- 1. GGeerroonnttoollooggiiccaall NNuurrssiinnggTHIRD
EDITIONCHAPTER9Pain ManagementCopyright 2014, 2010, 2006 by Pearson
Education, Inc.All Rights Reserved
2. Learning Objectives1. Define pain and the consequences ofpain
in the older adult.2. Identify appropriate pain
assessmenttechniques, including those to use withdementia.3.
Describe pharmacological andnonpharmacological approaches usefulin
treating pain in the older adult.Gerontological Nursing, Third
EditionPatricia A. Tabloski 3. Learning Objectives4. Recognize the
nurses role in treatingpain in the older adult.5. Explain
patient-family teachingguidelines for pain
management.Gerontological Nursing, Third EditionPatricia A.
Tabloski 4. Introduction Pain is a common unpleasant
sensationexperienced by all human beings. This complex phenomenon
is both asensory and emotional experience.Gerontological Nursing,
Third EditionPatricia A. Tabloski 5. Introduction Older adults are
at particular risk forexperiencing both acute pain andpersistent
pain. Nurses working with the older adultpopulation must be
educated inappropriate pain assessment andmanagement
techniques.Gerontological Nursing, Third EditionPatricia A.
Tabloski 6. Pathophysiology of Pain Pain and pain transmission
involve boththe peripheral receptors and sensorypathways and
synaptic contacts in thespinal cord and brain stem. Pain can be
classified as nociceptive orneuropathic.Gerontological Nursing,
Third EditionPatricia A. Tabloski 7. Acute Pain in Older Adults It
is important for the nurse toadequately identify the source of
thepain and facilitate treatment of theunderlying disease or trauma
wheneverpossible.Gerontological Nursing, Third EditionPatricia A.
Tabloski 8. Pain Assessment Techniques Pain is measured
subjectively accordingto the patients self-report or by
carefulobservation in the nonverbal orseverely cognitively impaired
patient. A comprehensive clinical assessmentfor pain is
multifaceted and shouldinclude a medical and pain history,
aphysical exam, and diagnostic testing.Gerontological Nursing,
Third EditionPatricia A. Tabloski 9. Pain Assessment in the
Personwith Severe Cognitive Impairment For those unable to
verballycommunicate their pain experience,pain often goes
undertreated oruntreated. The nurse should assess for thepresence
of pain-related behaviors.Gerontological Nursing, Third
EditionPatricia A. Tabloski 10. Pain Assessment in the Personwith
Severe Cognitive Impairment These include: Facial
expressionVerbalizations/Vocalizations Body movementsChanges in
interpersonal interactionsChanges in activity patterns or
routinesMental status changesGerontological Nursing, Third
EditionPatricia A. Tabloski 11. Categories for Pain
InterviewQuestions Pain history Distinguish acute from persistent
pain Location Frequency IntensityGerontological Nursing, Third
EditionPatricia A. Tabloski 12. Categories for Pain
InterviewQuestions Alleviating and aggravating factors Associated
symptoms Response to previous and currentanalgesic therapy Meaning
of the painGerontological Nursing, Third EditionPatricia A.
Tabloski 13. The Art and Science of Pain Relief The goal of ideal
pain management isto relieve both acute and persistentpain with
appropriate pharmacologicaland nonpharmacological techniqueswhile
minimizing side effects.Gerontological Nursing, Third
EditionPatricia A. Tabloski 14. Pharmacological Management Pain
management in the older adultmay be more difficult due to
age-relatedchanges such as declines inrenal and hepatic function
and changesin body fat and water distribution. The World Health
Organization (WHO)has developed a Pain Relief Ladder toaid in the
administration of theappropriate pain management
plan.Gerontological Nursing, Third EditionPatricia A. Tabloski 15.
Pharmacological Management More than one medication may benecessary
to achieve pain control.Nonopioid AnalgesicsOpioid
AnalgesicsGerontological Nursing, Third EditionPatricia A. Tabloski
16. Preventing and Managing AdverseEffects Constipation Sedation
Respiratory depression Nausea and vomiting Myoclonus
PruritisGerontological Nursing, Third EditionPatricia A. Tabloski
17. Adjuvant Drugs for Older Patientswith Pain Examples of adjuvant
drugs that nursesmay see used in the clinical settinginclude:
Tricyclic antidepressantsMixed serotonin- and
norepinephrine-uptakeinhibitorsAnticonvulsantsCorticosteroidsGerontological
Nursing, Third EditionPatricia A. Tabloski 18. Adjuvant Drugs for
Older Patientswith Pain Examples of adjuvant drugs that nursesmay
see used in the clinical settinginclude: Topical analgesicsMuscle
relaxantsAntianxiety medicationsCalcitonin and
bisphosphonatesGerontological Nursing, Third EditionPatricia A.
Tabloski 19. Special Pharmacological Issues With the increased use
of opioids inpain management there is increasedconcern among
clinicians, families, andpatients that older adults will
becomeaddicted to these drugs.Gerontological Nursing, Third
EditionPatricia A. Tabloski 20. Special Pharmacological Issues
Nurses should urge patients to seekfurther diagnostic testing
andevaluation of chronic illnesses when theneed for opioid
medication increasessuddenly rather than assume thattolerance to
opioids is the underlyingissue.Gerontological Nursing, Third
EditionPatricia A. Tabloski 21. Polypharmacy Polypharmacy is the
excessive orunnecessary use of medications, bothprescription and
nonprescription.Gerontological Nursing, Third EditionPatricia A.
Tabloski 22. Pharmacological Principles forSuccessful Pain
Management The least invasive method of drugdelivery should be
used.Gerontological Nursing, Third EditionPatricia A. Tabloski 23.
Complementary and AlternativeTherapies Pain is among the most
commonreasons that adults use complementaryand alternative
therapies.Gerontological Nursing, Third EditionPatricia A. Tabloski
24. Consequences of Unrelieved Pain Depression, anxiety,
decreasedsocialization, sleep disturbance,impaired ambulation, and
increasedhealthcare costs have all been found tobe associated with
the presence of painin older people.Gerontological Nursing, Third
EditionPatricia A. Tabloski 25. Box 9-4 Your Rights as a
PatientGerontological Nursing, Third EditionPatricia A.
Tabloskiwith PainSource: Adapted from American PainFoundation
(2012). Pain care bill ofrights. 26. QSEN Recommendations Relatedto
Pain Management The Quality and Safety Education forNurses (QSEN)
project addresses thechallenge of preparing future nurseswith the
knowledge, skills, andattitudes (KSAs) to continuouslyimprove the
quality and safety of thehealthcare systems in which they
work.Gerontological Nursing, Third EditionPatricia A. Tabloski
