale.
Probable physiological causes of pain that may be specific to the patient.
Barriers to good pain control.
Address patient fears.
Alternative methods of pain management.
Pain intensity scales and patient's responsibility to report pain as soon as it starts before it gets severe because it is much easier to control.
How to take the prescribed medication to get the optimal effect.
Potential limitations and side effects of pain treatments.
Patient teaching about pain occurs in the following ways:
Individual teaching sessions between the clinicians and patient/family
Mosby's Patient Education resources
Written materials such as handouts and brochures
Planning for Pain Management after Discharge: planning for the need for pain control after discharge should be a collaborative effort between the patient/family, the nurse, the physician and other members of the interdisciplinary team as relevant. Instructions to the patient will be given on the Discharge Summary.
Age Specific Considerations:
Pediatrics: Ages 0 - 17
The health care professional must consider the age of the pediatric patient and the current stressors of the situation they are under when making the decision of which