week 11- pain and comfort Flashcards
comfort
- a personal and intrinsic balance of the most basic physiological, emotional, social and spiritual needs
- unique perception to each person
- without some level of comfort, wellness is beyond reach
pain
- a sensation of distress and can occur at a physical psychological and spiritual level
- multidimensional phenomenon
- any type of pain can result in reduced socialization, impaired mobility and a reconsideration of the meaning of life and self
how we talk about pain
- influenced by the persons unique history and the meaning they ascribe to pain
- a person responds to pain reflecting culturally acceptable behaviour
total pain
a) social pain: family, relationships, work, finances
b) spiritual pain: existential issues, meaning of life
c) physical pain: side effects, physical decline
d) psychological pain: grief, depression, anxiety, anger
physiology of pain
- transduction of pain signal into an action potential
- transmission of this signal from the site of injury to the thalamus/cortex for processing
- the signal is perceived as pain
- pain can be modulated by other pain/touch sensations
classification of pain by time
acute (up to 6 months) or chronic (6 months or longer)
classification of pain by inferred pathology
- nociceptive pain: injury or tissue damage
- can be somatic or visceral - neuropathic pain: damage to NS
- centrally generated or peripheral generated pain
acute pain
- rapid onset
- less than 6 months
- varies in intensity and duration
- protective in nature
- usually easily controlled with medication
- usually resolves as pathology resolves
persistent physical pain
- intermittent or always present
- lasted more than 6 months
- interferes with normal functioning
- can occur in absence or apparent illness, degenerative diseases or auto-immune
- often not well controlled with medications only
- older adults under report because of stigma, burden, fear of addiction
somatic pain
- results from injury or inflammation of tissues
- sharp, throbbing in quality and is well localized
visceral pain
- tumour, chemical or ischemia in organs
- aching, intermittent or cramping
- less well localized and sometimes referred
central nerve damage
- cancer, trauma, pressure, spinal cord injury
- severe sharp pain, continuous or exacerbations
peripheral nerve damage
- diabetic neuropathy, trauma to nerve, chemo/radiation therapy, herpes zoster, fibromyalgia
- burning or electric shock sensation along the nerve
factors influencing pain in OA
culture, mental health, experiences, gender, altered physical wellness
barriers in assessing and treating pain in OA
under-reporting of pain, inability to swallow pills, fear, perception of pain by others, cognitive function
assessing pain in OA
- impact on ADLs
- expressions of pain (change in disease state, irritability, withdrawal)
- effect of pain on relationships
- pain history (previous approaches, beliefs)
OPQRSTUV (pain)
onset, provocation or palliation, quality, radiation/region, severity, timing/treatment, understanding, values
OLDCART (pain)
onset, location, duration, characteristics, aggravating factors, relieving factors, treatment
pain assessment tools
- numeric scale
- visual analogue scale
- verbal descriptor scale (mild, moderate severe)
pain in dementia patients
- often goes undiagnosed
- can be communicated through agitation, aggression, increased confusion, passivity
- assessed using PAINAD (pain assessment in advanced dementia), PACSLAC (pain assessment checklist for seniors with limited ability to communicate) or faces scale
non-pharmacological pain management
a) physical: touch, cutaneous nerve stimulation, transcutaneous electrical nerve stimulation, heat/ice, acupuncture, positioning, movement
b) cognitive behavioural approaches:biofeedback, distraction, meditation, imagery, relaxation, music
forms of distraction
a) visual- reading, watching TV, scenery, guided imagery
b) auditory- humour, listening to music
c) tactile- massage, petting a dog
d) intellectual- crossword puzzle, card games, hobbies
nursing actions in promoting comfort
- determine if there is a reversible cause such as a UTI or fracture
- comfort measures include use of pillows for support or body positioning, comfortable seating/mattresses, frequent rest periods, pacing of activities
- encourage patient to stay as active as possible
pharmacological pain management in OA
- use a combo of pharm and non-pharm measures
- give adequate amounts of pain meds at the appropriate frequency
- use round the clock dosing (avoid PRN)
- use drugs that potentiate each other
- with narcotics, start at low doses
- anticipate and prevent side effects
