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Pain Management

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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

J.

Non-pharmacologic Pain Management

1.

2.

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:

  • a.

    Progressive muscle relaxation techniques

  • b.

    Music therapy (instrumental, rhythmic, 60-80 beats per minute; duration is typically 20-30 minutes (Wells, Pasero, McCaffrey, 2008)

  • c.

    Massage- systematic manipulation of soft tissues by manual or mechanical means; duration 5-20 minutes

  • d.

    Repositioning &/or splinting

  • e.

    Imagery

  • f.

    Transcutaneous Electrical Nerve Stimulation (TENS) unit - with physician order

  • g.

    Distraction- DVD, television, visitors, etc.

  • h.

    Heat/cold therapy- Protect skin when applying heat or cold.

z

z

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)

  • K.

    Patient education

    • 1.

      Patient teaching should include as applicable such topics as:

      • a.

        The patient’s right to controlled pain

      • b.

        His/her responsibility to give an accurate subjective assessment and report pain on a numerical or happy face scale.

      • c.

        Probable physiological causes of pain that may be specific to the patient.

      • d.

        Barriers to good pain control.

      • e.

        Address patient fears.

      • f.

        Alternative methods of pain management.

      • g.

        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.

      • h.

        How to take the prescribed medication to get the optimal effect.

      • i.

        Potential limitations and side effects of pain treatments.

  • 2.

    Patient teaching about pain occurs in the following ways:

    • a.

      Individual teaching sessions between the clinicians and patient/family

    • b.

      Mosby's Patient Education resources

    • c.

      PYXIS Lexicomp

    • d.

      Written materials such as handouts and brochures

  • L.

    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.

  • M.

    Age Specific Considerations:

    • 1.

      Pediatrics: Ages 0 - 17

      • a.

        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

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9/10/2010

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