Professional Documents
Culture Documents
I. Significance of Pain
A. Subjective response: only felt by the person
B. Negative: discomfort
C. Protective role: warning of potential threat to health (sometimes a life-
threatening condition); prompt for person to seek medical attention
D. Fifth vital sign according to JCAHO
II. Definition: “pain is whatever the person experiencing it says it is, and exists
whenever the person says it does” McCaffery, 1979
A. Pain has personal meaning to individual experiencing pain
B. All pain is real
C. Dimensions of pain include physical, emotional, cognitive, sociocultural,
spiritual aspects
D. Response to and warning of actual or potential trauma
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Assign students clinical experience with clients receiving Patient Controlled Analgesia
(PAC) either intravenous or epidural in the hospital on a surgical floor. Review client
documentation sheets and address each individual client’s specific pain level, sedation
level, and adverse effects over time.
Assign students clinical experience in the same day surgery unit to observe pain control
after surgery, and to see what is ordered for clients when they are discharged. Ask
students to compare the ways different clients express the need for pain medication. What
types of pain medications are ordered after surgery? What medications are prescribed for
use post discharge? What techniques are utilized in teaching clients how to control their
pain after they leave the surgery unit? Assist the students to understand ways nurses
deliver care that decrease the amount of client pain involved (e.g. positioning and other
comfort measures).
Assign students to clients in the hospital or nursing home with histories of chronic pain
illnesses. Have the students interview the clients and ask the clients about their
experiences with the painful conditions. What are some of the ways clients act to prevent
or deal with pain episodes?
The client is a 22-year-old woman who has arrived in the pre-surgery unit for surgery
scheduled later in the morning. The nurse completes a physical examination and nursing
history. Three months ago this client was in a serious motor vehicle accident in which she
sustained several fractures in her pelvis and in both legs. Today she is having surgery to
further repair one of the injuries. When the nurse asks if the client has any specific
concerns, the client begins to cry and relates that she is terrified of having terrible pain
like before without medicine to control it.
What are some of the factors affecting pain that are related to how this client will
experience pain after the surgery? What should the nurse do with this information?
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The nurse places a call to the surgeon and explains the client’s concerns. The physician
asks the nurse about the client’s present status regarding pain and how she is coping over
all. The surgeon orders an anti-anxiety agent to be given now if the client is agreeable and
will be in directly to talk to the client. Both the anesthesiologist and surgeon visit the
client and reassure her that her pain will be adequately relieved after the surgery.
The client is relaxed after receiving the anti-anxiety agent. She questions the nurse as to
whether her insurance will cover this surgery if she stays in the hospital overnight for
pain control as offered by the physicians. The nurse shares the concern with the surgeon
who states that the procedure has been certified for outpatient or for an overnight stay.
After the surgery is completed, the client is returned to the recovery area of the surgical
unit. The client awakens and is medicated with Morphine Sulfate 2 mg. IV Push every 30
minutes as needed. There is an order to notify the anesthesiologist if the client does not
achieve adequate pain relief.
What classification of pain medication is Morphine Sulfate? What is the onset and
duration of Morphine Sulfate when administered intravenously? What parameters should
the nurse assess when making decisions about intervening to control the client’s pain?
Over the next five hours the client makes satisfactory recovery from the anesthesia and is
visited by the surgeon and anesthesiologist. The client’s pain has been adequately
controlled with hourly dosages of the morphine sulfate. The client wants to go home this
evening and the pain medication is switched to Percocet 2 tablets orally. She will be
discharged home with a prescription for Percocet (Acetaminophen 325 mg with
Oxycodone hydrochloride 5 mg) 2 tablets every four hours as needed.
What classification of pain medication is Percocet? What should the nurse include in
discharge teaching for this client regarding pain medication and pain control? What are
some measures the client can take to keep her pain level under control?
Joyce Hammer
1/23/2018