Part IV: Nursing Assistant Roles in Observing and Relieving Pain
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1 Part IV: Nursing Assistant Roles in Observing and Relieving Pain Objectives: Describe the roles of the NA in EOL care and pain management Define pain Describe acute and chronic pain Describe some common side effects of medications used to treat pain Describe elements of pain observation
2 Nursing Assistant Roles in End-of-life Care Providing personal care & assisting in ADLs Observation and reporting of EOL symptoms Providing emotional & physical comfort to patients and families Providing care at the time of death
3 Nursing Assistant Roles in Pain Management Observe and report the presence and characteristics of pain Observe for and report effectiveness of therapies Observe for and report side effects of medications Deliver some nondrug treatments Support and get help for patients in pain
4 What is Pain? An unpleasant sensory & emotional experience... IASP, 1979
5 PAIN: Anything the patient says it is Pasero & McCaffery, 2011
6 How Common is Pain in the Nursing Home? Many studies have found that older adults in nursing homes have pain 45% to 80% of older adults have pain that leads to poor quality of life Derby et al., 2010
7 Most Common Types of Chronic (Persistent) Pain in Older Adults Musculoskeletal (e.g., low back pain, osteoarthritis, degenerative joint disease) Neuropathies (e.g., diabetic neuropathy, postherpetic neuralgia) Cancer Constipation Spinal stenosis Osteoporosis/compression fractures Pressure ulcers/wounds AGS, 2009
8 Acute and Chronic Pain ACUTE Sudden onset symptom Occurs in response to illness or injury Usually decreases or goes away over time as healing occurs Goal - pain goes away when cause is treated CHRONIC Slow onset, or follows acute Lasts > 3 months Cause sometimes is unknown Sometimes divided into cancer and noncancer Goal - maintain functioning and quality of life
9 Myths About Pain in Older Adults Pain is a natural part of growing old. Older people are less sensitive to pain. If an older person doesn t report pain, that person doesn t have pain. If a person can sleep or be distracted from pain, that person doesn t really have pain.
10 Myths About Pain in the Older Adult (cont.) Strong pain medicine, like morphine, can t be used safely for the older adult because they are too sensitive to dangerous side effects. People who use morphinelike drugs become addicted to them.
11 More Myths About Pain in Older Adults (cont.) People with dementia and other brain conditions don t feel pain. People with dementia and other brain conditions can t reliably report their pain.
12 Observing and Reporting Pain
13 Common Words for Pain Ache Discomfort Sore Heavy Burning Stiff No complaints no pain
14 Nonverbal Patients Advanced dementia Progressive neurological disease Post stroke (CVA) Imminently dying Developmentally disabled
15 Behavioral/Observational Cues Obvious: Grimacing or wincing Bracing/guarding Rubbing Calling out, moaning, groaning Less Obvious: Changes in activity level Sleeplessness, restlessness Resistance to movement Decreased participation in activities Increased agitation, anger, etc. Decreased appetite
16 Pay particular attention to changes from normal behaviors
17 How Does the Older Adult Describe the Pain? Muscle or Bone Pain Aching Dull Sore Throbbing/cramping Deep Nerve Pain Shooting Burning Sharp Electric shock/tingling
18 How Bad is the Pain (Intensity)? Fink & Gates, 2010; Herr, 2006; Paice, 2010
19 Pain Location
20 Pain Patterns Is the pain constant? Does it come and go? What times of the day is it worst?
21 What Makes the Pain Worse? Examples: Movement Feeling blue or depressed Fatigue Nausea
22 What Makes the Pain Better? Medications Moderating physical activity Distraction Heat and cold Home remedies Complementary therapies
23 Overview of Medications for Pain
24 Commonly Used Pain Medicines Nonopioids Opioids Adjuvants/co-analgesics
25 Nonopioids Acetaminophen/APAP (Tylenol ) Nonsteroidal anti-inflammatory drugs (NSAIDs): Ibuprofen (eg, Advil ) Naproxen (eg, Naprosyn, Aleve ) Celebrex
26 Opioids Sometimes referred to as narcotics - but the correct term is opiods Examples: morphine, Percocet, Vicodin, Duragesic, codeine Are effective for moderate to severe pain Common side effects: Constipation Sleepiness Nausea, vomiting Urinary retention Itchiness
27 Adjuvants/Co-analgesics Antidepressants Anticonvulsants Topicals Others
28 Side Effects of Pain Medicines? NSAIDs: Swelling Stomach upset Bleeding Opioids: Constipation Sleepiness Nausea/vomiting
29 Finally, When to Observe for Pain During personal care During transfers and ambulation Following activities Following pain management interventions
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