Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Module 2: Part III Part III: A. Nursing assistant roles in observing and relieving pain B. Nondrug interventions for pain and other symptoms E L N E C Geriatric Curriculum ELNEC Attribution Statement The End-of-Life Nursing Education Consortium (ELNEC) Project is a national end-of-life educational program administered by City of Hope National Medical Center (COH) and the American Association of Colleges of Nursing (AACN) designed to enhance palliative care in nursing. The ELNEC Project was originally funded by a grant from the Robert Wood Johnson Foundation with additional support from other funding organizations (Oncology Nursing, Aetna, Archstone, and California HealthCare Foundations; National Cancer, and Open Society Institutes). Materials are copyrighted by COH and AACN and are used with permission. E L N E C Geriatric Curriculum Part III A: Nursing assistant roles in observing and relieving pain Objectives: • Describe the roles of the NA in EOL care and pain management • Define pain • Describe acute and chronic pain • Describe some common side effects of medications used to treat pain • Describe elements of pain observation E L N E C Geriatric Curriculum Nursing Assistant Roles in Endof-life Care • Providing personal care & assisting in ADLs • Observation and reporting of EOL symptoms • Providing emotional & physical comfort to residents and families • Providing care at the time of death E L N E C Geriatric Curriculum Nursing Assistant Roles in Pain Management • Observe and report the presence and characteristics of pain • Observe for and report effectiveness of therapies • Observe for and report side effects of medications • Deliver some nondrug treatments • Support and get help for residents in pain E L N E C Geriatric Curriculum What is Pain? an unpleasant sensory & emotional experience... IASP, 1979 E L N E C Geriatric Curriculum PAIN: “anything the patient says it is” McCaffery & Pasero, 1999 E L N E C Geriatric Curriculum How Common is Pain in the Nursing Home? 71% to 83% of residents have pain Gagliese & Melzack, 1997 E L N E C Geriatric Curriculum Most Common Types of Pain in LTC • Musculoskeletal: osteoarthritis, osteoporosis • Nerve related: diabetic neuropathy, pain after shingles, phantom limb pain • Constipation • Cancer pain E L N E C Geriatric Curriculum Acute and Chronic Pain ACUTE • Sudden onset symptom • Occurs in response to illness or injury • Usually decreases or goes away over time as healing occurs • Goal: pain goes away when cause is treated E L N E C Geriatric Curriculum CHRONIC • Slow onset, or follows acute • Lasts > 3 months • Cause sometimes is unknown • Sometimes divided into cancer and noncancer • Goal: maintain functioning and quality of life Myths About Pain in the Older Adults • Pain is a natural part of growing old. • Older people are less sensitive to pain. • If an older person doesn’t report pain, that person doesn’t have pain. • If a person can sleep or be distracted from pain, that person doesn’t really have pain. E L N E C Geriatric Curriculum Myths About Pain in the Older Adult • Strong pain medicine, like morphine, can’t be used safely for the older adult because they are too sensitive to dangerous side effects. • People who use morphine-like drugs become addicted to them. E L N E C Geriatric Curriculum Myths About Pain in the Older Adult (cont.) • People with dementia and other brain conditions don’t feel pain. • People with dementia and other brain conditions can’t reliably report their pain. E L N E C Geriatric Curriculum Overview of Analgesics E L N E C Geriatric Curriculum Commonly Used Pain Medicines • Nonopioids • Opioids • Adjuvants/co-analgesics E L N E C Geriatric Curriculum Nonopioids • Acetaminophen (Tylenol®) • Nonsteroidal anti-inflammatory drugs (NSAIDs): – Ibuprofen (eg, Advil®) – Naproxen (eg, Naprosyn®, Aleve®) – Celebrex® E L N E C Geriatric Curriculum Opioids • Sometimes referred to as “narcotics” • Examples: morphine, Percocet®, Vicodin®, Duragesic®, codeine • Are effective for moderate to severe pain • Common side effects: – – – – – E L Constipation Sleepiness Nausea, vomiting Urinary retention Itchiness N E C Geriatric Curriculum Adjuvants/Co-analgesics E • • • • Antidepressants Anticonvulsants Topicals Others L N E C Geriatric Curriculum Observing and Reporting Pain E L N E C Geriatric Curriculum Common Words for Pain • • • • • • Ache Discomfort Sore Heavy Burning Stiff No complaints ≠ no pain E L N E C Geriatric Curriculum How Bad is the Pain (Intensity)? Herr, 2002; Hicks et al., 2001 E L N E C Geriatric Curriculum Pain Location E L N E C Geriatric Curriculum How Does the Resident Describe the Pain? Muscle or Bone Pain • Aching • Dull • Sore • Throbbing/cramping • Deep Nerve Pain • Shooting • Burning • Sharp • Electric shock/tingling E L N E C Geriatric Curriculum Pain Patterns • Is the pain constant? • Does it come and go? • What times of the day is it worst? E L N E C Geriatric Curriculum What Makes the Pain Worse? Examples: • Movement • Feeling blue or depressed • Fatigue • Nausea E L N E C Geriatric Curriculum What Makes the Pain Better? E • • • • • • Medications Moderating physical activity Distraction Heat and cold Home remedies Complementary therapies L N E C Geriatric Curriculum Side Effects of Pain Medicines? • NSAIDs: – Swelling – Stomach upset – Bleeding • Opioids: – Constipation – Sleepiness – Nausea/vomiting E L N E C Geriatric Curriculum Nonverbal Patients • Advanced dementia • Progressive neurological disease • Post stroke (CVA) • Imminently dying • Developmentally disabled E L N E C Geriatric Curriculum Behavioral/Observational Cues Obvious: • Grimacing or wincing • Bracing/guarding • Rubbing • Calling out, moaning, groaning Less Obvious: • Changes in activity level • Sleeplessness, restlessness • Resistance to movement • Decreased participation in activities • Increased agitation, anger, etc. • Decreased appetite E L N E C Geriatric Curriculum Pay particular attention to changes from normal behaviors E L N E C Geriatric Curriculum When to Observe for Pain • During personal care • During transfers and ambulation • Following activities • Following pain management interventions E L N E C Geriatric Curriculum Part III B: NonDrug Pain & Symptom Management Objectives • Describe reasons for using nondrug therapies to relieve EOL symptoms • Describe special considerations and precautions for using specific nondrug therapies • Demonstrate the use and teaching of several nondrug techniques E L N E C Geriatric Curriculum Non-Drug Techniques Physical • Massage • Cold • Heat • Vibration • Positioning • Exercise E L N E C Geriatric Curriculum Psychological • Distraction • Relaxation • Music • Comfort Foods • Imagery • Controlled Breathing Common Myths Myth If people can be distracted from their pain, the pain isn’t “real” or it’s not as bad as they are saying. Use nondrug measures instead of pain medication E L N E C Geriatric Curriculum Reality People can be distracted from pain because distraction is an effective nondrug therapy Nondrug treatments are not an appropriate substitute for pain medication Observations Prior to Starting Therapy • Understanding of options • Attitude and comfort • Family interest and availability • Need for education • Ability to participate E L N E C Geriatric Curriculum Non-Drug Symptom Relief: Specifics • • • • • • • E L Massage Applications of cold and heat Positioning Distraction Relaxation Music Comfort foods N E C Geriatric Curriculum Massage Decreases pain by soothing the skin and relaxing tense muscles E L N E C Geriatric Curriculum Massage Examples • Brief touch such as rubbing someone’s shoulder • A warm foot soak and rub • Massaging a hand with warm lotion E L N E C Geriatric Curriculum Applications of Cold • Reduces pain by: – numbing nerve endings – reducing muscle spasms – decreasing inflammation • Also decreases the desire to scratch areas that itch! E L N E C Geriatric Curriculum Cold Examples • An ice pack to the neck and upper shoulders • Ice massage to the knee with a Dixie Cup™ • Ice cloth to the hip opposite the one that hurts E L N E C Geriatric Curriculum Hot Applications • Relieves pain by reducing inflammation and soreness • Also decreases sensitivity to pain and increases blood flow to the skin E L N E C Geriatric Curriculum Heat Examples • Warm washcloth to head • Hot water bottle to abdomen • Jacuzzi™ bath E L N E C Geriatric Curriculum Positioning/Movement • Positioning eases pain by placing the body into postures that maintain or promote normal function of the muscles • Movement helps maintain or restore ease of function in joints, bones, nerves, and ligaments E L N E C Geriatric Curriculum Positioning/Movement Examples • Use of full-length body pillow • Pillow between knees when lying on either side • Pretend write the alphabet by using the feet – switch feet every 6 or 8 letters E L N E C Geriatric Curriculum Distraction Used to focus attention on something other than pain. By decreasing concentration on pain, it becomes more bearable. E L N E C Geriatric Curriculum Distraction Example • Compile a file of pictures • Have resident describe picture by: – Talking about the picture – Pretending they are in the picture – Telling a story about the picture • Choose a new picture as soon as their interest decreases in the current one E L N E C Geriatric Curriculum Relaxation • Described as freedom from physical and mental tension • Relaxation techniques reduce stress, muscle tension and reduce pain E L N E C Geriatric Curriculum Relaxation Examples • Put on headphones with a tape of calming music • Breathe in deeply; exhale slowly • Think of a calm setting or peaceful place that you’ve enjoyed visiting E L N E C Geriatric Curriculum Music Decreases pain by: • Providing distraction • Reducing anxiety • Prompting recall of pleasant memories • Interrupting the stress response E L N E C Geriatric Curriculum Comfort Foods Assists in decreasing pain by: • Providing distraction • Evoking comforting memories • Promoting relaxation and physical calm E L N E C Geriatric Curriculum Building a Toolkit E L N E C Geriatric Curriculum Role of the Nursing Assistant • Activities not requiring an order: – Distraction – Backrub/shoulder massage – Music – Positioning – Reading – Prayer – Comfort foods E L N E C Geriatric Curriculum Role of the Nursing Assistant • Activities that require an order or are clearly part of a care plan: – Application of heat or cold – Use of menthol-based product – Massage of extremities E L N E C Geriatric Curriculum E L N E C Geriatric Curriculum