Neurological system (Pain) Flashcards
Pain
Defined as an unpleasant sensory and emotional experience
Associate with actual or potential tissue damage or described in terms of such damage
Pain assessment tools
- Initial pain assessment
(-) Ask patient questions about the pain using COLDSPA - Brief pain inventory
(-) using a scale to rate the pain within the past 24 hours - McGill Questionnaire
(-) Ask patient to rank a list of descriptors in terms of their intensity and to give an overall intensity rating to his or her pain
Three main pain rating scales
The FLACC (face, legs, activity, crying and consolability)
Wong-Baker Faces pain rating scale
Numeric Rating Scale
Complex regional pain syndrome (CRPS)
is a broad term describing excess and prolonged pain and inflammation that follows an injury to an arm or leg
Factors influencing the perception of pain
Past experience Anxiety and Depression Culture Gender Genetics
Harmful effects of Pain
Unrelieved pain causes
Undue suffering
Sleep deprivations – produces hyperalgesic changes.
Pulmonary, cardiovascular, gastrointestinal, endocrine and immunological changes
Promotes tumor growth
Depression and disability
Types of pain
Acute
Chronic
Cancer-related pain
Acute pain
- Sudden onset
- Associated with a specific injury
- Last no longer than the healing of trauma or injury
- Lasts from 6 seconds to 6 months
Chronic pain/ persistent pain
Often has a poorly defined onset
Lasts beyond 6 months
Pain that is intermittent or constant and lasts beyond the expected time of healing
Cancer related pain
May be acute or chronic
May be associated with tumors or cancer treatment (radiation, surgery)
Classification
- Nociceptive pain
- Visceral pain
- Neuropathic pain
Nociceptive pain
Somatic (result of thermal, mechanic, or chemical injury)
Skeletal muscle, fascia , joints, tendons, cornea
May be sharp ,pricking or sticking in nature
Visceral pain
Result of inflammation, stretching, ischemia, dilation of internal organs
May be dull aching cramping in nature
Neuropathic pain
Occurs there has been damage to the peripheral nervous system
Pain continues after healing has taken place
May be also associated with a diabetic neuropathy
Post herpetic neuralgia (Shingles)
May be described as burning in nature
Pain classified by etiology
Post Mastectomy Syndrome
Hemiplegia-Associated Shoulder Pain Syndrome
Pain Associated with Sickle Cell Disease
Aids Related Pain
Burn Pain
Pain classified by location
Abdominal Pain
Headaches
Chest pain
Goals for pain management
Based on the client’s needs No Pain Reduced pain Reduced on the person’s ability to function Person’s ability to rest
Management
Establish the nurse client relationship by:
Acknowledging the client’s pain is real to the client
Teaching, managing and preventing side effects
Providing physical care
Pharmacological Interventions
Non-pharmacological Interventions
Pharmacological interventions
Analgesia
- Opioids- may be given PO,SC, I.V intraspinal, intranasal, rectal transdermal
(-) Side effects: Respiratory depression, Nausea and vomiting, constipation, allergic responses,
Nonsteroidal Ant-inflammatory Drugs
- Aspirin, ibuprofens
(-)Side effects: may cause
gastrointestinal bleeding , bruising, renal
impairment.
Local anesthetics
- Lidocaine injected around the site of injury,
- Emla cream that is applied directly to the
skin
Approaches of giving pain drugs
Balanced approach
- more than one approach. Better relief with fewer side effects. Require less of one type of analgesia
Pro Re Nata (PRN)
- as necessary, usually when patient is in severe pain
Preventative Approach
- Administer on time rather than on the patient’s report of pain
Non-pharmacological interventions
Cutaneous Stimulation and massage
Thermal therapies
- Ice – joint injuries no longer than 15-20 mins at a time - Heat- do not apply to sites which are areas of untreated infection.
Tens- transcutaneous electrical nerve stimulation
Distraction
- Relaxation techniques- breathing exercises
- Guided imagery
- Music
- Hypnosis
Other aromatherapy, acupressure, reflexology
Neurosurgical Approaches to pain.
Cordotomy- interrupts the transmission of pain by dividing certain tracts in the spinal cord.
Rhizotomy- nerve roots are destroyed as they enter the spinal cord.
What are the benefits of epidural versus systemic administration of opioids?
Epidural analgesia provides better pain management than systemic opioids.
It significantly reduces the number of people who will suffer heart damage, time to return of unassisted respiration, gastrointestinal bleeding, and intensive care unit length of stay
Epidural
a procedure that injects a local anaesthetic in to the space around the spinal nerves in your lower back.
