Patients with unrelieved pain may focus on obtaining medications, may “clock watch,” or otherwise may seem inappropriately “drug seeking.” Even such behaviors as illicit drug use and deception can occur in the patient’s efforts to obtain relief. Pseudoaddiction is a term that describes patient behavior that may occur when pain is undertreated. Physical dependence is a state of adaptation that often includes tolerance and is manifested by a drug class–specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreased blood level of the drug, and/or administration of an antagonist. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.
Physical dependence is a state of adaptation that often includes tolerance and is manifested by a drug class–specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreased blood level of the drug, and/or administration of an antagonist.Īddiction is defined as a primary, chronic, neurobiological disease with genetic, psychosocial, and environmental factors that influence its development and manifestations. Pseudoaddiction can be distinguished from true addiction in that behaviors resolve when pain is effectively treated. Addiction is defined as a primary, chronic, neurobiological disease with genetic, psychosocial, and environmental factors that influence its development and manifestations. Guided imagery can be used as a distraction technique.ĭrug tolerance is defined as a state of adaptation in which exposure to a drug induces changes that result in diminution of one or more of the drug’s effects over time. This image creates a positive psychophysiological response. The goal of imagery is to have the patient use one or several of the senses to create an image of the desired result. Cold is effective for inflamed joints and muscles. Cold produces vasoconstriction, reduced cell metabolism, and increased blood viscosity. Heat helps relieve muscle spasms and joint stiffness. Heat produces vasodilation, reduced blood viscosity, reduced muscle tension, and increased tissue metabolism. Massage hastens the elimination of wastes stored in muscles, improves oxygenation of tissues, and stimulates the relaxation response in the nervous system. A proper massage not only blocks the perception of pain impulses but also helps relax muscle tension and spasm that otherwise might increase pain. Distraction directs a patient’s attention to something else and thus can reduce awareness of pain and even increase tolerance. By introducing meaningful stimuli, the nurse helps the patient refocus attention. Assess the patient’s cognitive ability to determine the appropriateness of PCA pain management.ĭistraction is a technique that diverts an individual’s attention away from the pain sensation. Operators may incorrectly program the dose, concentration, or rate. The pump may fail to deliver drug on demand, may have a faulty alarm or a low battery, or may lack free-flow protection. Use of a PCA pump does not prevent mistakes.
Instruct the family not to push the timing device for the patient unless the patient is unable to push the button himself, and the nurse has instructed the family to do so. Patients may misunderstand how PCA therapy works, may mistake the PCA button for the nurse call button, or may have family members who operate the demand button. Potential concerns involving PCA use are pump failure, and operator errors. Because the blood level is maintained within a narrow range of the minimum effective analgesia concentration for the individual, pain relief is enhanced, and the incidence of side effects, such as sedation and respiratory depression, is decreased. PCA allows more constant serum levels of the opioid, and, as a result, it avoids the peaks and troughs of a large bolus.
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