Tanners CJM
Pain
Meds
Nursing Process
100

What is Tanners Clinical Judgement Model? 

NIRR 

Noticing, Interpreting, Reflecting, Responding 

100

What is pain?

Whatever the patient says it is! 

Complex and individualized 

100

What are the three categories of pain medications

Non-opioid

Opioid 

Co-analgesic 

100

What is the Nursing Process? 

ADPIE

Assessment, diagnosis, planning, implementation, evaluation

200

What does clinical judgement require? 

  • Flexible ability to recognize salient aspects of an undefined clinical situation, interpret their meanings, and respond appropriately 

  • Understanding the situations

  • Understanding of illness experience for both patient and family

    • Physical, social, and emotional strengths

    • Coping resources

200

Differences between acute and chronic pain 

Acute Pain

  • Sudden onset 

  • Less than 3 months time for normal healing to occur (can turn into chronic pain) 

  • Mild to severe 

  • Generally a precipitating event or illness can be identified 

  • Manifestations reflect sympathetic nervous system activation:

    • Increased heart rate 

    • Increased respiratory rate

    • Increased blood pressure 

  • Postoperative pain, labor pain, sudden trauma, some infections.  

  • Treatment of the underlying cause; goal is pain control with eventual elimination 

Chronic Pain 

  • Gradual or sudden onset 

  • Over 3 months duration; may start acute but continues past normal recovery time 

  • Cause may be unknown 

  • Does not go away; characterized by period of waxing and waning 

  • Behavior manifestations

    • Decreased physical movement/ activity 

    • Fatigue 

    • Withdraw from others and social interaction 

  •  Can be disabling and accompanied by anxiety and depression

  • Treatment goals

    • Focus on enhancing function and quality of life; this is how we measure intensity for chronic pain. 

200

Examples and Benefits to Nonopioid medications

Acetaminophen, NSAIDs (Ibuprofen, naproxen, celecoxib), aspirin. 

Do not produce addition, but can cause other problems with organs. 

Can be used with opioids to lower doses. 

200

Why do we use the nursing process?

We need some autonomy, we are the ones with the patient for a long time. It gives us a structure to follow

300

What are some things that make clinical judgement complicated? 

Number of patients, Families, Collaborative care team, coordination of admissions and discharges, time management, delegation, experinces, etc.

300

How do you treat breakthrough pain? 

  • Have to give them equivalent medication because the patient is worse. Can not really ‘cap out’ on opioids. Do not give medications such as tylenol when they are used to morphine. 

  • Preference route is PO, but the fastest route is IV route.    

300

What is a ceiling effect? What drug class does NOT have it? 

Taking higher doses does not increase the effect. 

OPIOIDs do not have a ceiling effect = overdose 

300

What is done in the implementation phase? 

  • Carry out the plan of care

  • Nurse assumes responsibility 

  • Goals are used as a focus 

  • Ongoing assessment 

  • Make revisions when necessary 

  • All interventions should be patient focused and outcomes directed 

  • Delegations: right circumstances, tasks, and person 

  • Communication needs to be clear: maybe have them repeat it back to you to make sure it is correct 

400

What is the most important thing to do when NOTICING data/ a situation? 

ALWAYS look at the patient first, do not rely on the monitors. Monitors can help, but you have to look at what is going on from the patient, collaborative care team, etc.

400

How do you measure intensity for chronic pain? 

Focus on enhancing function and quality of life; this is how we measure intensity for chronic pain.

400
Side Effects to Opioids to look out for
  • Constipation (most common)

  • Nausea/ vomiting 

  • Sedation 

  • Respiratory depression 

  • Hypotension

  • Pruritus

    • An uncomfortable, irritating sensation that creates an urge to scratch that can involve any part of the body.

400

4. The registered nurse (RN) has been assigned her patients for the day-shift. After completing initial rounds and assessing the patients, for which patient would the RN need to go to first?

A. A patient exhibiting a fever, sweating profusely, and appearing restless.

B. A patient who recently underwent an appendectomy and has just been administered pain medication.

C. A patient scheduled for occupational therapy at 1300.

D. A patient scheduled for a routine check-up later in the day.

A. A patient exhibiting a fever, sweating profusely, and appearing restless.


Symptoms indicate that the patient may be experiencing an acute issue requiring immediate intervention. Fever, profuse sweating, and restlessness can be signs of infection, pain, or other serious conditions that need prompt assessment and management to prevent complications and ensure the patient's well-being.

500

Give me an example (in detail) using the steps of NIRR

Student answer


500

PCA Rules/ Education for Patient and Family 

  • Patient presses a button to self administer analgesic agent at set time; ONLY the patient can hit the button

  • Educate patient

    • Relationship between pain, pushing button, pain relief, and only patient can push the button 

    • Can still have side effects and can still lead to complications such as sedation

500

What are some gerontologic considerations with using pain medications?

  • Sensitive to agents that produce sedation and CNS effects 

  • Initiate with low dose and titrate slowly 

  • Increased risk for NSAID induced GI toxicity 

  • Acetaminophen preferred for mild pain 

  • Opioid dose should be reduced 25-50%

  • Musculoskeletal pain is the most common with this age; pain is not a normal part of aging. Patients will a lot of the time think that it is okay just because they are getting older. 

  • Metabolize drugs slowly, increased risk of GI bleeding, drug interactions (polypharmacy), cognitive impairment 

500

Upon identifying a nursing diagnosis of acute pain, the nurse establishes the following suitable patient-focused goal:

A. Educate the patient about non-pharmacological pain management techniques.

B. Provide pain relief medication 30 minutes prior to physical therapy sessions.

C. Ensure pain intensity is reported as 3 or lower throughout the hospital stay.

D. Evaluate the impact of pain intensity on patient functionality.

C. Ensure pain intensity is reported as 3 or lower throughout the hospital stay.

Suitable patient-focused goal, as it is specific, measurable, and time-bound. It addresses the nursing diagnosis of acute pain and outlines a clear objective (keeping pain intensity at a manageable level) that can be evaluated during the patient's hospital stay.

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