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61 Cards in this Set
- Front
- Back
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Cancer Pain
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*"Pain is whatever the experiencing person says it is, existing wherever he/she says it does."
*Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." |
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Epidemiology of Cancer Pain
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*At the time of diagnosis
-One quarter of clients report pain *During active treatment -Two thirds of clients report pain *Hospitalized with advanced cancer -Three quarters of clients report pain |
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High Risk Populations for Under Treatment of Cancer Pain
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*Minorities
*Elderly (>70 years old) *Women |
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Under Treatment of Pain: Healthcare Professionals
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*Lack of knowledge and skills to assess pain
*Lack of access to practical treatment protocols *Inadequate understanding -Fear of addiction -Fear of hastening death |
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Under Treatment of Pain: Patients Attitudes
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*Fear of addiction
*Side effects *fatalism |
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Dimensions of Pain
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*Affective
-Emotions -Suffering *Behavioral -Behavioral response *Cognitive -Beliefs -Attitudes -Evaluations -Goals |
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Sensory:
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*P pattern
*A area *I intensity *N nature |
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Dimensions of Pain
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*Physiologic
-Transmission of nociceptive stimuli *Sensory -Pain perception |
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Physiologic/Sensory
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*Transduction
*Transmission *Perception *Modulation |
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Cancer Pain
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*Alteration in comfort r/t cancer pain (back pain) aeb client rates pain as an "8/10" on the pain scale.
*Related Nursing Dx: -Activity Intolerance -Altered Family Processes -Altered Thought Process -Anxiety -Constipation -Fear -Powerlessness -Hopelessness -Ineffective Individual Coping -Sleep-Pattern Disturbance |
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Types of Pain
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*Acute
-Combination of tissue damage and anxiety *Chronic -Pain greater than six months -Ongoing and not responding to current treatment regime |
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Manifestations of Acute Pain
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*Increased heart rate
*Increased BP *Increased respirations *Diaphoresis *Pallor *Anxiety, agitation or confusion *Urinary retention Goal: pain control |
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Manifestations of Chronic Pain
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*Flat affect
*Decreased mobility *Fatigue *Social withdrawal *Depression Goal: enhance quality of life with pain control |
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Malignant Pain
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*Malignant pain is a complex, progressive process
-Acute or Chronic -Resistant to cure -Intractable, but can be relieved -All consuming interfering with mood, family, relationships and quality of life |
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Etiology of Cancer Pain
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*Direct Tumor Involvement
-Pressure within organ or extending to other organs *Nerve Compression *Unrelated to Cancer -Pressure ulcers, aching muscles, bedrest *Cancer Treatment -Chemotherapy, Radiation Therapy & Surgical Interventions |
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Physiology of Pain
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*Neuropathic Pain
-Pain resulting from injury to the nervous system Examples: Diabetic Neuropathy Chemotherapy related (very difficult to relieve) *Nociceptive Pain -Pain occuring in the periphery -Impulses are transmitted to the CNS where interpretations occurs Examples: Somatic Pain Visceral Pain |
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Neuropathic Pain
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*Characteristics
-Sensation of pain elected by a non-noxious stimuli -Nerve related distribution: follows nerve pathway -Resistant to standard opiods Constant pain Anti-Seizure Drugs NSAIDS |
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High Risk Populations for Under Treatment of Cancer Pain
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*Minorities
*Elderly (>70 years old) *Women |
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Under Treatment of Pain: Healthcare Professionals
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*Lack of knowledge and skills to assess pain
*Lack of access to practical treatment protocols *Inadequate understanding -Fear of addiction -Fear of hastening death |
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Under Treatment of Pain: Patients Attitudes
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*Fear of addiction
*Side effects *fatalism |
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Dimensions of Pain
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*Affective
-Emotions -Suffering *Behavioral -Behavioral response *Cognitive -Beliefs -Attitudes -Evaluations -Goals |
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Sensory:
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*P pattern
*A area *I intensity *N nature |
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Dimensions of Pain
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*Physiologic
-Transmission of nociceptive stimuli *Sensory -Pain perception |
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Physiologic/Sensory
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*Transduction
*Transmission *Perception *Modulation |
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Cancer Pain
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*Alteration in comfort r/t cancer pain (back pain) aeb client rates pain as an "8/10" on the pain scale.
*Related Nursing Dx: -Activity Intolerance -Altered Family Processes -Altered Thought Process -Anxiety -Constipation -Fear -Powerlessness -Hopelessness -Ineffective Individual Coping -Sleep-Pattern Disturbance |
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Types of Pain
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*Acute
-Combination of tissue damage and anxiety *Chronic -Pain greater than six months -Ongoing and not responding to current treatment regime |
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Manifestations of Acute Pain
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*Increased heart rate
*Increased BP *Increased respirations *Diaphoresis *Pallor *Anxiety, agitation or confusion *Urinary retention Goal: pain control |
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Manifestations of Chronic Pain
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*Flat affect
*Decreased mobility *Fatigue *Social withdrawal *Depression Goal: enhance quality of life with pain control |
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Malignant Pain
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*Malignant pain is a complex, progressive process
-Acute or Chronic -Resistant to cure -Intractable, but can be relieved -All consuming interfering with mood, family, relationships and quality of life |
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Etiology of Cancer Pain
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*Direct Tumor Involvement
-Pressure within organ or extending to other organs *Nerve Compression *Unrelated to Cancer -Pressure ulcers, aching muscles, bedrest *Cancer Treatment -Chemotherapy, Radiation Therapy & Surgical Interventions |
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Physiology of Pain
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*Neuropathic Pain
-Pain resulting from injury to the nervous system Examples: Diabetic Neuropathy Chemotherapy related (very difficult to relieve) *Nociceptive Pain -Pain occuring in the periphery -Impulses are transmitted to the CNS where interpretations occurs Examples: Somatic Pain Visceral Pain |
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Neuropathic Pain
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*Characteristics
-Sensation of pain elected by a non-noxious stimuli -Nerve related distribution: follows nerve pathway -Resistant to standard opiods Constant pain Anti-Seizure Drugs NSAIDS |
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Nociceptive Pain
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*Somatic Pain
-Bone Pain -Pain in soft tissue -Throbbing -Treated with NSAIDS *Visceral Pain -Hepatic Capsular Distention -Referred shoulder pain from pancreatic cancer -Deep Aching -Treated with Steroids |
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Pain Scales
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*Visual analog scales
*Simple Descriptive *Numeric Pain Intensity Scales |
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Components of Cancer Pain
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*Basal Pain
-Constant or Baseline Pain -Lasts more than 12 hours per day -Not "cured pain" -Treat ATC to control pain -Best treated via PO Transdermal *Breakthrough Pain -Transient Flare in Pain -Moderate to severe -Occurs in conjunction with basal pain -Usually occurs 4 X day -NOT END OF DOSE PAIN |
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Analgesic Ladder for Management of Cancer Pain
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*Cancer can be relieved in 80-90% of clients by use of the WHO 3-Step Analgesic Ladder
*Freedom from Cancer Pain -Strong Opiod +/- non-opiod +/- adjuvant *Pain Persisting or Increasing -Weak Opiod +/- non-opiod +/- adjuvant *Pain Persisting or Increasing Non-Opiod +/- adjuvant |
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Pharmacological Agents: Analgesic Ladder
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*Step 1 - Non-opiods for mild to moderate pain.
Examples: ASA, Tylenol and NSAIDS *Step 2 - Opiods for moderate pain. Examples: Percocet, Codeine, MS and Fentanyl *Step 3 - Opiods for persistent or escalating pain -Oxycontin, MS contin *Lewis Table 14-24 Page 142 |
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Adjuvant Analgesics
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-Medications for clients with cancer aimed at treating target symptoms
-Neuropathic pain -Pain associated with spinal cord compression -Somnolence (prolonged drowsiness or sleepiness) -Anxiety -Muscle spasms/myoclonic jerks Subset of drugs: Anticonvulsants Ex: Neurotin used for neuropathic pain |
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Routes of Administration
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*PO
*Rectal *IV (opiods work immediately by IV) *SC *Transdermal *Epidural |
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Dosage Schedule
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*ATC
-Opiods should be dosed ATC and PRN -To manage basal pain *PRN -Opiods should be given PRN -To manage breakthrough pain |
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Cancer Pain Analgesia: Opiods
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*Long Acting
-Morphine CR -Oxycodone CR -Transdermal Fentanyl -Methadone *Short Acting -Morphine IR -Oxycodone IR -Transmucosal Fentanyl -Hydromorphone |
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Management of Cancer Pain
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*We have the knowledge and understanding of cancer pain
*We have the drugs and guidelines to effectively manage cancer pain.... -...so why are so many of our clients pain not effectively managed? |
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Barriers to Effective Pain Management
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*Health Care Providers
-Inadequate Assessment *Clients -Lack knowledge of untreated pain *Health Care System -Making pain the 5th vital sign |
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Pain Assessment: RELIEF
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R Reason for the pain
E Exacerbating factors L Location I Intensity E Effects of pain F Follow up/Reassessment (always assess 30 minutes after pain med is given) |
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Pain Assessment:
Essential Components of Cancer Pain |
*Quality
*Pattern *Location *Intensity *Measures *Relief |
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Plan of Care (Examples of an outcome)
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-Assist your client to identify his/her goals for comfort
What is your clients acceptable level of pain? What side effects need to be addressed? -Be an advocate in reaching your clients goals -The outcome will reflect the goals The client will report pain less than "3/10" The client will be awake during meals |
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Interventions
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*All nursing interventions are designed to assist the client in achieving the selected goals and outcomes
-Manage basal and breakthrough pain -Manage side effects of treatment: constipation, nausea, sedation -Adapt to living with pain: coping, powerlessness, hopelessness, anxiety, depression -Client education: knowledge deficits, non-pharmacological pain management |
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Education Strategies
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*Assist your client to adapt to living with pain
-Establish a pain management goal and routine Write down all instructions. Take home materials Design a schedule around ADL's, commitments *Discuss types of pain and management of pain -Basal Pain vs Breakthrough Pain Help client to determine when to take PRN dose Explain how long it takes for medication to work *Discuss communication -Teach client to report pain: location, intensity, etc. -Teach client to keep a record of pain -Teach client to keep track of how many doses left |
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Management of Side Effects
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*Constipation
-Diet, Fluids, Stool Softener, Activity *Nausea -Education, Antiemetics *Sedation -Education, Assessment, Medication Adjustment *Respiratory Depression |
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Management of Less Common Side Effects
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*Confusion/Delirium
*Urinary Retention *Myoclonus (twitching or clonic spasm of a muscle or group of muscles) *Pruritus |
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Non-pharmacological Pain Management Strategies
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*Physical Modalities
*Cognitive-Behavioral Interventions |
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Settings for Cancer Pain Management
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*Hospital/Acute Care
*Long-term Care *Home |
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Psychosocial Considerations
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*Cancer diagnosis usually viewed as crisis
*Common fears: -Disfugurement -Dependency -Pain -Financial depletion -Abandonment -Death |
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Predictors of Client's Ability to Cope with Cancer Diagnosis
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*Ability to cope with stress in the past
*Presence of significant others, support *Ability to express feelings and concerns *Age at diagnosis *Extent of disease *Disruption of body image *Presence of symptoms (pain, SOB etc.) |
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Ability to Cope, (cont.)
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*Past experience with cancer, ie, is this recurrent disease?
*Attitude associated with cancer, is the client in control or feeling hopeless, helpless? |
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Role of the Nurse
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*Assess client and family's ability to cope
*Assess client and family's readiness to learn about the disease and treatment course *Teach client and family rationale for diagnostic tests and treatment **Teach client and family information only as they are ready** |
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Potential Nursing Diagnosis Related to Cancer Diagnosis
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*Knowledge deficit re: new diagnosis
*Ineffective coping - individual, family *Fear *Grieving *Hopelessness *Self-care deficit *Caregiver role strain |
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Nursing Interventions (cont.)
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*Use therapeutic touch when appropriate
*Assist client in setting realistic goals *Assist client in maintaining usual lifestyle patterns *Maintain hope - key to effective cancer care *Help client find appropriate resources |
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Nursing Interventions for Newly Diagnosed Client with Cancer
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*Be available, especially during difficult times: new diagnosis, recurrent disease
*Display caring attitude *Listen actively to fears, concerns *Provide symptom relief *Provide information re: treatment *Maintain open relationship based on trust, caring, honesty |
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Potential Nursing Diagnosis (cont.)
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*Altered role performance
*Risk for lonliness *Risk for sorrow *Self-esteem disturbance |
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Samples of Resources
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*American Cancer Society
*www.cancer.org *National Cancer Institute *www.nci.nih.gov *Oncology Nursing Society *www.ons.org |
