1-57. PAIN

a. Pain serves an important role. Pain can cause a person to allow injured parts time to heal and to seek medical care for disease or tissue damage. However, pain frequently persists long after its warning purpose has been achieved. Nursing care should be directed toward reducing the perception of (and reaction to) pain and enhancing the analgesic effect of medications.

b. Pain can be classified in various ways. It is often classified by intensity, such as mild, moderate, or severe. Pain may be classified by its source as superficial, visceral, or somatic. Superficial pain arises from the skin or mucous membranes. Visceral pain has its origin in smooth muscles and organ systems. Somatic pain arises from skeletal muscle, ligaments, vessels, or joints. Pain is also classified by the length of time it persists.

(1) Acute. Acute pain is typically caused by tissue injury. It has a sudden onset and it usually subsides with treatment. Acute pain generally lasts a few days.

(2) Subacute. Subacute pain is similar to acute pain and is expected to end when the tissue heals. It may persist for days or weeks.

(3) Recurrent. Recurrent pain is intermittent bouts of what is typically acute pain. The underlying cause of the pain may not be known.

(4) Chronic. Chronic pain is pain that persists longer than 6 months.

1-58. NON-NARCOTIC ANALGESIC/ANTIPYRETIC DRUGS

a. Nonnarcotic analgesic/antipyretic drugs are used to relieve pain of mild to moderate intensity and reduce body temperature in selected febrile conditions. Examples are: acetylsalicylic acid (aspirin) and acetaminophen (Tylenol®, Datril®).

b. Nursing care implications consist of administering aspirin products with food or milk, monitoring the patient for complications from aspirin therapy, observing the patient for allergic reactions to the drugs, and monitoring the patient’s temperature.

c. Gastric irritation or bleeding and tinnitus (sensation of ringing in the ears) are complications of aspirin therapy. Gastric side effects may be minimized by giving medication with a full glass of water or with milk, food, or an antacid. An exception is enteric-coated tablets, which may dissolve too quickly if taken with milk. Tinnitus is an indication of salicylate toxicity. The drug is generally discontinued with the onset of tinnitus. Inform the patient that the hearing impairment is reversible.

1-59. NON-STEROIDAL ANTI-INFLAMMATORY DRUGS

a. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to reduce inflammation and relieve pain. They appear to act by inhibiting an enzyme that is key to the formation of prostaglandins. Examples are indomethacin (Indocin®) and ibuprofen (Motrin®, Advil®, Nuprin®).

b. Nursing care implications include monitoring the patient for gastric irritation and careful observation of patients with impaired hepatic or renal function when administering these drugs.

c. These drugs should be given after meals. If gastric intolerance occurs, the physician may prescribe administration of the drug with food or milk or may decrease dosage. The absorption rate is slower when ibuprofen is given with food. The physician will rely on the nurse’s accurate observation and reporting in order to estimate the lowest effective dosage level.

1-60. NARCOTICS

a. The active principles of opium are alkaloids, of which there are about twenty. Two opium alkaloids widely used in the practice of medicine are morphine and codeine. Opium alkaloids and synthetic narcotics such as meperidine (Demerol®) are narcotic agonist that have an affinity for certain receptor sites and depress brain cells involved in pain perception.

b. Morphine and codeine act mainly on the central nervous system (CNS) where they produce a combination of depressing and stimulating effects. Papaverine has little effect on the nervous system, but produces relaxation of certain smooth muscles. The analgesic effect of morphine is indicated for the treatment of severe pain. Morphine may be administered orally, intramuscularly, intravenously, subcutaneously, epidurally, and rectally.

c. Frequently seen side effects of opioid use include vertigo, faintness, and lightheadedness, occurring most often in ambulatory patients. Less frequently seen side effects include dry mouth, headache, anorexia, abdominal cramping, nervousness, increased anxiety, mental confusion, urinary retention or painful urination, visual disturbances, and nightmares. Among the more serious adverse reactions are seizures, tinnitus, jaundice, breathing difficulties, and respiratory depression.

d. Nursing care implications consist of properly accounting for narcotics, observing the patient’s response to the analgesic, and recording the degree and duration of pain relief and any adverse effects that may occur. Naloxone hydrochloride (Narcan®) is an opioid antagonist; that is, it can reverse opioid-induced respiratory depression and sedation by displacing the opioids at the receptor site. Naloxone should be available on nursing units where opioid medications are used.

1-61. CONCLUSION

a. This subcourse has introduced the basic nursing care techniques and procedures involved in the nursing care related to the musculoskeletal system.

b. Review the lesson objectives once again. If you feel confident that you have achieved the lesson objectives, complete the exercises at the end of this lesson.

c. If you do not feel that you have met the lesson objectives, review the necessary material before you attempt the end of lesson exercises.