1. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 05: Relieving Pain and Providing Comfort

2. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Factors That Contribute to Pain in the Critically Ill Patient See Box 5-1.

3. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins The Most Painful and the Least Painful Procedures in Intensive Care

4. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Preparing Your Patient for a Procedure That Could be Painful Provide patient education on the procedure, explaining the procedure from a patient’s perspective. Provide pain medication as ordered and wait to start the procedure until the medication has taken effect. Provide medications to decrease anxiety as ordered. Provide ongoing assessment of pain and sedation level during the procedure and repeat medications as needed.

5. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Benefits of Effective Pain Relief

6. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Addiction, Tolerance, and Dependence

7. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins National Guidelines and Standards for Pain Management See Table 5-4.

8. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Websites Pertaining to Pain Management See Table 5-5.

9. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Diagnoses for Patients in Pain

10. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins General Guidelines for Nursing Interventions for the Patient in Pain

11. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Nonopioid Analgesics Commonly Used in Critical Care

12. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Commonly Used Opioid Analgesics

13. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Why Meperidine Should Not Be Administered to Critically Ill Patients See Box 5-4.

14. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Nonpharmacological Interventions Modify the environment to promote relaxation and rest Provide distraction through activities of interest to the patient Relaxation techniques Therapeutic touch Massage of hands, feet, or shoulders

15. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Instructions Regarding Quieting Reflex

16. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following statements about providing an appropriate analgesic for a high-risk critically ill client is correct? A. Meperidine is the most potent opioid of choice to use. B. National experts consider hydromorphone to be dangerous and don’t recommend it. C. Morphine sulfate is a preferred opioid to be given intravenously. D. Older patients are less sensitive to opioids.

17. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. Morphine sulfate is a preferred opioid to be given intravenously. Rationale: Morphine, fentanyl, and hydromorphone are recommended by national standards to be given IV to critically ill patients who need an opioid analgesic. Meperidine is the least potent opioid; national guidelines consider the drug to be dangerous in the critically ill population and do not recommend giving it. Older patients are more sensitive to opioid analgesics because as the body ages it takes longer for a drug to be metabolized and excreted from the body.

18. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question After taking an opioid, a client has increased drowsiness, urinary retention, and 10 respirations/minute. The nurse should recommend which of the following? A. Decrease the opioid dose. B. Add an NSAID to the regimen. C. Provide reduced doses around the clock and avoid giving the opioid prn. D. All of the above.

19. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer D. All of the above. Rationale: Side effects of opioid analgesics are managed by reducing the opioid dose and by adding an NSAID as an adjunct. Opioid analgesics work best if given around the clock so that there is a steady blood level of the drug in the system; giving the opioid prn causes a fluctuation in the levels of the drug, increasing the risk for sedation and respiratory depression.

20. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following statements about pain is correct? A. Acute pain has a sudden onset and no identified cause and resolves quickly with treatment. B. Acute pain has an identified cause and resolves within a given time frame. C. Chronic pain has a quick onset and an identified cause and is compounded by acute pain. D. Chronic pain has a definite cause and lasts for a short period, after which it resolves completely.

21. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Acute pain has an identified cause and resolves within a given time frame. Rationale: According to Prevost, “acute pain has an identified cause and will resolve in a given time frame.” According to Prevost, chronic pain may last for an indefinite period and is difficult to treat fully.