14 Chapter 15 Pain Management ______________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 15.2
Instructor Preparation
Textbook Objectives Covered
8. Describe interventions used in the management of pain.
10. List the factors that should be considered when pain is not relieved with analgesic medications
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Guest speakers: a nurse who specializes in pain management
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying pain management, including:
• Nociceptors and pain physiology
• Physical and psychological factors influencing pain
• Chronic and acute pain
• Steps in pain assessment
• Physical, psychological, and pharmacologic interventions
• Assemble materials and supplies needed for each lesson as indicated below.
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• acute pain (p. 215)
• addiction (p. 227)
• analgesic (p. 212)
• anesthesia (p. 213)
• chronic pain (p. 216)
• neuropathic (p. 216)
• nociceptor (p. 213)
• pain (p. 212)
• pain threshold (p. 213)
• pain tolerance (p. 214)
• referred pain (p. 218)
• tolerance (p. 227)
Student Preparation
Assignments 2 hours
7
READ – Textbook (pp. 217-221)
REVIEW
• Figure 15-5: Examples of pain intensity scales (p. 220)
• Box 15-2: Six Steps in Pain Assessment (p. 218)
ANSWER – Study Guide
• Part IIE: 10 (p. 83)
• Part IIIF: 16 (p. 86)
______________________________________________________________ Chapter 15 Pain Management 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 15.2
8
READ – Textbook (pp. 221-232)
REVIEW
• Figure 15-2: Nursing management of pain (p. 217)
• Table 15-3: Nonpharmacologic Interventions (p. 222)
ANSWER – Text
ANSWER – Study Guide
• Part IC: 1-7 (p. 82)
• Part IIE: 11, 12, 14 (p. 83)
• Part IIIF: 6, 9, 10 (p. 85)
9
READ – Textbook (pp. 224-232)
REVIEW
• Figure 15-6: The World Health Organization three-step analgesic ladder (p. 225)
• Table 15-4: Nonopioid Analgesics: Commonly Used NSAIDs (p. 226)
ANSWER – Text
• Review Questions for the NCLEX Examination: 8, 9 (p. 233)
ANSWER – Study Guide
• Part IA: 4-7, 9 (p. 81)
• Part ID: 1 (p. 82)
• Part IIE: 13, 15-26 (pp. 83-84)
• Part IIIF: 3, 11-14 (p. 84)
10
READ – Textbook (pp. 230-232)
REVIEW
• Table 15-6: Adjuvant Drugs and Pain Treatment (p. 229)
16 Chapter 15 Pain Management ______________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 15.2
50-Minute Lesson Plan
Lecture Outline 20 minutes
7
Slide 19
Assessment
• Should be done on admission and on a regular basis
• Pain is called the fifth vital sign
TALKING POINTS:
• Assessment is the first step in pain management.
• Pain should be anticipated as a result of what situations?
Slide 20
Assessment (cont.)
• Six steps
• Accept the patient’s report
• Determine the status of the pain
• Describe the pain
TALKING POINTS:
• Obtain specific details about the pain, and respond positively that action will be taken to
relieve the pain.
• Ask the patient if he or she has had this pain before and whether it was diagnosed by a
physician.
• Assess the area for heat, redness, swelling, tenderness, abnormal position, or other
8
Slide 21
Interventions
• Nonpharmacologic
• Pharmacologic
______________________________________________________________ Chapter 15 Pain Management 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 15.2
Slide 22
Nonpharmacologic Interventions for Pain
• Comfort measures
• Cold
• Heat
• Guided imagery
• Relaxation techniques
TALKING POINTS:
• Walk students through a deep-breathing exercise.
8
&
9
Slide 23
Pharmacologic interventions
• Nonopioid
• Aspirin
• Acetaminophen
• NSAIDs
• Opioid
• Hydromorphone
• Meperidine
• Morphine
TALKING POINTS:
Slide 24
Pharmacologic Interventions: Opioid Analgesic Misconceptions
• Patients, families, nurses, and physicians have misconceptions about addiction;
therefore, the term must be defined and differentiated from the terms tolerance and
TALKING POINTS:
• The patient who is tolerant requires higher doses of a drug to achieve an analgesic
effect.
18 Chapter 15 Pain Management ______________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 15.2
Slide 25
Pharmacologic Interventions: Opioid Analgesics
• Routes of administration
• Oral
• Intramuscular
• Sublingual
• Intravenous: intermittent bolus injections, continuous infusions, or patient-controlled
TALKING POINTS:
• A limited number of opioids, such as morphine, hydromorphone, and oxymorphone, may
Slide 26
Pharmacologic Interventions: Opioid Analgesics (cont.)
• Side effects
• Constipation
• Nausea, with or without vomiting
• Sedation
• Respiratory depression
• Confusion
Slide 27
Pharmacologic Interventions: Placebos
• Inactive substances (e.g., saline) used in research or clinical practice to determine the
Slide 28
Pharmacologic Interventions: Placebos (cont.)
• Many health care organizations take the position that placebos should not be used to
assess or manage pain
• Nurses have ethical obligation to ensure that patients are not deceived and that
institutional policies related to placebos are followed
Pharmacologic Interventions: Adjuvant Analgesics and Medications
• Drugs not usually classified as analgesics may relieve pain in certain situations
Slide 30
Pharmacologic Interventions: Adjuvant Analgesics and Medications (cont.)
• Specific pain syndromes, especially neuropathic, may be controlled with drugs other than
the commonly known analgesics
• See Table 15-6 (p. 229)
______________________________________________________________ Chapter 15 Pain Management 19
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 15.2
10
Problem-Solving with Pain Medication
• Patients whose prescribed analgesic drugs do not relieve pain
TALKING POINTS:
• The administration of analgesics is simply one intervention in the nursing care of a
patient in pain.
Activities
Classroom Choose from below to make 30 minutes
Online
7
DISCUSS
• Discuss the assessment of pain. Outline
the six steps in pain assessment.
• Discuss communication skills and
behaviors necessary for the nurse to use
when interviewing a patient in pain.
• Discuss the four factors that should be
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe all
the components of pain assessment.
20 Chapter 15 Pain Management ______________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 15.2
8
DISCUSS
• Discuss situations in which
nonpharmacologic interventions may be
used in conjunction with pharmacologic
interventions to treat pain.
• Discuss the various types of physical and
psychological pain interventions and when
each might be used.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Compare and
contrast pharmacologic and
nonpharmacologic interventions for pain.
______________________________________________________________ Chapter 15 Pain Management 21
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 15.2
9
DISCUSS
• Discuss situations in which opioid
analgesics, nonopioid analgesics, and
adjuvant drugs might be used individually
or in combination to alleviate pain.
• Discuss side effects of nonopioid
analgesics. List contraindications to the use
of nonopioid analgesics.
• Discuss side effects of opioid analgesics.
How might the plan of care change when a
particular side effect is experienced?
• Divide the class into small groups. Assign
each group one of the following analgesics.
Using a drug reference, have the groups
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Compare and
contrast opioid vs. nonopioid analgesia.
22 Chapter 15 Pain Management ______________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 15.2
10
DISCUSS
• Present the following scenario to the class
for discussion:
• A 44-year-old man is admitted with
severe, unrelenting, incapacitating back
pain. The patient’s pain is not being
adequately controlled with the
analgesics he is receiving.
What other factors should be considered
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Discuss how a
nurse should respond to patients who do not
experience pain relief from analgesics.
Critical Thinking Question
What care should the nurse plan to provide for the patient having pain? What are some
specific actions you would take as the nurse to address patient pain?
Discussion Guidelines: Lead students in a discussion of pain that is guided by the nursing
board and finally discuss how these things would be evaluated.
Instructor Notes/Student Feedback
______________________________________________________________ Chapter 15 Pain Management 23
Introduction to Medical-Surgical Nursing, 6th ed.
15
Assessments for
Pain Management
CHAPTER OBJECTIVES
Lesson 15.1:
1. Define pain.
3. Explain the relationships between past pain experiences, anticipation, culture, anxiety, or activity and
a patient’s response to pain.
5. Identify situations in which patients are likely to experience pain.
Lesson 15.2:
7. List the data to be collected in assessing pain.
9. Describe the nursing care of patients receiving opioid and nonopioid analgesics for pain.
10. List the factors that should be considered when pain is not relieved with analgesic medications.
Assessments by Lesson & Objective
1
Study Guide
• Part IA: 1, 2 (p. 81)
Evolve Instructor Resources
• Test Bank: 2, 20
2
Study Guide
• Part IA: 7, 10 (p. 81)
Evolve Instructor Resources
Evolve Student Resources
• NCLEX Review: 5
3
Study Guide
• Part IIE: 3 (p. 82)
Evolve Instructor Resources
• Test Bank: 5
Evolve Student Resources
24 Chapter 15 Pain Management ______________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
4
Study Guide
• Part IA: 8 (p. 81)
Evolve Instructor Resources
• Test Bank: 12, 22
Evolve Student Resources
• NCLEX Review: 1
Evolve Instructor Resources
• Test Bank: 21
6
Study Guide
• Part IIE: 4 (p. 82)
• Part IIIF: 5, 7 (p. 85)
Evolve Instructor Resources
Evolve Student Resources
• NCLEX Review: 7
• Prioritization: 2
Lesson 15.2
7
Study Guide
• Part IIE: 10 (p. 83)
Evolve Instructor Resources
• Test Bank: 3, 18
Evolve Student Resources
• NCLEX Review: 10
• Prioritization: 3
8
Study Guide
Evolve Instructor Resources
• Test Bank: 1, 2, 8, 9, 26, 27
Evolve Student Resources
• NCLEX Review: 3
______________________________________________________________ Chapter 15 Pain Management 25
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
9
Study Guide
• Part IA: 4-7, 9 (p. 81)
Evolve Instructor Resources
• Test Bank: 11, 14, 15, 23
Evolve Student Resources
• NCLEX Review: 2, 4, 9
• Prioritization: 1, 4, 5
Evolve Instructor Resources
Instructor’s Notes/Student Feedback