Factors Influencing Pain

7/30/2019 Factors Influencing Pain

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QUIZ! QUIZ! QUIZ!


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1. It is considered as the fifth vital

sign


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2 .The type of Pain that lasts fromseconds to 6 months


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3 5 Give 3 Objective Cues of your answer inNumber 2


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6. These are also called pain receptors


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7. These are chemicals released thatexert inhibitory or excitatory activity at

postsynaptic nerve cell membranes


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8. Differentiate A delta fibers from Cfibers (2 Points)


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10 15. NociceptorsStimuli:

Mechanical

Thermal

____10_____

Mast cells

11

PNS

A delta fibers C fibers

Neospinothalamic tract

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Paleospinothalamic tract

1315

14


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Factors Influencing Pain


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Past Experience

Anxiety and Depression

Culture

Gerontologic Consideration

Gender

Genetics

Placebo Effect


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Nursing Assessment of Pain


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Characteristics of Pain

Intensity none-mild discomfort-

excruciating

Pain threshold the smallest stimulusfor which a person reports pain

Pain tolerance the maximum amount

of pain a person can tolerate


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Timing

Onset

DurationRelationship between time and intensity

Changes in rhythmic patterns


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Location

Quality

Personal measuring

Aggravating and Alleviating Factors

Pain Behaviors


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Instruments For Assessing the

Perception of Pain

Visual Analogue Scale (VAS)


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Faces Pain Scale


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PAIN MANAGEMENT

STRATEGIES


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PHARMACOLOGIC

INTERVENTIONS

Premedication AssessmentAllergies

History

OTC drugsPain status


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APPROACHES FOR USING

ANALGESIC AGENTS

BALANCED ANALGESIA

refers to the use of more than one form ofanalgesia concurrently to obtain more pain

relief with fewer side effects


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ANALGESIC AGENTS

Pro Re Nata (PRN)

using this method, the only way to

ensure significant periods of analgesiais to give doses larger enough to

produce periodic sedation


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ANALGESIC AGENTS

Preventive Approach

Considered the most effective strategy


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ANALGESIC AGENTS

Patient-Controlled Analgesia (PCA)

Allows patient to control the administration

of their own medication withinpredetermined safety limits

GOAL: achieve a minimum therapeutic level

of analgesia and to allow the patient to

maintain that level by using the PCA pump


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Patient-Controlled Analgesia

(PCA)

Advantages:Allows client to receive a predetermined IV

bolus of an opioid by hitting a syringe pump

mechanism

Gives client a sense of control, less anxiety

Provides quick and consistent pain relief

Maintains a constant level of pain relief

Eliminates the need for repeated injections

Saves time

Especially recommended for acute pain


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Patient-Controlled Analgesia

(PCA)

DisadvantagesRequires use of pump

Requires reinforced client teaching for

maximum effectivenessRequires two nurses to program to prevent

errors

Requires designated person to hit button if

client cannot


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Instruct patient:

Not to wait until the pain is severe before

pushing the button to obtain a bolus dose Do not become so distracted by an activity

or visitors that he/she forges to self

administer


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AGENTS USED TO TREAT PAIN


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OPIOIDS

GOAL: relieve pain

and improve quality

of life Work centrally by

blocking the release

of neurotransmitters

in the spinal cord


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Adverse Effects

ConstipationAssess previous bowel habits

Use measures to prevent this problem

Keep a record of bowel movementAdminister stool softeners and stimulant

laxatives

Suppository of fleets enema


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Adverse Effects

Nausea and VomitingAssess actual cause of nausea

Recognize that it can only be initial

Antiemetic prophylactic beforeadministration as prescribed

Prochlorperazine (Compazine) every 4 hrs

as prescribed

Metoclopramied 10 mg before meals and atbedtime as prescribed


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Adverse Effects

Sedation and ConfusionAsses the actual cause of sedation

Recall that tolerance to this side effect

generally occurs after 2 3 daysBe aware that stimulants such as caffeine

may counteract opiod-induced sedation

Consider opioid rotation using an

equianalgesic chart


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Adverse Effects

Respiratory DepressionBe aware that clinically significant

respiratory depression is rarely seen in

clients with severe pain due to cancer, even

when large doses of opioids are given

Recognize that pain and stress seem to

counteract the respiratory depression effects

of opioidsRecall that respiratory depression is usually

preceded by sedation


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Monitor sedation level and respiratory statusfrequently for the first 24 to 48 hours,

especially in opioid-naive clients

If increased sedation occurs, decrease

opioid dose and attempt to stimulate client

Be aware that respiratory rate alone is not

indicative of respiratory status


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NSAIDS

Thought to decrease pain by inhibiting COX

LOCAL ANESTHETIC


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LOCAL ANESTHETIC

AGENTS Work by blocking nerve conduction when applied

directly to the nerve fibers

Topical Application

Intraspinal Administration


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TCA

Antiseizure medications


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ROUTES OF ADMINISTRATION


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INTRAVENOUS

AdvantagesGood for acute pain or procedures

Immediate pain relief

Provides fastest onset but shortest duration

Peak in 5 15 minutes

Eliminates anxiety and prevents pain

Recommended when unable to achieve pain control

through oral or rectal routes with high dosages of

opioids or unable to use oral/rectal routesContinuous IV administration provides steady blood

level


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INTRAVENOUS

Disadvantages Not recommended for constant pain due to

peaks and valleys in bloodstream

Requires use of infusion pump (PCA) withalarm


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SUBCUTANEOUS

AdvantagesAvoids needs for IV and cheaper than IV

Readily managed at home

Recommended for cancer clients who cannot take

PO and IV access is not desirableavoids peaks and valleys in bloodstream; maintains

steady blood level

Provides prolonged parenteral administration of

opioidNo delay in drug administration


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SUBCUTANEOUS

Disadvantages SC boluses have slower onset and low

peak effect

Requires use of ambulatory infusion pump


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ORAL

AdvantagesPreferred route of analgesia

Allows greater mobility and convenience

Drug levels peak in 1 to 2 hours

Greater client satisfaction

If client is NPO or has NGT or GT, medications can

still be given orally

Cost efficient

Relatively steady blood levels produced


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ORAL

Disadvantages Slow onset

Long-acting opioids cannot be crushed,

broken or chewed Some clients are unable to swallow

Requires functional GIT


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RECTAL

AdvantagesGood for clients who are on NPO, nauseated or at

home

Easy for clients to administer, especially for the

elderlyDuration of action 4 6 hours

Any opioid can be compounded by a pharmacist for

rectal route

Clinical practice suggests oral and rectal doses ofanalgesics fairly equal


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RECTAL

Disadvantages May be more expensive than oral route

and difficult to obtain

Contraindicated to thrombocytopenic

clients


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TRANSDERMAL

AdvantagesNoninvasive, easy to use, accepted by clients


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TRANSDERMAL

Disadvantages Due to gradual increase in plasma

concentration, may need to supplement

with short-acting analgesics for first 12

24 hours after initial application

Costly

Difficult to adjust dose

Febrile clients absorb medication quickly Concerns over disposal


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TOPICAL

AdvantagesEasy to use

Little systemic absorption


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TOPICAL

Disadvantages May cause skin reactions


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SPINAL

AdvantagesPreservative free morphine

Useful for post operative pain

May be intermitted bolus or continuous


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SPINAL

Disadvantages Careful client selection is necessary

Many side effects

Complications


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NONPHARMACOLOGIC

INTERVENTIONS

Cutaneous stimulation and


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Cutaneous stimulation and

massage


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Thermal Therapies

Transcutaneous Electrical Nerve


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Transcutaneous Electrical Nerve

Stimulation (TENS)


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Distraction


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Relaxation Techniques


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Guided Imagery


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Hypnosis


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Music Therapy


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Alternative Therapies


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QUIZ!!!!


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True/False


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1. A patients definition of pain ishighly subjective, making nurses

and physicians the best authority of

the existence of pain.


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2. People who have had multipleexperiences with pain will be less

anxious and more tolerant of pain

than those who have had littleexperience with pain.


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3. Pain threshold and pain toleranceare terms that can be used

interchangeably when describing a

patients pain level.


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4. Alternate forms of communicationmust be used for patients with

sensory impairments and other

disabilities, because painassessment is such a vital part of a

patients care.


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5. The prn approach to administeranalgesics is no longer considered

the most effective strategy for pain

management.


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6 7. 8.

9. 10. 11

14.12 13


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What organ is found:

15. 16.


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17-19. Draw an assessment toolused to measure pain and explain

how it is used


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20 22. Give one approach in usinganalgesic agent and give one

advantage and disadvantage.


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23. Give the mechanism of action ofopioids


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24. How many hours doesrespiratory depression peak

after giving epidural opioids?


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25. How does cutaneous stimulationwork in managing pain?


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ASSIGNMENT

PROVIDE A COPY OF THECOMMON INSTRUMENTS USED

IN THE OPERATING ROOM WITH

PICTURES AND THEIR USEINYOUR NOTEBOOK.

Factors Influencing Pain

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