E3 Pain & comfort Flashcards
The nurse is assessing new-onset pain in a patient that just came to ED. The pt describes the pain throughout his abdomen, but cannot point to exact place the pain is. What term best describes this type of pain?
Visceral Pain
What is pain?
-Universal, but individual experience
-Under-recognized, misunderstood, inadequately treated
-Purely Subjective
-Its whatever the experiencing person says it is
-The most common reason people seek care
Nociception
Observable activity in the nervous system in response to an adequate stimulus
-Protective Mechanism
4 steps of the Pathophysiology of pain
- Transduction: convert stimuli to action potention
- Transmission: action potential travels from PNS to CNS
- Perception: Interpretation of stimuli as painful or not
- Modulation: Response to pain
Acute pain
-Usually Protective
-Short duration & limited tissue damage
-If not treated can threaten pts recovery
-May progress to chronic
-Observable signs of discomfort (physiological responses)
Ex. Appendicitus
Chronic pain
-Not protective
-No guarding, grimacing, sweating
- >3-6 months
-Major cause of psychological and physical disability
-Goal of treatment is improve functional status (quality of life)
-Highly correlated w/ suicide
-Mostly emotional
-NOT cancer
Cancer pain
Damaged or abnormal pain nerves related to all aspects of their cancer
-tumor location
-treatment: chemo or radiation
-Infection
Nociceptive pain
-Arises from pain receptors
-Usually responsive to opioids/ analgesia
-Aching, gnawing, pounding
-Acute injury
-Somatic, Visceral, cutaneous
Neuropathic pain
-Injury to nerves or abnormal processes of sensory input
-treat with adjuvant analgesics (gabapentin)
-Burning, shooting, electrical, abnormal sensation
Ex. Spinal cord pain, diabetic neuropathy, phantom limb pain
Somatic Pain
Localized in bones, joints, muscles, skin or connective tissue
Visceral pain
Nonlocalized in internal organs, often associated with referred pain (nonspecific)
Ex. Pancreatitis may have random shoulder pain
Cutaneous pain
Localized in skin or subcutaneous tissue
Idiopathic pain
Form of chronic pain w/o known cause
-Pain that exceeds typical pain levels with the clients condition
-Hard to treat
Acute pain often stimulates the
Sympathetic Nervous System
-Think Fight or Flight
-Tachycardia, hypertension, anxiety, diaphoresis, muscle tension
Chronic pain does not commonly have physiologic response to pain instead had
fatigue, depression, decreased level of function
Research has shown that nurses subjective opinion about what a patients says about their pain impacts……
How they decide to treat it
Bottom line is that pain is what the patient says it it and we must assess it and treat it as such (Still like safety: respiratory & drowsiness)
What are some common biases and misconceptions about pain?
- Patients who abuse substances overreact to discomforts
- Patients with minor illnesses have less pain than those with severe physical alterations
- Administering analgesics regularly leads to drug addiction
- The amount of tissue damage in an injury accurately indicates pain intensity
- HCP are the best authorities on the nature of a patients pain
- Psychogenic pain is not real (pt gets stomach pain w/ anxiety stomach pain is real)
- Chronic pain is psychological
- Pts who are hospitalized experience pain
- Patients who can’t speak do not feel pain
What are factors that influence the pain experience?
-Age
-Fatigue
-Genes
-Cognitive/neurologic function
-Previous pain experience
-Supports systems/coping mechanisms
-Spirituality
-Anxiety/Fear
Cultural beliefs and values affect
how individuals cope with pain
When pain threatens a person’s individual or family role, they….
may not acknowledge the pain
Some cultures find it to be normal to….
be very demonstrative about pain and others tend to be more introverted
Make sure that we are assessing pain in a person’s _____
native language
What does pain impact?
- Quality of life
- Self-care
- Work
- Social support
What do we need to make sure of when using pain scales?
That it is appropriate for our patient
Pain Assessment using PQRSTU
P: What makes your pain worse/better?
Q: Describe your pain to me?
R: Show me where you hurt
S: Can you rate your pain on a scale 0-10
T: Do you have pain all the time? When did it start?
U: What are you not able to do bc of your pain
Pain treatment interventions
-Use different types of interventions
-Be willing to use more than one type of pain relief measure
-Use measures the pt believes in like prayer
-Keep an open mind
-Keep trying
-Pain might not be eliminated- focus on substantial improvements in functional status
Relaxation & Guided Imagery
-Helps alter affective-motivational and cognitive pain perception
-Help decrease physiologic responses to pain (decrease HR, BP, RR)D
Distraction
-Works best for short intense pain
-Reticular activating system inhibits painful stimuli if a person receives sufficient or excessive sensory input
Music therapy
-Shown to be effective for acute or chronic pain
-Diverts attention away from pain and elicits a relaxation response
-Creates a positive change in mood and emotional state and helps them participate in care
Cutaneous stimulation
-Stimulation of the skin through massage, temperature, or transcutaneous electrical nerve stimulation (TENs)
-MOA unclear–> theory suggest it may block the transmission of painful stimuli (gate-control theory)
What is the key of managing pain?
Assessing the patient and then assessing the interventions you used
-Start with the least intense and gradually increase
Pain management mediations
Analgesics
What is the max acetaminophen (Tylenol)
4g/24hrs
Acetaminophen
-Safest/most tolerated
-MOA not totally clear
-Analgesic (pain) and antipyretic (fever)
-No anti-inflammatory effects
-IV Tylenol cross BBB, good for pts after surgery, works rapidly
-Nonopioid: mild to moderate pain
-Ceiling effect
NSAIDs Examples and SE
Aspirin, ibuprofen, naproxen
-watch for GI bleeding especially in elderly pts
-Nonopioid: mild to moderate pain
-Ceiling effect
Opioids Examples and SE
-Morphine, codeine, hydromorphone, fentanyl, oxycodone, hydrocodone
-Lots of SE: Constipation, GI upset, memory, thought changes
-Do not give opioid then try to educate pt
-No ceiling effect
Respiratory depression
-Serious adverse-effect
-Common in opioid naive patient or patients with around the clock dosing
-Often seen with pts who take benzodiazepines
-Treatment: naloxone, put on O2, maintain patent airway
Around the clock dosing
Maximizes pain relief and potentially decreasing opioid use
-Keep pain from getting out of control
Range-order medicine
-Medication orders in which a dose varies over a prescribed range to provide flexibility
-Nurses are responsible for assessing, administering, and following these orders
-Key is to know your patient
Patient-Controlled Analgesia (PCA)
-Nurses program the machine
-Always IV
-Starts with loading dose
-Patients then Bolus
-There is a frequency and a limit
-Must have a order for narcan
-Sometimes required to wear pulse ox
-Pt is the only one to hit button
-Y tubing that connects to NS or lactate ringer to push medicine through and keep line patent
Epidural Anesthesia
-Form of regional anesthesia
-Preservative free
-PCA or continuous infusion
-Abdominal surgery, birth, lower body surgery
What is the benefit of epidural anesthesia?
help decrease amount of systemic narcotics and treat pain locally
SE of epidural anesthesia
-Hypotension
-N/V
-Urinary retention
-Constipation
-Respiratory depression
-Pruritus (itching)
Nursing care for epidural anesthesia
-Monitor site placement
-Monitor for infection/bleeding
-Urinary retention: may need urinary catheter
-Depending on location, may not be able to walk (fall risk)
-Monitor coags (platelets, PT/INR)
Tolerance
-Occurs after repeated exposure
-Doesn’t occur with short-term use of opioids
-Associated with chronic opioid use, especially in malignancy (cancer)
-Not a sign of addiction
Dependence
-Occurs after repeated exposure to opioids analgesic
-Withdrawal symptoms will occur if drug abruptly withdrawn
-Drug withdrawn by gradually decreasing the dose
-Withdrawal symptoms not a sign of addiction
Addiction
-Psychological dependence (Addiction)- overwhelming involvement with obtaining and using a drug for their mental altering effects
-“drug seeking behavior”
-Not taken for pain relief
-Mental health issue
