癌症疼痛评估及护理

癌症在威胁人类健康和生命的疾病中位居首位,在患者自觉症状中,疼痛发生率最高,世界上约有350万人忍受着癌痛的折磨,严重影响患者的生存和生活质量。因此正确评估和护理癌症疼痛患者,是提高和改善其生存和生活质量的重要措施之一。     

癌症疼痛的评估及护理

疼痛是癌症患者最常见的症状之一,严重影响了患者的生活质量。肿瘤专科护士在保证疼痛治疗顺利进行以及缓解由疼痛带来的痛苦方面起到至关重要的作用。因此,作为肿瘤科护士,应熟练掌握癌症疼痛的护理知识,以保证患者得到更加专业有效的护理,提高癌症患者的生活质量。1疼痛概述1     

癌症疼痛的评估及护理

癌症患者有30％以上伴有疼痛，其中晚期癌症患者约有60％～95％经历过疼痛。医学研究显示，癌症疼痛是可以控制的，只要正确评估疼痛程度，恰当应用止痛药物，90％以上患者的疼痛可以得到缓解，提高生活质量。现将癌症疼痛的评估方法、治疗方法和护理方法综述如下。     

癌症疼痛的评估及护理

2005年6月～12月，我们对360例剖宫产产妇进行有预见性的护理，取得满意效果。现报告如下。     

癌症疼痛的评估及护理

癌症患者有30%以上伴有疼痛,其中晚期癌症患者约有60%～95%经历过疼痛[1].医学研究显示,癌症疼痛是可以控制的,只要正确评估疼痛程度,恰当应用止痛药物,90%以上患者的疼痛可以得到缓解,提高生活质量[2].现将癌症疼痛的评估方法、治疗方法和护理方法综述如下.     

癌症疼痛的护理评估

根据主诉疼痛分级法(VRS)评定46例癌症患者,轻、中、重疼痛程度,及时处理、治疗。根据患者的病情、年龄、性别、疼痛的程度采用三阶梯止痛法。疼痛有不同程度缓解,有效缓解率96%(44/46),提示准确护理评估疼痛程度,可达到理想的镇痛效果。     

癌症疼痛的护理评估

根据主诉疼痛分级法(VRS)评定46例癌症患者，轻、中、重疼痛程度，及时处理、治疗。根据患者的病情、年龄、性别、疼痛的程度采用三阶梯止痛法。疼痛有不同程度缓解，有效缓解率96％(44/46)，提示准确护理评估疼痛程度，可达到理想的镇痛效果。     

癌症患者疼痛的评估及护理

目的探讨癌症患者疼痛评估和护理干预方法,评估护理干预对减轻疼痛的影响。方法收集2014年12月-2015年6月我科60例癌症患者作为研究对象,按照五指疼痛评估法对其进行详细疼痛评估并及时准确给予疼痛治疗,总结患者接受护理干预后的效果。结果 60例癌症患者根据疼痛评估后及时进行护理干预,干预效果显著,患者入院时、干预2周后和干预4周后两两比较差异有统计学意义(P0.05)。结论对于伴有癌痛的患者,应引起足够的护理重视,早期进行动态疼痛评估,适时了解患者疼痛情况和采取针对性的疼痛护理干预措施,能够改善患者生存质量。     

晚期癌症患者疼痛的评估及护理

总结了146例住院癌症患者疼痛的评估及疼痛护理措施,主要包括疼痛的评估、心理护理、药物止痛护理、药物不良反应的护理。认为正确的疼痛评估及有效的护理措施在癌症患者的疼痛控制中起着至关重要的作用,能帮助患者解除或减轻疼痛,提高肿瘤患者的生活质量。     

评估控制癌症疼痛的影响因素及对策

疼痛是癌症病人普遍存在的症状，本文对各种影响因素、评估控制及护理对策进行综述，旨在为今后护理工作缓解肿瘤病人的疼痛症状提供依据。     

Cross-Sectional Assessment of Factors Related to Pain Intensity and Pain Interference in Lower Limb Prosthesis Users

Objective

To determine relationships between pain sites and pain intensity/interference in people with lower limb amputations (LLAs).

Nurses' Beliefs and Self-Reported Practices Related to Pain Assessment in Nonverbal Patients

This study explored the beliefs and self-reported practices of nurses related to pain assessment in nonverbal patients. A convenience sample of 74 nurses from one Midwestern community hospital responded to a researcher-developed questionnaire based on established pain standards and clinical practice recommendations. Areas of nonverbal pain assessment beliefs and practices with low scores were identified. One-way analysis of variance with Tukey post hoc tests showed a significant difference in belief scores based on unit worked. No significant differences in beliefs or practices were found based on age, years of experience, or degree. Paired t tests showed significant differences between general pain beliefs and nonverbal pain beliefs, between general pain beliefs and practices, and between nonverbal pain beliefs and practices. Additional testing using Pearson correlation coefficients demonstrated that only three out of seven questions relating to beliefs were significantly correlated with similar questions related to practices. Good reliability of the instrument was demonstrated by Cronbach alpha coefficient α = 0.82. Recommendations include further education for hospital nurses related to pain assessment standards in nonverbal patients, as well as utilization of techniques to integrate this knowledge into nurses' belief systems and practice environment.     

Interrater Variability in Pain Assessment of Long-term Care Residents with Dementia

PurposePeople with dementia are at great risk of their pain being undetected. In long-term care facilities, certified nursing assistants are on the front-line to detect whether a resident with dementia is experiencing pain, but research on certified nursing assistants' abilities to accurately assess pain are scarce. This study aims to examine certified nursing assistants’ pain assessment skills using a simulated standardized video context.DesignA cross-sectional study was conducted.MethodsFifty certified nursing assistants and 40 individuals with no professional experience in the field of care (controls) watched the same video of an older adult woman with dementia experiencing pain. Afterwards, they completed visual analog scales (pain intensity, affective distress), an observational pain assessment scale (Algoplus), and a set of questionnaires.ResultsIn both groups, pain intensity assessment and empathic reaction scores showed important interrater variability. Moreover, certified nursing assistants and controls did not differ in detecting the presence of pain or assessing its intensity. But certified nursing assistants displayed lower empathic reactions and dispositions. Certified nursing assistants pain assessment scores decreased with experience and expertise.ConclusionsThe practice of pain assessment is challenging for certified nursing assistants in long-term care facilities. Their professional status does not prevent inter-personal inconsistency and tends to lower their empathic dispositions. Personal determinants may interfere with their assessment behaviors and must be considered to enhance pain management for residents with dementia.     

Pain and Analgesic Related Insomnia

ObjectivesThe aim of this review is to describe the effects of analgesics on sleep.Data sourcesSystematic search of the databases of PubMed and the Cochrane Library was performed between January and September 2021.Review/Analysis methodsThe search included all articles on the topic published during the past 20 years (2000-2020). The search strategy was developed using a controlled vocabulary of known studies meeting the inclusion criteria and focused on the following terms: chronic pain, pain, sleep disturbance, insomnia, analgesic, analgesic medication, antidepressants, antiepileptic drugs, nonsteroidal drugs, opioids, and quality of life. Two reviewers independently considered the studies for inclusion in the review, assessed the risk of bias, and extracted data.DesignReview and analysis.ResultsA total of 37 studies met the inclusion criteria: 15 analyzed the effects of opioids, 6 those of nonsteroidal anti-inflammatory drugs and acetaminophen, and 16 the effects of adjuvant analgesics.ConclusionsSleep quality may be adversely affected by a variety of medications used in clinical practice, including those used in analgesic indications. The class of analgesics most affecting sleep quality are opioids.     

Pediatric Pain Assessment in the Intensive Care Unit: An Evidence-Based Algorithm

BackgroundConducting an adequate pain assessment in the Pediatric Intensive Care Unit (PICU) is multifactorial and complex due to the diversity of the population. It is critical that validated pain assessment methods are used appropriately and consistently to aid in evaluation of pain and pain management interventions.PurposeThe aim of this evidence-based practice project was to improve pain assessment practices in the PICU through a decision-support algorithm.Design & MethodsThe Iowa Model-Revised was used to guide the development and implementation of an evidence-based decision algorithm. Pre- and postdata were collected via surveys (nursing knowledge and confidence) and documentation audits (nursing pain assessments). Various implementation strategies were used to facilitate the integration and sustainability of the algorithm in practice.ResultsThe majority of survey items showed an increase in nursing knowledge and confidence. Audits of pain assessment documentation displayed an increase in appropriate pain assessment documentation related to a child's communicative ability. However, there is a need for reinfusion related to the documentation of sedation assessments.ConclusionsThe use of an algorithm supported the ability of PICU nurses to critically consider and choose the pain assessment method most appropriate for the patient's condition. The algorithm promotes nursing clinical judgement, prioritizes pain management, and includes patients receiving sedation. The algorithm supports a comprehensive pain assessment in a difficult pediatric patient population. Future research is needed to strengthen and standardize the usage of terms “assume pain present” and “assume pain managed,” and to also improve the overall feasibility and effectiveness of the algorithm.     

Assessment and Management of Procedural Pain During the Entire Neonatal Intensive Care Unit Hospitalization

BackgroundDespite strong evidence that repeated pain exposure in neonates is associated with adverse outcomes, pain assessment and management continues to be less than optimal in most neonatal intensive care units (NICUs).AimsTo evaluate current pain assessment and management practices, and identify factors associated with optimal treatment throughout a cohort of preterm neonates over the entire hospital stay.DesignA secondary analysis of study data collected from 2012 to 2016 as part of a larger clinical trial and supplemental chart review.SettingsTertiary level neonatal intensive care unit.Participants/Subjects242 stable preterm neonates born at less than 37 weeks gestational age.MethodsData were analyzed quantitatively using R for statistics.ResultsThe 242 neonates underwent a total of 10,469 painful procedures (4,801 tissue breaking and 5,667 non–tissue breaking, with only 56.6% and 12.2% having a documented pain score using the Premature Infant Pain Profile, respectively). Average pain exposure was 43 with a median of 32(10-576) per entire hospital stay. Documented pain score and greater postnatal age were associated with higher use of a pain reducing intervention and lower gestational age, first day, first week, higher illness severity, non tissue breaking and night time procedures were associated with lower. Use of a pain relieving intervention was documented in 58.5% of procedures. Sucrose was most commonly used pharmacologic and non nutritive sucking the most common non pharmacologic interventions.ConclusionsIncreased efforts are needed to promote consistent pain assessment and management to ensure optimal outcomes for vulnerable at risk neonates.