This is the process of identifying and managing an acute traumatic/surgical pain by the nurse using parenteral medications and non-pharmacological measures to relieve pain during peri-operative period or post traumatic experience.
Aims
· Assess level of pain in patient
· Relieve the patient of pain, discomfort and suffering
· Promote the dignity of the patient
· Promote early ambulation and discharge of patient
· Prevent acute pain from progressing to chronic
· Prevent complications such as shock, death etc.
· Reduce pain with minimal adverse effect
Principles of Pain Management
1. Pain assessment is part of vital signs
2. Provide patient and family with adequate information and education on pain management
3. Assess the pain using objective scales such as 0-10 Numeric Pain Rating Scale, Wong-Baker Faces Pain Scale, Colour-Circle Pain Scale etc. and document
4. Treat each patient as an individual and involve the patient and family in the pain management
5. Employ evidence-based contemporary recommendations for pain management such as:
· Pre-emptive analgesia (analgesic given before a painful stimulus)
· Multi-modal analgesia (using two or more forms of analgesic concurrently)
· Time-scheduled analgesic administration (giving the analgesics according to the time prescribed regularly)
· Non-pharmacological methods of relieving pain such as early mobilization, passive mobilization, positioning, and other appropriate measures should be used as adjuncts to analgesic administration for pain management
6. Evaluate the pain management and review decisions per assessment findings
7. Investigate allergies to pain medications and other co-morbidities
8. Employ effective teamwork with doctors and other health team members when managing pain
9. There should be hospital protocol for pain management
10. There should be input and monitoring from hospital management and departmental leadership to achieve effective pain management
11. Guard against dependence or addiction
Requirements
a. Patient’s folder (electronic or manual)
b. Pain assessment tools: numerical scale and facial scale
c. Sharp box
d. Vital signs tray
e. Medication tray
f. A tray containing the following
· Prescribed parenteral pain medication
· Syringes
· Needles
· Cotton wool swabs in a gallipot
· Treatment chart (Electronic or Manual)
· Methylated spirit
· Receiver/kidney dish
· Intravenous set
Steps
1. Establish rapport and explain pain management strategies to the patient
2. Practice the five moments of hand hygiene
3. Assess the level of pain using the appropriate pain assessment tool based on the level of literacy of the patient
4. Show empathy to the patient
5. Explain pain management techniques and reassure patient of competent care
6. Provide diversionary/distraction therapy by allowing the patient to listen to music or watch television or engage in a healthy conversation with the patient
7. Apply ice and/or heat at the site of pain to relieve pain
8. Position patient ensuring less pressure on trauma/surgical site
9. Examine trauma/surgical site to ensure the wound dressing is not tight or wet
10. Assess baseline vital signs; temperature, blood pressure, pulse, respiration and oxygen saturation
11. Observe for the rights of medication administration
12. Assemble syringe and needle using aseptic technique
13. File/ break/hang pain medication depending on the type
14. Draw medication with a syringe as per the prescription and discard the needle in a sharp box
15. Replace needle with a new one and expel air
16. IV or IM are administered as follows:
· Intravenous - remove needle and administer the drug into the venous access for the patient. OR
· Intramuscular - assist patient into a required position and clean injection site with alcohol swab. Inject analgesic following standard protocol
17. Dispose off, decontaminate and clean used items
18. Observe for the therapeutic effects within 15-30 minutes of administering the drug
19. Observe for adverse effects of pain medication and intervene appropriately
20. Encourage patient to report pain concerns and continue to intervene as per prescribed alternative analgesic therapy
21. Document and report in the nurses’ notes (Electronic or Manual)
Management of Patients with Sickle-Cell Disease with Trauma/Surgical Pain:
· Position patient in a comfortable position supporting limbs with pillows
· Ensure adequate intravenous fluid therapy
· Monitor intake and output
· Assist patient with activities of daily living
· Administer oxygen if necessary
Management of Patients with Cardiac Disease with Trauma/Surgical Pain:
· Position patient in a high Fowlers position in a cardiac bed ensuring the use of bed accessories
· Ensure patient is not wearing tight or excess clothing
· Assist patient with activities of daily living
· Administer prescribed adjuvants targeting the cardiovascular system
· Administer oxygen if necessary
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