Page 388 - WSAVA2018
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 25-28 September, 2018 | Singapore
WSV18-0179
NURSES (HILLS)
PAIN IDENTIFICATION AND MANAGEMENT
T. Mothershaw1, M. O’Leary1, S. Crampton1, C. Harvey-Stevenson1
1Provet, AIRC, Brisbane, Australia
PAIN IDENTIFICATION AND MANAGEMENT
Mik O’Leary BVSc, Carole Harvey-Stevenson
VN, VTS (ECC), DIP ECC, CERT IV WPA, TAYLOR MOTHERSHAW, CERTIFICATE IV IN VETERINARY NURSING
Brisbane, Australia, tmothershaw@provet.com.au
Pain types in dogs
Behavioural sings
Physiological
• Rapid breathing rate
• Rapid heart rate
• Elevated temperature
• Increased blood pressure
• Increased blood cortisol level
• Increased blood glucose levels
• Salivation
• Weight loss if pain has been chronic
Signs of pain in cats
Behavioural
Physiological
• Rapid breathing rate
• Rapid heart rate
• Elevated temperature
• Increased blood pressure
• Increased blood cortisol level
• Increased blood glucose levels
• Salivation
• Weight loss if pain has been chronic
Common techniques nurses may use to manage pain.
• Provide clean, dry and comfortable bedding at all times.
• Keep the patient clean and dry.
• Gentle handling when moving the patient.
• Patting and talking to the patient.
• Massage may be beneficial. Check this with the vet.
• Toys or bedding from home
• Cats may like a box to hide in or part of the cage door covered for privacy.
• Provide a quiet environment.
• Provide warmth, either localised (e.g. covered hot water bottle) or general (heated room).
• Keep out of draughts.
• Minimal disturbance (e.g. do TPR when medicating)
• Don’t wake sleeping patients.
• Regular toilet walks if the patient’s condition allows.
• Rotate the patient at least 4 times daily if they are unable to turn themselves.
• Assess wounds and bandages regularly.
• Assess pain levels regularly and discuss the patient’s condition with the vet.
Pain scoring
Simple unit-dimensional scale
     Posture
  Changes in behaviour
   Facial expressions
    Other
   Hunched posture Guarding painful area
 Withdrawn or uninterested
in surroundings Aggressive Clingy Reluctance to move Restlessness Unusual
licking or chewing at an area Reduced appetite Aversion to being touched Nausea
  May have a ‘worried’ look above the eyesMay look pinched around the mouth.May show whites of eyes
or make darting movements with eyes
   Lameness or abnormal gait Vocalisation Muscle atrophy may occur if pain has been chronic
  Type of uni- dimensional scale
  Description of scale
  Advantages
   Disadvantages
   Simple descriptive scale (SDS)
 3- or 5- point scale where scorer assigns a description based upon their own un-structured assess- ment of the animal. For example; no pain/mild pain/moderate pain/ severe pain.
   Very simple to use and understand
  No validated Non-linear Defini- tions of the descrip- tive words is open to interpretation (very subjective)
   Numerical rating scale (NRS)
A score from 0 to 10 is given based upon scorer’s own un-structured assessment of the animal, with 0 being no pain and 10 the maximum pain possible
  Simple to use More sensitive and reliable than SDS or VAS
 Not validated Non-linear (e.g. an- imal with a score of 8 is not necessarily four times as painful as one with a score of 2) Subjective
 Visual analogue scale (VAS)
  Based upon the scorer’s own un-structured assessment of the animal, a mark is made on a 100m line with the 0mm end representing no pain and 100mm end represent- ing the worst possible pain.
  Simple to use
   Significant inter- individual variability Subjective
    Posture
  Changes in behaviour
    Facial expressions
   Hunched posture. Tense muscles.
 Very quiet. May stop grooming or start over-groom. Unwillingness to move. Lameness or abnormal gait. Muscle atrophy if pain has been chronic. Appetite loss. Hiding.
   Half closed or squinting eyes
 Pain relief medication
Analgesia is a state of reduced sensibility to pain. Analgesics interrupt the ascending pain pathway at various points and therefore suppress the sensation of pain.
Types of analgesics
Various types of analgesics are commonly used in veterinary medicine. They include:
• NSAIDS: Non-steroidal anti-inflammatory drugs
• Local: Local anaesthetic preparations
• Opioids: Narcotic analgesics
• Glucocorticoids: Steroidal anti-inflammatory drugs
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43RD WORLD SMALL ANIMAL VETERINARY ASSOCIATION CONGRESS AND 9TH FASAVA CONGRESS





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