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The flashcards below were created by user
alyn217
on FreezingBlue Flashcards.
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Factors affecting pain
- Age/developmental stage
- Gender
- Culture
- Meaning of pain
- Previous experience
- Attention
- Anxiety
- Fatigue
- Coping style
- Family and Social support
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Classification of pain
- Superficial
- Visceral
- Somatic: bones/muscles
- Radiating/referred
- Phantom: pain from an abscent source, ie amputated
- Psychogenic
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What is breakthru pain/
Transitory exacerbation of pain that occurs on a background of otherwise stable pain in a patient receiving chronic opioid therapy.
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what is nocioceptive pain
- The process by which information about tissue damage is conveyed to the central nervous system (CNS). Exactly how painful stimuli is perceived as pain is unclear.
- There can be pain without nociception (e.g., phantom limb pain) and nociception without pain.
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4 Processes of pain
- 1) transduction: pain stimuli
- 2) transmission: pain signals transfered to brain
- 3) perception: signals interpreted as pain
- 4) modulation: down reg of response.
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Steps in pain management and assessment
- Definition
- Recognition
- Assessment
- Treatment
- Monitoring
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Principles of pain assessment
- Assess and reassess
- Use methods appropriate to cognitive status & context
- Assess intensity, relief, mood & side effects
- Use personal verbal report whenever possible
- Document in a visible place
- Expect accountability – staff, family, patient
- Elevate importance of pain management
- Engage patient & family/loved ones
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Roe of nurse in pain management
- Requires effective patient advocacy that takes
- Time
- Patience
- Courage
- Must establish:
- Trust
- Rapport
- And communicate, “I believe you are in pain”
- Must identify pain and share information with health care team as well as family
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Attitudes of openness and availability
- I want to discuss with you what your pain means to you
- I am willing to stay with you even if I fail to help control your pain
- I f you cannot relate to me, I will try to find someone else for you.
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Barriers and false beliefs
- Belief that failure of the patient to express pain equates with the absence of pain
- Patient fears
- Belief by older adults that pain is an inevitable consequence of aging
- Belief by the patient that caregivers know pain is present and are doing all they can to relieve it
- Lack awareness on the part of the patient that effective pain management is their right
- Fear that persistent use of PRN and IM medications will cause them addiction
- Fear of medication side effects/addiction
- Fear of being seen as a complainer
- Fear the meaning of the pain
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Joint Commission
says we MUST assess and treat
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Methods of assessing pain
- Visual Analogue Scale (VAS)
- Numeric Rating Scale (NRS)
- Simple descriptor scale
- Wong-Baker Faces Pain
- Rating Scale
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What is your goal with pain management
- To reach the pain number the pt states is tolerable.
- Is subjective.
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Which pain assessment tool is best?
- No single preferred assessment tool
- Individualize the tool for your patients
- Make sure the patient understands the scale
- Use the same scale with each assessment
- Familiarity with 2 tools is suggested
- Education of staff vital
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FLACC scale
- scored scale based on location and responses.
- Face
- Legs
- Activity
- Cry
- Consolability
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Populations requiring special consideration
- Inadequate pain assessment
- Concommitent pain from another source
- Better performance status
- High expectations for optimal management
- Old & Young
- Allergies
- Culture and traditions
- History of substance abuse(ETOH or drug)
- Chronic and preoperative pain history
- High anxiety about post-operative problems
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Nonverbal signs of pain in the elderly
- Increased confusion
- Decreased decision-making skills
- Decreased communication
- Combative behavior
- Impaired mobility
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Goals of pain management
- Establish a baseline
- Define a cause
- Or not
- Sometimes don’t know the cause
- Select interventions
- Evaluate response to treatment
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Nonpharmacy pain intervensions
- Cutaneous stimulation:
- Based on “gate control” theory
- TENS-electrodes to override nerves.
- PENS
- Acupuncture
- Acupressure
- Massage
- Use of heat and cold
- Contralateral stimulation
- Distraction
- Progressive muscle relaxation
- Guided imagery
- Hypnosis
- Therapeutic touch
- Humor
- Journaling
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Postop pain management options
- On-Q pump
- Patient Controlled Analgesia (PCA)
- Epidural
- Regional Anesthesia
- Oral Medications
- Opiods
- Nonopiods
- Adjuvants
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consequences of poorly treated pain
- Gait Disturbances
- Falls
- Cognitive dysfunction
- Agitation or restlessness
- Polypharmacy like use of 9 or more medications
- Increased nursing time
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Chronic pain assessment in the elderly
- Unreliable signs:
- Hypertension
- Tachycardia
- Diaphoresis
- Pupillary dilitation
- Sleep cycle changes
- Change in mood
- Resisting care
- Change in behavior
- Changes in ROM/ADL’s
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Pearls for elderly pain treatment
- Routine not PRN dosing
- Start low, go slow BUT GO!!!!
- Least invasive route
- Reassess frequently
- “He who write the narcotic, writes the cathartic”
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Warning signs for drug seeking behaviors
- Preference for short acting or bolus opioids
- Reports that “nothing else helps”
- Multiple Prescribers:Multiple Pharmacies
- Noncompliance with other therapies
- Continued use despite adverse effects
- Loss of Control
- Not taking prescribed meds
- Repeatedly “running out” or “losing meds”
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