Pain Assessments for Certified Perioperative Nurse (CNOR)
Included In This Lesson
Outline
Pain Assessments
Guidelines:
- Narcotics to be minimized wherever possible
- Increase use of blocks where appropriate
- Consider alternative treatment options where appropriate
- Longer acting pain control
- Avoid peaks and valleys
- Ongoing participation in continuing education and pain control development
Considerations:
- Patient fear of pain
- Opioids increase post op nausea
- Blocks can be performed intra-op
- TAP blocks
- Needs consent!
Nurse’s role:
- Advocate for reduction in opioid use
- Patient education on pain control and alternative techniques
- Preop and PACU
- Be expert in block care and spinal assisting
- Cat back
- Reassurance
- Blocks take time, anticipate and reduce delays for more adoption
- OR interview before block!
- Typically given versed if needed during block
- Can no longer consent
Pitfalls:
- Blocks cause delays, incentivizing avoidance
- Opioids are easy for PACU discharge
- Typically 20 min stay after dosing
- Conversion to open procedure without tap block consent
- Anticipate!
- Unaccounted for narcotics
- Anesthesia carts
- Block before interview
Examples:
- Patient with extreme pain in PACU despite narcotic dosing (consider admission, consult surgeon, anticipate return to OR if warranted)
- OR has 2 blocked cases and one traditional case (traditional case first, to give time for block to be placed before surgery time)
Linchpins (Key Points):
- Opioids to be avoided wherever possible, with new techniques finding adaptation into existing OR practice
Transcript
References
- Association of periOperative Registered Nurses. (2022). Guidelines for Perioperative Practice (2022 ed.).
NCLEX
Concepts Covered:
- Circulatory System
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- Cardiac Disorders
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