Nursing Component Task
Nursing procedures & clinical learning

Pain Management (PM)

ACUTE PAIN MANAGEMENT WITH ORAL MEDICATIONS FOR A TRAUMATIC/SURGICAL ADULT PATIENT

This is the process of identifying and managing an acute traumatic/surgical pain by the nurse using oral medications and non-pharmacological measures to relieve pain during peri-operative period or post traumatic experience.

Purpose

  • Assess level of pain in patient
  • Relieve the patient of pain, discomfort and suffering
  • Promote the dignity of the patient
  • Promote early ambulation and discharge of patient
  • Prevent acute pain from progressing to chronic
  • Prevent complications such as shock, death etc.
  • Reduce pain with minimal adverse effect

Indications

  • Patient experiencing pain requiring management

Equipment

  • Patient’s folder (electronic or manual)
  • Pain assessment tools: numerical scale or facial scale
  • Vital signs tray
  • Medication tray
  • A tray containing the following
  • Patient Treatment chart (Electronic or Manual)
  • Spoon
  • A jug of water
  • Examination gloves
  • Surgical gloves
  • Tissue paper
  • Plastic cup of water on a plastic saucer
  • Prescribed pain medication

Procedure steps

  • Establish rapport and explain pain management strategies to the patient
  • Practice the five moments of hand hygiene
  • Assess the level of pain using appropriate pain assessment tool based on the level of literacy of the patient
  • Reassure patient of proper pain management to calm patient
  • Show empathy to the patient
  • Provide diversionary/distraction therapy by allowing the patient to listen to music or watch television or engage in a healthy conversation with the patient
  • Apply ice and/or heat at the site of pain to relieve pain
  • Position patient ensuring less pressure on trauma/surgical site
  • Examine trauma/surgical site to ensure the wound dressing is not tight or wet
  • Assess for the presence of bowel sounds
  • Inform patient about plans to administer prescribed oral/suppository analgesics if pain persists
  • Assess baseline vital signs; temperature, blood pressure, pulse, respiration and oxygen saturation
  • Observe the rights of medication administration
  • Put patient in a suitable position for medication administration
  • Prepare tray and send to the patient bedside
  • Check the analgesic prescription in the treatment chart (Electronic or Manual) (Electronic or Manual) again and compare with the available analgesic for the patient
  • Serve the prescribed pain medication to the patient and provide him/her with sufficient water
  • Dispose off, decontaminate and clean used items
  • Sign the treatment chart (Electronic or Manual)
  • Observe patient for therapeutic and adverse effects of prescribed pain medication within the next hour
  • Continue to assess patient’s pain level and report to ward in-charge if pain persists for use of alternative analgesics
  • Document and report in the nurses’ notes (Electronic or Manual)
  • MANAGEMENT OF PATIENTS WITH SICKLE-CELL DISEASE WITH TRAUMA/SURGICAL PAIN:
  • Put patient in a comfortable position supporting limbs with pillows
  • Ensure adequate intravenous fluid therapy
  • Monitor fluid intake and output
  • Assist patient with activities of daily living
  • Administer oxygen if necessary

Precautions

  • Pain assessment is part of vital signs
  • Provide patient and family with adequate information and education on pain management
  • Assess the pain using objective scales such as 0-10 Numeric Pain Rating Scale, Wong-Baker Faces Pain Scale, Colour-Circle Pain Scale etc. and document
  • Treat each patient as an individual and involve the patient and family in the pain management
  • Employ evidence-based contemporary recommendations for pain management such as:
  • Pre-emptive analgesia (analgesic given before a painful stimulus)
  • Multi-modal analgesia (using two or more forms of analgesic concurrently)
  • Time-scheduled analgesic administration (giving the analgesics according to the time prescribed regularly)
  • Non-pharmacological methods of relieving pain such as early mobilization, passive mobilization, positioning, and other appropriate measures should be used as adjuncts to analgesic administration for pain management

References and further reading

Educational resource only. Follow current Nursing and Midwifery Council guidance, local institutional protocols, scope of practice, and clinical supervision.

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