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Pain Management | 마이메르시 MyMerci
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Pain Management

NCLEX Review Guide: Fundamentals - Comfort, Safety & Mobility, Pain Management

Safety & Mobility Fundamentals

Fall Prevention Strategies

  • Fall risk assessment tools like Morse Fall Scale should be completed within 24 hours of admission and reassessed regularly based on patient condition changes.
  • High-risk medications including sedatives, antihypertensives, and diuretics increase fall risk and require enhanced monitoring protocols.
  • Environmental modifications include adequate lighting, non-slip surfaces, clear pathways, and accessible call lights to promote patient safety.

Memory Aid: SPLINT for Fall Prevention

Safety equipment, Position bed low, Lighting adequate, Identify risks, Non-slip footwear, Toilet schedule

Key Points

  • Always assess fall risk on admission, after procedures, and with condition changes
  • Two-person assist required for high fall risk patients during transfers
  • Document all fall prevention interventions and patient responses

Safe Patient Transfer Techniques

  1. Assess patient's ability to assist and weight-bearing status before initiating transfer
  2. Use proper body mechanics: wide base of support, bend knees, keep back straight
  3. Utilize mechanical lifts for patients over 35 pounds or those unable to assist
  4. Ensure adequate staffing - minimum two people for dependent transfers

Clinical Scenario

Patient with hip fracture needs transfer from bed to wheelchair. Never allow weight-bearing on affected side - use slide board or mechanical lift with healthcare team assistance.

Pain Management Principles

Pain Assessment & Documentation

  • Pain is the 5th vital sign and should be assessed using standardized scales appropriate for patient's age and cognitive ability.
  • Comprehensive pain assessment includes location, quality, intensity, timing, aggravating/alleviating factors, and impact on function.
  • Reassess pain within 30 minutes of IV medication administration and 60 minutes after oral medication.

Pain Scale Comparison

Scale TypeBest ForRange
Numeric (0-10)Adults, adolescents0 = No pain, 10 = Worst pain
Wong-Baker FACESChildren 3+, cognitive impairmentSmiling to crying faces
FLACCInfants, non-verbal patientsFace, Legs, Activity, Cry, Consolability

Key Points

  • Patient's self-report is the gold standard for pain assessment
  • Cultural factors influence pain expression and must be considered
  • Chronic pain requires different management approach than acute pain

Pharmacological Pain Management

  • Opioid administration requires respiratory monitoring with pulse oximetry and assessment of sedation level using standardized scales.
  • Non-opioid analgesics like acetaminophen and NSAIDs have ceiling effects and specific contraindications that must be assessed before administration.
  • Patient-controlled analgesia (PCA) requires thorough patient education and continuous monitoring for effectiveness and adverse effects.

Memory Aid: PQRST for Pain Assessment

Provocation, Quality, Radiation, Severity, Timing

Non-Pharmacological Comfort Measures

  • Heat and cold therapy applications require skin assessment and temperature monitoring to prevent thermal injury, especially in elderly or diabetic patients.
  • Positioning techniques include elevation of edematous extremities, frequent turning schedules, and use of supportive devices to maintain proper body alignment.
  • Relaxation techniques such as deep breathing, guided imagery, and progressive muscle relaxation can significantly reduce pain perception and anxiety.

Clinical Scenario

Post-operative patient reports 8/10 incisional pain. Assess surgical site first, then implement multimodal approach: prescribed analgesic, positioning for comfort, ice pack (if appropriate), and relaxation techniques.

Commonly Confused Points

Heat vs. Cold Therapy

Therapy TypeIndicationsContraindicationsDuration
HeatMuscle spasms, chronic pain, stiffnessAcute injury, bleeding, infection15-20 minutes
ColdAcute injury, inflammation, post-procedurePeripheral vascular disease, open wounds10-15 minutes

Common Pitfalls

  • Never leave heat/cold applications unattended or apply directly to skin
  • Don't assume pain medication isn't working if patient still reports pain - reassess and consider non-pharm interventions
  • Avoid using pain as the 5th vital sign to delay necessary procedures - manage pain appropriately first

Study Tips & Self-Assessment

Quick Check: Pain Management Priority

What's your first action when a patient reports sudden, severe pain?

Answer: Assess the patient thoroughly - location, quality, associated symptoms, then implement appropriate interventions

Self-Assessment Checklist

  • ☐ I can identify fall risk factors and appropriate interventions
  • ☐ I understand proper body mechanics and transfer techniques
  • ☐ I can select appropriate pain assessment tools for different populations
  • ☐ I know when to use heat vs. cold therapy
  • ☐ I can prioritize pharmacological vs. non-pharmacological pain interventions
  • ☐ I understand monitoring requirements for opioid administration

Remember: Safety first, patient comfort second, but both are essential for quality nursing care. You've got this - trust your assessment skills and prioritize based on patient needs!

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