vetining Unaracteristics - Acute rain = Patient reports pain = Guarding behavior, protecting body part = Selffocused = Narrowed focus (e.g., altered time perception, withdrawal from social or physical contact) = Relief or distraction behavior (.g., moaning, crying, pacing, seeking out other people or activit restlessness) = Facial mask of pain = Alteration in muscle tone: listlessness ar flaccidness, rigidity of tension = Autonornic responses (e.g., diaphoresis; change in blond pressure [BP], pulse rate; pupil dilation; change in respiratory rate; pallor, nausea) cove cie Betionte: vignetuiie &pitpuoTio wevouiuten Yih plait; GaROH Uae Ory Hibue rating eennNpere color and moisture of skin, restlessness, and ability to focus. Some people deny the experienc pain when it is present. Attention ta associated signs may help the nurse in evaluating pain + Assess for probable cause of pain. Different etiological factors respond better to differant therapi + Assess patient's knowledge of or preference for the array of pairrrelief strategies available. © patients may be unaware of the effectiveness of nonpharmacolagical methods and may be will try them, either with or instead of traditional analgesic medications. Often a combination of there (e.g., mild analgesics with distraction or heat) may prove most effective + Evaluate patient's response to pain and medications or therapeutics aimed at abolishing ot reli: pain. It is important to help patients express as factually as passible (Le, without the effect of rr emotion, or anxiety) the effect of pain relief measures, Discrepancies between behavior or appear and what patient says about pain relief (or lack of if) may be more a reflection of other methods pe is using to cope with than pain relief itself + Assess to what degree cultural, environmental, intrapersonal, and intrapsychic factors contribute to pain or pain relief These variables may modify the patient's expression of his o experience. For example, some cultures openly express feelings, while others restrain expression. However, health care providers should not stereotype any patient response but r evaluate the unique response of each patient, » Evaluate what the pain means to the individual. The meaning of the pain ~will directly influence patient's response. Some patients, especially the dying, may feel that the “act of suffering” mes spiritual need + Assess patient's expectations for pain relief Some patients may be content to have decreased; others will expect complete elimination of pain. This affects their perceptions ot ee aexample, a PCA patient becomes confused and cannot manage PCA, or a successful mod ceases to provide adequate pain relief, as in relaxation breathing. = If patient is on PCA, assess the following * Pain relief The basal or lock-out dase may need to be increased to cover the patient's pain. + Intactness of IV line Ifthe IV is not patent, patient will nat receive pain medication = Amaunt of pain medication patient is requesting If demands for medication are quite frequ patient's dosage may need to be increased. If demands are very low, patient may require ful + instruction ta properly use PCA, < * Possible PCA complications such as excessive sedation, respiratory distress, uri retention, nausea/vomiting, constipation, and IV site pain, redness, or swelling Patients may "experience mild allergic response ta the analgesic agent, marked by generalized itchin . nausea and varmiting. Lt Hfpatient is receiving epidural analgesia, assess the following = Pain relief Intermittent epidurals require redosing at intervals. Variations in anatomy may re in a"patch effect.” = Numbness, tingling in extremities, a metallic taste in the mouth These symptoms mat indicators of an allergic response to the anesthesia agent, or of improper catheter placement = Possible epidural analgesia complications euch as excessive sedation, respiratory distr urinary retention, or catheter migration Respiratory depression and intravascular infusio anesthesia (resulting from catheter migration) can be potentially life-threatening.= Ustermine the appropriate pam rehet method. * Pharmacological methods include the following: Nonsteroidal antiinflammatory drugs (NSAIDs) may be administered orally or parenterally (to date, ketorolac is the only available parenteral NSAIL = Use of opiates that may be administered orally, intramuscularly, subcutaneously, intravenot systemically by patient-contralled analgesia (PCA) systems, or epidurally (either by bolus continuous infusion). Narcotics are indicated for severe pain, especially in the hospice or h setting = Local anesthetic agents. = Nonipharmacological methods include the following: Cognitive-behavioral strategies as follows: a2 = Imagery The use of a mental picture or an imagined event involves use of the five sense distract oneself from painful stimuli. = Distraction techniques Heighten one's concentration upon nonpainful stimuli ta decrease o awareness and experience of pain. Some methods are breathing modifications and n stimulation = Relaxation exercises Techniques are used to bring about a state of physical and me awareness and tranquility. The goal of these techniques is to reduce tension, subseque reducing pain = Biofeedback, breathing exercises, music therapy Cutaneous stimulation as follows: = Massage of affected area when appropriate Massage decreases muscle tension and promote comfort = Transcutaneous electrical netve stimulation (TENS) units = Hot or cold compress Hot, moist compresses have a penetrating effect. The warmth rus blood to the affected area to promote healing. Cold compresses may reduce total edema ppamete enma mimhina tharahy ReneAntinn RmPAfn ee+ Give analgesics as ordered, evaluating effectiveness and abserving for any signs and symptom untoward effects. Pain medications are absorbed and metabolized differently by patients, so t effectiveness rnust be evaluated from patient to patient. Analgesics may cause side effects that ra from mild to life-threatening, «= Notify physician if interventions are unsuccessful or if current complaint is a significant change f patient's past experience of pain. Patients wha request pain medications at more frequent inter than prescribed may actually require higher doses or more potent analgesics. « Whenever possible, reassure patient that pain is time-limited and that there is more thanwith narcotic being infused. IV incompatibilities are possible. + If patient is receiving epidural analgesia: Label all tubing (¢.g., epidural catheter, IV tubing to epid catheter) clearly to prevent inadvertent administration of inappropriate fluids or drugs into epid space + For patients with PCA or epidural analgesia: Keep Narcan or other narcotic-reversing agent tee available. In the event of respiratory depression, these drugs reverse the narcotic effect + Fost "No additional analgesia" sign over bed. This prevents inadvertent analgesic overdosing. Education/Continuity of Care - Acute Pain » Provide anticipatory instruction on pain causes, appropriate prevention, and relief measures. + Explain cause of pain or discornfart, if known. = Instruct patient to report pain. Relief measures may be instituted = Instruct patient to evaluate and report effectiveness of measures used. + Teach patient effective timing of medication dose in relation to potentially uncomfortable activi and prevention of peak pain periods + For patients on PCA or those receiving epidural analgesia: Teach patient preoperatively. Anesth: effects should rot abscure teaching + Teach patient the purpose, benefits, techniques of use/action, need for IV line (PCA only), 0 alternatives for pain control, and of the need to notify nurse of machine alarm and occurrence uintnward affacts: