Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 14

PAIN MANAGEMENT

Pain

An unpleasant sensory sensory and emotional experience associated with actual or potential tissue damage.

Whatever the client says it is, existing whenever the client says it does.

Nature of Pain

A major function of pain is to signal ongoing or potential tissue damage.

Pain can also be a protective mechanism against further injury.

Types of Pain

Pain Categorized by Origin.

Pain Characterized by Nature.

Pain Characterized by Origin

Cutaneous Pain (caused by stimulation of the cutaneous nerve endings in the skin).

Somatic Pain (nonlocalized and originates in support structures such as tendons, ligaments, and nerves).

Visceral Pain (discomfort in the internal organs).

Referred Pain (originating from the abdominal organs).

Pain Characterized by Nature

Acute Pain: Sudden onset, relatively short duration; mild to severe intensity; steady decrease in intensity over days to weeks.

Chronic Pain: Long-term (lasting six months or longer), persistent, nearly constant, or recurrent pain that produces significant negative changes in the client’s life.

Physiology of Pain

The body cannot sustain the extreme stress response of pain for more than short periods of time.

The body will conserve its resources by adapting even in the face of continuing pain of the same intensity.

The Gate Control Theory of Pain

Theorizes that person experiences pain with combination of these processes: Sensory. Motivational-Affective. Cognitive.

Conduction of Pain Impulses

Transduction (stimulus triggered). Transmission (impulse travels to spinal

cord). Perception (neural message converted

into subjective experience). Modulation (pain transmitters selectively

inhibited).

Factors Affecting Pain Experience

Age. Previous Experience with Pain. Cultural Norms.

Assessment: Subjective Data

Location of pain. Onset and duration. Quality. Intensity (on a scale of 1 to 10). Aggravating and relieving factors. How pain affects the activities of daily

living.

Assessment: Objective Data

Physiologic (Acute pain involves elevated respiratory rate and blood pressure; pallor; dilated pupils, etc. Chronic pain shows adaption).

Behavioral (Acute pain behaviors include crying, moaning, clenched fists, etc. Chronic pain behaviors include depression, listlessness, loss of libido and weight).

Nursing Diagnoses

Two primary diagnoses used to describe pain are acute and chronic.

General Principles of Pain Relief

Individualize the approach. Use a preventive approach. Use a multidisciplinary approach.

Nursing Interventions

Pharmacological. Noninvasive. Invasive.

Nurse’s Role in Administering Analgesics

Determine whether or not to give the analgesic.

Assess the client’s response to the analgesic.

Report to the physician when a change is needed.

Teach the client and family regarding the use of analgesics.

Principles of Administering Analgesics

Preventive approach.

Titrate to effect.

Preventive Approach

Pain is much easier to control if treated when it is anticipated or at a mild intensity.

Two methods of preventive approach are ATC (around the clock) and PRN (“as required”).

Titrate to Effect

The analgesic regimen needs to be titrated until the desired effect is achieved.

This involves adjusting the following: Dosage. Interval. Route . Choice of drug.

Three Classes of Analgesics

Nonopioid. Opioid. Analgesic adjuvants.

Cognitive-Behavioral Interventions

Trusting Nurse-Client Relationship.

Relaxation. Reframing.

Distraction. Guided Imagery. Humor. Biofeedback.

Reframing

Teaching clients to monitor their negative thoughts and replace them with ones that are more positive.

Guided Imagery

Using one’s imagination to provide a pleasant substitute for the pain.

Biofeedback

A process through which individuals learn to influence their physiological responses to stimuli.

Cutaneous Stimulation

The technique of stimulating the skin to control pain.

Includes: Heat and cold application. Cryotherapy (cold applications) Acupressure and massage. Mentholated rubs. Electrical Nerve Stimulation.

Transcutaneous Electrical Nerve Stimulation

The process of applying a low-voltage electrical current to the skin through cutaneous electrodes.

Other Noninvasive Pain Interventions

Psychotherapy (including hypnosis). Exercise. Positioning and Body Alignment.

Invasive Pain Interventions

Used when noninvasive and pharmacological measures do not provide adequate relief.

Include: Nerve block. Neurosurgery. Radiation therapy Acupuncture.