Nurb Test 3: chronic pain Flashcards
-Unpleasant sensory and/or emotional (suffering) experience.
Two components of pain: Physical and suffering experience
-don’t judge what a person calls pain, evaluate pain based on what they say it is
Pain has a lot of cultural influences: tx differently
Musculosceletal System: Persistent Pain
- guard body part, grimace, crying, other vocalization=grown or grunt, clinch jaw, contract non-affected muscles
Nonverbal showing pain
- everyday bangs, bumps, nicks and cuts , lasts a short amount of time Example: Occasional headache caused by stress., fall off bike
Transient Pain
- short period of time then goes away, lasts several months but goes away slowly less than 3 months, sudden onset
the body’s predictable response to adverse chemical, thermal, or mechanical stimulus.
Tx: sufficient dose on schedule q 4 hours rather than pca
Acute pain
- is persistent, not amenable to routine pain controls. Way beyond initial injury, more than 3 months
regional pain syndrome= certain area way after surgery is over
-May start with an injury or disease, but persists well after the injury is healed or disease is cured.
-Brain is thought to develop a memory for pain much like the skill of learning to ride a bicycle is never unlearned.
-periods of waxing and waning
Chronic pain
- pain both above/below waste and on right side/ left side of body to dx
-Chronic pain syndrome
-3 to 6 million Americans, more frequently diagnosed
-Long time thought it was psychological
Mostly women – some men
World Health Organization recognized as a disease in 1990.
Fibromyalgia
- manifests chronic nature of pain Widespread pain At least 3 months left & right sides of the body above and below the waist, Axial pain (central part of the body) Non-cardiac chest discomfort Fatigue Sleep disturbance Headache Irritable bowel Irritable bladder Memory loss- bc meds, pain, or not enough sleep
Characteristics of FMS
Pain (not just tenderness) in 11 of 18 specific tender points
Digital pressure of 4K
Diagnosing FMS
= most reliable indicator of pain intensity is Pain Assessment scales:
Self-report
= bad for not coherent, as long as still won’t experience as much , hard to transfer feeling into number
Numerical
= intensity
Ex: Burning, stabbing, throbbing, aching, tightens, pulling,
-Call it something else not pain=ppl think it means out of control
Frequency= how often, is it different
word descriptor scale
elevation of bp and hr= could be due to something else- goes up bc anxiety and frustration
Restless, moan or grown= true with people with dementia
Assessing not cognitively intact :
- Belief that compared to younger persons, older patients experience less pain= false just have more experience and except suffering more
- May use the words burning, discomfort, aching, soreness, heaviness, tightness
- Say they want pain pill but don’t look like it= most of time nurse will cut back and say they are drug seeker: faking it to the public
- Biggest concern greatest fear about surgery or dying is that they are going to be in pain no one will champion her cause- get meds they need
- Failure to apply standardized assessment instruments.
- Belief that the cognitively impaired elderly cannot be assessed for pain- use standardized tool
- Misinterpretation of cognitively impaired person’s behavior is unrelated to pain. Ex: moaning lady
Barriers to Pain Relief in Elderly
- Not decreased pain, but decreased ability to report pain.
- Changes in function, vocalizations (moaning, groaning, crying)
- Changes in gait: not standing up straight
- Withdrawn: from family and friends
- Agitated Behavior
- Reports from caregivers :know when they will give meds
- maintain a pain log
Assessing Pain the Cognitively Impaired Older Adults
- patient or caregiver
Time, Relief obtained, Pain Location, Side effects, Intensity , frequency, Other pain relief strategies, Medication, Activity and Mood.
*Mood can change how they feel
Maintain a Pain Log/Diary
- other factors
Decrease Quality of life,
Depression- different levels usually on SSRI
Hopelessness
Suffering=never ending, will never go away, effect lifestyle, can’t maintain home or job/ acute won’t mention
Decreased Socialization
Sleep disturbance- usually take meds, trouble waking up, other med during the day that is a stimulant
Impaired ambulation
Suicidal ideation- not being able to deal with it anymore
Decreased appetite and food intake
Increased health care utilization and costs.
Slower rehab
Consequences of Chronic Pain
Combination of pharmacological and non-pharmacological strategies Goal: pain meds need to be adjusted Optimal pain relief - minimal side effects=Constipation, nausea, Sedation, gastric distress.Bowel regimen when opioid begun laxatives and stool softeners.
: toxic levels, used for Mild to moderate pain
= bleeding tendency a lot of bruising
Treatment of Persistent Pain
Acetaminophen
Ibuprofen
Over the counter drugs Prescription Medications Heat/Cold* Exercise* Education Programs* -*Recommended for older adults by Hartford Institute for Geriatric Nursing
Traditional Pain Relief Measures
- look like narcotic
The American Society of Pain Management Nurses (ASPMN)
position is that: they should not be used by any route of administration in the management of pain in any patient regardless of age or diagnosis.
-Better than 40 percent rate to use, isn’t effective only works 20- 40 percent of time
Use of Placebos
mind over matter, will receive and it will relieve pain
Placebo effect:
might not get any relief but know that they should, decreases trust, long term problems with trust possibly
Down side: placebo
use traditional, western medicine Oral medications Epidurals- very effective Steroid Injections Nerve blocks Trigger Point Injections Joint blocks Morphine Sulfate Pump Can give a lot of relief, major hospitals have one Some nurses are trying to coordinated group programs, healing touch, massage therapy= multiple ways to deal with pain
Chronic Pain Clinics:
- healing system with different culture or origin
- Used alone not with conventional medicine
- In combination with other alternative therapies
- Often constitute healing systems with a different origin outside the realm of accepted western medical theory and practice
Alternative Therapies
A. : balance each other, balance of mind body and spirit
dev in india
imbalance of persons life force (prana) and basic metabolic condition ( dosha)
Specific lifestyle interventions major preventative and therapeutic approach
Each person is prescribed individual diet and exercise program based on dosha, herbal preparations are added for preventative or regenerative purposes. Yoga breathing exercises and meditative techniques are also used
alternative therapies
Ayurveda
= wooden structure or tent, build hot fire with a lot of hot water/ smoke and sage involved, sort of like a sauna/ cleans and purifying
native therapies 1. sweat lodge
alternative therapies
- Navajo= spirts will heal sick person /
- Singing or dancing
native therapies
alternative therapies
- pray for people having faith= Christian
alternative therapies native american
- tea has aspirin in it
Willow bark
alternative therapies
native therapies
- Acupuncture
- massage therapy
- Q-gong
- Tai chi
- Herbal medicine
- Heat therapy
alternative therapies
- use collectively
Used in addition to conventional Western therapies
Often consistent with physiological principles of Western medicine
Becoming established in mainstream medicine.
Complementary Therapies
- Distraction, Relaxation, Biofeedback, Acupuncture, TENS, Massage, Prayer & Spiritual healing, Hypnosis
Recommended for older adults by Hartford Institute for Geriatric Nursing:
complementary therapies
- take in as many elements as possible
1. Health care practitioner considers the whole person
Physical, Mental, Emotional, and Spiritual aspects.
Preventive therapies now instead of just taking care of when they occur
Practitioner educates and treats the person to prevent health problems from arising
Does not necessarily treat symptoms after problems have occurred.
Holistic Therapies
(Biofields)
magnet therapy : influence field
light therapy: need 20 min of sun everyday bc need for mood restoration: anxious, sad
People with depression almost become immobilized
Electromagnetic fields
energy based interventions
herbal medicine for pain
capsicum
turmeric
chaparral/creosote
wintergreen
peppers, used in lotion, irritation used for analgesics, ointments have in help to close gate, affects substance p= mediator of pain stimuli
problem: stinging, eye irritation
capsicum:
- what is in curry, make powder and capsule, used as anti-inflammatory, affective as nsaid
Turmeric
- Mexican traditional, make tea to help with arthritic pain
Affects liver and causes problem
Chaparral/Creosote
- produces skin reddening affect, helps with joints and ligaments
Wintergreen
-use substances found in nature for their impact on health and wellness
Biological-Based Therapies
therapies that use or manipulate energy fields
Energy Therapies-
-meditative physical exercise, slow movement, require focused breathing
. Qi Gong
-used to treat pain the causative agent , Alternative medicine
-Attempts to treat “like with like.”
-holds the belief that treating the sick with extremely diluted agents that causes the illness.
Like a vaccine- gives you a little bit of the agent that causes the disease it will help the person bring up their own natural defenses
Self healing system
Homeopathy
biological treatments
chelation therapy
anti-oxidiazing agents
colonic
- waste out of the body
- IV of amino acid EDTA (ethylenediamine tetraacetic acid. [Edetate])
- heavy metal poisoning (lead or mercury), some people who have chronic pain.
- binds these metals, so they can be excreted in the urine.
Chelation Therapy
biological treatment
Anti-oxidiazing Agents
biological treatments
(Vitamin A, C, etc.)
– Colon irrigation warm filtered water, more popular now, takes waste out of the body, enema
-problem: causes diarrhea and fatigued
Colonics
biological treatments
manual healing interventions
massage
osteopathy
feldenkrais
reflexology
– feels good, helps relax the muscles, intervention when in pain contract muscle=reduces stress
-Effects musculoskeletal, circulatory, lymphatic, and nervous system, affects positively in the mental and emotional states
Massage
manual intervention
manual manipulation, moving stretching and massaging persons muscles and joints
- want body to function smoothly together
- tx is thought to help the body heal itself
. Osteopathy-
manual intervention
- movement through awareness, physical therapist use, modality
Reduces pain or limitation of movement
Feldenkrais
manual intervention
– massage areas on the foot which correspond to areas/organs of the body, -firm thumb press and massage certain area and other areas that correspond to pt symptom list
. Reflexology
manual intervention
-soft tissue manipulation, posture & movement education, Manage discomfort by managing posture, train self to do exercises to fix posture
Manual Healing Interventions Rolfing
- therapist uses their hands to tune into, can do laying or sitting
gently working with the spine, the skull and its cranial sutures, and fascia,
-Realign and manipulate neck and head takes 15-20 minutes,
-Releases restrictions of nerve passages are said to ease pain
-Pain in back neck and shoulder
Cranial Sacral
manual intervention
- Use of drawing, painting, sculpting, or other artistic expression to provide insight into patient’s feelings.
- provides insight into how they feel
- use with children a lot to see is abused
Mindbody Interventions
A. Art Therapy
For: Burns, Substance abuse, Cancer, Bereavement, Sexual abuse, Pain, Autism, HIV, Asthma, Deafness, Aphasia,
art therapy mindbody intervention
- distraction during a procedure and interfere with pain experience, living in your body the experience you have in your head
Ex: ob and for surgery to know what going through= rehearse to be less anxious
is the thought process
invokes the senses: feel all energy in body
-Vision, Audition, Smell, taste, and senses of movement, position, and touch.
-Communication between perception, emotion, and bodily change.
Pain , Anxiety, Natural childbirth, Surgery preparation
Guided Imagery
mindbody intervention
- helps them learn how to get self-ready to go to sleep
Induced altered state of consciousness , state of relaxation, guided imagery to a new lovel
C. Hypnotherapy
mindbody intervention
-Using equipment for self-regulation of one’s physiological functioning
-Learning how to shift from sympathetic to parasympathetic
-Visual and auditory signals
-Teach a person to control functions related to all areas of the nervous system
brain activity
-autonomic nervous system responses. =learn to shift form sympathetic to para
Biofeedback
mindbody intervention
respiration heart rate muscle tension sweating sensors skin temperature brain waves
physiological signals frequently recorded for biofeedback
-oximeter, watches o2 sat, alarm goes off will tell them how to breath , with copd to learn diaphragmatic breathing respiratory sensor-with relaxing breathing
Respiration
biofeedback physiological signal
– surface electromyogram (sEMG) emg put on muscle on arm, learn how to control/visualize in mind by how it showed on the screen/monitor pain can place on area look to see if there is a balance between the two muscles
When a muscle is tensed, you can see that the signal gets higher (more electricity) and has different wave forms.(hands act as sensors
Muscle tension
biofeedback
physiological signal
on palm and are gel like sensors, creates electricity across palm, picks up moisture in skin
Sweating (GSR) sensors
biofeedback physiological signals
(EEG – electroencephalogra: spike in feed back because anxiety there is sweat
On head and right hand
Brain waves
biofeedback
physiological signals
Uses: Anxiety, Pain, Pulmonary Disease, Diabetes, Headaches, Heart disease, Irritable Bowel, Raynaud’s Disease=bad peripheral circulation, Incontinence
biofeedback
To Run And Think Better - And Be Less Anxious Stretchy sensors around the Upper chest and diaphragm respond to inhalation and exhalation. (teach how to breath)
Up to half of people with anxiety actually have a breathing disorder. Learn diaphragmatic breathing = causes the person to relax
When the breathing disorder is corrected , the anxiety goes away with no further intervention.
Learning To Control Breathing Patterns
respiration biofeedback
- increase sensations of anxiety
- associated with changing carbon dioxide levels in the blood and
- oxygen levels in the cerebrospinal fluid.
- Correcting the breathing patterns
- significantly alleviates or eliminates the “anxiety” disorder.
Many People With “Anxiety” Actually Have Breathing Problems Studies by Gevirtz
Recording skin surface temperature
to determine near surface blood flow patterns
All of the heat coming out of the hands and feet is caused by blood flowing just under the skin. Relaxation vasodilatation response, warmth of hands increase
Home practice: Thermometer worn on a finger to detect stress responses
Thermisters:
Uses relaxation , quiet the mind =aware of thoughts but let float on by
- Shifts the mind from logical, externally oriented thought
- To gain control over one’s attention.
Meditation
:we feel the entire universe and farthest Goal deep inside ourselves
Contemplation
meditation
:type of meditation take a prayer or bible passage, pick out a phrase that has special meaning and rehearse in the head, creating quieting peace, like contemplation
centering prayer
meditation
words or phrases chanted out loud or internally, say sound and feel vibration in sound, lips, chest, and throat
Mantra (Vocalization)-
meditation
- centering prayer
-mantra
-movement - mindfulness
Breathing: - Focused sensory awareness
-contemplation
meditation
in and out, deep from diaphragm
breathing
meditation
(Ex: walking labyrinth)- noticed every movement, shift awareness internal shifting away from external stimuli
Movement meditations
– a walking meditation, very long walk and reencounter self, go to center of become peaceful and in present moment
Helps achieve a contemplative state= realize inner potential
One loses track of direction and outside world= quiets the mind.
Found in churches and parks
LABYRINTH
movement meditation
– get rid of unwanted thought the intentional, accepting and non-judgmental focus of one’s attention on the emotions, thoughts and sensations occurring in the present moment
–alpha brain wave is used during meditation, alpha rhythm training, can change physiology
Mindfulness meditation
Used for: Chronic pain, Hypertension, Anxiety, Insomnia
meditation
-we ask each other to pray for person, do a mental prayer or one of the saints, different ways and different words Ex: prayer beads, rosary
It gets your mind off of the problem
gives hope it is a way of coping
Research showed that prayer groups got together and prayed for coronary unit pt: found that the people who were prayed had one day less in hospital, and less repeated heart attacks, and longer life span
Prayer Therapy
mindbody intervention
- used a it in hospice settings, in labor =help relax or energize
Influences physiological, psychological and emotional integration of the individual
Music effects changes in behaviors, emotions or physiology.
Ex: music with headache=quiet classical music , spa music
Music Therapy
mindbody intervention
- response is the opposite of “fight or flight response.”
- Absence of physical, mental, and emotional tension
- Parasympathetic dominance
-Stress increases hr, blood pressure, respiration, muscle tension, perspiration, brain wave frequency/ Decrease hand skin temperature, foot skin temperature
Brain wave- goes from alpha to a high frequency beta when stressed
Relaxation
mindbody intervention
-Ancient Hindu exercise and health maintenance program
Consists of assuming specific positions combined with deep breathing and meditation. Suppose to produce relaxation
Used for: Relaxation
-Restores flow of prana=hindu word chi, move energy through body
-Stimulate endocrine and nervous systems
-Improve Circulation
-Breathing create better ways
-promote strength, flexibility, and diaphragmatic breathing.
Yoga
mindbody intervention
)- movement meditation, energy systems
-Chinese exercise practiced three centuries +
-Origins in Chinese medicine & philosophy.
-physical exercise, relaxation, and meditation
-Extensively researched:
Enhancing flexibility – elderly
Chronic pain= energy moving through the body helps to elevate
Preventing falls in the elderly = helps improve balance
Energy movement activities Tai Chi (Qi Gong
– training to be able to do, a lot of refinement=feel energy along meridians
- Traditional Chinese medicine, western
- needles work by enhancing the flow of energy (qi) in the body. feel if there is a blockage
- Qi: form of energy found in all life, when disrupted causes pain and illness
- thickness of hair of horses tail, fine/thin needles inserted at designated points on the body (acupoints) to restore health.
- look carefully at needle, prepackaged needles now
- Safe when practitioner properly trained and have disposable needles
- Problem is it is expensive, and wears off in short time 3-4 weeks
Acupuncture
energy based interventions
, located along vertical channels known as meridians correspond to specific body organs.
Acupoints
Used for: Pain, Headache, Nausea and vomiting, Addiction , Carpal tunnel, Menstrual cramps, Stroke rehabilitation, Fibromyalgia, Asthma
acupuncture
energy based interventions
-using electrical generator to put electricity through the needle for extra stimulus, can feel it, local
Electo Acupuncture
-place between nose and upper lip= helps with pain in legs/ pinch tightly to work
Neiguan point
hegu point
Accupressure
energy based intervention
(PC6). Indicated for treatment of nausea
anterior forearm two fingers away from wrist between tendons of palmaris longus and flexor carpi radialis
Neiguan point
accupressure
(L14). Indicated for treatment of headaches. Push down hard to almost where it hurts
skin between thumb and pointer finger
Hegu point
accupressure
A. seasonal affective disorder/ affects pain experience, can have full spectrum lighting, 20 minutes a day
B. small amount of electricity runs through needle for extra stimulus
C.: in back supports, ring, or soles in shoes, can be put in mattresses have to have skin up against magnets
-electromagnetic energy for long periods of time is bad
Bioelectricomagnetic Applications energy based intervention light therapy elctroaccupuncture magnetic fields
- Contemporary interpretation of several ancient healing practices
- Invented by a group of nurses, involves chi
- Purpose is to potentiate the healing process of the one who is ill or injured.
- Intentionally directed process
- Energy is modulated: Focus within human energy field, Does not necessarily involve body contact client
- Working within biofield, outside the system, bodies release all kinds of energy
- able to feel presence of body, assess whole field of energy find high and low, try to redistribute the energy
- Quiet mind and body, get rid of opinion
Therapeutic Touch (TT) energy based intervention
- Center self- Person relaxes self with breathing
- Assessment of energy field
- Unrufffling- smooth out energy field , should feel rhythmical- disturb energy field and seeing if it was re-distributed
4 Investing energy-channel energy from environment - Smooth out energy field
-Anywhere from 15-30 min
therapeutic touch process
Used for: Anxiety : works best, Stress in children, Chemotherapy, Relaxation in dementia, Pain, Wound healing, Premature babies= to help them breath
therapeutic touch
- use and refuse energy, hands are stationary, energy will go where the body needs it
-bad because feel energetic overload in area
Japanese – universal (rei) life energy (ki).
Foundations in Tibetan Buddhism,originally a form of spiritual development,
-now is an art focused on the healing of energetic imbalances.
-energy is “conducted” through the body of the practitioner and transferred to the person being assisted.
-restores balance and harmony to the person
-sense of wholeness, relaxation, and well-being. - stationary hand on body
Reiki
mindbody interventions
Used for: Stress, Fatigue, Insomnia, Anxiety, Pain
reiki
- heat up air and placed on skin
Heated glass cups draw Qi and blood, it is supposed to pull out toxins in space
Leaves bruises like a hicky
Cupping
mindbody intervention
Used for: Aches & pains, Respiratory problems= pneumonia, Cough, Wheezing,
cupping
Example: Trauma:fractures, sprain, lacerations, surgery injury, childbirth, heat
Acute pain
: Low-voltage electrical current
A person can rent or buy one to take home- can use at night or wear when working
-Used a lot for fibro and back pain
- Electrodes placed on pain area or pressure point
-Electricity stimulates nerves in affected area
sends signals to the brain that block or “scramble” normal pain signals.
-electrical stimulation stimulates body to produce endorphins
-Pads are placed on muscle or nerve bundles, generate certain amount of energy= not lethal, turn up dial till person feels the tingle
Bioelectricomagnetic Applications
Transcutaneous Nerve Stimulator (TENS)
Example: Trauma:fractures, sprain, lacerations, surgery injury, childbirth, heat
Acute pain
Examples: Rheumatoid and Osteoarthritis most common, fibromyalgia=non-articular, not joints, can’t see the disease, doesn’t look like anything wrong/ many different levels manage pain with narcotics around clock, feel it= skin hurting, not everyone has the same symptoms
Chronic pain
Recent injuries or trauma, open wound, dvt, inflammation, infections, bleeding or decreased sensation
Massage is contradicted
Tune into the senses of aight sound taste touch, external sense
Keeps you in the present
Helps to decrease stress
Focused sensory awareness meditation
Used for: Raynaud’s, Anxiety/panic, Hypertension
Relaxation
Mindbody intervention
To treat medical or psychological problems: Anxiety, Pain, Depression, Headaches, Self esteem
Stop smoking=very common, Overcome substance abuse, Insomnia
Hypnotherapy
Pregnant and breastfeeding should be cautioned to take internally except mild tea
Illness such as asthma, experiencing chest pain, or notice sx that persist longer than a few days should seek medical attention
Herbal medicine for pain
