Concepts Related to the Care of IndividualsConcepts Related to the Care of Individuals

PAINPAIN

Concepts of Nursing NUR 123

PainPain

Is a highly unpleasant and very personal Is a highly unpleasant and very personal sensation that cant be shared with other.sensation that cant be shared with other.

It is considered the fifth vital sign.It is considered the fifth vital sign.

It is one of the human body defence It is one of the human body defence mechanisms that indicates the person is mechanisms that indicates the person is experiencing problem. experiencing problem.

Sources of PainSources of Pain

NociceptiveNociceptive: pain that is usually transmitted : pain that is usually transmitted after normal processing of noxious stimuli after normal processing of noxious stimuli

NeuropathicNeuropathic: results from injury or abnormal : results from injury or abnormal functioning of peripheral nerves or CNS functioning of peripheral nerves or CNS

PsychogenicPsychogenic: unknown physical cause : unknown physical cause

PHYSIOLOGY OF PAIN

SOURCES

Chemical/Thermal

Injury, Inflammation Heat, Cold

PAIN RECEPTORS

(Nociceptors)

DISCHARGE IMPULSES

Electrical Activity to spinal cord and onto the Brain

BRAIN = Electrical activity becomes the experience of

PAIN

Duration of pain Duration of pain

Acute pain: generally rapid in onset, varies in Acute pain: generally rapid in onset, varies in intensity from mild to severe, lasts from brief intensity from mild to severe, lasts from brief period to less than 6 months period to less than 6 months

Duration of painDuration of pain

Chronic pain: may be limited, intermittent or Chronic pain: may be limited, intermittent or persistent but lasts for 6 months or longer and persistent but lasts for 6 months or longer and interferes with normal functioning. interferes with normal functioning.

Remission: when the pain present but the patient does Remission: when the pain present but the patient does experience symptomsexperience symptoms

Exacerbation: reappearance of symptoms Exacerbation: reappearance of symptoms

Intractable pain: resistant pain to therapy, and persists Intractable pain: resistant pain to therapy, and persists despite a variety of interventionsdespite a variety of interventions

Origin of PainOrigin of Pain

Physical cause — cause of pain can be Physical cause — cause of pain can be identifiedidentified

Psychogenic — cause of pain cannot be Psychogenic — cause of pain cannot be identifiedidentified

Referred — pain is perceived in an area Referred — pain is perceived in an area distant from its point of origindistant from its point of origin

Pain thresholdPain threshold

Is the lowest intensity of stimulus that causes Is the lowest intensity of stimulus that causes the subject to recognize pain the subject to recognize pain

Common Responses to PainCommon Responses to Pain

Physiologic: ↑BP, ↑HR,↑RR, pupil dilation, Physiologic: ↑BP, ↑HR,↑RR, pupil dilation, muscle tension and tension rigidity, pallor, muscle tension and tension rigidity, pallor, ↑adrenaline level, ↑blood glucose ↑adrenaline level, ↑blood glucose

Behavioral: grimacing, moaning, crying, Behavioral: grimacing, moaning, crying, restlessnessrestlessness

Common Responses to PainCommon Responses to Pain

Affective: exaggerated weeping, Affective: exaggerated weeping, withdrawal, anxiety, depression, fear, anger, withdrawal, anxiety, depression, fear, anger, anorexia, fatigue, hopelessness, anorexia, fatigue, hopelessness, powerlessness.powerlessness.

Factors Affecting Pain ExperienceFactors Affecting Pain Experience

CultureCulture Ethnic variablesEthnic variables Family, gender, and age variablesFamily, gender, and age variables Religious beliefsReligious beliefs Environment and support peopleEnvironment and support people Anxiety and other stressorsAnxiety and other stressors Past pain experiencePast pain experience

General Assessments of PainGeneral Assessments of Pain

Patient’s verbalization and description of painPatient’s verbalization and description of pain

Duration of painDuration of pain

Location of painLocation of pain

Quantity and intensity of painQuantity and intensity of pain

Quality of painQuality of pain

General Assessments of PainGeneral Assessments of Pain

Chronology of pain Chronology of pain

Aggravating and alleviating factorsAggravating and alleviating factors

Behavioral responsesBehavioral responses

Effect of pain on activities and lifestyleEffect of pain on activities and lifestyle

Pain Assessment ToolsPain Assessment Tools

Pain Assessment ToolsPain Assessment Tools

Pain assessment tools Pain assessment tools

WILDA Scale WILDA Scale

WWords that describe the painords that describe the pain IIntensity of painntensity of pain LLocation of painocation of pain DDuration of painuration of pain AAggravating or ggravating or AAlleviating factorslleviating factors

Diagnosing PainDiagnosing Pain

Type of painType of pain

Etiologic factorsEtiologic factors

Behavioral, physiological, affective responseBehavioral, physiological, affective response

Other factors affecting pain processOther factors affecting pain process

Nursing Diagnosing Diagnosing

NANDA includes the following diagnostic labels for clients experiencing pain or discomfort:

Acute pain Chronic pain

When writing the diagnostic statement, the nurse should specify the location (e.g, left frontal headache)

Nursing DiagnosingDiagnosing

Pain may be the etiology of other nursing diagnosis. e.g:

-Disturbed sleep pattern related to increased pain perception at night

Nursing Interventions for PainNursing Interventions for Pain

Establishing trusting nurse-patient relationshipEstablishing trusting nurse-patient relationship

Initiating nonpharmacologic pain relief measuresInitiating nonpharmacologic pain relief measures

Considering ethical and legal responsibility to relieve Considering ethical and legal responsibility to relieve painpain

Teaching patient about pain and home careTeaching patient about pain and home care

Manipulating Pain Experience FactorsManipulating Pain Experience Factors

Remove or alter cause of painRemove or alter cause of pain

Alter factors affecting pain toleranceAlter factors affecting pain tolerance

Initiate nonpharmacologic relief measuresInitiate nonpharmacologic relief measures

Nonpharmacologic Pain Relief MeasuresNonpharmacologic Pain Relief Measures

DistractionDistraction HumorHumor MusicMusic ImageryImagery RelaxationRelaxation Acupuncture Acupuncture HypnosisHypnosis Therapeutic touchTherapeutic touch

DistractionDistraction

ImageryImagery

RelaxationRelaxation

AcupunctureAcupuncture

HypnosisHypnosis

Therapeutic touchTherapeutic touch

Pharmacologic Pain Relief MeasuresPharmacologic Pain Relief Measures

Analgesic administrationAnalgesic administration

Nonopiod analgesics e.g. NSAIDsNonopiod analgesics e.g. NSAIDs

Opioids or narcotic analgesicsOpioids or narcotic analgesics

Adjuvant drugs e.g. anticonvulsants, Adjuvant drugs e.g. anticonvulsants, antidepressants, .. antidepressants, ..

Why clients may be reluctant to reportWhy clients may be reluctant to report pain:pain:

Fear of injectable route of analgesic administrationFear of injectable route of analgesic administration

Belief that pain is to be expected as apart of the recovery Belief that pain is to be expected as apart of the recovery processprocess

Belief that pain is a normal part of agingBelief that pain is a normal part of aging

Belief that expression of pain reveal weaknessBelief that expression of pain reveal weakness

Concerns about side effects and risks especially of opioid Concerns about side effects and risks especially of opioid drugs drugs

Additional Methods for Administering Additional Methods for Administering AnalgesicsAnalgesics

Patient controlled analgesiaPatient controlled analgesia

Epidural analgesiaEpidural analgesia

Local anesthesiaLocal anesthesia

Patient controlled analgesiaPatient controlled analgesia

Epidural analgesiaEpidural analgesia

Local anesthesiaLocal anesthesia