TLO 2.7a Pain/sleep Flashcards
Pain defined
Multidimensional consisting of sensory, physiological, cognitive, affective, behavioral and spiritual components. It may be an invisible problem that you can not see
Painful Stimuli
CHEMICAL EX.
Ischemia
Tissue trauma
Inflammation
Painful Stimuli
MECHANICAL EX.
Spasms
Compression
Extreme muscle stretch/contraction
Painful stimuli
THERMAL EX
Contact with extreme heat or cold
Pain Assessment
PQRST
Precipitating factors Qualities Region or location Severity Timing
Assessment
SUBJECTIVE VS OBJECTIVE
Subjective: communicate by client/family, feelings, beliefs, sensations
Objective: physical assessment, labs, test, measurable
Factors affecting responses to pain
Age
Gender
Sociocultural
Psychological influences
How body reacts to pain
PHYSIOLOGIC RESPONSES
Muscle tension Tachycardia Rapid shallow resp Increase BP Dilated pupils Sweating/Pallor
How body reacts to pain
BEHAVIORAL RESPONSES
Facial grimacing
Bracing/guarding painful part
Crying
Moaning
What is Nociceptive pain?
Occurs when pain receptors respond to stimuli caused by trauma, surgery, inflammation
Two types of nociceptive pain?
Visceral: organs, internally
Somatic: skin, muscle, bone, connective tissue
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
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
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
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
Three types of Acute Pain?
Somatic
Visceral
Referred Pain
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.
