Class 8-Comfort Flashcards
pain is…
-an unpleasant sensory and emotional experience associated with actual or potential tissue damage
-pain is what the person says it is, existing whenever they say it does
-pain is accompanied by suffering
scope of the problem
-75 million americans suffer chronic pain annually
-25 million suffer acute pain
-pain costs more than $100 billion each year in medical expenses, lost wages and lost productivity
-inadequate pain relief hastens death (by psychological stress)
barriers preventing effective pain relief by health care providers
-poor assessment of pain (under assessed)
-inadequate knowledge of pain management
-biases and judgements regarding pain
barriers preventing effective pain relief by patients in pain:
-“I might get addicted”
-opioids should be saved for when it is really needed
-unpleasant side effects
-“I want a shot”
treat pain as soon as pt feels pain
look at slide 6
the pain process
-transduction: activation of pain receptors (touch something hot)
-transmission: pain sensations sent to higher
-perception: awareness of the characteristics of pain
-pain threshold: lowest intensity of a stimulus that causes you to recognize pain
-modulation: inhibition or modification of pain (pain electrical stimuli comes back down spinal cord; natural response for body to help pain)
gate control theory of pain
-describes the transmission of painful stimuli and recognizes a relationship between pain and emotions
-small and large diameter nerve fibers conduct and inhibit pain stimuli toward the brain
-gating mechanism determines the impulses (signals) that reach the brain
categories of pain
-duration
-acute (sudden cause; usually has a distinct cause_
-chronic (lasts longer/beyond normal healing period (can be difficult for pts to describe))
responses to pain
-physiologic
-behavioral
-affective (psychological; my pain has caused fear, anger, etc)
factors affecting pain experience
-family, gender, and age variables (boys don’t cry)
-environment and support people (noise; lack of sleep)
-anxiety and other stressors
-past pain experience
people in and out of room; sense of powerlessness
pain assessment is…
asking and believing the patient! (the right questions!)
nonverbal pain indicators
-moaning
-crying
-grimacing
-guarded position
-increased VS but not always especially with chronic pain
-reduced social interactions (withdrawal)
-irritability
-difficulty concentrating
-changes in eating and sleeping
when should pain be assessed
-at regular intervals (at every shift)
-with each new report of pain
-after each pharmacological and non-pharmacological intervention (every 4 hours to see if intervention worked)
-assess pain and sedation! (how awake are they?)
intensity
-FLACC in epic
-1-10 in epic
-baker Wong faces (usually for kids)
-checklist of nonverbal indicators
-PAINAD in epic
-payen behavior pain scale
location(s)
-indicate area(s) of pain
-different areas may have different types of pain
-referred pain (move some place?)
quality of pain based on source
-somatic
-visceral
-neuropathic
-cutaneous
somatic
descriptors: aching, deep, dull, gnawing, throbbing, sharp, stabbing
ex: muscle, tendon, bone injuries
visceral
descriptors: cramping, squeezing, pressure (referred to different sites)
ex: gallstones, kidney stones, pancreatitis
neuropathic
descriptors: burning, numbness, radiating, shooting, tingling, touch sensitive
ex: herpes zoster, peripheral neuropathy
cutaneous
descriptors: superficial, skin or subcutaneous tissue. short with a burning sensation
phantom limb pain
painful or non painful usually sensations
intractable pain
severe; relentless; no cure; can result in early death
what are the patient goals?
-objective measure on a scale
-in terms of function
-ability to perform ADL’S
-ambulate
-to be able to deep breath after surgery
ask about goals
1-3=mild
4-6=moderate
7-10=severe
pain assessment is NOT
-relying on changes in vital signs
-deciding a patient does not “look like he is in pain”
-assuming a sleeping patient does not have pain
-knowing how much a procedure or disease should hurt
-assuming a pt will tell you when they are in pain
non pharmacologic pain relief measures
-distraction (tv)
-humor
-music
-imagery (guided; meditation)
-relaxation
-cutaneous stimulation (“close gate” to prohibit painful stimuli from reaching brain)
-acupuncture
-hypnosis
-biofeedback
-therapeutic touch
-animal-facilitated therapy
don’t need orders to do
look at slide 22
terms
-opioids controlled substances
-morphine-considered the gold standard COMMON SIDE EFFECT NAUSEA/VOMITTING; itch
-codeine
-hydromorphone
-methadone
-fentanyl transdermal patches take up to 12 hours to reach effectiveness. is 8-10 time more powerful than morphine
-adjuvant drugs
-anticonvulsants, tricyclic-antidepressants, steroids, anti-anxiety
PCA patient controlled anesthesia
-must be alert and able to work the pump
-patient is in charge of the pain control
-morphine, fentanyl, hydromorphone
-iv administration
-maximum dose and lock out settings
-can be used for continuous infusion
look at slide 26
break through pain
flare up of moderate to severe pain that occurs even when the patient is taking around the clock (etc) mediation (in-between doses of pain meds)
physical dependence
the body physiologically adapts to the presence of an opioid and suffers withdrawal symptoms if the opioid is suddenly withdrawn
psychological dependence (addiction)
a pattern of compulsive drug use characterized by continued craving for an opioid and the need to use the opioid for effects other than pain relief
tolerance
a common physiological result of chronic opioid use, a larger dose of opioid is required to maintain the same level of analgesia (don’t have biases chronic pain is real)
placebo
-a harmless pill, medicine, or procedure prescribed more for the psychological benefit to the patient than for any physiological effect
-a person unaware of the placebo’s properties may find it to be effective for the relief of pain because of the perception that it will provide comfort and because of belief in the person administering it
-considered to be unethical
pain experience in the elderly
-myth: pain is a natural component of the aging process
-fact: pain is often unreported leads to a higher risk for patient experiencing pain
-fact: adverse effects of pain medications are more dramatic in the elderly due to decreased liver and renal function (drugs metabolized and excreted slower)
