Download PLANNING COMMITTEE NAMES AND CREDENTIALS: ® Nancy

3/10/2015
GOAL OF PROGRAM:
To gain understanding about caring for
different pain populations and keeping
them safe.
SUCCESSFUL COMPLETION:
To receive contact hours, participants
must attend the entire program. Please
return your completed evaluation form to
the conference registration desk at the
end of the conference
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PLANNING COMMITTEE NAMES AND
CREDENTIALS:
 Nancy Irish, MSN, RN-BC
 Roberta Goff, MSN ED, RN-BC, ACNS-BC, ONC
 Vickie Harrington-Thompson BS, RN, CMSRN
SPEAKER NAME AND CREDENTIALS:
 Roberta Goff, MSN Ed, RN-BC, ACNS-BC, ONC
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The activity planners and the speaker for
Excellence in Nursing have reported no
conflicts of interest related to the
presentation.
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No Commercial support or sponsorship was
received for the Excellence in Nursing
presentation.
NON-ENDORSEMENT OF PRODUCTS:
The discussion of commercial products during
the conference does not imply endorsement by
Munson Medical Center, Wisconsin Nurses
Association, or the American Nurses
Credentialing Center’s Commission on
Accreditation.
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 The
learner will be able to differentiate the
difference between chronic pain pathways
and acute pain pathways
 The learner will be able to describe risks for
and assessment of sedation
 The learner will be able to state 3
medications that could be used for a patient
who is opioid-naïve
 The learner will be able to express
alternative treatments for those with pain
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 Chronic
pain has become a label that is
fraught with negativity and stereotypes
 Persistent
pain fosters more of a positive
undertone and hope
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 “Unpleasant
sensory and emotional
experience arising from actual or potential
tissue damage; sudden or slow onset of any
intensity from mild to severe, constant or
recurring without an anticipated or
predictable end and a duration of greater
than 6 months”
 “…persisting a month longer than the usual
course of an acute disease…”
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 Neuropathic
 Radiculalgia
 Central
 Radiculopathy
neuropathic
 Poststroke syndrome
 Spinal cord injury
 Complex regional
pain syndrome
(types I and II)
 Peripheral
neurogenic
 Peripheral
neuropathy
 Radiculitis
 Phantom
limb pain
limb pain
 Fibromyalgia
 Myofascial pain
 Residual
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 Physical
 Malingering
dependence
 Tolerance
 Addiction
 Chronic Pain
Syndrome
 Drug-Seeking
 Factitious Disorder
 Pseudoaddiction
 Psychogenic
Pain
Disorder
 Somatoform
Disorder
 Substance Abuse
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 Fear
of addiction
tolerance
 Limitations of activities such as driving
 Harm to the immune system
 Opioid-induces hyperalgesia
 Opioid-induced hypogonadism
 Building
 “Can’t
I just have cancer please?”
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 Patients
receiving long-term opioid therapy
may need up to a fourfold higher opioid dose
than someone who is opioid-naïve.
 Make sure that the patient gets normal doses
of home pain medications before surgery
 Have the down and dirty talk about exactly
how much pain medication they were taking
at home
 Ask how they cope with pain at home
 Add a non-opioid to the pain regimen early
on
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 “Frequent
Painer”
Flyer”, “Drug Seeker”, “Chronic
 Evidence
suggests that pain in people with
addictive disease are undertreated
 Giving medications will not worsen the
disease and not giving them will not help
with recovery
 Withholding opioids could put them into
serious withdrawal
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 “Pain
Management in Patients with Addictive
Disease”
“…patients with addictive
disease and pain have the
right to be treated with
dignity, respect, and the
same quality of pain
assessment and management
as all other patients.”

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 “Whatever
the experiencing person says it is,
existing whenever the experiencing person
says it does.” (Margo Mcaffery)
 “Pain perception is an inherent quality of life
that appears early in ontogeny to serve as a
signaling system for tissue damage.” (Anand &
Craig)
 “Acute
pain is a warning signal to the body
that something is wrong or needs attention”
(Bonica)
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 Recent
onset
nociceptors are involved in the
transmission of sensation
 Usually associated with the sympathetic
portion of the autonomic nervous system
responses
 Treatment is focused on the cause
 Peripheral
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Opioids, Alpha2 Agonist,
Anticonvulsants, TCA
TCA, SNRI
Local anesthesia, Alpha2 Agonists,
NSAIDs
Local, NSAIDs, Cox 2 inhibitor,
Acetaminophen, capsaicin
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 All
opioid naïve patients
tolerant patients receiving more
opioid than they are tolerant to
 Coexisting conditions such as chronic
pulmonary disease, major organ failure,
obesity, and those with sleep apnea
 Age greater than 65, especially with
comorbidities
 Those whose pain was uncontrolled, but is
now controlled
 Opioid
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 Opioid
Naïve: No daily use of opioids within
the past 7 days.
 Opioids
are sedating…sedation causes CO2
retention…followed by respiratory
depression…leading to respiratory arrest
 Start low-Go slow!
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 Rate

(less than 6 needs action)
Needs to be counted for at least 1 full minute
 Quality




(compare to baseline)
Depth
Effort
Noise (snoring)
Regularity
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 Highly
reliable measure of the quality of
ventilation
 Early indicator of impending respiratory
depression
 Uses a nasal cannula to detect expired CO2
 Programmed to alarm and when the device
detects a reading outside of the preset
parameters
 If the monitoring module is attached to a
PCA or PCEA, the opioids will actually stop
infusing if respiratory depression is realized
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Safe
pain management
Reduce
Naloxone usage
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 ASSESSMENT:



What is the nature and characteristics of the
pain?
What works at home?
Are there medications you are not willing to try?
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 Especially
in the elderly, many times plain
acetaminophen is enough.
 If the patient does not have any
contraindications, there are a variety of
NSAIDS that could be offered.
 A drug like Tramadol is often a great starting
point for more severe pain
 For severe pain, start with the lowest dose of
opioid.
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 Adjuvant
medications
 Ice
 Heat
 Repositioning
 Distraction
 Home
coping measures
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



Dykstra, K. (2012). Perioperative pain management in the opioidtolerant patient with chronic pain: An evidence-based practice
project. Journal of Perianesthesia Nursing, 27(6), pp 385-392
McCaffery, M. & Pasero, C. (1999). Pain: Clinical manual (2nd
ed.). St. Louis, MO: Mosby
Pasero, C. & McCaffery, M. (2011). Pain assessment and
pharmacologic management. St. Louis, MO: Mosby Elsevier
St. Marie, B. (2010). Core curriculum for pain management
nursing (2nd ed.). Kendall Hunt Publishing
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REMEC
SITES:
Please make sure to fill out
your evaluations and sign-in
sheets. They need to be
mailed to Nancy Irish in Staff
Development in order to
receive your CEUs.
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