CONTROLLING PAIN: Making an ethical plan for treating patients in pain

CONTROLLING PAIN: Making an ethical plan for treating patients in pain

Reactivation of the varicella virus appears to be related to a decline in VZV-specific immunity. In the healthcare setting, you will encounter many different skin problems. Acute herpes zoster: 800 mg q 4 hr five times daily for 7–10 days. Peripheral neuropathy; history of syncope, dehydration, hypotension; concurrent antihypertensive drugs; history of allergies, asthma; preexisting electrolyte or acid-base disturbances, especially hypokalemia or hyponatremia; liver disease; myelosuppression, renal impairment; history of peripheral neuropathy or other neurologic disorders; GI toxicities. If started with 2 to 3 days of the outbreak, the shingles will be less severe. PREPARE: IV Infusion: Wear disposable gloves; contact of drug with skin can cause burning, dermatitis, and hyperpigmentation. Intermittent: May be further diluted with 100–250 mL D5W, NS, D5/NS, RL, or other compatible solution.

W talking on the phone. CNS: Tremor, muscle twitching, headache, weakness, fatigue, confusion, anxiety. Multivitamins, antinauseants, and fortified cereals usually contain vitamin B6. Irrigate immediately if eye contact occurs. opioid because she has a history of substance abuse. She also uses hydrocodone for chronic back pain. Notified about Ms.

The most standard treatment for cancer that has invaded the muscle is radical cystectomy with urinary diversion. Ms. A nurse assesses a wife who is caring for her husband. This article explores ethical issues that are involved with making ethically sound pain management decisions and proposes a plan for overcoming barriers and providing ethical care for people experiencing pain. These challenges can be more intense when they involve children, older adults, minorities, noncommunicative patients, and those with comorbidities, particularly mental health or substance abuse issues. Avoid uninterrupted sitting in any chair or wheelchair. An older client is observed scratching and rubbing white ridges on the skin between fingers, on the wrists, in the axillae, and around the waist.

When you receive a booster dose, you will need to tell the doctor if the previous shots caused any side effects. Exceeding the dose limit for acetaminophen can cause liver damage. Nonsteroidal anti-inflammatory drugs can also cause adverse reactions that may limit the dose or duration of treatment. Opioids can cause adverse reactions that may require dose limitations in some patients as well. A randomized, double-blind, placebo-controlled trial. The goal needs to be to help patients control pain as well as possible while keeping them as safe as possible. In an industrial accident, a male client that weighs 155 lb (70 kg) sustained full-thickness burns over 40% of his body.

Before the procedure, obtain a baseline neurologic assessment. Such clients often have open, draining, or weeping wounds. The ethical principle of beneficence also requires nurses to decide how to advocate for her. Justice. The principle of justice can be considered from various frameworks. The most appropriate in this case is this: People with similar diagnoses should be treated in a similar way and those with different diagnoses should be treated differently.4 For instance, when following this principle, all patients who complain of leg pain would be assessed and subsequently treated in a similar manner, regardless of race, ethnicity, gender, or ability to pay. Those diagnosed with a fractured femur would all be treated in a similar manner while considering their individual assessment and pain control needs.

Be careful not to cut your child when using a razor, scissors, or clippers to cut his or her nails or hair. This principle is also important in pain control because opioid-tolerant patients will need to receive their home medications or equivalent doses as well as additional medication to address acute pain. In that sense, opioid-tolerant patients can be considered to be different than opioid naive patients who may be sensitive to opioids and require less medication. Apply protective pads to heels and elbows. 4. Add a small amount of alcohol to the daily bath water. This can be perplexing for healthcare professionals when a patient’s self-report is severe pain but the patient’s behavior isn’t what they expect to observe when a person is in severe pain.

A starting dose of amitriptyline 25 mg at bedtime wasrecommended. This quandary develops because about 55% of communication is nonverbal, and many people trust nonverbal cues more than verbal communication.6,7 When Ms. W reports severe pain (verbal) while she’s observed reading or talking on the phone (nonverbal communication), nurses may have trouble integrating seemingly conflicting messages. Understanding another person’s severe pain is more difficult for a nurse who’s had a similar surgery or injury and experienced little pain. Nurses raised in a culture that encourages emotional expression of pain may not understand how a patient raised in a stoic culture can stay very quiet despite being in severe pain. In some instances, patient autonomy can conflict with what healthcare professionals consider optimal pain management (nonmaleficence). Ms.

W specifically requests an opioid that wasn’t prescribed and asks for it to be given via a particular route. A patient may insist on receiving a particular medication or undergo a certain procedure when the healthcare professional doesn’t consider such treatments appropriate, desirable, or even safe when evaluating factors such as diagnosis, history, and comorbidities. On the other hand, the patient may know better than anyone else what’s been effective in the past. Be sure to ask the patient why he or she is requesting a particular medication or treatment. This can open a dialog and improve patient care, education, and satisfaction. Pain may be complicated by fears about what the pain means. Acute pain is a symptom that relays a message.

CONTROLLING PAIN: Making an ethical plan for treating patients in pain
Many patients, realizing this, become concerned when pain is greater than they expected. Patients may be worried about postsurgical pain if they weren’t well educated before surgery. After trauma or a cancer diagnosis, patients may interpret pain as an indication of the gravity of their condition. In an attempt to determine the developmental characteristics that predict the ability to self-report pain in children 3 to 7 years of age, von Baeyer and colleagues (2011) studied various characteristics of children. By definition, pain is a subjective experience that can’t be objectively seen, felt, or measured in another person. In technologically dependent healthcare settings, this makes pain an anomaly among the signs that are assessed and measured. Because only the person experiencing pain knows how it feels, that person is the expert and the healthcare professional must accept the patient’s self-report as fact.

Pain is a multifaceted experience. Besides physical sensations, it has emotional, cognitive, and spiritual aspects. Pain is influenced by each person’s culture, experiences, and coping mechanisms. Patients may have difficulty explaining characteristics of the pain they’re feeling. Time constraints often interfere with nurses’ ability to actively listen to patients. Many healthcare professionals lack adequate education in pain assessment and management. Personal experiences, beliefs, and emotional responses to pain can affect how a healthcare professional responds to a patient’s behavior or self-report of pain.

With all these points in mind, we’ll now consider how to design an ethical pain management care plan that balances beneficence (doing good) with nonmaleficence (doing no harm) while advocating for autonomy and justice. Nurse Kevin reviews the client’s chart and notes that the physician has documented a diagnosis of paronychia. The client should wear a pajama bottom with a gown for protection of modesty. •    Premoisten existing dressings with warmed, sterile, normal saline if ordered. For example, a patient may seem like another patient, friend, or family member who had severe pain that was difficult to relieve. Or a patient may seem like someone the nurse knows who abuses opioids or other substances. Accepting undesirable or distasteful behavior in people who remind us of ourselves or someone we know can be the biggest challenge; being tolerant of people with whom you don’t seem to have anything in common can be easier.

When problematic connections occur, it’s important for nurses to remind themselves that this patient is unique. Every patient needs to be understood as an individual. Impressions relayed by other healthcare professionals can influence assessments and opinions about a patient. When one healthcare professional labels a patient as “drug seeking,” this can negatively influence the perceptions of those who hear it, even before they meet the patient. Each patient deserves to have each healthcare professional become acquainted with him or her on an individual basis. 4. 1.

The nurse is providing instructions regarding skin care to a client after removal of a leg cast. Self-awareness about pain behavior is an important starting point. Develop a habit of assessing your reactions to patients with pain, particularly if pain is difficult to control. Think of the words that describe how you feel. People with pain that’s difficult to manage may elicit feelings of sadness, sympathy, frustration, anger, disgust, annoyance, or inadequacy. When patients are asked what level of pain would be satisfactory, many respond with “no pain,” which is understandable-nobody wants to be in pain. But nurses must help patients understand the need to balance safety with comfort and work toward realistic goals (beneficence, nonmaleficence, autonomy, justice).

Differentiate between pain elimination and pain control. Some pain control is always possible, but eliminating pain while keeping the patient safe may not be possible.11 Inform patients that while you care about their comfort, you also care about their safety (beneficence, nonmaleficence). Realistic goals may be easier for patients to understand and identify from a functional perspective. Because most facilities or agencies require pain management goals to be recorded numerically, nurses need to help patients put functional goals into numeric form. If Ms. W, the patient requesting more pain medication, has the goal of walking around the unit four times per day, help her to identify what number her pain needs to be to accomplish that goal. Optimal pain management is like making customized vegetable soup.

Among the many options that can be included, some may not be appropriate for the individual and others may not be safe for the individual. In some situations, the patient may not want to receive a particular medication (autonomy, justice). Medication selection depends on various factors, such as the etiology of pain, previous experiences, allergies, comorbidities, and contraindications.11,12 Work to help patients control pain by finding the recipe that works best for them. Ask patients what has worked previously to manage pain and what doesn’t work (beneficence, nonmaleficence, autonomy, justice). Knowing what has worked to control pain in the past is critical to respecting ethical principles and requires you to put aside preconceived notions. (1990). Analgesic medications are only one component in multimodal pain management.

Depending on the type of pain, patient preferences and beliefs, and available resources, adding various nonpharmacologic interventions can help control pain and foster patient autonomy and justice.11 Healthcare providers can improve available options for patients (justice) by identifying available nonpharmacologic and complementary modalities. Knowledge is power. Educate yourself in pain assessment and multimodal pain management, remembering that pain is multidimensional. Seek assistance from other professionals, such as pain management experts, physical and occupational therapists, clergy, managers, and members of ethics committees. Ms. W tells the nurse that she’ll be able to rest if her pain level is a 6/0-10. Ms.

W explains that because she used large doses of opioids after an accident last year, she seems to need more medication to relieve pain. Using data from pain assessment and concepts of multimodal analgesia, the nurse advocates for the patient to obtain analgesia that includes adequate scheduled (around-the-clock) and p.r.n. opioids for breakthrough pain, acetaminophen, distraction, therapeutic touch, and animal-assisted therapy. To help a client maintain healthy skin, the nurse should avoid strong or harsh detergents and should use mild soap. W reports being more comfortable and better able to concentrate and sleep. By putting aside personal biases and listening to the patient, the nurse successfully developed a pain control plan that was safe, effective, and ethically sound. * Is the pathology underlying the acute condition known to cause pain?

If so, advocate to begin a trial of analgesic medication. Then assess the patient’s response to the analgesic trial.

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