Clinical case example Ana is a 50-year-old female with chronic arthritis pain in her hands and knees. She states that the pain has worsened in the past two months, and previously tried therapies do not alleviate the pain. She went to the pharmacy for a refill of tramadol but was turned back to the pain specialist, since her prescription
had expired. So now Ana is asking the nurse practitioner for another prescription. Given the information provided, which tier aligns with Ana’s symptoms? Provide one short-term and one long-term intervention using the integrative approach examples.
Suggest one immediate intervention for your patient and provide a brief rationale.
Immediate interventions for Ana would include: • Therapeutic listening, presence, therapeutic use of self • Touch • Heat/cold therapy
Because of the recent change in pain and increase in the past two months, gather some diagnostics—check a rheumatoid factor, sed rate (ESR), and C-reactive protein (CRP). For long-term therapies, Ana could focus on some movement therapies, including: • Yoga • Hydrotherapy • Tai chi These therapies might help with circulation. In addition, they might help encourage deep breathing exercises and a sense of appreciation for self. INSTRUMENTS FOR EVALUATING PAIN
Suggest one long-term intervention for your patient and provide a brief rationale.
Socrates To correctly determine a course of treatment, it is critical to gain as much information as possible about the specific complaint of pain. The SOCRATES acronym is a helpful tool that can be used to remember key points to be collected when assessing a complaint of pain (Swift, 2019): ● Site : Where exactly is the pain? ● Onset : When did it start? Was it constant/intermittent? Was it gradual/sudden? ● Character : What is the pain like? Sharp? Burning? Tight? ● Radiation : Does the pain radiate/move anywhere? ● Associations : Is there anything else associated with the pain, such as sweating or vomiting? ● Time course : Does it follow any time pattern? How long does it last? ● Exacerbating/relieving factors : Does anything make it better or worse? PQRST P What provokes symptoms? What improves or worsens the condition? What were you doing when it started? Do position changes or activities make it worse? Q Quality and Quantity of symptoms: Is it dull, sharp, constant, intermittent, throbbing, pulsating, aching, tearing, or stabbing? R Radiation or Region of symptoms: Does the pain travel, or is it only in one location? Has it always been in the same area, or did it start somewhere else? Opioids for chronic noncancer pain in adults An estimated 100 million adults in the U.S. are affected by chronic pain and are frequently diagnosed with chronic low back pain, joint pain/arthritis, or headaches (Smith & Hillner, 2019). Chronic pain often has no cure, and treatment will not provide complete resolution. Treatment interventions for chronic pain should focus on the long-term management of physical, psychological, and social symptoms to improve pain management and quality of life, as well as to decrease suffering. Thus, a multidisciplinary, multimodality approach is the most effective method to manage adults’ chronic noncancer pain (et al., 2022). Assessment of chronic opioid therapy in adults A comprehensive assessment of the patient, caregiver(s), and family member(s) is necessary to determine an appropriate chronic pain management regimen. The goal is to determine
● Severity : How severe is the pain? Consider using a 1-to-10 scale. The physical examination conducted as part of the initial patient screening contains all the elements common to contemporary practice. However, a few areas should be emphasized because of the unique nature of opioid prescriptions (Clark & Galati, 2015). Here are topics to consider (Clark & Galati, 2015): ● A rigorous evaluation of the patient’s nervous system. ● An assessment of allodynia (pain from the stimulation that would not usually evoke pain, such as light touch). ● Hyperalgesia (amplified pain response to stimulation that would usually evoke only mild pain). ● Pain insensitivity, which is also known as congenital analgesia and is one or more rare conditions in which a person cannot feel (and has never felt) physical pain. ● A sensory examination that could include response to light touch, light pressure, pinpricks, cold, or vibrations. S Severity of symptoms or rating on a pain scale. Does it affect activities of daily living (ADL), such as walking, sitting, eating, or sleeping? T Time or how long have they had the symptoms? Is it worse after eating? Changes in weather, or time of day? Other tools, such as the Brief Pain Inventory form, assess pain and gauge treatment options (AAFP, 2021).
Self-Assessment Quiz Question #4 Are integrative nursing therapies and complementary therapies the same?
a. Yes. b. No.
the nature of the pain and how the pain affects the patient’s functioning and quality of life; assess prior treatment approaches; and detect other conditions that could influence
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