ATI FUNDAMENTALS PAIN Flashcards
REASONS CLIENTS EXPERIENCE PAIN
injury, surgery, acute or chronic diseases, and even as a response to emotional distress.
WHAT DOES PAIN LIMIT
clients’ abilities to complete activities of daily living, participate in meaningful activities, work, and sleep. In fact, pain is often the reason clients seek care from their health care providers in the outpatient setting or report to an emergency care facility
WHAT SYSTEMS PROCESS PAIN STIMULI
Both the central nervous system (CNS) and the peripheral nervous system (PNS)
WHEN THE CNS AND PNS PROCESS PAIN STIMULI, WHAT HAPPENS
This processing mobilizes the nociceptors (the sensory receptors for noxious stimuli) and activates their pathways. Once the pathways are activated, the subjective response that a client experiences is described as pain.
WHAT PART OF THE BRAIN CAN PAIN ARISE FROM
ain can also arise from the somatosensory cortex—the sensory system within the brain that receives impulses from areas throughout body.
pain
Subjective and can be caused by stimuli that are actual or anticipated; official IASP definition: “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”
pain threshold
SUBJECTIVE
The point at which a stimulus causes the client perceive pain.
PAIN TOLERANCE
SUBJECTIVE
How much of a stimulus the client is willing to accept.
The biopsychosocial model of pain suggests that three categories of factors form the experience of pain:
BIOLOGICAL
PSYCHOLOGICAL
SOCIAL
PSYCHOLOGICAL FACTORS
MOOD/AFFECT
CATASTROPHIZING
STRESS
COPING
BIOLOGICAL FACTORS
DISEASE SEVERITY
NOCICEPTION
INFLAMMATION
BRAIN FUNCTION
SOCIAL FACTORS
CULTURAL FACTORS
SOCIAL ENVIRONMENT
ECONOMIC FACTORS
SOCIAL SUPPORT
A nurse is caring for a postoperative client who states that he is worried about being discharged after surgery because he has no place to live. Describe how the biophysical model of pain, particularly the social factors, contributes to this client’s experience of pain.
The client is expressing concern that he has nowhere to live upon discharge. According to the biophysical model of pain, the client likely does not have anyone to care for him after discharge and may lack a social support system, which can lead to increased anxiety and perception of pain. Economic factors that may affect the client include that, if the client has no home, the client may not be employed, have insurance, or be able to pay for follow-up care, prescriptions, supplies, or therapies. These concerns can contribute to an increase in the client’s pain level and response to stimuli.
WHAT IS PAIN
WHATEVER THE CLIENT SAYS THAT IT IS
Nurses should not impose their own opinions or perceptions of a client’s pain, but recognize that the client is the only person who can truly rate and describe their own pain.
Descriptive Characteristics of Pain
ACHING, THROBBING, STABBING, POUNDING, SHARP, GRIPPING, DULL, TEARING, RADIATING, CUTTING, BURNING, SCALDING
ACUTE PAIN
has a sudden or slow onset of any intensity and an anticipated or predictable end. By definition, acute pain is pain that lasts less than six months
ACUTE PAIN CAN RESULT FROM
tissue damage caused by trauma or injury, incisional pain from surgery, and pain from environmental factors such as heat or cold
CHRONIC PAIN
has a sudden or slow onset of any intensity and is constant or recurring without an anticipated or predictable end. By definition, chronic pain usually has a duration of lasting longer than six months.
EXAMPLES OF CHRONIC PAIN
arthritis, back pain, and headaches. Chronic pain can be both physically and emotionally debilitating. If acute pain is not addressed, it can become chronic.
NOCICEPTORS
Found in multiple parts of the body (skin, joints, muscles, viscera) and activated by many different chemical substances, extreme temperature and pressure changes, and tissue damage
NOCICEPTIVE PAIN
Pain that is felt in the tissue, an organ, a damaged part of the body, or a referred pain.
SOMATIC PAIN
pain occurring in the skin, bones, joints, muscles, or connective tissues
VISCERAL PAIN
with pain occurring in the internal organs and referring to other locations of the body
CUTANEOUS PAIN
pain occurring in the skin or subcutaneous tissue
NOCICEPTIVE PAIN IS USUALLY
LOCALIZED
DESCRIBED AS THROBBING OR ACHING
NEUROPATHIC PAIN
Nerve pain that arises from the somatosensory system, described as intense, burning, and shooting.
EXAMPLE OF NEUROPATHIC PAIN
diabetic neuropathy, phantom limb pain, and pain associated with a spinal cord injury.
NEUROPATHIC PAIN IS DESCRIBED AS
INTENSE, SHOOTING, BURNING, INTENSE ITCHING, PINS AND NEEDLES
Match the client condition with the type of pain
1. NEUROPATHIC
2. NOCICEPTIVE
A. BACK PAIN
B. TRIGEMINAL NEURALGIA
C. BROKEN RIB
D. SCIATIC PAIN
E. BELOW THE KNEE AMPUTATION
1: B, D, E
2. A, C
CANCER PAIN
A newly recognized category of pain that can involve tumor pain, bone pain, and treatment-associated pains such as chronic post-surgical pain.
CHILDREN
Age-Related Considerations
- HIGH RISK OF UNDERTx
- DISPLAY PAIN DIFFERENTLY
- behaviors, physiological measurements such as blood pressure and pulse, physical assessment, and parental or guardian reports must be considered when assessing pain in the child.
PAIN SCALE FOR CHILDREN
WONG-BAKER FACES SCALE
FLACC SCALE
CRIES SCALE
Clients in their 30s, 40s, and 50s have more complaints of
headaches, abdominal and back pain, and temporomandibular problems
As age increases, pain seems to
increase in conjunction with neuropathic conditions, as well as for joint and lower extremity conditions.
DOES PAIN TOLERANCE CHANGE AS A PERSON AGES
NOT SIGNIFICANTLY
List facts you have learned about age-related considerations and pain management.
As age increases, pain seems to increase for neuropathic conditions, as well as for joint pain and pain in the lower extremities. Many clients live with more than one chronic condition and experience pain on a daily basis. Pain tolerance does not change significantly as a person ages. Older adult clients who have cognitive impairment and/or communication challenges (e.g., expressive aphasia) require careful nursing assessment. These clients may not report pain effectively, so the nurse should look for behaviors that suggest pain is present.
MALPRACTICE
A negligent act that has been performed by a professional or trained person.
CAN BE CHARGED WITH MALPRACTICE IF WE ARE NOT ADHERING TO STANDARDS OF CARE FOR PAIN MANAGEMENT
negligence
Failing to perform in a manner that a reasonable and prudent person should perform.
ETHICS
The application of principles that guide moral behavior of an individual or group.
WHEN CAN ETHICAL DILEMMAS OCCUR
when there are no clear right and wrong solutions for a problem.
WHAT DOES THE ANA OFFER IN REGARDS TO ETHICS
guidance to nurses in the form of a position statement on nurses’ ethical responsibility to alleviate the pain and suffering that clients may experience.
WHAT ETHICAL CONCEPTS GUIDE PAIN MANAGEMENT
beneficence, nonmaleficence, autonomy, and justice
beneficence
acts of doing good and acting in the best interest of clients by providing care that benefits them
nonmaleficense
working to do no harm
Failing to manage a client’s pain can indeed cause harm, and it is each nurse’s ethical responsibility to avoid this outcome.
to do good, requires that nurses decrease the suffering of their clients. how does this relate to pain
Controlling and alleviating pain is one way in which nurses can minimize suffering
autonomy
granting client the right to self determination
allows them freedom of choice, but that choice must be based on informed decisions
what is the nurse’s responsibility in autonomy
provide clients with the education they need to make such informed decisions.
justice
requires that all clients be treated equally. The relief of pain should be available to all, regardless of age, race, background, or history.
nightingale pledge
in relation to ethics and pain management
“I will abstain from whatever is deleterious and mischievous and will not take or knowingly administer any harmful drug.”
morality
an individual’s sense of right and wrong or their personal values. Every client has the right to pain management as a basic human right.
provider assisted suicide and ethics
illegal in most of us.
if you feel it is immoral, you have the right to refuse to provide care that violates the nurse’s own moral or ethical beliefs, and can ask that someone else provide this care.
barriers to end of life Tx
can be from client, family, providers or health care system itself.
fear of addiction, intellectual abilities, belief that pain is part of the process, inadequate pain assessment, uninformed individuals, lack of education
how can the health care system be a barrier to end of life pain management
- cost of meds
- lack of insurance coverage
- shortage of palliative care providers
- shortage of education resources
American Society for Pain Management Nursing (ASPMN) and the Hospice and Palliative Nurses Association (HPNA) created a joint position statement that identifies effective pain management as a basic human right. This statement also calls for
education on pain management for providers and the public, and greater accessibility of treatments, both pharmacological and nonpharmacological. Such treatments include palliative care as well as hospice care for clients who are experiencing pain as they near the end of life.
subjective descirptors
pain scale, location, length of time, what precipitated, what relieves, radiation of pain, how pt characterizes
objective indicators
manifestations that we can observe and measure by sight, hearing, smell, and touch
crying, sweating, restlessness, grimacing, guarding, vs, physical assessment, lab tests, imaging reports, diagnostic info