PAIN MANAGEMENTBarbara Spear

Kaplan University

April 3, 2012

COURSE OBJECTIVESThe student will identify ways to assess and document pain in the cognitively impaired resident. The student will identify ways to assess and document in the alert and oriented resident. The student will evaluate effectiveness of pain management by utilizing a pain scale.

LEARNING OBJECTIVES

By the end of the course the student will be able to:Assess and obtain a pain goal upon admission.Recognize signs and symptoms of pain.Implement interventions to decrease pain levels.Manage pain.Improve resident satisfaction through pain management.

TECHNOLOGIESEmail power point presentation prior to webinar.Webinar for conference with guest speaker.On line research to support the data.Lab simulation inserted into power point presentation

PAIN IS…Chronic (obtain the history).Acute (why admitted?).Perception of the resident (varying ability to endure pain).Disease related (Neuropathy, CVA, Osteoporosis…).Physical and emotional stressor (newly admitted, chronic depression…).

FACTORSCulture and traditions (alternative medicines, non medical, spiritual…)History (chronic disease, trauma…). Condition emotionally and physically (depression, stress, anxiety…).Age related (Osteoporosis, decreased mobility…)Cognition related (dementia/behaviors, decreased activity…).

COGNITIVELY IMPAIREDUnable to communicate needs (review records, interventions identified…).Unable to reposition frequently (schedule repositioning, care plans…). Poor nutrition (intake/output records, weights, medical review…)Depression (referrals).

DIAGNOSISX-ray (baseline)Disease process (know the history!).Positional (interventions, referrals, schedules…).Further intervention versus comfort care (medical review, family meetings).Team approach (social worker, nurse, aid, educator…).

PAIN ASSESSMENTGoal upon admission (varying pain tolerance).Signs (facial grimace, body position, vocal, behaviors, Symptoms (nausea, depression, descriptors).History Chronic versus acuteSCALES!! (questionnaires, audit, tools, interview…).

PAIN SCALE

PAIN MANAGEMENTSymptomsMedicationNon-medication relief (rehab consults)Control (interview and assessment)Care plans with interventions

NON-PHARMACOLOGICAL

RepositionRehab consult for Physical or Occupational TherapySocializationHand to hand contactHeat cold or alternativeMeditation

PAIN DOCUMENTATIONFlow sheets Care plansMAR and TAR’sProgress notes with interventionsReview staff reports Ongoing education for either discharge or maintenance for LTC resident.

RESIDENT SATISFACTION

Did the intervention work?What worked?Medication review PRN versus a standing order to be more effective?

OVERVIEWObtain a goal for pain upon admission! Assess, intervene and document pain relief measures. Is the pain intervention working?Scales!Is the resident comfortable, improved quality of life?Any questions?

REFERENCESBillings, D. M., & Halstead, J. A. (2009). Teaching in nursing: A guide for faculty. St. Louis, MO:

Saunders Elsevier.

Oermann, M. H., & Gaberson, K. B. (2009). Evaluation and testing in nursing education. New

York, NY: Springer.