Editing Medical-Surgical Nursing (section)

== Pain Management and Safety ==

Pain is what the patient says it is. Use a consistent scale, accept the patient's self-report, reassess after every intervention within the medication's expected onset, and document both the score and the functional effect.

Opioid monitoring focuses on respiratory depression, which is preceded by sedation. A rising sedation score is the earliest warning; naloxone reverses opioid effect but also reverses analgesia and can precipitate withdrawal. Constipation does not resolve with tolerance, so a bowel regimen is started with the opioid.

Nursing application: with patient-controlled analgesia, only the patient presses the button. Family members pressing it for a sleeping patient removes the built-in safety of a sedated patient being unable to self-dose, and this must be taught explicitly to visitors.

Nonpharmacologic measures including repositioning, heat or cold as appropriate, distraction, relaxation, and music are used alongside medication, not instead of appropriate analgesia.