NCLEX Review Guide: Adult Health - Hematological & Oncological Pain Control

Sickle Cell Crisis Pain

• Vaso-occlusive crisis causes severe pain due to tissue hypoxia from sickled red blood cells blocking microcirculation. Pain is typically described as deep, throbbing, and excruciating in bones, joints, chest, and abdomen.
• Acute chest syndrome is a life-threatening complication requiring immediate intervention with oxygen, bronchodilators, and possible exchange transfusion.

Leukemia-Related Pain

• Bone pain occurs due to leukemic cell infiltration in bone marrow, causing pressure and inflammation. This pain is often worse at night and may be the first symptom of acute leukemia.
• Avoid aspirin and NSAIDs in patients with low platelet counts due to increased bleeding risk.

Cancer Pain Types

• Nociceptive pain results from tissue damage and responds well to opioids and anti-inflammatory medications. Neuropathic pain is caused by nerve damage and requires adjuvant medications like gabapentin or tricyclic antidepressants.
• Breakthrough pain occurs despite around-the-clock medication and requires immediate-release opioids for rapid relief.

WHO Pain Ladder

1. Step 1: Non-opioid analgesics (acetaminophen, NSAIDs) for mild pain (1-3/10)
2. Step 2: Weak opioids (codeine, tramadol) plus non-opioids for moderate pain (4-6/10)
3. Step 3: Strong opioids (morphine, fentanyl) plus non-opioids for severe pain (7-10/10)