Chapter 5 Flashcards
One of the greatest stressors and most
common symptoms in critically ill
patients.
Pain
Is a complex, subjective phenomenon
(can be directly known).
Pain
It is a protective mechanism, causing one
either to withdraw from or to avoid the
source
Pain
An unpleasant sensory and emotional
experience with actual or potential tissue
damage.
Pain
Types of Pain (2)
Based on duration
Based on source
Types of Pain
- Based on duration (2)
Acute pain
Chronic pain
Types of Pain
- Based on source (3)
Somatic
Visceral
Nerve
Factors Contributing to Pain (3)
PHYSICAL
PSYCHOSOCIAL
INTENSIVE CARE UNIT ENVIRONMENT OR
ROUTINE
Factors Contributing to Pain
- PHYSICAL (5)
• Symptoms of critical illness (eg, angina,
ischemia, dyspnea)
• Wounds: post-trauma, post-operative,
post-procedural or penetrating tubes and
catheters
• Sleep disturbance and deprivation
• Immobility; inability to move to a
comfortable position
• Temperature extremes
Factors Contributing to Pain
- PSYCHOSOCIAL (6)
• Anxiety and depression
• Impaired communication; inability to report
and describe pain
• Fear of pain, disability or death
• Separation from family and significant
others
• Boredom or lack of pleasant distractions
• Sleep deprivation, delirium or altered
sensorium
Factors Contributing to Pain
- INTENSIVE CARE UNIT ENVIRONMENT OR
ROUTINE (5)
• Noise from equipment and staff
• Unnatural patters of light
• Awakening and physical manipulation
every 1 – 2 hours for vital signs or
positioning.
• Frequent invasive or painful procedures
• Competing priorities in care
Procedural Pain in Intensive Care
- Based on research the following are common
source of procedural pain in the ICU: (5)
• Position changes
• Tracheal suctioning
• Deep breathing and coughing exercise
• Dressing changes
• Drain removal
Barriers to Effective Pain Control (3)
TOLERANCE
DEPENDENCE
ADDICTION
Barriers to Effective Pain Control
- a state of adaption in which
exposure to a drug induces changes that result in
a diminution of one or more drug’s effect over time.
TOLERANCE
Barriers to Effective Pain Control
- can be produced by abrupt
cessation, rapid dose reduction, decreasing blood
level of the drug or administration of antagonist.
DEPENDENCE
Barriers to Effective Pain Control
- characterized by behaviors that
include one or more of the following:
• impaired control over drug use
• compulsive use
• continued use despite harm
• craving
ADDICTION
Clinical Practice Guidelines
- These guidelines were intended to serve
_ of care for specific
clinical problems.
nationwide standards
Clinical Practice Guidelines
- _ was the topic of the first
guideline and now there are over 2,500
practice guidelines on the _.
Acute pain
National
Guideline Clearinghouse
Clinical Practice Guidelines
- These guidelines are also used as _ representing the national
standard of care for pain management in
medical liability.
legal
documents
CPGs for the management of pain (2)
PALLIATIVE CARE
PAIN ASSESSMENT (Self-Report and Observation)
CPGs for the management of pain
- multidisciplinary approach
to improving the quality of life in persons with
serious or life-limiting illness based on open
communication, patient and family centered goals
and multidimensional and symptom management.
PALLIATIVE CARE
CPGs for the management of pain
- should be done
systematically and at regular intervals using
multiple sources of data.
PAIN ASSESSMENT
PAIN ASSESSMENT
- is considered the gold standard in
pain assessment. For patients able to self-report,
a numeric rating scale, in which the patient rates the pain on a scale of 1 to 10, with 10 being
severe pain, is most used
Self-Report
Observation
- Nonverbal behaviors (4)
guarding,
withdrawal, and avoidance of movement, protect
the patient from painful stimuli
Observation
- Palliative behaviors; Attempts by the patient to seek relief (2)
touching or rubbing the affected area and changing
positions
Observation
- affective
behaviors (3)
Crying, moaning, or screaming
Observation
- Facial Expressions (5)
frowning,
grimacing, clenching of the teeth, tight closure of
the eyes, and tears
Critical care nurses are skilled in assessing the
patient’s physical status in terms of changes in
blood pressure, heart rate, or respirations.
Therefore, the observation of the physiologic
effects of pain will assist in pain assessment.
Physiologic Parameters
The nurse plays a key role in providing pain relief.
While pharmacologic intervention is the most used
strategy, nursing management of pain also
includes physical, cognitive, and behavioral
measures.
Pain Intervention
Pharmacologic Interventions (2)
Opioids
Sedatives and Anxiolytics
Pharmacologic Interventions
- administered by the IV route should be
the first-line drug class of choice for critically ill
patients.
Opioids
Opioids can be administered by the (9). However, the _ is most used
in the ICU setting.
oral,
sublingual, parenteral, rectal, buccal,
subcutaneous, transdermal, topical, or nebulized
routes
parenteral route
Pharmacologic Interventions
- Opioid Effects; Opioids cause undesirable
side effects, such as (5)
constipation, urinary
retention, sedation, respiratory depression, and
nausea.
Pharmacologic Interventions
- Management for Opioid Effects (4)
• Decreasing the opioid dose
• Rotating the opioid
• Avoid PRN Dosing
• Adding an NSAID (rescue dose)
Pharmacologic Interventions
- If serious respiratory
depression does occur, naloxone (Narcan), a
pure opioid antagonist that reverses the effects of
opioids, can be administered. The dose of
naloxone is titrated to effect—which means
reversing the oversedation and respiratory
depression, not reversing analgesia.
OPIOID ANTAGONISTS
Pharmacologic Interventions
- Nonsteroidal antiinflammatory drugs (NSAIDs), IV acetaminophen,
anticonvulsants, antidepressants, and local and
regional anesthesia can be used for selected
populations as adjunctive medications to optimize
the patient’s response and overall comfort.
NONOPIOID ANALGESICS
SEDATIVES AND ANXIOLYTICS (3)
BENZODIAZEPINES
PROPOFOL
DEXMEDETOMIDINE
SEDATIVES AND ANXIOLYTICS
- such as midazolam
(Versed), diazepam (Valium), and lorazepam
(Ativan), can control anxiety and muscle spasms,
and produce amnesia for uncomfortable
procedures.
BENZODIAZEPINES
SEDATIVES AND ANXIOLYTICS
- is a rapid-acting sedative/hypnotic
agent that has no analgesic properties and minimal
amnesic effects.
PROPOFOL
SEDATIVES AND ANXIOLYTICS
- is a selective alphareceptor agonist with sedative, sympatholytic, and
analgesic/opioid-sparing properties
DEXMEDETOMIDINE
Nonpharmacologic Comfort Measures (7)
• Environmental Modification
• Sleep Hygiene
• Early Mobility
• Complementary and Alternative Therapies
• Relaxation Techniques
• Touch
• Patient Education
Types of Pain
- generally time-limited and
responds well to therapies.
Acute pain
Types of Pain
- usually exceeding to 3 to 6
months and responds poorly to routine pain
management strategies and affects the
quality of life for the individual.
Chronic pain
Types of Pain
- skin, muscles, joints and bones
somatic
Types of Pain
- arises from deep organs
visceral
Types of Pain
- often feels like a shooting, stabbing
or burning sensation.
nerve
