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What is pain
- Whateer the person experiencing
- the pain say it is-existing whenever he says it is and feeling however they say it does
What vital signs is pain categorized in?
- Fifth Vital Sign
- Not a vital sign but just as important like you would assess for.
Is pain objective or subjective?
- Its what the person states they are feeling.
- (Unless patients have objective signs of pain.)
Pain is a protective mechanism
Acute pain warns of tissue damage and alerts the body to protect itself.
- Usually has an identifiable cause following acute injury, disease or surgery.
- Localized in one place
- It begins rapidly, varies in intenity (mild to severe) and lasts briefly.
- Intense pain
- Less than 6 months
- If not taking care of quickly may become chronic
- Prolonged pain develops more slowly over 6 months
- Endorphins either cease to function or are reduced.
- Few outward signs because you might not see the cause
- The pain is outgoing and does not respond to treatment
- Patients will have time of remission and or exacerbation (increases in severity)
- Resistant to ain cure or relief
- No matter what we do never goes away
- Pain felt in a body part that is no longer there
- Ex: amputation, they still feel the pain of the limb that is no longer there.
- Perceived at the source and spreads to surrounding tissues.
- Ex: MI spreads one point moves or spreads to other.
3 physiology of pain
- Requires an intact peropheral nervous system and spinal cord.
- Common factors that distrubt pain reception include trauma, drugs, tumor growth and metaboblic disorders.
Reception: process starts with a stimulus (pain), name 4 stimulus:
Trauma, edema, blockage, tumor or muscle spasm
- Heat or cold
- Low or High temperature
- Tissue ischemia, perforation of an organ
- Leakage of hydrochloric acid out of stomach
The cellular damage releases pain producing susbstances:
- Enlarges blood vessels and lowers BP
- Smooth muscle contriction
Seprates the cells in the capillary walls and allows fluids and leukocytes to move into the area.
conduction of nerve impluses so impluse can travel
The stimulation causes (BHP) causes
- an action potential on nociceptors ( receptors that respond to harmful stimuli)
- Starting the nueral transmission of painful stimulus
- The conversion is known as transduction.
- Some tissues have numerous receptors
- Brain and alveoli ahve not pain receptors
- some receptors respond to many types of stimuli and other receptors to one type
Why do some people tolerate pain better than others?
Pain is indiviualized and it depends on there chemical makeup
Nerve impulses that travel along the different peripheral nerve fibers:
A delta fibers
- Carry sharp, localized distinct sensations
- Carry dull, achy, chronic type of pain
Example of A delta and C fibers
- Injection-hurts first at the site later the area hurts
- Like a flu shot
Speeds the transmission
- Increases receptiveness to pain and transmission
- (makes it hurt more)
When the impulse reaches the dorsl horn and the spinal cord
Neurotransmitters (substance P) released allow transmission into the CNS and higer brain centers.
Bodys protective reflux
- Stimulates motor pathways to withdraw from a pain source.
- therefore: you move away from a flame (superficial) you guard and tighten an area that hurts (internal)
Body is able to adjust to or modify the pain response-
nerve fibers send stimuli back down the dorsal horn causing release of neuroregulators that inhibt the painful stimuli.
Substances that affect the transmission of impluses across the synapse between nere fibers found at neve termainal within the dorsal spine and along receptor tracts.
Two types f of neuroregulators
- Affect the transmission of impluses
- Maybe be either exitatory or inhibatory
- Substance P
Neurotransmitters: Substance P
Needed to transit pain impulses from the periphery to higher brain centers.
Carries impluse faster across synapse.
an important regulator for pain sensation, the more the better to tolerate pain.
Increases pain sensitivy by also effecting bradykinin
- Natural morphine like substances
- They are activated by pain and stress
- Increased with exercise (ex. football playes get hurt but don't realize it right away)
- Released from plasma that leaks from surrounding blood vessels at the site of tissue injury.
- Causes releases of prostaglanin-which release sensitivy of pain.
- The pain becomes real
- The point at which the person is aware of the pain
- Gives meaning of the pain
- It travels to the limbic system (same part that controls emotions anxiety)
- Once it has meaning the patient reacts to pain
Patients with an impaired limbic system respond
- Differently to pain.
- They will have a dramatic response to pain.
- Opoids mess with the limbic system
Autonomic nervous system activated
Low to moderate pain - sympathetic nervous system
Scale 2,3, or 4
- Increase: R, HR, B/P, Glucose, diaphoresis, muscle tension, pupil dilation
- Decrease GI motility
Severe pain - parasympathetic system
- Blood shift from periphery -pallor
- decrease HR and B/P
- Tachypnea (rapid breathing) and irregular R
Three behavioral responses:
- Person knows pain will occur
- Explain to patient what to expect
- Pain threshold-level at which the pain is felt
- Pain tolerance-pain a person is willing to tolerate
- Aftermath-occurs afther the pain is reduced or stopped. might get rid of pain but still have physical signs of it.
Factors affecting the pain experience:
- Age: the very young and old may not express pain well
- Gender: men and women respond differently
- Culture: concepts of acceptable behavior affect a persons reaction
- The meaning of pain: some are good ex labor
- Attention: the more you pay attenton the more you feel
- Anxiety: the more you have the worse you feel
- Fatigue: the more you are the worse you feel
- Previous exerience: may effect either way. no experience with pain might cause you to panic
- Coping style: people in control tolerate pain better ex. PCA(patient control anaglesia)
- Support system: may effect either way
- A- ask about pain regulary
- B- believe patient
- C-choose appr. control
- D-deliver pain relief in a timely manner
- E-Empower the patient towards pain control an Educate about the pain and controlling it.
For Nursing Interventions:
- P-precipate factors
- R-relief measures
- U- effect of pain o patient
- Precise location
- Precipating factors
- Alleviating factors
- Associated symptoms
- Effects of ADL's
Assessment Behavorial Responses:
- Facial expression
- clenching of teeth
- Closed eyes
- Biting lip
- Speech and Vocal Pitch
- Immobilization of body parts
- Purposeless, rythmic movements
Assessment Physiological Responses:
- Increase B/P P R
- Dilated pain
- chronic pain
- ineffective indiviual coping
- Impaired mobility
- sleep pattern distrubance
Implementation: general stratgies
- Acknowledge pts pain
- assist significant other to manage pain
- provide accurate information
- try heat or cold but some might need an order
- treat anxiety as well
- theraputic touch
- cutaneous stimulation
Specific strategies: anaglesics
these alter the perception and inerpretation of the pan generally by depressing the CNS at the thanlmus and cerebral cortex
Basically they raise the pain thresold therefore MUST be given before the pain is sever
Two major classifications
- ASA-Salicylates- (aspirin) use for mild to moderate interferes with release of prostagladin.
- Antipyretic- reduces fever
- May cause iron insufficiency
- Acetaminophen (tylenol)
- similar to ASA
- Not anti flammatory
- Doesn't inhibit platelet
- NSAID's (mortin)
- No for to reduce fever
- Opiod agonist- Morphine and Demerol
- Bind t opiate receptors and interfere with impluse transmission
- Sever pain
- addiction can lead 3-6-8 continuous
- Assess respirations
- IM Z tack method
- Opiod agonist/antagonist
- Less respiratory supression
- (Narcan- for overdose revert of opiod)
anything that produces an effect on a patient because of its intent rahte than its properties.
There is 3 types of analgeics
- nonopioid-acteamiophen, aspirin, nonsteriodal inflammatory
- Opoid (severe pain) narcotic codeine, morphine, demerol
- Adjuvant or coanalgesic-sedatives, anticonvulants, steriods, or antidepressants