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Pain Assessment

Introduction to Clinical Pharmacology Chapter 13- Nonopioid Analgesics: Salicylates and Nonsalicylates. Pain Assessment. Nursing role in providing contraceptive care: Need to take patient’s report of pain seriously Understand patient’s pain level Teach patient to rate pain 0-10

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Pain Assessment

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  1. Introduction to Clinical PharmacologyChapter 13-Nonopioid Analgesics: Salicylates and Nonsalicylates

  2. Pain Assessment • Nursing role in providing contraceptive care: • Need to take patient’s report of pain seriously • Understand patient’s pain level • Teach patient to rate pain 0-10 • Fifth vital sign: Accurate assessment necessary for effective pain management

  3. Pain Assessment • Performed using a measurement tool • Rate their pain level on a scale • May use a visual tool depicting facial expressions or colors • Wong-Baker FACES scale • Beneficial to children or populations that cannot understand numbers • FLACC scale

  4. Salicylates • Drugs derived from salicyclic acid • Useful in pain management due to analgesic, antipyretic, and anti-inflammatory effects

  5. Salicylates: Actionsand Uses • Lowers body temperature • Inhibit production of prostaglandins • Aspirin: Inhibits prostaglandin synthesis and has greater anti-inflammatory effects; prolongs bleeding time • ASA prolongs the bleeding time by inhibiting aggregation of platelets • ***Used for: Mild to moderate pain; reduce elevated body temperature; treating inflammatory conditions; decreasing risk of myocardial infarction; reduces risk of transient ischemic attacks

  6. Salicylates: Adverse Reactions • Gastrointestinal (GI) reactions: • Gastric upset; heartburn; nausea; vomiting; anorexia; GI bleeding; allergy • Significant blood loss HERBAL alert: Willow bark used as an analgesic • has fewer adverse reaction than salicylates

  7. Salicylates: Contraindications and Precautions • Contraindicated in clients with: • Known hypersensitivity; bleeding disorders; children with chickenpox, influenza CHRONIC CARE ALERT • May exceed recommended dose of ASA • Develop salicylism • s/s dizziness, tinnitus, flushing

  8. Salicylates: Interactions • Interact with foods containing: • Curry powder • Paprika • Licorice • Prunes • Raisins • tea

  9. Nonsalicylates: Actionsand Uses • Actions: • Analgesic and antipyretic activity: Same as salicylates • No anti-inflammatory action • Uses: • Used to treat mild to moderate pain-analgesic; reduce elevated body temperature-antipyretic; manage pain and discomfort - arthritic disorders-anti-inflammatory

  10. Nonsalicylates: Action and Uses • Useful for people: • With aspirin allergy; bleeding disorders; receiving anticoagulant therapy; who had recent minor surgical procedures

  11. Nonsalicylates: Adverse Reactions • Adverse reactions: Skin eruptions; urticaria; hemolytic anemia; pancytopenia; hypoglycemia; jaundice; hepatotoxicity; hepatic failure • Overdose: Causes acute acetaminophen poisoning or toxicity • **s/s: n/v, confusion, liver tenderness, hypotension, cardiac arrhythmias, jaundice and acute hepatic and renal failure

  12. Nonsalicylates: Contraindications and Precautions • Contraindication in patients with Hypersensitivity • Used cautiously in patients: • With severe or recurrent pain or high or continued fever • Acetaminophen used cautiously during pregnancy and lactation

  13. Chronic Care Alert • Polypharmacy interactions: • Acetaminophen + diabetics • May cause falsely lower blood glucose value

  14. Nursing Process: Assessment • Preadministration assessment: • Assess: Type, onset, intensity, location of pain • Evaluate: Ability to carry out activities of daily living • Evaluate the response to drug therapy • **Those who consume ETOH are at a greater risk of hepatotoxicity with acetaminophen use

  15. Nursing Process: Assessment (cont’d) • Ongoing assessment: • Monitor relief of pain; reassess pain rating 30-60 minutes following administration of the drug; monitor vital signs at least every 4 hours • Assess and document - Severity, location, and intensity of pain • Report any adverse reactions

  16. Nursing Process: Implementation • Promoting an optimal response to therapy: • A**void salicylates 1 week before or after any surgery • Observe for adverse drug reactions • Observe for signs of salicylism • Therapeutic blood levels are between 100-300 mcg/ml

  17. Nursing Process: Implementation • Promoting an optimal response to therapy (cont’d): • *Administer acetaminophen with full glass of water; with meals or empty stomach • Symptoms of overdosage: Nausea; vomiting; hypotension; generalized malaise • Acute overdosage treated with acetylcysteine to prevent liver damage

  18. Nursing Process: Implementation • Monitoring and managing patient needs: • Impaired comfort: • Check temperature before and 45-60 minutes after administration • Suppository form of drug used: Check after 30 minutes for retention of suppository • Notify PHCP if temperature not controlled

  19. Nursing Process: Implementation • Monitoring and managing patient needs(cont’d): • Pain: • Notify PHCP if no relief from pain or discomfort • Check cause of new pain experienced; report to PHCP other therapy may be needed • Check the color of the stools

  20. Nursing Process: Implementation • Educating the patient and family: • Develop a teaching plan that includes: • Take the drug exactly as prescribed by the primary health care provider • Do not consistently use an OTC nonopioid analgesic to treat chronic pain • Use of salicylates have been associated with Reye’s syndrome in children with chickenpox or influenza

  21. Nursing Process: Implementation • Educating the patient and family (cont’d): • Do not use these drugs on regular basis unless PHCP notified • Teaching on salicylates include: • Salicylates deteriorate rapidly when exposed to air, moisture, and heat • Consult pharmacist about the product’s ingredients if in doubt

  22. Nursing Process: Implementation • Educating the patient and family (cont’d): • Discontinue use 1 week before surgery or dental procedure • Teaching on acetaminophen include: • Acetaminophen lacks anti-inflammatory properties of aspirin • Notify primary health care provider if any adverse reactions occur • Avoid use of alcoholic beverages • **Pain persisting more than 10 days-consult PCP

  23. Nursing Process: Evaluation • Relief from Pain; body temperature normal • Adverse reactions are identified, reported, and managed • Patient verbalizes the importance of complying with the prescribed treatment regimen • Patient demonstrates understanding of prescribed treatment regimen and adverse effects

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