C7- Alterations In Comfort: Flashcards
What is pain?
Pain is whatever the patient says it is and occurs whenever they say it does.
Essential nursing behavior regarding a patients pain? (Do you believe someone is in pain?)
Essential for the nursing to believe that the patient’s pain is real. Nurse needs to be willing o become involved in the patient pain experience and develop effective pain management regimens.
What are 4 specific physiologic processes involved in the ability to feel painful stimuli (nociception)?
Transduction
Transmission of pain stimuli
Perception of pain
Modulation of pain
Transduction
Activation of pain receptors
When the threshold of perception of pain has been reached and when there is injured tissue, the injured tissue releases chemicals that excite/activate the nerve endings
Transmission of pain
When pain sensations from the site of an injury or inflammation are conducted along pathways to the spinal cord and then on to higher centers
(No specific pain organs or cells exist in the body)
Perception of pain
The sensory recess that occurs when a stimulus for pain is present, it includes the person’s perception of pain
Modulation of pain
The sensation of pain is inhibited or modified. Neuronmodulators= opioid compounds that occur naturally in the body, morphine-like chemical regulators in spinal cord and brain
Specific theory for pain
- does not explain pain tolerance or allow for social, cultural factors that influence pain*
Specialized nerve fibers are responsible for transmission
Pain pattern theory
doe address the brain’s ability to determine the amount, intensity, and type. DOES NOT address neurological influences or pain perceptions
Excessive stimulation of all nerve endings reduces a unique pattern interpreted by the cerebral cortex as pain
Gate control theory for pain
More of a Hollistic approach
Some sort of gate mechanism in the spinal cord that allows nerve fibers to receive pain sensations
Common misconceptions of pain/ pain management
-The doctor has prescribed pain relieving medication for me, which I will be given routinely
-If I ask for something for my pain, I will immediately become addicted to the medication
-Sometimes it is better to put up with the pain than to deal with the side effects of the pain medication
-It is better to wait until the pain gets really bad before asking for help. If I take the medication now for moderate pain, it won’t relieve severe pain later on
-I don’t want to bother anyone-I know how buy everyone is
-It’s natural for me to have excruciating pain after surgery. After a few days I should notice it lessening
Acute pain is
Rapid in onset
Varies in intensity and duration
In response to specific injury
Protective in nature
Treatable
Chronic pain is
Persists or progresses over a long period of time
Limited, intermittent, or persistent
Periods of remission or exacerbation are common
May worsen in response to environmental-psychological factors
May be resistant to medical treatment
Best managed with around-the-clock pain intervention opposed to as needed
Intractable pain
Resistant to therapy
Persistent despite various interventions
Cutaneous pain
Superficial (usually involves the skin)
Somatic pain
Deep pain
Originates in tendons ligaments bones blood vessels and nerves
(Sprains)
Visceral pain
Poorly localized and originates in the body organs
Potentially produced by disease
(Ileus/abdominal pain)
Referred pain
Pain originates in one part of the bod it perceived in an area distant from point of origin
( MI (Heart attack)- neck, chest, shoulder, jaw, arm pain)
Neuropathic pain
Pain caused by a lesion or disease of the peripheral or central nerves
(Phantom leg pain)
Peresthesia
Pins and needles
Numbness and tingling
Allodynia
Painful response to a normally not painful stimuli (cold beverage or light touch)
Hypoalgesia
Diminished sense of pain from raised pain threshold
Hyperalgesia
Increase response to a painful stimulus
Physical pain
Comes from a physical cause
Psychogenic pain cause
Physical cause for pain cannot be ID
Mental events can cause just as intense pain that results from physical event
new standards were released from the Joint Commission requiring hospitals to:
-Identify pain assessment and pain management, including safe opioid prescribing, as an organizational priority.
-Actively involve the organized medical staff in leadership roles in organization performance improvement activities to improve quality of care, treatment, and services and patient safety.
-Assess and manage the patient’s pain and minimize the risks associated with treatment.
-Collect data to monitor its performance.
-Compile and analyze data.
Pain is often viewed as (VS)?
Fifth vital sign
Accept patient’s complaint of pain
Use their own description of the pain
Pain assessment principles
History of pain
Assess patients own goal of pain relief
Nonverbal signs of pain
Psychological impact of pain
Diagnostic work up
PAINAD scale (pain assessment in advanced dementia 5 items
Breathing
Vocalization
Facial expression
Body language
Consolable
Wong-Baker comfort scale (faces) effective with
Children to compare their pain to a series of faces
Age can affect pain in two different age groups, what happens with these age groups?
Infants
-cannot verbalize pain
Older adults
-can have multiple pathologies that cause pain and limit function
-polypharmacy
-may associate pain with serious illness or death which results in reluctance to admit pain
Fatigue
Increase sensitivity to pain
Genetic sensitivity
Can increase or decrease pain tolerance
Cognitive function
Cognitive impairment= might not be able to report pain accurately if at all
Prior experiences of pain
Can increase or decrease sensitivity
Anxiety/fear
Increase sensitivity to pain
Culture
Can influence how clients express or report pain
Subjective assessment of pain: characteristics of the pain
Description of pain
Onset/duration
Location/site
Severity/intensity
Patterns
Associated/relieving factors
Subjective assessment of pain: we want to assess
Characteristics of the pain
Medication hx
Effects of pain on quality of life
Cultural implications (perception of pin and adaptive coping mechanisms)
Affective responses (anxiety/depression)
Objective pain assessment: what does the nurse assess?
Physiologic responses (VS, nausea, muscle tension, anxiety)
Behavioral responses (posture, gross motor function, facial features, verbal expression)
Affective responses Subjective/objective (anxiety/depression, interactions with others)
There will be ongoing reassessment and follow up
Typical sympathetic response to pain
Increase BP
Increase pulse and respiration
Pupil dilation
Muscle Tension
Pallor
Increase adrenaline output
Increase Blood Glucose
Typical Parasympathetic Response to pain
Nausea and Vomiting
Fainting or unconsciousness
Decreased bp
Decreased pulse rate
Prostration
Rapid and Irregular Breathing
Behavioral (Voluntary) Response to pain
Moving away from painful stimuli
Grimacing, Moaning, Crying
Restlessness
Protecting the painful area and refusing to move
Affective (Psychological) Responses
Exaggerated weeping and restlessness
Withdrawal
Stoicism
Anxiety, Depression, Fear
Anger, Anorexia, Fatigue, Hopelessness, Powerlessness
Pain threshold
Physiologic attribute that denotes the intensity of the stimulus needed to feel pain
Tolerance
The maximum intensity of a stimulus that produces pain person is willing to accept in a given situation
When a nursing diagnosis of acute or chronic pain is developed, the diagnostic statement and care plan should identify
-type of pain
-etiologic factors, to the extent that they are known and understood
-patient’s behavioral, physiologic, and affective responses
-other factors affecting pain stimulus, transmission, perception and response
Nursing Interventions for Pain
Establishing trusting nurse-patient relationship
Initiating non-pharmacologic pain relief measures
Considering ethical and legal responsibility to relieve pain
Teaching patient about pain
Select analgesic that is effective for the type & level of pain
Choose an administration schedule on the basis of the drug’s half-life
Plan care activities at times of peak medication effect
Treat procedural pain appropriately
Plan for pain management across the continuum of care
What type of nursing intervention for pain should ALWAYS be used first?
Non-pharmacologic pain relief measures
3 Classes of Analgesics
Non-opioid analgesics
Opioids or Narcotic Analgesics
Adjuvant medications (used to enhance pain relief provided by commonly used pain medicines)
Non-pharmacologic Pain Relief Measures
Distraction
Music
Relaxation, breathing
Humor
Imagery
Cutaneous stimulation
-Touch, massage
-Heat or Cold application
-TENS
-Acupressure
