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NR 226: Patient CareMarch 2016TopicsPain Management1.Pain in older adults, adults, children and infants; nursing processPain in older adults– muscle mass decrease, body fat increases, & percentage body water decreases (means increase concentration of water-soluble drugs (morphin) & amount of distribution for fat-soluble drugs increases (fentanyl)); poor eating results in low serum albumin levels (protein made by liver) causing drugs that are high protein to increase the risk for side and/or toxic effect; liver & kidney functions decrease reducing the metabolism & excretion of drugs (means they experience a greater peak effect & longer duration); skin is thinner w/ loss elasticity making absorption of topical analgesic rate faster. ; development of pathological conditions that cause pain (reduces mobility, ADL’s, social activities, & activity tolerance. Infants– they don’t understand pain and why it happens; they cant express themselves through words; they feel pain beforethey are born; they have same sensitivity to pain as older children; their pain is observable; very sensitive to drugs (absorb faster, response is intense & prolonged) Children– they don’t remember how the pain happened or associate it w/ experiences Nursing process for older adults– aggressive assessment, diagnosis,& management; make detailed assessments when they have more than one source of pain; they have difficulty recalling pain or giving detailed explanations about pain.Nursing process For infant and children– learn how to assess pain for them; know what to ask; what behaviors to observe; learn how to prepare them for a painful medical procedure. 2.Classifications of pain by location: Superficial/Cutaneous, Deep/Visceral, Referred, and RadiatingSuperficial/cutaneous - pain on the skin; short duration & localized; sharp sensation Deep/ visceral pain – pain coming from an organ; diffuse pain & radiates in several directions; duration varies but last longer than superficial; sharp, dull, or unique to organ.Referred – feeling pain that is distal to the actual site; common in visceral pain because organs have no receptors; sensory from organ goes into spinal cord in same segment as the area where the pain is felt; pain is felt in area that is not effected; different characteristics for painRadiating – pain that extends from the pain initial area to another part; traveling pain down or along body; intermittent or constant3.Pain management; analgesics and nonpharmacological pain relief methods; nursing implications, safety precautions, medication administrationAnalgesics– Nonopioids- acetaminophen & nonsteroidal anti-inflammatory drugs (NSAIDS); acetaminophen(Tylenol) has no anti-inflammatory effects, most tolerated & safe, hepatotoxicity is an adverse effect; max 24 hr dose is 4g, used w/ opioids to reduce dose for pain relief; NSAIDs (aspirin & ibuprofen) mild- moderate pain relief for acute intermittent pain, postoperative pain begins w/ NSAIDs unless contraindicated, does not depress CNS or interfere w/ bowel &