Herbal Alert Passion Flower

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The term "passion flower" is used to denote many of the approximately 400 species of the herb. Passion flower has been used in medicine to treat pain, anxiety, and insomnia. Some herbalists use the herb to treat symptoms of parkinson-ism. Passion flower is often used in combination with other herbs, such a valerian, chamomile, and hops, for promoting relaxation, rest, and sleep. Although no adverse reactions have been reported, large doses may cause CNS depression. The use of passion flower is contraindicated in pregnancy and in patients taking the monoamine oxidase inhibitors (MAOIs). Passion flower contains coumarin, and the risk of bleeding may be increased when used in patients taking warfarin and passion flower.

The following are recommended dosages for passion flower:

• Tea: 1-4 cups per day (made with 1 tablespoon of the crude herb per cup)

• Tincture (2 g/5 mL): 2 teaspoons (10 mL) 3-4 times daily

NURSING PROCESS

• The Patient Receiving a Narcotic Analgesic for Pain

In addition, the nurse determines if any controllable factors (eg, uncomfortable position, cold room, drafts, bright lights, noise, thirst) may be decreasing the patient's tolerance to pain. If these factors are present, the nurse corrects them as soon as possible. However, the nurse should not deny pain drugs or make the patient wait for the drug. Pain medication is delivered in a timely manner.

Narcotic analgesics can produce serious or potentially fatal respiratory depression if given too frequently or in an excessive dose. Respiratory depression may occur in patients receiving a normal dose if the patient is vulnerable (ie, in weakened state or debilitated state). Elderly, cachectic, or debilitated patients may have a reduced initial dose until the response of the drug is known. If the respiratory rate is 10/min or below, the nurse must monitor the patient at frequent intervals and notify the primary health care provider immediately.

When an opiate is used as an antidiarrheal drug, the nurse records each bowel movement, as well as its appearance, color, and consistency. The nurse should notify the primary health care provider immediately if diarrhea is not relieved or becomes worse; if the patient has severe abdominal pain; or if blood in the stool is noted.

NURSING DIAGNOSES

Drug-specific nursing diagnoses are highlighted in the Nursing Diagnoses Checklist. Other nursing diagnoses applicable to these drugs are discussed in depth in Chapter 4.

PLANNING

The expected outcomes of the patient may include a relief of pain, an understanding of the use of the patient-controlled analgesia device (when applicable), an absence of injury, an adequate nutrition intake, an absence of drug dependence, and an understanding of and compliance with the prescribed treatment regimen.

Relieving Acute Pain

The nurse assesses the patient for relief of pain about 30 minutes after a narcotic analgesic is given. It is important to notify the primary health care provider if the analgesic is ineffective because a higher dose or a different narcotic analgesic may be required.

The nurse should perform tasks, such as getting the patient out of bed, and encouraging therapeutic activities, such as deep breathing, coughing, and leg exercises (when ordered), when the drug is producing its greatest analgesic effect, usually 1 to 2 hours after the nurse administers the narcotic.

Using Patient-Controlled Analgesia. Patient-controlled analgesia (PCA) allows patients to administer their own analgesic by means of an IV pump system (Fig. 19-1). The dose and the time interval permitted between doses is programmed into the device to prevent accidental overdosage.

Many postoperative patients require less narcotics when they are able to self-administer a narcotic for pain. Because the self-administration system is under the control of the nurse, who adds the drug to the infusion pump and sets the time interval (or lockout interval) between doses, the patient cannot receive an overdose of the drug.

Relieving Chronic Severe Pain

Morphine is the most widely used drug in the management of chronic severe pain, such as pain associated with cancer. The fact that this drug can be given orally,

Figure 19-1. Patient-controlled analgesia allows the client to self-administer medication, as necessary, to control pain.

Nursing Diagnoses Checklist

✓ Acute Pain related to medical or surgical disorder (specify)

Chronic Pain related to medical disorder (specify)

✓ Risk for Injury related to effect of narcotic on the CNS

Constipation related to the effects of the narcotics on the gastrointestinal system

✓ Imbalanced Nutrition: Less Than Body Requirements related to anorexia secondary to effects of the narcotic subcutaneously, intramuscularly, IV, and rectally in the form of a suppository allows tremendous versatility. Medication for chronic pain should be scheduled around the clock and not given on a PRN (as needed) basis. Most patients with cancer can be treated with 30 to 60 mg morphine orally every 4 hours. The oral route is preferred as long as the patient is able to swallow or can tolerate sublingual administration. Respiratory depression is less likely to occur when the drug is given orally.

OxyContin is a controlled-released form of oxycodone and indicated for the management of moderate to severe pain when a continuous, around-the-clock analgesic is needed for an extended period of time. OxyContin is not intended for use as a PRN analgesic. The patient may experience fewer adverse reactions with oxycodone than morphine, and the drug is effective and safe for the elderly. The tablets are to be swallowed whole and are not to be broken, chewed, or crushed.

Fentanyl transdermal is a transdermal system that is effective in the management of the severe pain associated with cancer. The transdermal system allows for a timed-release patch containing the drug fentanyl to be activated over a 72-hour period. A small number of patients may require systems applied every 48 hours. The nurse monitors for adverse effects in the same manner as for other narcotic analgesics (eg, the nurse notifies the primary health care provider if the respiratory rate is 10/min or less).

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Natural Pain Management

Natural Pain Management

Do You Suffer From Chronic Pain? Do You Feel Like You Might Be Addicted to Pain Killers For Life? Are You Trapped on a Merry-Go-Round of Escalating Pain Tolerance That Might Eventually Mean That No Pain Killer Treats Your Condition Anymore? Have you been prescribed pain killers with dangerous side effects?

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