TLO 2.7a Pain/sleep Flashcards by jodi Trethewey

Pain defined

Multidimensional consisting of sensory, physiological, cognitive, affective, behavioral and spiritual components. It may be an invisible problem that you can not see

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Painful Stimuli

CHEMICAL EX.

Ischemia
Tissue trauma
Inflammation

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Painful Stimuli

MECHANICAL EX.

Spasms
Compression
Extreme muscle stretch/contraction

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Painful stimuli

THERMAL EX

Contact with extreme heat or cold

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Pain Assessment

PQRST

Precipitating factors
Qualities
Region or location
Severity
Timing

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Assessment

SUBJECTIVE VS OBJECTIVE

Subjective: communicate by client/family, feelings, beliefs, sensations
Objective: physical assessment, labs, test, measurable

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Factors affecting responses to pain

Age
Gender
Sociocultural
Psychological influences

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How body reacts to pain

PHYSIOLOGIC RESPONSES

Muscle tension
Tachycardia
Rapid shallow resp
Increase BP
Dilated pupils
Sweating/Pallor

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How body reacts to pain

BEHAVIORAL RESPONSES

Facial grimacing
Bracing/guarding painful part
Crying
Moaning

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What is Nociceptive pain?

Occurs when pain receptors respond to stimuli caused by trauma, surgery, inflammation

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Two types of nociceptive pain?

Visceral: organs, internally
Somatic: skin, muscle, bone, connective tissue

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What is neuropathic pain?

Pain that arises when injury to nerves result in repeated transmission of pain signal in absence of pain stimuli
ex: diabetes, tumors, vial infections, chemotherapeutic agents

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Pain duration

ACUTE PAIN

Varies in intensity
Short duration
Limited tissue damage
Eventually resolves w/wo treatment after area heals
ex: acute injury, disease, surgery

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Pain duration

CHRONIC PAIN

Dramatic effect on person’s quality of life
Prolonged
Varies in intensity
Usually last longer than 6 mo
Not always have identifiable cause
ex:arthritis, low back, HA, fibromyalgia, peripheral neuropathy

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Pain duration

INTRACTABLE PAIN

Doesn't go away
Difficult to treat/manage
Is not curable
Frustrating to pt
Multiple method approach to relief
ex: muscle spasms

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Three types of Acute Pain?

Somatic
Visceral
Referred Pain

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What is referred pain?

Tenderness or increased pain away from the area of injury or disease involving visceral organs

Three categories of chronic pain?

Recurrent acute pain: migraine
Chronic malignant pain: cancer
Chronic nonmalignant pain: lower back

What is Breakthrough pain?

Pain that exceeds baseline chronic or persistent pain.

Unpredictability and inconsistency can be debilitating

Non-pharmacological interventions for pain

Relaxation/guided imagery
Distraction
Hypnosis
Music
Cutaneous stimulation (TENS)
Herbs (check med interactions)
Promote comfort

Pharmacological interventions for pain

Analgesics:
non-opioids (acetaminophen, NSAIDs)

opioids (morphine, hydromorphone, fentanyl, oxycodone, hydrocodone

adjuvants (variety of medication that enhance analgesics)

Physical pain relief strategies

Massage
Exercise
Acupuncture
TENS
Cold/hot therapy

Things to consider when choosing appropriate medications

Pt’s in severe pain should start at step 3
Pt’s monitoring should be regular & continuous
Assess pain and determine where on ladder to start
Important to know potential interactions and side effects along the way

Choose appropriate medication steps 1, 2, 3

Sept 1: pain persisting or increasing
nonopioid/adjuvant
Step 2: pain persisting/increasing
Opioid for moderate to severe pain, nonopioid/adjuvant
Step 3: freedom from cancer pain
Opioid for moderate to severe pain, nonopioid/adjuvant

Opioid side effects?

``` Sedation Drowsiness Dizziness Itching Constipation CNS/Respiratory depression ```

Patient controlled analgesia (PCA)

``` Self administration of med Patient control Programmable pump w/ lockout Patient only button Narcan available ```

What does local anesthesia do?

Interrupts the generation of nerve cells by altering the flow of sodium into the nerve cells through cell membranes. Can be topical, ophthalmic, nebulized or injected

Assessment pain according to developmental level | NEWBORNS

NB can feel pain By 6 mo demonstrate anticipatory fear of pain if had prior experience Children in acute pain may behave in similar ways with anxiety/fear

Assessment pain according to developmental level | TODDLERS

Cry longer than infants, verbalize discomfort by saying ouch/hurt, associate discomfort with procedure, face may show anger/fear

Assessment pain according to developmental level | PRESCHOOL

Egocentric and relate only to the present, difficulty associating pain with positive outcome, thinks it will magically go away or that they are being punished

Assessment pain according to developmental level | SCHOOL AGE

Can describe pain and relate to body part, quantify pain intensity, beginning to understand painful procedures, fear body harm, awareness of death

Assessment pain according to developmental level | ADOLESCENT

Can think abstractly, understand cause and effect, are able to perceive/understand pain, egocentric, think that others focus on their behavior, won't report pain

Non pharmacological management of pain in children

Form trusting relationship with family Prepare the child for painful procedures w/o planting idea of pain Stay with child during procedures Educate the child about pain Give the child doll allow the child to do everything to the doll that will be done to the child

Non pharmacological management of pain in children pt 2

``` Distraction Relaxation Guided imagery Positive self talk Hypnosis Behavioral contracting ```

Pharmacological management

Nonopioids are used for mild to moderate pain Children over 6 mo metabolize drugs faster than adults therefore younger children need higher doses to achieve same effect Children's doses are calculated according to body weight

Pain scale | FLACC

``` Face Legs Activity Cry Consolability Numeric scale, 0-10 points, higher the points the more pain Best used: nonverbal, preverbal, infants ```

Pain scale | FACES

Six cartoon faces from no pain to worse pain. Words and faces a child can easily point to the picture that bests describes their pain. Best used with 3+ years old

Pain scale | NUMERIC/VERBAL

Patient is asked to rate their pain from zero, being no pain to 10 being severe pain. This is best used with children 9+ year old

Pain scale | PAINAD

``` Pain assessment for advanced dementia Breathing Negative vocalization Facial expression Body language Consolability Numeric scale, higher the score, higher pain level ```

Nursing responsibilities with PCA use

Pt education on how to use prior to procedure Inform pt the purpose of a PCA Explain the pump reduces risk of overdose Tell family/friends not to push button for pt Evaluate pt's pain while using PCA

Nursing care for patients with Epidural Infusions

``` Prevent catheter displacement Maintain catheter function Prevent infection Monitor for resp depression Ensure adequate hydration Notify prescriber if significant change in VS Assess for N/V Maintain urinary/bowel function ```

Gate control theory?

Emotional, cognitive and physical sensations. Gating mechanisms located along CNS regulate/block pain impulses. Pain passes through when open, blocked when closed Closing the gate is the basis of nonpharmacological pain relief intervention.