Assessment 1- NRSG 374 PDF

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Pain Management in Palliative Care

2 – Intended audience and learning objectives, 3 – Pain in palliative care 4 – Pain assessment in palliative care 7 – Pain management 11– National Palliative Care Standard 12– How does pain management uphold the National Palliative Care Standard

(Frankenthaler & Leven, 2016)

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Intended audience

Pain in palliative care

This resource could be reviewed by the third-year undergraduate

Pain management is one of the most common and important

nursing students and graduate nurses.

issues in palliative care. Even though pain could be likely controlled by pharmacological or non-pharmacological methods, it is still a challenge in palliative care to improve pain relief. It is

Learning outcomes and objectives

insufficient for over 50 percent of patients with advanced cancer

On the completion of reading this resource, the following

to manage their pain (Sackheim, 2015). Also, it is crucial for

learning outcomes and objectives could be expected: •

To understand Pain in palliative care and different types

palliative care, which could rob patients of valuable time at the

of pain specific to the patient with cancer •

To understand pain assessment in palliative care

•

To understand pain management and likely issues with

end of their life (Moore, 2018). Pain in palliative care is considered as a complex issue and is contributed from many aspects. According to Matzo and

pain management •

nurses and other clinical professionals to deal with the pain in

Sherman (2019), pain could be understood as having physical,

To understand how pain management, uphold the

psychological, spiritual, and social components. Each

National Palliative Care Standard

component has its possible contributors, as the column below: Components Physical

Possible contributors to pain Primary and current disease, and complications

Psychological

Mood

Spiritual

Cultural beliefs, expectation

Social

Daily activities, relationships

https://www.harborlighthospice.com/blog/pain-management-during -end -of-life-care/

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Pain assessment in palliative care

clients with cancer suffered pain from many stages of the

When assessing pain in a patient, clinical professionals are

disease, which is probably chronic pain, acute inflammation

responsive to respect patients' dignity, culture, and belief. It is

pain, and radiated pain from pre-existing disease. Also, it is

essential to carefully listen to the self-report of description by

complicated to identify types of pain in palliative care as for as

patients, as it could be assessed or planned for what therapies

varieties of age or condition of patients, for instance, patients

should be used (Mcguire, Kaiser, Haisfield-Wolfe, & Iyamu,

might be very young children, older adults, unconscious, and

2016). It is important for any healthcare professionals to

unable to report the exact pain condition (Hall & Gregory,

accurately identify the sources of pain to guide the right choice

2017).

of pain therapies (Mcguire et al, 2016). According to Moore

While evaluating the pain level of young children, the age and

(2018), a thorough assessment of pain includes previous pain

developmental stage should be considered, as children should be

assessment or treatments and several components: Components

Examples

Pain characteristics

Location, quality, temporal

able to understand what the questions exactly is (Thomas, Philips, & Hamilton, 2018). And self-report could be encouraged by asking a patient to choose a face as below, and explaining

aspects, and triggers Associated symptoms

that face 0 is very happy and face 10 is hurting as much as

Any changes in mobility and

imagining:

strength Pain impact

Daily life, and daily activities

Documents

Regular documentation of pain intensity (Penrose, 2019)

However, in palliative care, it is complicated to implement as

Besides, young children might not admit to having any pain due

people with cancer often experienced two or more pains.

to the fear of painful injection or unwell tasting medications.

According to Hall and Gregory (2017), about two-thirds of !

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Therefore, healthcare professionals need to take behavioral cues with related tools to improve pain assessment, an example of FLACC pain scale showed below:

(Fry & Elliott, 2018) (Redmann, Wang, Furstein, Myer, & De Alarcón , 2017))

Pain management Besides, there is another pain assessment tool called Pain

Pain management is a fundamental part of palliative care, and

Assessment in Advanced Dementia Scale (PAINAD), which is

pain relief should be one of the most top priorities for patients

used for patients with advanced dementia, aphasic patients, and those unable or reluctant to report the level of pain (Fry &

main idea is to control symptoms of advanced diseases and make

Elliott, 2018). This pain assessment tool should be used at

patients at the end of life comfortable, and to provide patients

admission, any time pain status changed, and for older patients

with a good quality of terminal life (Sackheim, 2015). All the

in long term healthcare as a review assessment, which is showed as below: !

during the treatment in palliative care (Sackheim, 2015). The

care provided by clinical professionals should be taken to respect patients’ and families’ rights, dignity, wishes, and limitations.

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In general palliative care, there are two approaches applied to

Adjuvant analgesics

pain relief: primary analgesic approach and adjuvant treatments

According to Lussier and Portenoy (2015), “adjuvant analgesic

guided by the World Health Organisation (WHO) analgesic 3-

is a medication that is not primarily designed to control pain but

step ladder, and secondary, alternative approach (Macleod,

can be used for this purpose.” Adjuvant analgesics include:

2014).

Adjuvant analgesics

Medications example

Anticonvulsants

Gabapentin, Pregabalin, and Carbamazepine

Muscle relaxants

Cyclobenzaprine, Methocarbamol, and Baclofen

Antidepressants

Amitriptyline, Doxepin, Clomipramine, Duloxetine, and Venlafaxine

(Macleod, 2014)

Non-pharmacologic and complementary therapies Non-pharmacologic treatments refer to management and The WHO 3-step analgesic ladder:

intervention that medications are not involved to cope with pain,

•

First step: mild pain -Paracetamol and NSAIDs

•

Second step: moderate pain- Codeine or Dihydrocodeine

•

Third step: severe and persistent pain- Morphine,

for instance: physical modalities, psychological interventions, psychosocial interventions, and traditional Chinese medicine. •

Fentanyl, Oxycodone and Hydromorphone

Physical modalities: rehabilitative treatment and transcutaneous electrical stimulation(TENS)

(Macleod, 2014)

•

Psychological interventions: coping with psychological distress, depression, fear, and anxiety.

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Psychosocial interventions: cognitive-behavioral

an adjuvant pain, and giving pain relief when the baseline of

therapies (CBT), which aims to improve mental health,

morphine has not reduced (MacLeod, McAllum, & Swire, 2014).

emotional regulations, and to change negative cognitive

National palliative care standard

distortions. •

Traditional Chinese medicine: acupuncture, acupressure,

According to the Palliative Care Australia (PCA) in 2018,

and electro acupuncture.

"Palliative care is a person and family-centered care provided for

(Onshi, 2016)

Likely issues of concern

a person with an active, progressive, advanced disease, who has

While the analgesics could be used to cope with pain, there are

little or no prospect of cure and who is expected to die."

still some drawbacks and issues of concern. The lack of

Besides, palliative care aims to provide symptoms relief for

knowledge of medications, misusing drugs, and fear of addiction

people at the end of life, and maintain the dignity of patients, and

in patients are all examples of limitations (Cascella, Cuomo, &

their families by offering a holistic support system to live as

Viscardi, 2016).

active as possible (PCA, 2018)

A significant issue with pain management is the side effects of

The national palliative care standard is a guideline for clinical

opioid medicines. The most common side effects that patients in

practitioners and specialist providers to deliver high-quality care

palliative care experienced are constipation, which is often

and management. Care standards contain 9-specific standard as

treated with stool softening and stimulant properties, Coloxyl

the following figure:

with senna and Movicol (Samuelly-Leichtag, Adler, & Eisenberg, 2019). Another potential risk is opioid tolerance and opioid toxicity. Opioid tolerance could lead to increasing dosage of the medication to treat the pain. Opioid toxicity might occur at increasing rapid doses of medication, renal impairment, having (PCA,2018)

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Standard 5: Transition within and between services

How does pain management uphold the National palliative care standard?

Pain assessment, medications, and the goals of pain management

Standard 1: Assessment of needs Pain evaluation and management go through the whole process of the clinical care, from initial admission pain history and

are documented carefully, to effectively transit and process information within and between services. Standard 6: Grief support

assessment to ongoing pain monitoring management.

A pain management plan should be appropriate based on the

Standard 2: Developing the care plan

context of patients' life. Psychological interventions aim to

Based on pain assessment, holistic pain management could be

improve the mental health and emotional regulation.

developed in accordance with the patients’ goals and preferences to meet physical, psychological, spiritual, and social needs. Any details of pain development should be recorded carefully and up to date. Patients and families should be involved in developing pain management.

Standard 7: Service culture When assessing pain in patients, clinical professionals are obligated to provide support concerning patients' dignity, culture, and belief. Standard 8: Quality improvement

Standard 3: Caring for carers Patients and families should be educated with the knowledge of medications and side effects. Any specific needs regarding the information on pain management should be identified and

An ongoing pain assessment is monitored for each patient to review clinical outcomes and pain improvement. Standard 9: Staff qualifications and training It is responsive for clinical professionals to have recognized

documented.

qualifications and have sufficient knowledge of analgesics

Standard 4: Providing care Relative treatments, analgesics, medications, and complementary

application.

therapies, are given and embedded in evidence-based practice. The effectiveness should be monitored and documented. Physical modalities, psychological intervention, and psychosocial support are provided in pain management. !

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MacLeod, R., McAllum, C., & Swire, T. (2014). Pain

References Cascella, M., Cuomo, A., & Viscardi, D. (2016). Features and

Management in Palliative Care. Sydney, Australia:

Management of the Pelvic Cancer Pain (1st ed.). Cham, Switzerland: Springer International Publishing.

Hammond Care. MacLeod, R. (2014). Assessment Tools Palliative Care Bridge.

Frankenthaler, M. & Leven, D.C. (2016). Doctors need training in addiction, pain management: View [Online image].

Sydney, Australia: Hammond Care. Matzo, M., & Sherman, D. (2019). Palliative care nursing:

Lohud. Retrieved from

Quality care to the end of life (5th ed.). New York, NY:

https://www.lohud.com/story/opinion/contributors/2016/ 07/19/doctors-need-training-addiction-pain-

Springer Publishing Company. Moore, R. J. (2018). Handbook of Pain and Palliative Care Biopsychosocial and Environmental Approaches for the

management/87264828/ Fry, M., & Elliott, R. (2018). Pragmatic evaluation of an

Life Course (2nd ed.). Cham, Switzerland: Springer.

observational pain assessment scale in the emergency

Mcguire, D., Kaiser, K., Haisfield-Wolfe, M., & Iyamu, F.

department: The Pain Assessment in Advanced Dementia

(2016). Pain Assessment in Noncommunicative Adult

(PAINAD) scale. Australasian Emergency Care, 21(4),

Palliative Care Patients. The Nursing Clinics of North

131-136. doi: 10.1016/j.auec.2018.09.001

America, 51(3), 397-431. doi:

Hall, G., & Gregory, A. (2017). 54 Improving assessment of

10.1016/j.cnur.2016.05.009

pain in palliative care. BMJ Supportive & Palliative

Onishi, K. (2016). Complementary Therapy for Cancer

Care, 7(3), A367. doi: 10.1136/bmjspcare-2017-

Survivors: Integrative Nursing Care. Asia-Pacific

001407.54

Journal of Oncology Nursing, 3(1), 41-44. doi:

Lussier, D., & Beaulieu, P. (2015). Adjuvant analgesics (Oxford American pain library). New York, NY: Oxford

10.4103/2347-5625.178170 Palliative Care Australia. (2018). National Palliative Care

University Press.

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Standard (5th ed). Canberra, Australia.

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Pain Management During End of Life Care [Online image]. Harbor Light Hospice. Retrieved from https://www.harborlighthospice.com/blog/painmanagement-during-end-of-life-care/ Penrose, S. (2019). Pain assessment and measurement [Online image]. Retrieved from: https://www.rch.org.au/rchcpg/hospital_clinical_guidelin e_index/Pain_assessment_and_measurement/ Redmann, A., Wang, Y., Furstein, J., Myer, C., & De Alarcón, A. (2017). The use of the FLACC pain scale in pediatric patients undergoing adenotonsillectomy. International Journal of Pediatric Otorhinolaryngology, 92, 115-118. doi: 10.1016/j.ijporl.2016.11.016 Sackheim, K. A. (2015). Pain Management and Palliative Care A Comprehensive Guide (1st ed.). New York, NY: Samuelly-Leichtag, G., Adler, T., & Eisenberg, E. (2019). Something Must Be Wrong with the Implementation of Cancer-pain Treatment Guidelines. A Lesson from Referrals to a Pain Clinic. Rambam Maimonides Medical Journal, 10(3). doi: 10.5041/RMMJ.10369

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