exam 3 presentations Flashcards
acute pain
Rapid onset but resolves
Vital, physiological response
chronic pain
Constant or recurring pain
Normal vital signs, impacts mental well-being
nociceptive pain
Damage to body tissues
Throbbing, sharp, achy
Neuropathic pain
Damage to nerves
Stabbing, burning, shooting, pins/needle
intractable pain
Does not respond to therapy or interventions
Focus is reducing discomfort
phantom pain
Removal of limb
Burning, fiery, crushing, cramping
cutaneous classification pain
Superficial, involves skin or subcutaneous
tissue
somatic pain classification
Diffuse or scattered
*
Originates in tendons, ligaments, bones, blood
vessels and nerve
visceral pain classification
Poorly localized
*
Originates in the thorax, cranium and
abdomen
referred pain classifaictoin
Originates in one part of the body by is
perceived in a distant location
malignant/cancer pain classification
Results from direct effects of the disease and
its treatment
factors affecting pain
Past Experience / Background
Culture / Religion
Age
Family
Anxiety / Stressors
LOPQRST pain assess
when is it used
what does it do
used in beginning of assessment
Location (Where is the pain? If unable to answer, can you point?)
Onset (When did the pain start?)
Provocation (What makes it better or worse?)
Quality (How would you describe your pain?)
Radiation (Does the pain go from one place to another? Can you point to it?)
Severity (Can you rate your pain 0/10?)
Time (How long does the pain last?)
Numeric Scale pain assess
when is it used
what does it do
Used in patients above 9 who are able to use numbers correctly
give a number that correlates to pain currently
Wong- Baker FACES pain assess
when is it used
what does it do
used in patients above 3 years old that cannot use numbers
children rate pain based on :) to :( that correlates to a specific number
Verbal Descriptors pain assess
when is it used
what does it do
used in adults and children when they can process/talk through pain
used in all patients if they can, they will describe pain based on key words to narrow down how they feel
COMFORT Scale pain assess
when is it used
what does it do
children,adults/childern with cognitive impairments, ICU
each rated 1-5
alrtness
calmness
respitoary distress
crying
physical movement
muscle tone
facial tension
bp/hr
determine level on analgesic needed to adequately relieve pain in patient
FLACC Scale pain assess
when is it used
what does it do
used in infants/children from 2mon-7year who are unable to validate pain
Faces,legs,activity,cry,consalabiltiy
rate each on 0-2 scale
PAIN AD pain assess
when is it used
what does it do
Used in patients whose dementia is so far advanced that they cannot verbally communnicate
relies on: breathing, vocalization, facial expression, body language, consalability
non pharmelogical pain interventions
TENS unit
* Heat / Ice
* Repositioning
* Toileting
* Quiet Environment / Hypnosis
* Guided Imagery
* Massage / Acupuncture
* Distraction
phatmaolgical pain management
Non-Opioid Analgesics / NSAIDs
* Opioids
* Adjuvant or Co-Analgesics
* PCA Pump
factor affecting pain management
Pain Threshold
Pain Tolerance
Medication Tolerance
Breakthrough Pain
Dependence Addiction
Factors Affecting Sensory Function
AGE
CULTURE
MEDICATIONS
STRESS / ILLNESS
LIFESTYLE
disturbed sensory perception
Sensory Deprivation
Sensory Overload
Visual Impairment
Hearing Impairment
Olfactory Impairment
Tactile Impairment
Delirium
Dementia
Unconscious Patient
Pain Pathophysiology
The body gets the noxious signal from the stimuli (hot stove), sends an impulse to the spinal cord which relays the information to the brain. The brain interprets this as pain (ouch), localizes it and sends the instructions back to the body (removing hand from hot stove)
What does pain determine?
Warns the body of potential or actual injuries or diseases
acute pain (long)
Rapid onset and varies in intensity from mild to severe
–After underlying cause is resolved, pain disappears
-Body’s Response –
Increased HR/BP (fight of flight), diaphoretic (sweating), pupils normal or dilated, restlessness
chronic pain long
Pain that lasts beyond the normal healing period
-Anywhere between 1 and 6 months but commonly 3 months in practice-
Can be constant, episodic (remission with exacerbation), or recurring
Body’s Response –
Normal vital signs,
restlessness w/ exacerbation,
pupils normal or dilated, poorly localized,
varies from person to person,
commonly impacts mental well-being (depression, anger, frustration, sleep/appetite disturbance)
Nociceptive Pain
long
Caused by damage of body tissues
External injury: hitting elbow, falling or scrapping knee, twisting ankle, stubbing toe
Representative of the normal pain process (acute)
Locations can be visceral or somatic pain
Described as throbbing, sharp, or achy pain
Neuropathic Pain
long
Caused by damage to the nerves
Peripheral (hands/feet) & central neuropathic pain (anything impacting central nervous system)
Cancer, alcoholism, stroke, limb amputation, chemotherapy drugs, radiation, or diabetes
Described as stabbing, burning, shooting, pins and needles, or sharp pain (electric shock)
Does not generally respond to conventional analgesics
Intractable Pain
long
Does not respond to therapy or interventions
Degenerative spinal disease, chronic regional pain syndrome (CRPS), neuropathy, osteoporosis
Focus is reducing discomfort
phantom pain long
Caused when limb is removed
No nerve endings are present but patient still feels pain in their limb
Described as burning, fiery sensation, crushing, cramping
VERY REAL and needs to be treated
Treatment: NSAIDs, pain relievers, antidepressants, beta blockers, antiseizure medications, muscle relaxers, injections, neurostimulators, spinal cord stimulators, TENS units
Cutaneous Pain long
Superficial, involves the skin or subcutaneous tissue (burning).
Example: Papercut
Somatic Pain long
Diffuse (spread out) or scattered. Originates in tendons, ligaments, bones, blood vessels, and nerves (bone/joint pain)
Example: Ankle sprain
Visceral Pain
long
Poorly localized. Originates in the thorax, cranium, and abdomen (aching/squeezing).
Example: Bladder pain
Referred Pain
long
Originates from one part in the body but is perceived in an area distant from its point of origin.
Example: Heart attack – pain is felt in the neck, shoulder, chest, or arms (usually left)
Malignant /Cancer Pain
long
Results from the direct effects of the disease and its treatment
control gate theory
This is the concept that non-painful input, such as a TENS unit, massage, heat, ice, or acupuncture CLOSES the gate to painful input, preventing the pain sensation from traveling to the central nervous system
Factors that Affect Pain
Past experience with pain/ background
Cultural / Religious considerations
age
family
anxiety/stressors
communication do
Use open ended questions
Active listening
Seeking clarification
Summarizing
Reflecting
communication dont
Ask “why”
Use clichés (you’ll be just fine)
Stereotype / Judge
Give advice
Use “elderspeak” or baby talk
How Do We Assess Pain?
Location (Where is the pain? If unable to answer, can you point?)
Onset (When did the pain start?)
Provocation (What makes it better or worse?)
Quality (How would you describe your pain?)
Radiation (Does the pain go from one place to another? Can you point to it?)
Severity (Can you rate your pain 0/10?)
Time (How long does the pain last?)
Non-pharmacological Interventions
TENS unit
Heat/Ice
Toileting / Making Comfortable
Quiet Environment / Hypnosis
Guided Imagery
Massage / Acupuncture
Exercise or Repositioning
Distraction (laughter, music, TV)
Pharmacological Interventions
Non-opioid Analgesics or NSAIDs
Tylenol or Ibuprofen
Opioid Analgesics
Mild (Tramadol)
Strong (Hydromorphone/Morphine)
Adjuvant or Co-analgesics
Medications with a primary purpose other than pain relief (antidepressants, anticonvulsants, steroids)
pca pump
Patient-Controlled Analgesia
Set to administer scheduled and/or on-demand dosing
Patient must press the button
Assess who is appropriate!!!
Assess patient AT MINIMUM every 4 hours
Continuous pulse-ox d/t increased risk for respiratory depression
Two RNs must check the settings!!!
Priority Assessments w/ Opioid Administration
REMEMBER, ABC!!!!!
Level of Consciousness (LOC)
Respiratory Status (rate/quality)
Side effects (nausea/constipation)
Level of pain
Vital signs
Pain Threshold
Lowest intensity at which pain is experienced
Pain Tolerance
Point when a patient can no longer endure the pain
Medication Tolerance
Body becomes accustomed and needs a larger dose for pain relief
Breakthrough Pain
Pain that occurs in-spite of medical intervention / flare-up, often use PRN medications to treat
Dependence
Body becomes accustomed to opioid therapy and experiences withdrawal when stopped
Addiction
Inability to stop using a substance even though it causes physical harm – used for euphoric aspect in spite of pain resolving
Sensory Perception MOA
Stimuli
Stimuli is sensed and converted to nerve impulse
nerve impulsed conducted through nervous system
brain receives impulse and translate it into sensation
Factors affecting sensory
function
Developmental age
* Culture
* Stress
* Medications
* Illness
* Lifestyle
Sensory Deprivation
Drowsiness or Excessive
Yawning
“Escape Behaviors”
Unusual body sensations, Illusions & Hallucinations
Decreased attention span,problem-solving & ability to concentrate
Crying or irritability
Confusion
Depression & panic
Sensory Overload
Fatigue
Insomnia
Sleeplessness
Anxiety
Racing thoughts
Disorientation
Increased muscle tension
Difficulty with problem
solving
Visual sensory deficit/ impairment
interventions
Eye patches / surgery
* Presbyopia, Cataracts, Glaucoma, Macular Degeneration
bright colors, larger everything,enlarged text, clear pathways glasses
Hearing Impairment
interventions
Other senses enhanced
Amplification of devices
Hearing aids, FM systems, Cochlear implant
read lips, decrease background noise, check batteries, talk slower
Olfactory Impairment
Taught the dangers of working with chemicals
Carefully inspect food for freshness
tactile impairment
May not be aware of heat/cold
May not be aware for repositioning on bony prominences = pressure ulcer
complete rom, reposition, ambulate frequently, use moisturizers
Delirium
Sudden Onset
Either quiet, sleepy and
disorientated, or restless and very distressed.
Sleep may be disturbed
May hallucinate
Communicate using reality orientation
Cause: Medications, nutritional deficiency, illness, circulatory or metabolic problems – one specific cause
Interventions: Reorient frequently and immediately after surgery, structured environment, using aids (hearing/glasses) to minimize isolation and confusion, reduce the use of antipsychotics as they exacerbate the problem
Dementia
stages
what does
causes
interventions
Slow Onset
Forgetfulness (early AD)
Increased confusion (middle AD)
Trouble speaking with difficulty understanding others (advanced AD)
Alzheimer’s Disease is irreversible and progressive –impacts memory and advances to inability to self-care
Communicate using validation
Causes: Alzheimer’s Disease, stroke, or vascular event
Interventions: Safety, decreased stimuli, frequent or constant supervision and care, emotional support/education/empathy with family
Unconscious Client
who
risks
nursing considerations
Coma, Ventilated patient, Medication induced coma
Risk for sensory deprivation,uti
Hearing is the last sense lost
Assume the patient can hear you
Speak before touching
kinesthesia
awareness of position of body parts/movements
visceral
awareness of inner organs
