Assessing Pain
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What is pain?
Do you believe that “perception is reality”?
What are EB clinical practice guidelines??
What if client non-verbal, or you do not
speak the same language?
• Pain vs suffering
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Assessing Pain
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Location
Intensity
Quality
Onset, duration & recurrence
Manner of expressing pain
Precipitating factors
Alleviating factors
Effects on ADL (C&DB, ambulating)
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INS Standards of Practice, 2011
The nurse shall:
• be competent in the care of patients receiving PCA.
• have knowledge of the appropriate drugs used with
PCA, including:
– pharmacokinetics and equianalgesic dosing
– contraindications, side effects and their
management
– appropriate administration modalities
– anticipated outcomes.
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INS Standards of Practice, 2011
• The patient and caregiver shall be educated in the
use of PCA.
• The patient’s and caregiver’s comprehension and
ability to comply with procedures shall be evaluated
and documented prior to, and on initiation of
therapy.
• The use of infusion devices shall adhere to
manufacturers’ directions for use.
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Definitions
• Anesthesia
• Analgesia
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Equianalgesia
• “approximately equal analgesia”
• Used when switching from 1 pain med or
route to another
– Standard: Morphine, 10 mg IM/IV or
30 mg po
– Chart: Craven, p. 1202, Table 44-3
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Patient Controlled Analgesia
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Self-delivery of narcotics
Goal: constant plasma level
IV, SQ, epidural
Acute or chronic pain
Philosophy of care
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Patient Criteria
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Alert
Able to comprehend instructions
Physically able to push button
Acute or chronic pain
No allergy to medication ordered
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Advantages
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Pump infuser can be used – get pain med quicker
Shown to be safe and effective
Patient more relaxed when have more control
Analgesia more effective when serum level
constant
• Postop patients can avoid peak & trough
• Patients shown to ambulate sooner after
abdominal surgery.
• Better pain control= better able C&DB
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Potential Side Effects (opioids)
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Oversedation
Hypotension
Respiratory depression
Urinary retention
Nausea/vomiting
Constipation
pruritus
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Factors that reduce patient safety
• Improper patient selection
• Pump problems
• Programming errors
– Standards require 2nd signature on
initiation
• “PCA by proxy”
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Parts to PCA order
1.
2.
3.
4.
Name of drug
Concentration (mg/ml) of drug
Loading dose (Bolus)
Mode
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Continuous infusion (Basal)
PCA (patient activated)
Combination
5. PCA dose
6. lockout interval (Delay)
7. Hour limit (1 or 4 hour limit)
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Equipment
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PCA pump
Key
PCA tubing
Syringe/cassette of medication
Patent, running IV
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Teaching
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Teach before procedure
Button
Can't overdose (lockout)
Family/friends should not operate
Report to you if ineffective
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Teaching
• Report side effects
• Goals of therapy
• Return demonstration
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Assessment
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Pain level
Sedation level
Respiratory rate
Other side effects
History of attempt/injections
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Ineffective Pain Management
• First: look at history
• Pain r/t ineffective medication
– Is there a titration order?
• Pain r/t knowledge deficit
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Documentation
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Q4h
Assessment
# attempts / # injections
Amount of drug infused
Amount of drug in syringe
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