International journal of palliative nursing
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Dion Smyth's review of the internet for palliative nursing.
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Pain is prevalent among older people, yet is often under-recognised and undertreated in people with dementia. The nurse has a central role in identifying and appropriately assessing pain in order to provide effective treatment. Research however suggests there are significant deficits in this area. ⋯ Nurses play a key role in the effective management of pain through the use of pain assessment tools, behavioural observation, and analgesic choice. Pain assessment in dementia remains challenging for nurses due to the complexity and individualisation of pain behaviours. The accessibility of appropriate training, workforce stability and a standardised approach to pain assessment are key to the successful management of pain in older people with dementia.
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Constipation is common in the palliative population. Opioid medications, which are frequently prescribed to this cohort, represent a significant risk factor for this condition. Opioid-induced constipation may be of such severity that opioid doses are reduced or missed, and analgesia and quality of life are therefore reduced. ⋯ For patients not responding to laxatives, opioid antagonists (non-specific or peripherally acting μ-opioid receptor antagonists) can be co-prescribed with laxatives. These agents have also proven efficacy in treating opioid-induced constipation. This review discusses the recent literature regarding the management of opioid-induced constipation and provides a rational approach to assessing and managing constipation in the palliative population.