Non-Opioids Use in the PACU - Essay Sample

Non-opioid analgesics such as Acetaminophen, Non-steroidal- anti-inflammatory drugs (NSAIDSs) such as Ibuprofen and Ketorolac are essential supplements to opioid-based medications for administering analgesia in the PACU environment. Acetaminophen functions via inhibition of cyclooxygenase producing strong pain control as well as antipyretic effect. NSAIDS also inhibit cyclooxygenase and have powerful peripheral anti-inflammatory properties. The FDA approved the use of intravenous form of NSAID, ketorolac, which comes only in intravenous form and has been a useful non-opioid adjunct in managing acute pain in PACU (Madenski, 2014)Non-pharmacologic

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Nurses use non-drug mechanisms to help patients cope with pain. Interventions without drugs are effective because they require nurses to interact with patients in a manner that includes offering hope of relief, establishing an emphatic relationship and spending time working directly with the patient. Nurses are uniquely able to teach breathing, meditation, guided imagery, music, and distraction or focusing attention away from pain. Physical techniques include massage, repositioning as well as applying cold ice compress, polar ice or a warm compress. The aim of the research was to suggest these techniques are effective in alleviating pain ("Pain Management: Alternative Therapy," 2016).

Opiate analgesics (also known as narcotics) are the traditional class of drugs used in the treatment of moderate to severe pain. Clearly, there are many myths and misconceptions in the implementation of opiates for pain management even among health care professionals, as well as with the public. The purpose of this article was to report on how people in severe pain cannot function well, relate fully to others, become isolated, and how they suffer from anxiety, depression, and insomnia as a direct result of their pain. Due to physical stress people in constant pain suffer, their immune system weakens, and they are less able to fight infections. This leads to not only suffering, but also to the possibility of premature death, and even suicide in some cases (Madenski, 2014).

Opiates are a class of medication used for moderate to severe pain. They act on opiate receptors in the nervous system and the brain while diminishing the sensation of pain by the afflicted. The list of single drugs includes: morphine (also known as Roxanol, MS Contin, Kadian), oxycodone (Oxycontin), Fentanyl (Duragesic patches, Actiq), hydromorphone (Dilaudid) methadone, and tramadol (Ahmadi, 2016, p. 6) The purpose of this article, in summary, was patient education. It asserted that people who are prescribed opiates for the management of pain in accepted guidelines do NOT become addicted. The article states that addiction is a psychological disorder highlighted by a craving for a substance such as drugs or alcohol to feel a high or simply feel euphoric (Madenski, 2014).

The findings of this study strive to prove and encourage patient educate on prescription responsibility. The purpose of this authors study was to show how opiate medications are prescribed under the safe eye and supervision of a doctor. The author study shows as recommended by well-qualified pain management doctors; they are considered safe to a degree when taken as needed and tapered off as soon as possible. Addiction is perpetuated by continued daily use regardless of consequences, however; short term use is considered safe. For example opiates have a better safety record than aspirin which may cause ulcers and significant bleeding, hearing damage or kidney failure. Arthritis medicines like Motrin, ibuprofen, Advil, or naproxen can also cause ulcers, bleeding problems, kidney damage or heart damage. Tylenol may cause the risk of liver damage when used in higher doses (Arenella, 2017, p. 2).

An interesting fact regarding pain is the influence emotions have on our perception of pain. Everyone is aware of the emotional fear of anticipatory pain from his or her personal life. This is a motivating factor for researchers to discover how to make a patient experience a more positive one. A new innovative tool of distraction taught by new nursing graduates is Guided Relaxation which encourage patients to focus on their breathing. A nurse may encourage a patient to concentrate and focus on the rhythm and depth of their breathing as a cue to promote relaxation. This would supplement traditional pain medication control, such as simultaneously delivering an intravenous medication like morphine (Briggs, 2017).

Alternative therapy includes a variety of disciplines such as guided imagery, yoga, acupuncture, biofeedback, hypnosis, aromatherapy, relaxation, distraction, herbal remedies, and essential oils. Massage is being now considered a mainstream treatment by some in modern day hospitals for patients suffering from pain. Massage reduces stress and relieves tension by enhancing blood flow. The best benefit is that there are no unwanted side effects to massage. Professionally trained massage therapists are educated on the appropriate amount and depth of pressure to promote optimal healing. As declared by Pain Management: Alternative Therapy by WebMD (2017)The most common prescription opioids are fentanyl, methadone, morphine, and OxyContin. Fentanyl is a powerful opioid painkiller. It is fifty to one hundred times more potent than morphine. Fentanyl is thirty to fifty times stronger than heroin. This is a big reason why drug dealers sell fentanyl illegally. It is a growing concern. People who use the street versions of it may become addicted, experience seizures, fall into a coma, or overdose due to respiratory depression resulting in death. Some doctors prescribe Fentanyl for discomfort after surgery, cancer pain, or if similar drugs do not ease severe ongoing pain symptoms. It can make a person extremely relaxed or euphoric. The other anticipated side effects to be aware of are nausea, vomiting, anxiety, depression, confusion, hallucinations, and gastrointestinal constipation. It is available as a shot, a topical patch or a lozenge. Opioid withdrawal symptoms include tremors, pinpoint pupils, vomiting, diarrhea, bone and joint aches. Always keep in mind to take the medication as prescribed to avoid the risk of addiction. The purpose of this authors research was to strive to educate to avoid the risk of addiction. Ask your doctor for alternatives and options, taper off slowly after a couple of days, never take someone elses medicine, and do not mix alcohol and pain medication (Smith, 2016)The nurse can professionally judge the appropriate dosage of medication directly from the physicians order. Although it is not possible to eliminate pain completely, multimodal pain management techniques such as the administration of two or more drugs that have different alleviating mechanisms can provide relief (Briggs, 2017)

Fortunately, these drugs may be given via the same IV route, intramuscular, topical or oral route. Administration of a rapidly acting intravenous agent in small doses at frequent intervals until pain relief is achieved is recommended. This allows the nurse to determine if patients receive adequate pain relief. Hypotension in response to analgesics is the most common indication of hypovolemia. It may become necessary to begin resuscitation protocol if pain control leads to lack of respiratory effort or respiratory depression, and a reversal agent such as Narcan or CPR protocol would be required.

Non-opioid agents such as a steroid, nonsteroidal anti-inflammatory drugs, ice, and physical therapy reduce the opioid dose requirement and are considered effective techniques to prevent long-term consequences and complications from developing.

Clear communication between patients and doctors increase best patient satisfaction. Communication regarding pain is critical to patient comfort so concise and timely communication between nurses and physicians is necessary for pain management.

The purpose of this authors study was to present recent data suggesting 80 percent of patients experience pain post-operatively. The lack of appropriate pain management results in physiological and psychological impacts on the patients such as the risk of developing chronic pain.

The search of this literature was performed with Eastern Michigans search database using Pub Med, CINAHL, and WebMD. The recurrent theme is the fact nurses are continually confronted with challenges of treating pain. To ensure the optimal quality of care, nurses need knowledge, skill and a professional attitude to comfort a patient coping with pain. I feel challenged on a daily basis to treat an individuals pain in a safe, timely respectful manner. I am most definitely blessed to be lucky enough to work with a strong team of compassionate caregivers on the Sparrow Hospital postoperative team. I strive to be a strong patient advocate and as their voice when a person is in a vulnerable, crisis.

References

Ahmadi MD, Ph.D., A. (2016). Pain Management in Trauma: A review study. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4967367/Alternative Treatments for Pain Management. (2016). Retrieved from WebMdArenella MD, C. (2017). Use of Opiates to Manage Pain in the Seriously and Terminally Ill Patient. American Hospice Foundation, 1-5.Briggs MD, J. (2017). Pain Gains for Complementary and Integrative Medicine. NIH Medline Plus, 12-14.Madenski RN DNP, A. (2014). Improving Nurses Pain Management in the Post-Anesthesia Care Unit (PACU). Retrieved from ScholarWorks@UMassAmherstSmith MD, M. (2016). Prescription Opioid Addiction. Retrieved from Web MD