Now, when we're talking about pain medicine, this is really important.
We like to use the phrase, start low and go slow.
What I mean by this is less is really more here.
If we start the patient off with way too much pain medicine upfront,
we can compromise a respiratory status, their circulation or their blood pressure,
also, maybe even their cognitive status.
So, we need to be conscious about assessing and reassessing.
That's so important with pain medication.
Also, when we start with pain medicine, if we can, again, this always goes back to assessment.
If we can start with non-opioids
such as maybe like a Tylenol or an ibuprofen for example or Acetaminophen,
then, we're going to progress to something a little stronger in pill form,
then, we're going to start with IV medications.
Again, this is a great rule of thumb but you're going to have to go back to the assessment of your patient
and this is going to vary from each patient case.
Now, let's take a look of some examples of some orders and scenarios that you're going to see.
So, you see on these three points, we've got three different medicines here, right?
We've got Tylenol, 650 milligrams, we also see Oxycodone
which is a bit of a stronger pain pill and opioid.
Then, you also you see Hydromorphone or Dilauted, you may hear IV.
This one's pretty strong, so, you notice in the succession
or, excuse me, the order of the higher the pain scale, here's that IV stuff.
That's typically what we do. So, let's take a look at this order.
Anytime you get a pain order, you see we've got the name of the drug, right?
We've got the dose, so, that's at 650 milligrams, five or 10, 0.5.
We've got the route which you see is PO here or IV which means either by mouth or in the IV.
We have the frequency and what it's needed for.
One thing I want to hone in on though, do you notice how the Tylenol says for pain level two to four?
Oxycodone says five to seven and hydromorphone says from eight to 10.
Now, if a patient's stating their pain as maybe like a two, they seem like they're comfortable,
they're smiling, they don't seem like they're grimacing or crying,
it's not appropriate necessarily to give a patient an IV pain pill for a pain writing of maybe two
when it's ordered as you see here from eight to 10.
So, for example, Ms. Smith here reports a pain level of five.
It has these following orders.
So, if you see our criteria here, which drug do you think is the most appropriate?
Okay, so, if you answered Oxycodone, you guys did right.
So, because if you look, it's ordered for pain level from five to seven.
So, the Oxycodone is completely appropriate.
However, let's say the patient says, "I have a pain rating of a 10 and I'm in severe pain,
do we want to give the Oxycodone here? Probably not.
So, our pain medicines have parameters to help guide our decisions as nurses.
Now, let's take a look at this next section.
Now, Ms. Smith is talking about, same drugs here,
Ms. Smith's talking about she's got a pain level of nine.
Now, if you remember back to that numeric pain scale,
zero to 10, 10 being really severe, nine's pretty high, right?
So, let me ask you a question here.
Do we want to give Tylenol with a pain rating of two to four that's ordered for a level of nine?
Well, probably not, right? That's really probably not going to control the patient's pain.
So, instead, let's take a look here. What are we going to give?
That's right. We're going to give the IV, Hydromorphone, 0.5 milligrams because that's per the order.
Now, when we're talking about pain, this is a complex topic to be honest with you.
So, once we assess it, we get our pain level.
Also, when we're talking about pain assessment and reassessing,
notice there's all of these four different things that we need to consider with pain assessment, not just one.
So, again, this goes for pain assessment, also, reassessment.
We need to consider all of these things when we're talking about controlling pain.
So, timeframe's a biggy, right? So, standard time frame depends on your drug.
For example, so, let's say we're giving a PO pain medicine.
How long does that take to work? Does it take 10 minutes?
No, if you go back to your pharmacology, remember, that's going to take longer to kick in.
At least 45 to an hour maybe.
Now, when we're talking about IV, do we expect that IV medicine to last for four hours? Not necessarily.
Usually, IV pain medicine may be peaking in about 30 minutes or so,
so, we want to assess back in that time.
So, again, timeframe's important when we're talking about our patient.
Also, with timeframe, we've also got to look at how that drug is ordered.
Remember that frequency? So, timeframe's something to consider.
Also, characteristic of the pain.
So, sometimes, the patient's going to say, "Hey, I have a stabbing, sharp pain in my chest."
Okay, that's quite a bit different than maybe a dull, aching in my shoulder for example.
So, why the characteristic of pain is important.
Also, how is the patient responding to the pain medicine given?
Is that pain medicine helping at all?
If it's not, we may have to do some other interventions.
Also, if we give a pain medicine, is the patient's respiratory drive worse?
Are they really not arousable anymore? This is all cause for concern, right?
So, we need to assess this as a nurse.
Also, don't forget those other interventions like those non-pharmacological pain interventions.
Those distraction methods maybe, heating, cooling, depending on your patient.
So, you can see here in this image, there's a lot to consider, right?
In regards to pain control because it's so important post-op
and there's a lot of facets as a nurse that we need to consider before giving the pain medicine
and also after and how the patient responds.