The PAIN Problem
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PAIN Management San Diego Service Area
description
The PAIN Problem. Most common reason for medical appointments in the U.S. 50 million people affected by pain 1 out of 3 people affected by pain 140 million visits annually $120 billion in annual health costs Pain affects quality of life Patient’s fear addiction to treatment meds - PowerPoint PPT Presentation
Transcript of The PAIN Problem
PAIN Management
San Diego Service Area
San Diego
The PAIN Problem
Most common reason for medical appointments in the U.S. 50 million people affected by pain
1 out of 3 people affected by pain
140 million visits annually
$120 billion in annual health costs
Pain affects quality of life
Patient’s fear addiction to treatment meds
Healthcare provider’s fear treating malingering patients.
Our GOAL is to manage the patient’s PAIN effectively!
San Diego
Patient’s Rights
Be believed when pain is reported
Have pain relief
Be told how much pain to expect & how long it will last
Have pain prevented & controlled when it occurs
Be asked acceptable level of pain
Rate pain using appropriate scales
Develop a pain plan with the doctor & care delivery staff
Know the risks, benefits & side effects of treatments
Know what alternative pain treatments may be available
Ask for changes in treatments if pain persists
Receive pain medication in a timely manner
Include family & others in decision making about pain management
Considerate, respectful care, & made to be comfortable
Given respect for personal values & beliefs
Receive information about the pain causes & prevention
Refuse, accept, or suggest pharmacological or non-pharmacological interventions
San DiegoPain, the Fifth Vital Sign
San DiegoBarriers to Pain Management
San Diego
At Risk Populations for Under Treatment of Pain
• Patients with history of addiction or alcohol abuse• Nonverbal (intubated, unconscious)• Cognitively impaired• Elderly• Neonates, infants, children• Ethnic, racial minorities
San Diego
Numeric Pain Scale
No Pain
Unbearable Pain
0 1 2 3 4 5 6 7 8 9 10
For use in adults, adolescents & cognitively-appropriate pediatric patients
No Pain WORST Pain
Mild Pain
[1,2,3]
Moderate Pain
[4,5,6]
Severe Pain
[7,8,9,10]
May use FACES Scale if patient has difficulty with use of numeric scale
Distressing Pain
San Diego
Numeric Pain Scale - Spanish
0 1 2 3 4 5 6 7 8 9 10
No me Duele
No Aguantoel Dolor
Dolor Leve
[1,2,3]
Dolor Moderado
[4,5,6]
Dolor Furte
[7,8,9,10]
El Dolor meMortifica
For use in adults, adolescents & cognitively-appropriate pediatric patients
May use FACES Scale if patient has difficulty with use of numeric scale
San DiegoWong-Baker FACES
Pain Rating Scale
Spanish
English
San Diego
Pharmacological Pain Management
San DiegoFLACC Pain Rating ScaleFor infants to 7 years of age
Category Scoring0 1 2
Face No particular expression Occasional grimace or frown Frequent-constant quiver or smile withdrawn, disinterested chin, clenched jaw
Legs Normal position, relaxed Uneasy, restless, tense Kicking or legs drawn up
Activity Lying quietly, normal Squirming, shifting back & Arched, rigid or jerking position, moves easily forth, tense
Cry No cry (awake or asleep) Moans or whimpers; Crying steadily, screams, occasional complaint sobs; frequent complaint
Consolabilty Content, relaxed Reassured by occasional Difficult to console or touching, hugging, or being comfort talked to, distractible
San DiegoN-PASSNeonatal Pain, Agitation, & Sedation Scale
Premature Pain Assessment
+ 3 if < 28 weeks gestation/corrected age
+ 2 if 28-31 weeks gestation/corrected
age
+ 1 if 32-35 weeks gestation/corrected
age
San Diego
Non-verbal Pain ScaleNot validated but useful tool for pt’s who cannot communicate
Procedure1. Assess pt. according to
each 5 observation categories
2. Assign points according to criteria
3. Total the points4. Apply point total to the
0-10 numeric scale5. Reassess frequently to
compare scores & determine changes in pain level
San Diego
Non-verbal Pain ScaleUsed in Health Connect for Documentation
Movement0 = Positive response to interaction and touch1 = Startling, guarding, generalized tension2 = Thrashing, restless squirmingPosition0 = Restful position, joints relaxed, hands open1 = Finger curled, initial resistance to position change2 = Clenched fists, knees pulled up, strong resistance to positioningFacial Cues0 = Placid expression, smile, relaxed jaw1 = Frown, fearful expression, brow lowering2 = Scowling, clenched jaw, stern look
Emotion0 = Pleasant, serene, cooperative, sleeping1 = Uncooperative, anxious, confused2 = Irritable, combativeVerbal Cues0 = Agreeable responses, humming, singing to self, quiet1 = Moaning, groaning, monotone, muttering2 = Screeching, screaming, crying
San DiegoRASS Sedation Scale Richmond Agitation Sedation Scale used in Health ConnectUse PASS Score of Procedural Sedation
Observe Pt.1. Alert, restless, agitated (0 -
+4)2. Not alert, state pt’s name, ask to
“open eyes & look at me”a. Pt. awakens w/eyes open &
contact (-1)b. Pt. awakens w/eyes open &
contact unsustained (-2)c. Pt. has movement in
response to voice but not eye contact (-3)
3. No response to verbal, physically stimulate pt.
a. Pt. has movement (-4)b. Pt. has no response (-5)
Score Term Description+4 Combative Overly combative, violent, immediate danger
to staff+3 Very Agitated Pulls or removes tubes, catheters; aggressive+2 Agitated Frequent non-purposeful movement, fights
ventilator+1 Restless Anxious, movements not aggressive0 Alert & Calm-1 Drowsy Not fully alert, has sustained awakening
(eye-opening/contact) to voice >10secs-2 Light Sedation Briefly awakens w/eye contact to voice <10sec-3 Moderate Movement or eye opening to voice
Sedation (no eye contact)-4 Deep Sedation No response to voice, movement or eye
opening to physical stimulation-5 Unarousable No response to voice or physical stimulation
San DiegoPAIN Management Competency Post Test
FEEL GOOD!
GREAT!
EXCELLENT!
EXTRAORDINARY!
NEVER BETTER!
San Diego
Pain Management Competency Post Test
1. Your patient reports that they are still experiencing moderate to severe pain even though they are taking the maximum dose/frequency prescribed by the physician. What is an appropriate nursing action? A. Encourage the patient to “wait and let the medicine take effect”B. Perform a thorough pain assessment and communicate and collaborate findings
with the physicianC. Assume the patient is displaying drug seeking behaviors
2. A 45-year-old man arrives in the Outpatient Treatment Center. He is unable to adequately verbalize information requested. You need to assess his pain. What pain assessment scale(s) would be best to use? Choose any that could be used.
A. Faces B. 0-10 Numeric C. N-PASS D. None of the above
San Diego
Pain Management Competency Post Test
3. Patient rights include: relief or control of pain, to be asked about acceptable level of pain, to know the risks, benefits, and side effects of pain control measures, and
to have respect for personal values and beliefs. A. True B. False
4. When completing a pain assessment or reassessment, approved pain scales appropriate for the patient must be used.
A. True B. False
5. Once a pain control measure is given, further assessment is not needed. A. True B. False
San Diego
Pain Management Competency Post Test
6. Which of the following are validated and approved pain scales? Select all that apply.
A. 0-10 Numeric B. Wong-Baker Faces C. FLACC D. 0-5 Pediatric Faces E. N-PASS
7. A night shift RN notices that an infant is crying more than usual, and wants to assess the newborn’s pain. The RN would use the FLACC pain scale for assessment.
A. True B. False
San Diego
Pain Management Competency Post Test
8. Populations at risk for under management of their pain: A. ElderlyB. History of drug/alcohol abuse C. Neonate D. Cognitively impairedE. NonverbalF. All of the above
9. Patients and their caregivers must be provided education about the following: A. Pain scales B. How to control pain C. Consequences of uncontrolled pain D. Various pain control measures and potential side effectsE. All of the above
San Diego
Pain Management Competency Post Test
10. Which of the following best describes the “5th Vital Sign” initiative?A. Pain should be assessed at least five times a dayB. Pain should be assessed after other vital signsC. Pain is the least important vital signD. Pain information should be recorded at least as frequently as other vital signs
11. If a pain control measure is given and a re-assessment is completed but not documented, it really doesn’t matter.
A. True B. False
12. Failure to ask patients about their pain and accepting and acting on the patient’s reports of pain is probably the most common cause of unresolved treatable pain.
A. TrueB. False
San Diego
Pain Management Competency Post Test
13. A 14-year-old male admitted for ambulatory surgery at one of our clinics does not need pain assessment. A. True B. False
14. Assessment of pain must include location, quality, intensity, duration, aggravating and alleviating factors, and one other item. What is that item? Acceptable level of pain or pain goal
15. Which of the following statements is true regarding opioid therapy? A. Pain at a level of five or above on a 10-point scale is treatable by opioid agents B Intensive opioid therapy remains an end-of-live therapy for severe chronic pain C. Intensive opioid therapy is limited largely to cancer pain D. Opioid therapy for non-cancer pain exposes the clinician ti regulatory sanction
San Diego
Pain Management Competency Post Test
16. A 35-year-old male patient with testicular cancer is joking and playing cards with his roommate. When assessed by the pain management nurse, the patient rates his pain as a seven on a numeric pain rating scale of 0 to 10. The nurse concludes that the patient's behavior:
A. is an emotional reaction to the anticipated pain. B. is in anticipation of future pain. C. is more indicative of the need for pain medication than the pain rating. D. may be in conflict with the pain rating, and accepts the report of pain
17. The pain management nurse notices a male patient grimacing as he moves from the bed to a chair. The patient tells the nurse that he is not experiencing any pain. The nurse's response is to:
A. clarify the patient's report by reviewing the patient's nonverbal behavior B. confronting the patient's denial of pain C. obtaining an order for pain medication D. supporting the patient's stoic behavior
San Diego
Pain Management Competency Post Test
18. When teaching a 65-year-old patient to use a pain scale, a pain management nurse anticipates that:
A. additional time is needed for the patient to process the information B. older adults are unable to use pain scales reliably C. the Pain Assessment in Advanced Dementia Scale is appropriate for the patient D. the patient's family is included in the education sessions
19. Patients should be encouraged to establish an acceptable level of pain score or pain relief score goal.
A. True B. False
San Diego
Pain Management Competency Post Test
20. A 75-year-old female patient comes to the oncology clinic for management of chronic cancer pain. The patient has been prescribed morphine sulfate (MS Contin), 30 mg, every 12 hours. The patient states that she is taking the medicine only when the pain becomes severe because of her husband's concern about addiction. The pain management nurse responds: A. “It is okay to continue doing what you are doing.” B. “The risk of developing addiction when taking opioids for pain is very low.” C. “We need to consider other alternatives for managing your pain.” D. “You must take the medication as prescribed, regardless of your husband‘s concerns.”
