1: Pain assessment and management Flashcards
is pain subjective or objective?
Pain is subjective and individualized
How can pain be objective
it is not measurably objective, although we can report objective evidence
Transduction
stimulus converted into energy
Transmission
electrical impulses communicated
perception
recognition in the brain
modulation
release of inhibitors
Gate control theory
- First theory propose emotional and cognitive components of pain
- Gates along the nervous system open/close to allow or block pain impulses
- Explains pain threshold and why sometimes vital signs do not change
Noniceptive
Normal stimulation of peripheral nerve endings
What does nociceptive stimulation respond to
Non opioids and/or opioids
Classification of pain
- Nociceptive
- Neuropathic
Neuropathic
Abnormal processing of sensory input by peripheral OR central nervous system
Example of neuropathic pain
Phantom limb pain
Diabetic neuropathy
Tingling, burning, etc.
Types of pain
- Acute (Transient pain)
- Chronic episodic
- Chronic persistent
- Idiopathic
Chronic episodic
Sporadically over an extended duration (migraines)
Chronic persistent
Not protective, has no purpose, may or may not have an identifiable cause
Idiopathic
Chronic pain without identifiable cause
Factors that influence pain experience
- Physiological
- Social
- Psychological
- Pain tolerance
- Cultural
Sympathetic reaction to pain
Increase.. Cortisol level RR, HR,BP Blood glucose -Sweating (Diaphoresis) -Muscle Tension -Dilation of pupils and bronchial tubes Decreased gastrointestinal motility
Parasympathetic responses to pain
Pallor
decreased HR/BP
Rapid irregular breathing
Nausea and vomiting
Is sleep an indication of pain?
NO!
Intractable pain
Severe, constant, not curable, bed bound/house bound
Phantom pain
Pain in a body part that is no longer there
Referred pain
Pain perceived at a location other than the site of the painful stimulus
Pain threshold
The paint at which a person feels pain
Pain tolerance
level of pain you are willing to accept
Radiating
Pain extends from initial site to other part
Negative outcomes of pain
Decreased socialization/withdrawal Decreased ability to do ADLs Fatigue sleep disturbance irritability Malnutrition stress depression
OLD CART
Onset Location Duration Characteristics Aggravating factors Relieving factores Treatment
NANDA pain
Activity intolerance Anxiety Fatigue Insomnia Impaired social interaction ineffective coping Impaired physical mobility Impaired mood regulation
Non pharmacological pain relief
Cognition and behavioral approach
Relaxation and guided imagery
Music
Cutaneous stimulation
Pharmacological pain relief intervention
Topicals: ointments, creams, patches
Analgesia
Bolos/loading dose of analgesia
to get on top of the pain
Basal dose of analgesia
Consistent to maintain plasma level
PCA dose of analgesia
On demand
Acute care pain therapies
Epidural
Local anesthesia
Perineural local anesthetic infusion
Goal of palliative care
Learn how to live life fully with an incurable condition
