PM - Procedures

DESCRIPTION

This is the process of identifying and managing acute non-traumatic/medical pain by the nurse using oral medications and non-pharmacological measures to relieve pain.

AIMS

Assess level of pain in patient
Relieve the patient of pain, discomfort and suffering
Promote the dignity of the patient
Promote early ambulation and discharge of patient
Prevent complications

TYPES

N/A

PRINCIPLES OF PAIN MANAGEMENT

Pain assessment is part of vital signs
Provide patient and family with adequate information and education on pain management
Assess the pain using objective scales such as 0-10 Numeric Pain Rating Scale, Wong-Baker Faces Pain Scale, Colour-Circle Pain Scale etc. and document
Treat each patient as an individual and involve the patient and family in the pain management
Employ evidence-based contemporary recommendations for pain management such as:

Pre-emptive analgesia (analgesic given before a painful stimulus)
Multi-modal analgesia (using two or more forms of analgesic concurrently)
Time-scheduled analgesic administration (giving the analgesics according to the time prescribed regularly)
Non-pharmacological methods of relieving pain such as early mobilization, passive mobilization, positioning, and other appropriate measures should be used as adjuncts to analgesic administration for pain management

Evaluate the pain management and review decisions per assessment findings
Investigate allergies to pain medications and other co-morbidities
Employ effective teamwork with doctors and other health team members when managing pain
There should be hospital protocol for pain management
There should be input and monitoring from hospital management and departmental leadership to achieve effective pain management
Guard against dependence or addiction

Patient’s folder (electronic or manual)
Pain assessment tools: numerical scale or facial scale
Vital signs tray
Medication tray
A tray containing the following

Patient treatment chart (Electronic or Manual)
Spoon
A cup
A saucer
A jug/bottle/sachet of water
A pair of scissors
Tissue paper/napkin
Prescribed pain medication and other adjuvant medications

Establish rapport and explain pain management strategies to the patient
Perform the five moments of hand hygiene
Assess the level of pain using appropriate pain assessment tool based on the level of literacy of the patient
Reassure patient of proper pain management
Show empathy to the patient
Provide diversionary/distraction therapy by allowing the patient to listen to music or watch television or engage in a healthy conversation with the patient
Position patient appropriately ensuring the use of bed accessories and less discomfort
Ensure patient is not wearing tight or excess clothing
Assist patient with activities of daily living
Assess baseline vital signs: Temperature, Pulse, Respiration, Blood pressure and Oxygen saturation
Observe the rights of medication administration
Prepare tray and send to the patient bedside
Serve medications to the patient and provide him/her with sufficient water
Dispose off, decontaminate and clean used items
Sign the treatment chart (Electronic or Manual)
Observe patient for therapeutic and adverse effects of prescribed pain medication within the next hour
Continue to assess patient’s pain level and report to ward in-charge if pain persists for use of alternative analgesics
Document and report in the nurses’ notes (Electronic or Manual)
\n. MANAGEMENT OF PATIENTS WITH SICKLE-CELL DISEASE WITH NON-TRAUMA/MEDICAL PAIN:

Put patient in a comfortable position supporting limbs with pillows
Ensure adequate intravenous fluid therapy
Monitor fluid intake and output
Assist patient with activities of daily living
Administer oxygen if necessary

\n MANAGEMENT OF PATIENTS WITH CARDIAC DISEASE WITH NON-TRAUMA/MEDICAL PAIN:

Position patient in a high Fowlers position in a cardiac bed ensuring the use of bed accessories
Ensure patient is not wearing tight or excess clothing
Assist patient with activities of daily living
Administer prescribed adjuvants targeting the cardiovascular system
Administer oxygen if necessary

DESCRIPTION

This is the process of identifying and managing acute non-traumatic/medical pain by the nurse using parenteral medications and non-pharmacological measures to relieve pain.

AIMS

Assess level of pain in patient
Relieve the patient of pain, discomfort and suffering
Promote the dignity of the patient
Promote early ambulation and discharge of patient
Prevent acute pain from progressing to chronic
Prevent complications such as shock, death etc.
Reduce pain with minimal adverse effect

TYPES

N/A

PRINCIPLES OF PAIN MANAGEMENT

Pain assessment is part of vital signs
Provide patient and family with adequate information and education on pain management
Assess the pain using objective scales such as 0-10 Numeric Pain Rating Scale, Wong-Baker Faces Pain Scale, Colour-Circle Pain Scale etc. and document
Treat each patient as an individual and involve the patient and family in the pain management
Employ evidence-based contemporary recommendations for pain management such as:

Pre-emptive analgesia (analgesic given before a painful stimulus)
Multi-modal analgesia (using two or more forms of analgesic concurrently)
Time-scheduled analgesic administration (giving the analgesics according to the time prescribed regularly)
Non-pharmacological methods of relieving pain such as early mobilization, passive mobilization, positioning, and other appropriate measures should be used as adjuncts to analgesic administration for pain management

Evaluate the pain management and review decisions per assessment findings
Investigate allergies to pain medications and other co-morbidities
Employ effective teamwork with doctors and other health team members when managing pain
There should be hospital protocol for pain management
There should be input and monitoring from hospital management and departmental leadership to achieve effective pain management
Guard against dependence or addiction

Patient’s folder (electronic or manual)
Pain assessment tools: numerical scale and facial scale
Sharp box
Vital signs tray
Medication tray
A tray containing the following

Prescribed parental pain medication and other adjuvant medications
Syringes
Needles
Cotton wool swabs in a gallipot
A bottle of methylated spirit
Treatment chart (Electronic or Manual)
Intravenous set

Establish rapport and explain pain management strategies to the patient
Perform the five moments of hand hygiene
Assess the level of pain using appropriate pain assessment tool based on the level of literacy of the patient
Reassure patient of prompt pain management
Show empathy to the patient
Provide diversionary/distraction therapy by allowing the patient to listen to music or watch television or engage in a healthy conversation with the patient
Assess baseline vital signs: Temperature, Pulse, Respiration, Blood pressure and Oxygen saturation
Prepare and send tray to the bedside of the patient
Observe for the rights of medication administration
Assemble syringe and needle using aseptic technique
File/ break/hang pain medication depending on the type
Draw medication with a syringe as per the prescription and discard the needle in a sharp box
Replace needle with a new one and expel air
IV or IM are administered as follows:

Intravenous- remove needle and administer the drug into the venous access for the patient OR
Intramuscular- assist patient into a required position and clean injection site with alcohol swab. Inject analgesic following standard protocol

Dispose off, decontaminate and clean used items
Observe for the therapeutic effects within 15-30 minutes of administering the drug
Observe for adverse effects of pain medication and intervene appropriately
Encourage patient to report pain concerns and continue to intervene as per prescribed alternative analgesic therapy
Document and report in the nurses’ notes (Electronic or Manual)
MANAGEMENT OF PATIENTS WITH SICKLE-CELL DISEASE WITH TRAUMA/SURGICAL PAIN:

Position patient in a comfortable position supporting limbs with pillows
Ensure adequate intravenous fluid therapy c. Monitor intake and output
Assist patient with activities of daily living
Administer oxygen if necessary

MANAGEMENT OF PATIENTS WITH CARDIAC DISEASE WITH TRAUMA/SURGICAL PAIN:

Position patient in a high fowlers position in a cardiac bed ensuring the use of bed accessories
Ensure patient is not wearing tight or excess clothing
Assist patient with activities of daily living
Administer prescribed adjuvants targeting the cardiovascular system
Administer oxygen if necessary

DESCRIPTION

This is the process of identifying and managing an acute traumatic/surgical pain by the nurse using oral medications and non-pharmacological measures to relieve pain during peri-operative period or post traumatic experience.

AIMS

Assess level of pain in patient
Relieve the patient of pain, discomfort and suffering
Promote the dignity of the patient
Promote early ambulation and discharge of patient
Prevent acute pain from progressing to chronic
Prevent complications such as shock, death etc.
Reduce pain with minimal adverse effect

TYPES

N/A

PRINCIPLES OF PAIN MANAGEMENT

Pain assessment is part of vital signs
Provide patient and family with adequate information and education on pain management
Assess the pain using objective scales such as 0-10 Numeric Pain Rating Scale, Wong-Baker Faces Pain Scale, Colour-Circle Pain Scale etc. and document
Treat each patient as an individual and involve the patient and family in the pain management
Employ evidence-based contemporary recommendations for pain management such as:

Pre-emptive analgesia (analgesic given before a painful stimulus)
Multi-modal analgesia (using two or more forms of analgesic concurrently)
Time-scheduled analgesic administration (giving the analgesics according to the time prescribed regularly)
Non-pharmacological methods of relieving pain such as early mobilization, passive mobilization, positioning, and other appropriate measures should be used as adjuncts to analgesic administration for pain management

Evaluate the pain management and review decisions per assessment findings
Investigate allergies to pain medications and other co-morbidities
Employ effective teamwork with doctors and other health team members when managing pain
There should be hospital protocol for pain management
There should be input and monitoring from hospital management and departmental leadership to achieve effective pain management
Guard against dependence or addiction

Patient’s folder (electronic or manual)
Pain assessment tools: numerical scale or facial scale
Vital signs tray
Medication tray
A tray containing the following

Patient Treatment chart (Electronic or Manual)
Spoon
A jug of water
Examination gloves
Surgical gloves
Tissue paper
Plastic cup of water on a plastic saucer
Prescribed pain medication

Establish rapport and explain pain management strategies to the patient
Practice the five moments of hand hygiene
Assess the level of pain using appropriate pain assessment tool based on the level of literacy of the patient
Reassure patient of proper pain management to calm patient
Show empathy to the patient
Provide diversionary/distraction therapy by allowing the patient to listen to music or watch television or engage in a healthy conversation with the patient
Apply ice and/or heat at the site of pain to relieve pain
Position patient ensuring less pressure on trauma/surgical site
Examine trauma/surgical site to ensure the wound dressing is not tight or wet
Assess for the presence of bowel sounds
Inform patient about plans to administer prescribed oral/suppository analgesics if pain persists
Assess baseline vital signs; temperature, blood pressure, pulse, respiration and oxygen saturation
Observe the rights of medication administration
Put patient in a suitable position for medication administration
Prepare tray and send to the patient bedside
Check the analgesic prescription in the treatment chart (Electronic or Manual) (Electronic or Manual) again and compare with the available analgesic for the patient
Serve the prescribed pain medication to the patient and provide him/her with sufficient water
Dispose off, decontaminate and clean used items
Sign the treatment chart (Electronic or Manual)
Observe patient for therapeutic and adverse effects of prescribed pain medication within the next hour
Continue to assess patient’s pain level and report to ward in-charge if pain persists for use of alternative analgesics
Document and report in the nurses’ notes (Electronic or Manual)
MANAGEMENT OF PATIENTS WITH SICKLE-CELL DISEASE WITH TRAUMA/SURGICAL PAIN:

Put patient in a comfortable position supporting limbs with pillows
Ensure adequate intravenous fluid therapy
Monitor fluid intake and output
Assist patient with activities of daily living
Administer oxygen if necessary

FOR CARDIAC ORIGIN PAIN:

Put patient in a high fowlers position in a cardiac bed ensuring the use of bed accessories
Ensure patient is not wearing tight or excess clothing
Assist patient with activities of daily living
Administer prescribed adjuvants targeting the cardiovascular system
Administer oxygen if necessary

DESCRIPTION

This is the process of identifying and managing an acute traumatic/surgical pain by the nurse using parenteral medications and non-pharmacological measures to relieve pain during peri-operative period or post traumatic experience.

AIMS

Assess level of pain in patient
Relieve the patient of pain, discomfort and suffering
Promote the dignity of the patient
Promote early ambulation and discharge of patient
Prevent acute pain from progressing to chronic
Prevent complications such as shock, death etc.
Reduce pain with minimal adverse effect

TYPES

N/A

PRINCIPLES OF PAIN MANAGEMENT

Pain assessment is part of vital signs
Provide patient and family with adequate information and education on pain management
Assess the pain using objective scales such as 0-10 Numeric Pain Rating Scale, Wong-Baker Faces Pain Scale, Colour-Circle Pain Scale etc. and document
Treat each patient as an individual and involve the patient and family in the pain management
Employ evidence-based contemporary recommendations for pain management such as:

Pre-emptive analgesia (analgesic given before a painful stimulus)
Multi-modal analgesia (using two or more forms of analgesic concurrently)
Time-scheduled analgesic administration (giving the analgesics according to the time prescribed regularly)
Non-pharmacological methods of relieving pain such as early mobilization, passive mobilization, positioning, and other appropriate measures should be used as adjuncts to analgesic administration for pain management

Evaluate the pain management and review decisions per assessment findings
Investigate allergies to pain medications and other co-morbidities
Employ effective teamwork with doctors and other health team members when managing pain
There should be hospital protocol for pain management
There should be input and monitoring from hospital management and departmental leadership to achieve effective pain management
Guard against dependence or addiction

Patient’s folder (electronic or manual)
Pain assessment tools: numerical scale and facial scale
Sharp box
Vital signs tray
Medication tray
A tray containing the following

Prescribed parenteral pain medication
Syringes
Needles
Cotton wool swabs in a gallipot
Treatment chart (Electronic or Manual)
Methylated spirit
Receiver/kidney dish
Intravenous set

Establish rapport and explain pain management strategies to the patient
Practice the five moments of hand hygiene
Assess the level of pain using the appropriate pain assessment tool based on the level of literacy of the patient
Show empathy to the patient
Explain pain management techniques and reassure patient of competent care
Provide diversionary/distraction therapy by allowing the patient to listen to music or watch television or engage in a healthy conversation with the patient
Apply ice and/or heat at the site of pain to relieve pain
Position patient ensuring less pressure on trauma/surgical site
Examine trauma/surgical site to ensure the wound dressing is not tight or wet
Assess baseline vital signs; temperature, blood pressure, pulse, respiration and oxygen saturation
Observe for the rights of medication administration
Assemble syringe and needle using aseptic technique
File/ break/hang pain medication depending on the type
Draw medication with a syringe as per the prescription and discard the needle in a sharp box
Replace needle with a new one and expel air
IV or IM are administered as follows:

Intravenous - remove needle and administer the drug into the venous access for the patient. OR
Intramuscular - assist patient into a required position and clean injection site with alcohol swab. Inject analgesic following standard protocol

Dispose off, decontaminate and clean used items
Observe for the therapeutic effects within 15-30 minutes of administering the drug
Observe for adverse effects of pain medication and intervene appropriately
Encourage patient to report pain concerns and continue to intervene as per prescribed alternative analgesic therapy
Document and report in the nurses’ notes (Electronic or Manual)
MANAGEMENT OF PATIENTS WITH SICKLE-CELL DISEASE WITH TRAUMA/SURGICAL PAIN:

Position patient in a comfortable position supporting limbs with pillows
Ensure adequate intravenous fluid therapy
Monitor intake and output
Assist patient with activities of daily living
Administer oxygen if necessary

MANAGEMENT OF PATIENTS WITH CARDIAC DISEASE WITH TRAUMA/SURGICAL PAIN:

Position patient in a high Fowlers position in a cardiac bed ensuring the use of bed accessories
Ensure patient is not wearing tight or excess clothing
Assist patient with activities of daily living
Administer prescribed adjuvants targeting the cardiovascular system
Administer oxygen if necessary

DESCRIPTION

This is a process of managing chronic pain by the nurse/midwife using nonpharmacological and pharmacological interventions to promote quality of life. Chronic pain persists for over three to six months and for patients who are able to speak, self-report based on numerical, verbal or graphical rating scales ensures adequate management.

AIMS

Effectively assess chronic pain in patients who can describe their pain experience
Implement interventions that will ensure holistic management of pain to a verbal rating score of 0-3
Relieve the patient of chronic pain, discomfort and suffering
Promote the dignity of the patient
Promote early ambulation and discharge of patient
Reduce pain with minimal adverse effect
Prevent abuse and addiction
Counsel patient on adverse effects of pain relieving medications
Prevent medication resistance

TYPES

Nonpharmacological
Pharmacological

PRINCIPLES OF PAIN MANAGEMENT

Pain assessment is part of vital signs
Provide patient and family with adequate information and education on pain management
Assess the pain using objective scales such as 0-10 Numeric Pain Rating Scale, Wong-Baker Faces Pain Scale, Colour-Circle Pain Scale etc. and document
Treat each patient as an individual and involve the patient and family in the pain management
Employ evidence-based contemporary recommendations for pain management such as:

Pre-emptive analgesia (analgesic given before a painful stimulus)
Multi-modal analgesia (using two or more forms of analgesic concurrently)
Time-scheduled analgesic administration (giving the analgesics according to the time prescribed regularly)
Non-pharmacological methods of relieving pain such as early mobilization, passive mobilization, positioning, and other appropriate measures should be used as adjuncts to analgesic administration for pain management

Evaluate the pain management and review decisions per assessment findings
Investigate allergies to pain medications and other co-morbidities
Employ effective teamwork with doctors and other health team members when managing pain
There should be hospital protocol for pain management
There should be input and monitoring from hospital management and departmental leadership to achieve effective pain management
Guard against dependence or addiction

Patient Treatment chart (Electronic or Manual)
A tray containing the following

Spoon
A cup
A saucer
A jug/bottle/sachet of water
A pair of scissors
Tissue paper/napkin
Prescribed pain medication and other adjuvant
Pulse oximeter

Neurologic examination tray
Ice pack
Hot water bottle

Establish rapport with patient to facilitate openness in communication
Perform the five moments of hand hygiene
Obtain history of the pain as follows:

Ask patient about the onset of the pain to confirm chronicity noting if there was a sudden or gradual onset
Explore the quality of pain to determine if the pain is sharp, burning, tingling, gnawing or dull
Ask patient to describe the location of the pain and whether it is generalised or localised and illustrate this on the *body map if applicable
Ask about the severity of the pain on the scale of 0-10 or using the colour recognition from white-black
Find out whether pain is intermittent or continuous
Determine the factors that precipitate, aggravate or relieve the pain
Explore any associated symptoms such as weakness, anxiety, depression, sleep pattern changes, appetite and weight loss
Find out about the effect of the pain on functional abilities
Ask about previous treatment and therapies used to manage the pain
Explore the influence of patient’s perception, experiences and cultural context on pain expression

Conduct a physical examination to validate pain report

Inspect general mood, gait, mannerism, coordination, interpersonal interaction of the patient
Observe for use of assistive device, guarding behaviour and restlessness
Check for mental orientation to time, place, person and ability to name objects or recall objects in 1 minute and after 5minutes
Observe location/site of pain noting any swellings, scaring, discolouration, lesions, ulceration, atrophy or hypertrophy and compare with other regions of the body
Palpate lymph nodes for swelling, lesions or masses - If masses are present check for pulsation
Palpate for tenderness over areas where patient reports pain (conduct a systematic regional palpation if pain is generalised)
Check patients pulse noting rhythm, amplitude, equality and rate
Percuss for collection of fluid, air or rigidity in regions or structure where patient reports pain
Conduct an active or passive range of motion assessment according to the patient’s activity tolerance level (flexion, abduction, adduction, external and internal rotation) and observe for patient’s responses suggesting pain
Asses for increase or decrease in muscle tone as observed with level of resistance during range of motion assessment
Check for sensory reaction by pinching patient, pricking with needle and passing cotton wool balls gently over specific spots
Check for the sense of smell by asking patient to inhale pungent substance such spice or perfume
Assess for Achilles, patellar, bicep and triceps reflexes while observing patient’s reaction that suggest decrease or increase pain

Discuss with patient the need to keep a record of the pain and the strategies best suitable for dealing with the pain
Adopt the most appropriate nonpharmacological intervention that addresses pain report

Massage areas of pain to facilitate release of endorphins to decrease pain transmission
Teach patient relaxation techniques including deep breathing exercise, music therapy to allow for refocusing of energy on positive aspect of life
Apply cold compress for 20 to 30 minutes/hour to relieve pain associated with inflammation
Use heat application if increasing blood supply to the area of pain will decrease pain reflexes. Do not exceed 20minutes and take precautions to prevent burns or scalds

Administer prescribed medications according to WHO analgesic ladder and monitor for adverse reactions

For mild pain; give non-opioid analgesics such as paracetamol, ibuprofen or aspirin
Manage moderate chronic pain with weak opioid such as codeine, tramadol or low dose morphine
Manage severe pain with strong opioid such as morphine, fentanyl, oxycodone and hydromorphine
For breakthrough pain, give an extra dose of medication as prescribed
Administer adjuvants therapy as prescribed

Educate patient on side effects of medication and what to do
Be sensitive to patients report of pain and act promptly
Involve family in pain management goal setting and intervention
Connect patient with significant support groups
Dispose off, decontaminate and clean items as necessary
Document your assessment findings and management strategies

DESCRIPTION

This is the process of managing chronic pain by the nurse/midwife in a nonverbal adult patient using observation, physiologic assessment and reliance on subjective account of caregivers. Chronic pain is managed with nonpharmacological and pharmacological interventions.

AIMS

Use appropriate tools to assess pain in nonverbal patients
Effectively manage pain in nonverbal patients to ensure optimum pain relieve
Effectively assess chronic pain in patients who can indicate their pain using the appropriate scale
Relieve the patient of chronic pain, discomfort and suffering
Promote the dignity of the patient
Promote early ambulation and discharge of patient
Reduce pain with minimal adverse effect
Prevent abuse and addiction
Counsel patient on adverse effects of pain relieving medications
Prevent medication resistance

TYPES

Nonpharmacological interventions
Pharmacological interventions

PRINCIPLES OF PAIN MANAGEMENT

Pain assessment is part of vital signs
Provide patient and family with adequate information and education on pain management
Assess the pain using objective scales such as 0-10 Numeric Pain Rating Scale, Wong-Baker Faces Pain Scale, Colour-Circle Pain Scale etc. and document
Treat each patient as an individual and involve the patient and family in the pain management
Employ evidence-based contemporary recommendations for pain management such as:

Pre-emptive analgesia (analgesic given before a painful stimulus)
Multi-modal analgesia (using two or more forms of analgesic concurrently)
Time-scheduled analgesic administration (giving the analgesics according to the time prescribed regularly)
Non-pharmacological methods of relieving pain such as early mobilization, passive mobilization, positioning, and other appropriate measures should be used as adjuncts to analgesic administration for pain management

Evaluate the pain management and review decisions per assessment findings
Investigate allergies to pain medications and other co-morbidities
Employ effective teamwork with doctors and other health team members when managing pain
There should be hospital protocol for pain management
There should be input and monitoring from hospital management and departmental leadership to achieve effective pain management
Guard against dependence or addiction

Patient Treatment chart (Electronic or Manual)
A tray containing the following

Spoon
A cup
A saucer
A jug/bottle/sachet of water
A pair of scissors
Tissue paper/napkin
Prescribed pain medication and other adjuvant
Pulse oximeter

Neurologic examination tray
Ice pack
Hot water bottle

Practice the five moments of hand hygiene
Review patients record to look for information on disease condition and previous pain history
Check previous report of pain onset, duration, location, quality and intensity from records or significant other(s)
Touch patient and communicate warmth with facial expression if conscious and communicate your intention and expectation as applicable
Assess the level of consciousness using the Glasgow coma scale
Observe facial expression for grimacing, frowning, extreme sadness, rapid blinking or tearing
Observe body movement noting whether patient is relaxed, tense, guarding, pacing or fidgeting. Look out for clenching of the fist, pulled-up knee, rubbing or touching of body parts suggestive of pain
Observe if patient is restless, pulling sheets and looks unsettled or agitated
Listen for patient sounds such as moaning, groaning, grunting or crying
Listen for noisy or observe laboured respiration
Inspect patient’s body regionally and look for swellings, scaring, discolouration, lesions, ulceration, atrophy or hypertrophy
Asses patient’s response to touch prior to palpating for any areas of tenderness
Palpate lymph nodes for swelling, lesions or masses and if present, check for pulsation, and observe patient’s reactions such as guarding, grimacing or groaning.
Palpate for tenderness over areas where pain is suspected (conduct a systematic regional palpation if pain is generalised)
Check patients pulse noting rhythm, amplitude, equality and rate
Percuss for collection of fluid, air or rigidity in regions or structure of tenderness
Conduct passive range of motion assessment according to the patient’s activity tolerance level (flexion, abduction, adduction, external and internal rotation) and observe for patient’s responses suggesting pain
Assess for increase or decrease in muscle tone as observed with level of resistance during range of motion assessment
Check for sensory reaction by pinching patient, pricking with needle and passing cotton wool balls gently over specific spots and observe patient’s response
Assess for Achilles, patellar, bicep and triceps reflexes while observing patient’s reaction that suggest decrease or increase pain.
Offer pen and paper to patients who are literate to note their pain (onset, duration, location, quality and intensity)
Develop pain management goal with the health team and patient family
Adopt the most appropriate nonpharmacological intervention that addresses pain

Massage areas of pain to facilitate release of endorphins to decrease pain transmission
Apply cold compress for 20 to 30 minutes/hour to relieve pain associated with inflammation
Use heat application if increasing blood supply to the area of pain will decrease pain reflexes. Do not exceed 20minutes and take precautions to prevent burns or scalds

Administer prescribed medications according to WHO analgesic ladder and monitor for adverse reactions

For mild pain; give non-opioid analgesics such as paracetamol, ibuprofen or aspirin
Manage moderate chronic pain with weak opioid such as codeine, tramadol or low dose morphine
Manage severe pain with strong opioid such as morphine, fentanyl, oxycodone and hydromorphine
Administer prescribed adjunct therapy

Teach family how to assess and mange pain at home
Dispose off, decontaminate and clean used items
Document all interventions appropriately

DESCRIPTION

This is the process where the midwife institute measures to reduce labour pain and ensure a positive childbirth experience for the woman and the family. It can be achieved using pharmacological, nonpharmacological or a combination of both approaches.

AIMS

Assess pain during labour
Provide pain relief
Help women to cope with the discomfort of labour
Ensure satisfying childbirth experience
Facilitate smooth progress of labour
Prevent complications

TYPES

Pharmacological
Nonpharmacological
Combination of both pharmacological and nonpharmacological

PRINCIPLES OF PAIN MANAGEMENT

Pain assessment is part of vital signs
Provide patient and family with adequate information and education on pain management
Assess the pain using objective scales such as 0-10 Numeric Pain Rating Scale, Wong-Baker Faces Pain Scale, Colour-Circle Pain Scale etc. and document
Treat each patient as an individual and involve the patient and family in the pain management
Employ evidence-based contemporary recommendations for pain management such as:

Pre-emptive analgesia (analgesic given before a painful stimulus)
Multi-modal analgesia (using two or more forms of analgesic concurrently)
Time-scheduled analgesic administration (giving the analgesics according to the time prescribed regularly)
Non-pharmacological methods of relieving pain such as early mobilization, passive mobilization, positioning, and other appropriate measures should be used as adjuncts to analgesic administration for pain management

Evaluate the pain management and review decisions per assessment findings
Investigate allergies to pain medications and other co-morbidities
Employ effective teamwork with doctors and other health team members when managing pain
There should be hospital protocol for pain management
There should be input and monitoring from hospital management and departmental leadership to achieve effective pain management
Guard against dependence or addiction

Conducive environment
A tray containing the following

Prescribed pain medication
Syringes
Needles
Cotton wool swabs in Gallipot
Receiver for Used swabs

Client’s Maternal and Child Health record book (electronic or manual)
Pain assessment tools: Numeric Pain Rating Scale, Visual Analog Scale
Conducive environment
Sharps container

Establish relationship with the client and significant other based on mutual respect and trust
Reassure client and significant other (s) that there are ways to help her cope with pain
Encourage support person to remain with woman to provide support where possible
Assess client’s knowledge of labour process and her level of anxiety
Provide information on pharmacological and nonpharmacological pain management techniques available
Counsel the client regarding the risk, side effects and benefits of each
Obtain informed consent before administering pharmacologic agents
Assess the degree of pain using verbal reports and validated pain assessment tool (pay attention to frequency, intensity and duration of contractions)
Assist client to make an informed choice of pain relief options
Assess for bladder distention and encourage voiding often (at least every 2 hours)
Keep client and significant other informed about the progress of labour
Use various nonpharmacological techniques

Encourage client to change and assume comfortable position
Teach client to do deep breathing exercises in between contractions
Encourage client to rest between contractions to reduce fatigue
Perform sacral massage during contractions or teach and encourage companion to do so
Use diversional therapy such as:

Engage client in conversation of interest and encourage companion to do same if possible
Playing client’s preferred music where possible
Engage client in preparing of cotton balls

Administer prescribed pain medication where necessary

When administering opioid based medications, cervical dilatation, foetal condition and maternal condition should be assessed first
Opioid medications should not be given when cervical dilatation is 6cm or more
Ensure that local anaesthetic agent is given before cutting or suturing episiotomy for pain management (refer procedure for giving and suturing episiotomy)
Select appropriate steps for pain management of episiotomy (cutting and suturing)
For IM and IV medications refer procedure manual for administration of medications.

Inform obstetrician if client is in intense pain after all the above measures have been used
Document all pain relief strategies used in client’s Maternal and Child Health record book

DESCRIPTION

This is the process of managing pain in children and young adolescents using both pharmacological (multi-modal) and non-pharmacological (hypnosis, distraction, play, guided imagery) strategies to improve their quality of life.

AIMS

Assess pain in children and young adolescents
Manage pain using various strategies (pharmacological and non-pharmacological)
Prevent poor pain tolerance in adulthood
Provide comfort
Prevent complications

TYPES

Pharmacological
Non-pharmacological

PRINCIPLES OF PAIN MANAGEMENT

Pain assessment is part of vital signs
Provide patient and family with adequate information and education on pain management
Assess the pain using objective scales such as 0-10 Numeric Pain Rating Scale, Wong-Baker Faces Pain Scale, Colour-Circle Pain Scale etc. and document
Treat each patient as an individual and involve the patient and family in the pain management
Employ evidence-based contemporary recommendations for pain management such as:

Pre-emptive analgesia (analgesic given before a painful stimulus)
Multi-modal analgesia (using two or more forms of analgesic concurrently)
Time-scheduled analgesic administration (giving the analgesics according to the time prescribed regularly)
Non-pharmacological methods of relieving pain such as early mobilization, passive mobilization, positioning, and other appropriate measures should be used as adjuncts to analgesic administration for pain management

Evaluate the pain management and review decisions per assessment findings
Investigate allergies to pain medications and other co-morbidities
Employ effective teamwork with doctors and other health team members when managing pain
There should be hospital protocol for pain management
There should be input and monitoring from hospital management and departmental leadership to achieve effective pain management
Guard against dependence or addiction

Patient’s folder (electronic or manual)
Pain assessment tools: (Oucher Scale, Wong-Baker FACES Pain Scale, Children Hospital of Eastern Ontario Pain Scale, Non-Communicating Children Pain Checklist, Numeric Rating Scale)
Medication tray
Weighing scale
Pain management strategies (medications, Sucrose, cold compress, pain patch, play dolls, balloons, pictures, videos, colour pencils)
Vital signs tray
A tray containing the following

Patient Treatment chart (Electronic or Manual)
Spoon
A cup
A saucer
A jug/bottle/sachet of water
A pair of scissors
Tissue paper/napkin
Prescribed pain medication and other adjuvant medications
Pain management strategies (medications, Sucrose, cold compress, pain patch)
Syringes and needles
IV set (when necessary)
Cotton wool swabs
Receiver
Sharps box

Introduce yourself and explain procedure to child/young adolescent and parent/guardian
Assess the cognitive level of the child/young adolescent (non-verbal, verbal, unconscious, cognitive impairment)
Use language that child/young adolescent and parent/guardian understand and can express themselves
Educate parent/guardian on how to support during the pain management process
Prepare requirements and take to bed side
Practice five moments of hand hygiene
Assess pain using Precipitating factors, quality, radiation, severity, time (PQRST) (parent or child if verbal)
Use the age-specific pain scale (Oucher Scale, Wong-Baker FACES Pain Scale, Children Hospital of Eastern Ontario Pain Scale, Non-Communicating Children Pain Checklist, Numeric Rating Scale)
Make child/young adolescent comfortable when assessing pain
Check contraindications of pain medication (age, co-morbidities, route of administration, allergies)
Check baseline vital signs when necessary, before administration of some medication (opioids)
Check weight of child/young adolescent to calculate the dosage of medication
Provide appropriate pain medication as prescribed (Acetaminophen, NSAIDS, Opioids)
Administer medication through the appropriate route (topical, oral, parenteral, intra thecal)
Provide non-pharmacological strategies that can distract the child/young adolescent (Making bubbles, drawing, blowing balloons)
Prepare pain chart to monitor progress of management in chronic/palliative pain
Identify non-pain symptoms that can affect the severity of the pain (fatigue, drowsiness, dypsnoea)
Observe the therapeutic effect of the medication administered
Educate child/young adolescent and parent/guardian to report any adverse reactions after administration of medication
Monitor vital signs especially respiration if medication includes opioids
Reassess pain to check changes in pain intensity, medication and behaviour of patient
Congratulate and thank child/young adolescent parent/guardian
Protect the painful site by repositioning, protective handling. reduce pressure from beddings
Nurse neonate in a calm environment
Dispose off, decontaminate equipment, and clean items
Document findings and report on the pain management strategy used and the effect (manual/electronic)

DESCRIPTION

This is the process of managing pain in neonates using both pharmacological (multi-modal) and non-pharmacological (distraction, music) strategies to improve their quality of life.

AIMS

Assess pain in neonates
Manage pain using various strategies (pharmacological and non-pharmacological)
Prevent poor pain tolerance in adulthood
Prevent complications
Promote comfort
Prevent pain from bedside invasive procedures

TYPES

Pharmacological
Non-pharmacological

PRINCIPLES OF PAIN MANAGEMENT

Pain assessment is part of vital signs
Provide patient and family with adequate information and education on pain management
Assess the pain using objective scales such as 0-10 Numeric Pain Rating Scale, Wong-Baker Faces Pain Scale, Colour-Circle Pain Scale etc. and document
Treat each patient as an individual and involve the patient and family in the pain management
Employ evidence-based contemporary recommendations for pain management such as:

Pre-emptive analgesia (analgesic given before a painful stimulus)
Multi-modal analgesia (using two or more forms of analgesic concurrently)
Time-scheduled analgesic administration (giving the analgesics according to the time prescribed regularly)
Non-pharmacological methods of relieving pain such as early mobilization, passive mobilization, positioning, and other appropriate measures should be used as adjuncts to analgesic administration for pain management

Evaluate the pain management and review decisions per assessment findings
Investigate allergies to pain medications and other co-morbidities
Employ effective teamwork with doctors and other health team members when managing pain
There should be hospital protocol for pain management
There should be input and monitoring from hospital management and departmental leadership to achieve effective pain management
Guard against dependence or addiction

Patient’s folder (electronic or manual)
Pain assessment tools: (Premature Infant Pain Profile, Oucher Scale, Wong-Baker FACES Pain Rating Scale, Face Legs Activity Cry Consolability, Neonatal Infant Pain Scale, Parent Post-operative Pain Measure)
Medication tray
Weighing scale
Pain management strategies (medications, Sucrose, pain patch, balloons, pictures, videos)
Vital signs tray
A tray containing the following

Patient Treatment chart (Electronic or Manual)
Disposable spoon/rubber spoon
A cup
A saucer
A pair of scissors
Tissue paper/napkin
Syringes and needles
IV set (when necessary)
Cotton wool swabs
Receiver
Sharps box
Prescribed pain management strategies (medications, Sucrose, cold compress, pain patch)

Introduce yourself and explain procedure to parent/guardian
Use language that parent/guardian understands and can express themselves
Educate parent/guardian on how to support
Prepare requirements and take to bed side
Practice five moments of hand hygiene
Assess pain using Precipitating factors, quality, radiation, severity, time (PQRST)
Use the age-specific pain scale (Premature Infant Pain Profile, Oucher Scale, Wong-Baker FACES Pain Rating Scale, Face Legs Activity Cry Consolability, Neonatal Infant Pain Scale, Parent Post-operative Pain Measure)
Make neonate comfortable when assessing pain
Check contraindications of pain medication (age, co-morbidities, route of administration)
Check baseline vital signs when necessary, before administration of medication
Check weight of neonate to calculate the dosage of medication
Provide appropriate pain medication as prescribed (Acetaminophen, NSAIDS, Opioids)
Administer medication through the appropriate route (topical, oral, parenteral, intra thecal)
Use non-pharmacological strategies that can distract the neonate (distraction, music)
Prepare pain chart to monitor progress of pain management
Identify non-pain symptoms that can affect the severity of the pain (fatigue, drowsiness, dypsnoea)
Observe the therapeutic effect of the medication administered
Educate parent/guardian to report any adverse reactions after administration of medication
Monitor vital signs especially respiration if medication includes opioids
Reassess pain to check changes in pain intensity, medication and behaviour of neonate
Congratulate and thank neonate, parent/guardian
Protect the painful site by repositioning, protective handling. reduce pressure from beddings
Nurse neonate in a calm environment
Dispose off, decontaminate equipment, and clean items
Document findings and report on the pain management strategy used and the effect (manual/electronic)

Pain Management Procedures

ACUTE PAIN MANAGEMENT WITH ORAL MEDICATIONS FOR A MEDICAL/NON-TRAUMATIC ADULT PATIENTLast updated : 2021-11-19 08:46:52

DESCRIPTION

AIMS

TYPES

PRINCIPLES OF PAIN MANAGEMENT

ACUTE PAIN MANAGEMENT WITH PARENTERAL (IV, IM, SC, INTRATHECAL, INTRADERMAL) IN A MEDICAL/NON TRAUMATIC ADULT PATIENTLast updated : 2021-11-19 08:54:49

DESCRIPTION

AIMS

TYPES

PRINCIPLES OF PAIN MANAGEMENT

ACUTE PAIN MANAGEMENT WITH ORAL MEDICATIONS FOR A TRAUMATIC/SURGICAL ADULT PATIENTLast updated : 2021-11-19 08:57:39

DESCRIPTION

AIMS

TYPES

PRINCIPLES OF PAIN MANAGEMENT

ACUTE PAIN MANAGEMENT WITH PARENTERAL (IV AND IM) MEDICATIONS FOR A TRAUMATIC/SURGICAL ADULT PATIENTLast updated : 2021-11-19 09:00:56

DESCRIPTION

AIMS

TYPES

PRINCIPLES OF PAIN MANAGEMENT

MANAGEMENT OF A PATIENT WITH CHRONIC PAIN (VERBAL)Last updated : 2021-11-19 09:03:38

DESCRIPTION

AIMS

TYPES

PRINCIPLES OF PAIN MANAGEMENT

MANAGEMENT OF A PATIENT WITH CHRONIC PAIN (ADULTS NONVERBAL)Last updated : 2021-11-19 09:10:45

DESCRIPTION

AIMS

TYPES

PRINCIPLES OF PAIN MANAGEMENT

MANAGEMENT OF LABOUR PAINLast updated : 2021-11-22 08:32:28

DESCRIPTION

AIMS

TYPES

PRINCIPLES OF PAIN MANAGEMENT

MANAGEMENT OF PAIN IN CHILDREN AND YOUNG ADOLESCENTSLast updated : 2021-11-22 08:34:41

DESCRIPTION

AIMS

TYPES

PRINCIPLES OF PAIN MANAGEMENT

MANAGEMENT OF PAIN IN NEONATESLast updated : 2021-11-22 08:36:22

DESCRIPTION

AIMS

TYPES

PRINCIPLES OF PAIN MANAGEMENT