Today we
had the opportunity to attend the Maryland's Dietetics in Health Care
Communities annual spring workshop.
Presentation topics included how to better manage glucose levels in sub-acute
facilities, the basics of parentral nutrition, electronic medical/health records, renal failure
nutrition therapy and practical pain management for dietitians. While all the presentations were
informative, I found the pain management discussion especially thought-provoking
and interesting. How many times have we
as dietitians heard patients complain that their low po intake was directly related
to their high pain level? It had never occured to me that dietitians could help improve both appetite and intake through better pain management. During the talk, I learned that with the right
tools, dietitians can play an active role in a patient's pain management
regimen to improve mealtime outcomes.
Below are a few tips on how to assess a patient's pain level and the basic information needed to initiate a conversation within the health care
team regarding pain management.
1) Have
a dialogue with your patient if pain is impacting their intake
- Use the universal pain scale (seen below), but
ask follow up questions. For example, if a
patient gives you a 10/10 for pain, follow up by asking, is this the worst pain
imaginable, could you imagine the pain getting worse?
2) Know
the basics
- All opioids are created equal at
equal doses i.e. no medication is stronger than another
- All opioids are metabolized in the liver and cleared in the kidneys
- Short acting oral opioids and IV
opioids have different onset times but around the same average duration (3-4
hours)
3) Work
with the inter-disciplinary team to modify pain dosage or timing to improve
patients mealtime intake.
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