Pain management
Download
1 / 20

PAIN MANAGEMENT - PowerPoint PPT Presentation


  • 253 Views
  • Updated On :

PAIN MANAGEMENT. Carole Morgan, RN, MPA, LNHA Director of Nursing Patrick O’Toole, Pharm. D., MPA Director of Pharmacy Sea View Hospital Rehabilitation Center and Home. PAIN. Number 1 complaint among older adults

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'PAIN MANAGEMENT' - lee


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Pain management l.jpg

PAIN MANAGEMENT

Carole Morgan, RN, MPA, LNHA

Director of Nursing

Patrick O’Toole, Pharm. D., MPA

Director of Pharmacy

Sea View Hospital Rehabilitation Center and Home


Slide2 l.jpg
PAIN

  • Number 1 complaint among older adults

  • Nearly 60% of older adults taking pain medications

  • Can significantly affect ones well being

  • A barrier in treating pain in older adult is inadequate pain assessment


Assessment l.jpg
ASSESSMENT

What’s Needed

  • A comprehensive tool to capture both subjective/objective on admission, readmission, significant change or a newonset of pain

  • Anticipation of Pain – before dressing changes, Rehab therapy, ROM exercises

  • Assessment tool must also identify

    Residents needs and goals

    Etiology

    Severity


Assessment4 l.jpg

Subjective data

Onset – location and time or origin

Contributing factors – Causes of pain beginning or worsening

Quality – Description (sharp, dull, crushing, aching, burning, steady, movable)

Intensity – Severity on a scale of 1 – 10

Pattern – how often, how long, certain times

Relief measures – measures to relieve or control pain

Objective data

Appearance - Evidence of clenched teeth or fists clenched, swelling, deformity, redness, perspiration, tense muscles, change in pupil size, fatigue

Movements – Evidence of guarded movements, rigidity, restlessness, restriction of use

Affect – Evidence of mood changes, signs of anger, irritability, or depression

Vital signs – Change in pulse, bloodpressure, respiration

ASSESSMENT


Monitoring l.jpg
Monitoring

Once a resident is identified as having

pain, we begin a fluid and on-going process of evaluation of treatment modalities, to see

if they are effective


Interdisciplinary treatment l.jpg
Interdisciplinary Treatment

  • Attention must not only be directed at physiological aspects of addressing pain but also consider providing alternate treatments that focus upon psychosocial and environmental factors

  • ITC team and resident collaborate to arrive at a measurable treatment goals

  • Often, trials of various treatment modalities are needed to develop the most effective approach


Interdisciplinary measures l.jpg
Interdisciplinary Measures

  • Movies:

    Comedies - LAUGHTER releases endorphins which act like “Natural Opiates” to the body so that pain severity actually diminishes and even disappears for a period of time

  • Environmental:

    Adjusting room temperature, lighting, smoothing out linens, comfortable bedding, and using alternating air mattresses


Interdisciplinary measures8 l.jpg
Interdisciplinary Measures

Relaxation Techniques:

  • Guided Imagery

  • Muscle Relaxation

  • Reiki

    Aromatherapy:

    Increasingly used as part of an integrated approach to pain.

    Touch and smell affect the parasympathetic nervous

    system, that can induce deep state of relaxation and this in

    turn can alter patients perception of pain. Specific aromatherapy

    contains pharmacological active ingredients which can benefit pain

    sufferers

    • Oil from lavender and peppermint have been beneficial in reducing pain.

    • Vanilla to stimulate appetite


Interdisciplinary measures9 l.jpg
Interdisciplinary Measures

  • Range Of Motion exercises to maintain joint motion and relieve stiffness

  • Endurance exercises (e.g.) cycling, aerobic exercise can decrease inflammation

  • Walking – Pain from cancer or Neurological (Neuropatic pain) benefits to keep things moving


Interdisciplinary measures10 l.jpg
Interdisciplinary Measures

PET THERAPY - Studies show that pets reduce blood pressure, provide comfort and unconditional acceptance

MUSIC – Used for centuries to promote physical and emotional healing

  • Music brings harmony back to the whole self; it is a powerful distraction and promotes relaxation

  • Music competes with pain signals to the brain


Other approaches l.jpg
OTHER APPROACHES

  • WRITING

  • TALKING ON THE PHONE

  • PLAYING CARDS

  • CRAFT PROJECTS

  • READING

  • HOT AND COLD PACKS

  • COUNSELING

  • MASSAGE

  • SOCIAL SUPPORT


Pain management12 l.jpg
PAIN MANAGEMENT

Pharmacological Therapy (Medication)

  • Scheduled dosing instead of PRN

  • Start with short acting medication – once pain control is achieved, change to long acting meds with short acting PRN med for breakthrough pain

  • Assess patient’s response to medication


Case snapshot l.jpg
Case Snapshot

  • MR 83 years old, female

  • DX: Dementia, DM, Depression, HTN, S/P CVA, OA

  • Meds: Metformin 500 mg. twice a day, Norvasc 10 mg daily, Trazodone 50 mg. at bedtime, Zocor 20 mg. at bedtime, Plavix 75 mg daily, Acetaminophen 650 mg every 6 hours for OA pain

  • Continue to complain of pain

  • MD change Acetaminophen to Percocet 5/325 mg. every 6 hours


Case snapshot cont l.jpg
Case Snapshot, cont.

After a week , new issues noted

  • Episodes of falls

  • Change in mental status

  • Uncooperative with Rehab/ADLs

  • Constipation


Case snapshot cont15 l.jpg
Case Snapshot, cont.

Interventions

  • Taper dose of Percocet, re-start to Acetaminophen for OA pain

  • Encourage participation with Activities - Pet therapy, Music, aromatherapy

  • Use of hot packs, cold packs to knees

  • Use topical pain relieving cream


Case snapshot cont16 l.jpg
Case Snapshot, cont.

  • Continue to have discomfort (pins and needles sensations) in extremities

  • Intervention changed Trazodone to Cymbalta to address for Neuropathic pain

  • Continue Acetaminophen for OA pain

  • Percocet discontinued

  • Resident more cooperative and active with Rehab


Staff education l.jpg
Staff Education

  • Identification: Direct care and ancillary staff are often the first to recognize symptoms

  • Assessment: Review of current standards of practice, and policy

  • Discussion on cultural barriers and individual perceptions

  • Interdisciplinary Modalities: Pain Management including non - pharmacological approach

  • Evaluation of program


Right interventions with the right resident l.jpg
RIGHT INTERVENTIONS WITH THE RIGHT RESIDENT

INDIVIDUALIZED

And

MAY NEED TO BE MODIFIED


For additional information l.jpg
For Additional Information

Carole Morgan, RN

(718) 317-3612

[email protected]

Patrick O’Toole, Pharm.D.

(718) 317-3308

[email protected]


Resources on pain assessment and management l.jpg
Resources on Pain Assessment and Management

www.americangeriatrics.org/education/cp_index.shtml

www.amda.com/tools/guideline.cfm

www.cms.hhs.gov/surveycertificationgeninfo/downloads/scletter09-2.pdf


ad