Pain Management Flashcards
Transduction
nociceptors are activated when exposed to noxious stimuli
-mechanical, chemical, or thermal
Transmission
stimuli are converted to electrical impulses and relayed to spinal cord and brain by afferent nerve fibers and unmyelinated C fibers
-neurotransmitters facilitated transmission process to the brain
Pain
- an unpleasant sensory and emotional experience that is associated w/ actual or potential tissue damage
- whatever the person says it is
What is the 5th vital sign?
Pain
A-delta Fibers
lead to sharp stabbing local pain
C Fibers
lead to diffuse, dull burning or aching pain
Perception of Pain
- nerve fibers divide in dorsal horn of spinal cord, cross to opposite side, rise upward to thalamus
- thalamus sends message to somatosensory cortex of brain where impulse is interpreted as pain
Pain Threshold
point where person feels lowest intensity of painful stimulus
Modulation
neuromodulators modulate pain sensation
can be modified peripherally or centrally
Examples of Neuromodulators
Serotonin
Endorphins
Enkephalins
Dynorphins
Classifications of Pain
- duration
- etiology
- source/location
Types of Duration
Acute or Chronic
Acute Duration
rapid onset of varying intensity, sore throat, appendicitis, surgery, invasive procedure
Chronic Duration
pain that continues past the expected point of healing for injured tissue, abdominal pain, headache, sickle cell disease, or migraines
Types of Etiology
Nociceptive
Neuropathic
Nociceptive
due to noxious stimuli that damages normal tissue or has the potential to, chemical burn, sun burn, appendicitis
Neuropathic
pain due to malfunctioning or the peripheral or central nervous system, spinal cord injury, phantom limb pain
Types of Source/Location Pain
Somatic
Visceral
Somatic
pain that develops in the tissues; superficial or deep
Visceral
pain that develops w/in organs such as heart, lungs, GI tract, bladder, etc.
Factors Influencing Pain
Age Gender Cognitive level Temperament Previous experiences Family and Cultural background
Situational Factors Influencing Pain
behavioral
cognitive
emotional
Behavioral Factor
how the child and family react and what they do about the pain experience
Cognitive Factor
what the child understands and believes about the pain experience
Emotional Factor
how the child and family feels about the pain experience
Indicators of Pain in Infants
- facial expressions
- body movements
- crying
- changes in HR, RR, BP, oxygen sat, vagal tone, palmar sweating, and plasma cortisol or catecholamine levels
Toddlers and Pain
- encourage to verbalize pain
- may hit, bite, scream, or kick
- use words they understand
Preschoolers and Pain
- may not verbally report pain
- thinking pain is expected
- think adults are aware of pain
- “I need to go to the bathroom”
- difficulty describing pain
School Age Children and Pain
- type, location, and severity
- use descriptions based on things they know
- try to be brave
- might be embarrassed about acting out
- withdraw
- muscular rigidity
Adolescents and Pain
- concerned primarily w/ body language
- concerned w/ fear of losing control of behavior
- can deny or refuse meds
- mood affects response to pain
- don’t want to look like child
- look for subtle changes
What subtle changes should you look for in response to pain for adolescents?
rapid breathing, clenched teeth, clenched fists
Factors Affecting Child’s response to Pain
type of pain
extent of pain
age/developmental
Key Principles of Pain Assessment
- question the child
- use reliable and valid pain scale
- evaluate child’s behavior and physiologic changes to establish baseline
- secure parents involvement
- take cause of pain into account
- take action
Health History Data Related to Pain Assessment
- location, quality, severity, and onset of pain
- conditions that preceded the onset of pain and conditions that followed
- any associated symptoms such as weight loss, fever, vomiting, diarrhea, that may indicate illness
- any recent trauma including interventions used
Pain Management Guide For Children
- individualized interventions
- use nonpharmacologic and pharmacologic approaches to ease/eliminate pain
- teach child and fam about pain relief interventions and techniques
What should you base your individualized interventions on when managing pain?
Amount of pain experienced, the child’s characteristics such as developmental level, temperament, previous pain experience and coping strategies
Nonpharmacologic Techniques
relaxation
distraction
guided imagery
Behavioral-Cognitive Pain Management Strategies
- relaxation
- distraction
- imagery
- biofeedback
- thought stopping
- positive self talk
Biophysical Interventions for Pain Management
- sucking and sucrose
- heat and cold applications
- massage and pressure
