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PAIN MANAGEMENT

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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 – PowerPoint PPT presentation

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Title: PAIN MANAGEMENT


1
PAIN MANAGEMENT
  • Carole Morgan, RN, MPA, LNHA
  • Director of Nursing
  • Patrick OToole, Pharm. D., MPA
  • Director of Pharmacy
  • Sea View Hospital Rehabilitation Center and Home

2
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

3
ASSESSMENT
  • Whats Needed
  • A comprehensive tool to capture both
    subjective/objective on admission, readmission,
    significant change or a new onset of pain
  • Anticipation of Pain before dressing changes,
    Rehab therapy, ROM exercises
  • Assessment tool must also identify
  • Residents needs and goals
  • Etiology
  • Severity

4
ASSESSMENT
  • 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, blood pressure,
    respiration

5
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

6
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

7
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

8
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

9
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

10
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

11
OTHER APPROACHES
  • WRITING
  • TALKING ON THE PHONE
  • PLAYING CARDS
  • CRAFT PROJECTS
  • READING
  • HOT AND COLD PACKS
  • COUNSELING
  • MASSAGE
  • SOCIAL SUPPORT

12
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 patients response to medication

13
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

14
Case Snapshot, cont.
  • After a week , new issues noted
  • Episodes of falls
  • Change in mental status
  • Uncooperative with Rehab/ADLs
  • Constipation

15
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

16
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

17
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

18
RIGHT INTERVENTIONS WITH THE RIGHT RESIDENT
  • INDIVIDUALIZED
  • And
  • MAY NEED TO BE MODIFIED

19
For Additional Information
  • Carole Morgan, RN
  • (718) 317-3612
  • morganc_at_seaviewsi.nychhc.org
  • Patrick OToole, Pharm.D.
  • (718) 317-3308
  • otoolep_at_seaviewsi.nychhc.org

20
Resources on Pain Assessment and Management
  • www.americangeriatrics.org/education/cp_index.shtm
    l
  • www.amda.com/tools/guideline.cfm
  • www.cms.hhs.gov/surveycertificationgeninfo/downloa
    ds/scletter09-2.pdf
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