Pain Flashcards
Pain
A major problem that causes sufering and reduces quality of life
one of the major reasons why people seek healthcare
effective pain relief is a basic human right
If you don’t manage actute pain you are at higher risk of chronic pain
What is the nurses role in pain management
Assess pain, document it, and communicate with others
Ensure delivery of aqeduate pain relief measures
Evaluate effectiveness of interventions
Monitor ongoing effectiveness of pain management strategies
Provide education
Why is pain undertreated
inadequate skills to assess and treat pain
misconceptions about pain
innacurrate info about opiods
respiratory depression
clients underreporting pain
fear of addiction
belief that it is inevitable
expectations that drugs won’t help
desire to be a good client
What is pain?
Subjective-client’s experience and self-report is essential
Nociception
physiological process that communicates tissue damage to the central nervous system
mechanism by which pain is percieved (transduction, transmission, perception, modulation)
Perception of pain
occurs when pain is recognized, defined and responded to
nociceptive input is percieved as pain in the brain
Dimensions of pain-sensory-discriminative
the recognition of the sensation as painful
pattern, area, intensity and nature
Dimensions of pain-motivational affective
Emotional response to pain experience
anger, fear, depression, anxiety
Dimensions of pain-behavioural
observable actions used to express or control the pain
-facial expressions
-posturing
-adjusting social activities
Dimensions of pain-cognitive evaluative
beliefs, attitudes, memories, and meaning attributed to pain
the meaning of pain to the client is important in individual response to pain
the meaning of pain and related responses are critical aspects of nursing pain assessment
Dimensions of Pain-sociocultural
demographics, support systems, social roles, past experiences, cultural aspects
Causes and types of pain
underlying pathology-nociceptive and neuropathic
duration-acute and persistent
Nociceptive Pain
Damage to somatic or visceral tissue
surgical incision, broken bone, or arthritis
Nociceptive pain-somatic
aching or throbbing
localized
arises from bone, joint, muscle
Nociceptive pain-visceral
tumour involvement or obstruction
arises from internal organs such as the intestine and bladder
Neuropathic Pain
Damage to peripheral nerve or central nervous system
burning, shooting, stabbing, or electrical in nature
sudden, intense, short lived, or lingering
difficult to treat (opiods, antiseizure, antidepressant medications
Acute Pain
sudden onset
usually within normal time for healing
mild to severe
generally can identify a precipitating event or illness
Acute pain reflects what nervous system?
Sympathetic nervous system (increased heart rate, increased respiratory rate, increased blood pressure)
What is the treatment goal for acute pain?
pain control with eventual elimination
What is persistent pain
gradual or sudden onset
may start as acute injury but continuous past the normal time for healing to occur
mild to severe
3-6 months=chronic
fatigue, with-drawl from others and social interactions
Why assess pain?
describe the pain experience and factors that influence it
assist inidentifying the need for pain management
evaluate the effectiveness of pain management
provide an important indicator of the quality of patient care
Frequency of assessment
Dyring initial assessment
At least once per shift for inpatients
At least once every visit for outpatients and homecare
before, during, and after proceudre
following treatment plan
Comprehensive Pain assessment
pain history, physical exam and current pain experience
medication use-past and present
functional status
psychosocial impact
meaning of pain
expectations for pain relief
Self report of pain
primary source of assessment for verbal and cognitive intact people
Pain assessment goals
To describe the client’s sensory, affective, behavioural, cognitive and sociocultural pain experience, in order to implement pain management techniques and identify goals
Pattern of pain
onset and duration
acute pain typically increases during wound care, ambulation, coughing deep breathing
associated with injury
Breathrough pain
transient, moderate to severe
occurs beyond treated pain
rapid onset and brief duration
Area of pain
localized, all over, referred or radiated from origin to different site
ask client to describe the sites of pain
point to painful areas on the body
Intensity of pain
reliable measure to determine treatment
rated using scales, adjusted to client age and cognitive ability
numerical, visual descriptors, visual analogue, smiling or crying faces
Nature of pain
quality or characteristics of the pain (brief Pain Inventory)
Assist in identifying the type of pain (neuro or nociceptive)
What are the effects of pain on a client
affects sleep, daily activities, relationships, physical acitivty, emotional well-being
Somatic Pain examples
aching, dull, sharp, pulling, hurts, twisting, like being hit, tense, hard, friction, irritating, grabbing, pounding, stiffness, sore, bruising
Somatic pain meaning
muscles, bones, soft tissue pain
Visceral examples
pressure, squeezing, deep, dull, cramping, sickening, constant, steady, tightness, gassy
Neuropathic pain examples
burning, tingling, shooting, stabbing, jabbing, shouck-like, piercing, radiating, gnawing, pinching
Non-verbal pain assessment
acute-risk of undertreatment, pointing might work
persistant/chronic-risk of underdetection, may ive little indication of pain, ask how they behave when in pain
unconscious-grimacing, moaning, rigidity, arching, restlesness, shaking (Critical Care observation tool)
Tips for nurses when doing cognititively impaired pain assessments
remember they feel pain but can’t communicate it
father info from various sources
note any voacalizations
ensure comprehensive assessment physical and environmental factors
pay attention to non verbal behaviours
Feldt tool-assess pain in non-verbal patients
Pain behaviours in the non-verbal (cognitively impaired persons)
flat affect
decreased interaction
decreased intake
altered sleep patterns
Valid and reliable tools for pain?
depression screening (patient health questionnaire)
TSK-fear of movement
Relevant physical exam for pain
review system/vitals
physical appearance
MSK exam and neuro exam
gait
examine painful body locations
consequences (stiffness and atrophy)
signs of neuropathic pain
hyperalgesia, allodynia, parasthesia, skin changes
Nonpharmacological Therapy for pain?
massage
therapeutic exercise
TENS
Application of heat
Application of cold
Cognitive techniques (distraction, relaxation strategies, self-management)
Nursing Managament of pain
Effective Management
client report must be believed
communicate concern and assure commitment to client
Barriers to effective pain management?
tolerance-patient might need more than standard amount
Dependence-might go into withdrawl if they don’t get meds on time
addiction
Ethical issues in Pain Management
fear of hastening death by administering analgesics
use of placebos in pain assessment and treatment
Age related concerns?
persistent pain is a problem associated with physical disability and psych problems
the most common sources of pain among older adults are muskoskeletal conditions
despite its high prevalence, pain inn older adults often is inadequately assessed and treated
What does persistent pain often result in?
depression
sleep disturbance
decreased mobility
decreased health care utilization
physical and social role dysfunction
Age related concern with barriers
belief that pain is inevitable part of aging
greater fear of using opiods
using words like aching, soreness, or discomfort insteadof pain
Age related concerns with treatment
metabolize drugs more slowly
greater risk for adverse effects
risk of GI bleed with NSAIDs
multiple drug use interactions
cognitive impairement and ataxia can be axacerbated
Ataxia meaning
group of disorders that impact coordination, balance and sleep
Special populations when considering pain
clients with substance abuse problems-they still have the right to recieve effective pain managament (challenging)
establish a treatment plan that will relieve pain andf minimize withdrawl symptoms
interprofessional team approach
