Pain: Module 1 Flashcards
What is pain?
Pain is subjective (patient reported) & different to everybody
Physiological process of pain
Pain is caused when a stimulus causes electrical impulses to travel to the spinal cord
If tissue is injured it releases chemicals that excite nerve endings causing pain
Acute pain
Sudden, onset pain lasting less than 6 months
Chronic pain
Long-term intermittent/continious pain lasting longer than 6 months
Performing a pain assessment
- use an appropriate/valid tool depending on client
- obtain objective data (vitals) & subjective date (PQRSTU)
- accept client’s report of pain
- Assist client in creating a goal
Subjective indicators of pain
Anything patient reported is subjective (PQRSTU)
Objective indicators of pain
Anything observed by the nurse is objective (grimacing, vitals)
Numeric Pain Scale
Used in normal functioning adults, adolescents, and children who understand numbers (6 & up)
Scale 0-10
Slight pain 1-3
Moderate pain 4-7
Severe pain 8-10
Visual Pain Rating Scale
Used with children or cognitively and physically functioning, nonverbal patients
Uses a scale of a series of facial expression expressing pain
Factors affecting pain perception
Culture, ethnic, religious beliefs
Family, support system, gender, age
Environment, past experiences, anxiety
Nonpharmacological Pain Intervations
Interventions that do not involve the use of medications to relieve pain
Can be delivered independently by a nurse
Involves Positioning, cutaneous stimulation, cognitive strategies, therapeutic touch
changing positions, massage, TENS, distraction, music therapy, touch
Pharmacological Interventions
Pain relief from medications
Opioids or Narcotic Analgesics
Nonopoids
Adjuvant Analgesics
Opioids / Narcotic analgesics
Treats moderate to severe pain
Controlled substances
Morphine, codeine, fetanyl, oxycodone
Nonopoids
Non narcotic, OTC medications
NSAIDs, acetaminophen
Adjuvant Analgesics
enhance the effect of opioids by reducing pain and anxiety, NOT nonopioids
Corticosteroids. antidepressents, anticonvulsants, biphosphates
Patient-Controlled Analgesia (PCA)
Computerized IV pump with prescribed opioids dispensed according to patient needs
Used commonly in post op patients
Pain
Multimodal, multidisciplinary, client-centered approach
Patients have a right to pain management
Nurses role in pain management
Be a patient advocate, recognize the nature of pain, assess pain, assist in appropriate pain interventions
Types of pain
Categorized by duration, origin, or disease causing it
Acute/chronic pain
Nociceptive/neuropathic pain
Cancer pain
Can be multiple at once
Nociceptive pain
Origin pain that is felt in a tissue, organ, or damaged part of the body
Referred pain
Back pain, broken leg
Neuropathic Pain
Origin pain dealing with nerve pain arising from the somatosensory system
Sciatic pain, spinal pain
What is the most effective pain management approach
Multimodal approach
combine pharmacological and nonpharmacological interventions
What is the current pharmacological approach to acute & chronic pain
multimodal analgesia - combining 2 different drugs for efficient pain relief
Preferred administration of pharmacological interventions
ATC rather than PRN
Cultural considerations in pain
Understand cultural differences when assessing pain
Assess need for interpreter
Understand patient may be reluctant to express or state any pain
Patients receiving opioids should be monitored for -
Oversedation and respiratory depression with a sedation scale
Complementary therapies
Nonpharmacological and pharmacological therapies administered together
Alternative therapies
Nonpharmacological therapies used instead of pharmacological therapies
Tolerance
Patients receiving opioids for extended periods of time may need a higher dose due to a built up tolerance
Routes of analgesic administeration
IV
IM
PO
PR
TOP
Epidural space - in epidural space of back
Local anesthetic pump - pumps meds directly into surgical wound site
Naloxone
opioid antagonist
reverses opioid effects
administered slowly , and with caution
duration time shorter than opioids
Moist heat
Increase muscle/ligament flexibility
Promote relaxation/healing
relieve spasms, joint stiffness, pain
Warm compress, moist heat packs, baths
Dry heat
No more than 20 minutes
Reduce pain, increase healing
increase blood flow
Heat pads
Cold therapy
Treats inflammation in injury
reduces edema, hematomas, muscle spasms, tissue metabolisms, exymatic activity and pain.
Cold compress, ice packs, ice baths
