Promoting Home and Community-Based Care
In preparing the patient and family to manage pain at home, the patient and family need to be taught and guided about what type of pain or discomfort to expect, how long the pain is expected to last, and when the pain indicates a problem that should be re-ported. The person who has experienced acute pain as a result of injury, illness, procedure, or surgery will probably receive one or more prescriptions for analgesic medication.
The patient and family need to understand the purpose of each medication, the appropriate time to use it, the associated side ef-fects, and the strategies that can be used to prevent these prob-lems. The patient and family often need reassurance that pain can be successfully managed at home.
Inadequate control of pain at home is a common reason people seek health care or are readmitted to the hospital. When chronic pain exists, anxiety and fear are often intensified at the time the patient is about to return home. The patient and family are instructed about the techniques for assessing pain, using pain assessment tools, and administering pain medications. These instructions are given verbally and in writing (Chart 13-6).
Opportunities are provided for the patient and family mem-bers to practice administering the medication until they are com-fortable and confident with the procedure. They are instructed about the risks of respiratory and central nervous system depres-sion associated with opioids and ways to assess for these compli-cations. If the medications cause other predictable effects, such as constipation, the instructions include measures for preventing and treating the problem, as described earlier. Steps are taken to en-sure that the needed medications are available from the local phar-macy so that the patient receives the medication when required.
Education for patients and families must stress the need for keeping analgesic agents away from children, who might mistake them for candy. Elderly patients may become lax about this be-cause no children live in the home, but visiting children can be placed at risk. Additionally, analgesic agents must be kept away from other family members who may take them inadvertently. Further, analgesic medications should be stored safely and out of sight to prevent others from taking them for their own use or for diverting them to others.
If the patient is to receive parenteral or intraspinal analgesia at home, a referral to a home care nurse is indicated. The home care nurse makes a home visit to assess the patient and to determine if the pain management program is being implemented and if the technique for injecting or infusing the analgesic agent is being car-ried out safely and effectively. If the patient has an implanted in-fusion pump in place, the nurse examines the condition of the pump or injection site and may refill the reservoir with medica-tion as prescribed or may supervise family members in the proce-dure. Any change in the patientâ€™s need for analgesic medications is assessed. In collaboration with the physician, the nurse then as-sists the patient and family in modifying the medication dose. These efforts enable the patient to obtain adequate pain relief while remaining at home and with family.
As tolerance develops, ever-increasing amounts of opioids are needed. It is important to assure the patient and family that slowly increasing doses will not cause an increased risk of respi-ratory depression and central nervous system depression, be-cause the patient will become tolerant to these effects also. However, the patient will not become tolerant to the constipat-ing effects of opioids and will require increased efforts to prevent constipation.