pain management Flashcards
what is pain
Unpleasant sensory/emotional experience
what can pain do
Can have destructive effects
Can warn of potential injury
A multidimensional experience
how do you classify pain
By origin Superficial Visceral Somatic Radiating/referred Phantom Psychogenic
classifying by cause
By cause
Nociceptive
Neuropathic
classifying by duration
By duration
Acute
Chronic
Intractable
what is transduction of pain
: activation of nociceptors by stimuli
what is transmission of pain
conduction of pain message to spinal cord
what is pain perception
: recognizing and defining pain in cortex
what is pain modulation
: changing pain perception
what are some factors that influence pain
Past experience with pain Emotions Developmental stage Sociocultural factors Communication skills Cognitive impairments Other illnesses contributingto pain
some ways that you can assess pain
Includes Obtaining a complete pain history (e.g., onset, location, aggravating/alleviating factors) Nonverbal signs of pain Elevated pulse/blood pressure Crying, moaning Grimacing
what are the different pain scales
Visual Analogue Scale (VAS)
Numeric Rating Scale (NRS)
Simple descriptor scale
Wong-Baker Faces Pain Rating Scale
steps for a pain assessment
Client’s expression of pain
Characteristics of pain
Onset and duration-When did the pain begin? How long has it lasted?
Location- Where is your pain? (don’t always assume that the pain will be in the same place).
Intensity- Is the pain mild? Severe? Unbearable?
Quality- Tell me what your discomfort feels like?
Pattern- What makes your pain worse? Does anything make it feel better?
nursing diagnosis of pain
Anxiety Ineffective coping Fatigue Acute pain Chronic pain Ineffective role performance Disturbed sleep pattern
what are some goals and outcomes of pain
- Client is using pain relief measures safely
Setting priorities—pain rating 7 out of 10 requires immediate action.
Continuity of care—need variety of resources for pain control.
what are some nonpharmalogical measures
Cutaneous stimulation Based on “gate control” theory TENS PENS Acupuncture Acupressure Massage Use of heat and cold Contralateral stimulation
other nonpharmalogical measures
Immobilization and rest Cognitive-behavioral interventions Distraction Progressive muscle relaxation Guided imagery Hypnosis Therapeutic touch Humor Journaling
pharmalogical measures
Nonopioid analgesics NSAIDs Acetaminophen Opioid analgesics Includes IV, IM, transdermal, and epidural forms Client-controlled analgesia pumps
patient controlled analgesia
Safe method for delivery of post-op and cancer pain management.
Allows client to self-administer opioids with minimal risk of overdose.
Goal is to maintain a constant plasma level of analgesic so that the problems of prn dosages can be avoided
topical pain meds
Good example is EMLA cream (Eutectic mixture of local anesthetics).
Used mostly in Ped’s for premedicating for IV insertion.
Lidoderm-patches (3) containing lidocaine that are placed on and around a site of pain using an on 12 hr, off 12-hour schedule to avoid toxic effects of lidocai
special nursing considerations
Managing pain in the elderly
Managing pain in clients with addictions
Use of placebos
what is addiction?
primary, chronic, neurobiological disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following:
Impaired control over drug use
Compulsive use
Continued use despite harm
Craving.
Pseudo-addiction
Drug seeking behaviors that may appear when pain is under treated.
pseudo-tolerance
Need to increase opioid dosage for reasons other than opioid tolerance: Progression of disease Onset of new disorder Increased physical activity Lack of adherence Change in opioid formulations Drug-drug interactions Drug-food interactions
somatic pain
pain emanating from muscles, skeleton, skin
radiating
pain that starts in one area and spreads to a larger area
visceral pain
deep internal pain. pain that results from the activation of nociceptors of the thoracic, pelvic, or abdominal viscera. It is felt as a poorly localized aching or cramping sensation and is often referred to cutaneous sites
chronic pain
pain that has lasted longer than 6 months.
nociceptive
most common type of pain. Associated with visceral and somatic.
neuropathinc
chronic pain. Hard to identify. hard to isolate. very complex. usually develops into something else. sometimes related to a nerve injury
how is pain perceived
pain is perceived by the interplay between 2 different kinds of fibers. Those that produce and those that inhibit
