Pain Management (Nursing)

by Samantha Rhea, MSN, RN

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    00:04 Now, guys, let's talk about a big topic, pain control.

    00:07 This is, oh, so important postoperatively.

    00:11 The reason why this is so important, if a patient we want to for example ambulate them, participate in any sort of physical therapy, if we want the patient to be willing to comply with treatment or to move, their pain has to be controlled.

    00:27 You can imagine that this is one of the biggest fears after surgery, that the patient's going to have a lot of pain.

    00:33 Now, as a nurse, we need to be diligent and making sure we stay on top of this.

    00:38 It's also very, very, important that as a nurse, we communicate with our patient here, because everybody's pain control is going to look different, right? So make sure you're communicating with your patient, making a plan, and having interventions in place that will suit them.

    00:55 Now before we gets started as nurses again, you know we like to assess, right? This is so important because we have to give a baseline of what the patient's pain at, that way, if we do an intervention, how do we know if it gets any better, right? We need a tangible way to assess that, and we use this by using assessment tools.

    01:16 So, you're going to see the numeric rating scale, this is the most popular that you're going to see.

    01:21 If you look at this graphic here, you see the green which is great, that means they have no pain and then you've got all the way to severe at 10, so what's that going to look like is I may say, "Hey, Ms. Jones, I just want to check on how your pain is today.

    01:35 Can you give me a rating of how your pain is?" I want to use a 0 to 10 scale.

    01:41 Now, explain to them what that scale means.

    01:44 Zero means absolutely no pain at all, ten means the absolute worst pain you've ever felt? Where do you feel like your pain is? So, then, maybe your patient says, "You know, I'm at about a four on this scale, or I'm about a six." If they say that, we know they're in about the moderate range.

    02:02 So the numeric rating scale, if the patient's an adult or a child that can verbalize this and understand the scale, this is a great rating scale. We use this all the time.

    02:12 Now, next, this fun chart you're going to see here with the faces, we love this.

    02:17 This is called the Wong-Baker faces pain scale.

    02:20 You're also going to see this a lot using pediatrics, or sometimes a patient may not even be able to verbalize very well, but again this is really popular with maybe the ages of children from about like three to seven and up.

    02:34 This is a great alternative to the numeric rating scale.

    02:38 So you can see that green again, that smiley face, say, "Hey, I don't have any pain" That's great, all the way up to the really sad red crying face of ten where it hurts a lot.

    02:49 So again, key thing, before you have a patient rate their pain, explain what the scale is, if you need a patient to verbalize a rating to you.

    02:58 Now, let's look at the FLACC scale.

    03:00 This looks a little bit more complex, right? But, as a nurse, we're going to use this tool to rate an assessment base on the patient's behaviors.

    03:08 So this is going to mainly be used with like infants for example or really young children that can't tell us a number or use that Wong-Baker scale.

    03:17 So you notice on the topics, we're going to look at the patient's face, their legs, their activity, what their cries sounds like, can they be consoled? So, if you notice, it also goes from zero to two.

    03:30 Now, the higher the number, the worst off the patient's pain.

    03:33 So this is another good alternative especially with our pediatric or really young neonates? Now, next we have a pain assessment for dementia patients.

    03:43 As you can imagine, sometimes the patient can't necessarily give us a cognitive score or cognitive way to let us know, this is where my pain is at, like such as using the numeric rating scale.

    03:55 So, again, the nurses really going to use this based on what she assess or he assess on the patient's activity.

    04:02 So we're going to look at breathing, negative vocalization, what I mean by this is like moaning, crying, stuff like that.

    04:09 Facial expression of the patient, are they grimacing, and consolability.

    04:14 Again, notice this pain scale much like the FLACC, the higher the number, the worst off the patient's pain.

    04:21 Now pain scales are great. Pain control is important.

    04:26 However, non-pharmacological interventions are a really great alternative.

    04:31 And as many you guys know, these are becoming increasing more popular in the community.

    04:36 Here's an example.

    04:37 Sometimes post-back surgery or knee surgery, sometimes we use like an ice pack for patients to help reduce the pain.

    04:45 This is a great alternative because it's going to keep their blood pressure stable, it's also going to not affect their lung capacity or their cognitive capacity, so here's some really great example of some maybe adjunct therapies with pain medicine, or just these on their own.

    05:01 So like we talked about here, heat or cool for example? Now the heat thing, let's talk about there for a minute.

    05:08 Not all surgeries can have heat, so just know a lot of the times we're not going to apply heat to a fresh post-op incision, that's usually a no, no. So make sure you check your orders and assess your patient.

    05:22 Repositioning is a great one.

    05:24 Sometimes, we need to offload some pressure off of incision or maybe off someone's back, so repositioning is also a great idea.

    05:32 Also distraction.

    05:34 Sometimes listening to music, watching TV.

    05:36 Also, sometimes, visitors are also really helpful for our patients.

    05:41 Here's another great distraction, some units in some facilities may have therapy dogs for example. That'll be a great pain intervention for me.

    05:49 Relaxations great, counseling or pastoral services, also complementary alternative medicine.

    05:57 This one's an interesting topic because this is really vast.

    06:00 Also, think about this in regards to the cultural and ethnicity awareness of your patient.

    06:06 Sometimes, they may use complementary or different alternative medicines just in place of their pain medicine, and they also may prefer it.

    06:15 So, again, make sure you talk to your patient here.

    About the Lecture

    The lecture Pain Management (Nursing) by Samantha Rhea, MSN, RN is from the course Postoperative Care (Nursing).

    Included Quiz Questions

    1. Numeric pain scale
    2. Wong-Baker faces pain scale
    3. FLACC pain scale
    4. PAINAD
    1. 3 years of age to around 7 years of age
    2. 2 years of age to 5 years of age
    3. Infants to 2 years of age
    4. 3 years of age to around 12 years of age
    1. PAINAD
    2. FLACC pain scale
    3. Numeric pain scale
    4. Wong-baker faces pain scale

    Author of lecture Pain Management (Nursing)

     Samantha Rhea, MSN, RN

    Samantha Rhea, MSN, RN

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