Promoting healthy adaption to pain

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Promoting healthy adaption to pain
2014-04-25 17:12:58

fundamentals nursing
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  1. Defining the pain experience
    Pain is whatever the person says it is, existing whenever it was

    Pain is an unpleasant sensory or emotional experience associated with actual or potential damage or described in terms of such damage

  2. Neuroanatomy of Pain
    Affrent fibers (nociceptors) carries impulses from the pain receptors to the CNS (brain)

    a delta fiber is a large nerve fiber covered with myelin, and conducts pain impulses rapidly

    c fibers- smaller nerve fibers and have no myelin and conduct pain more slowly
  3. Neuroanatomy of pain continues
    how does the pain get to the brain (substance that increase pain)
    substances that increase pain transmission and cause inflammatory response by stimulating nociceptors (pain receptors) are known as neurotransmitters (chemical mediators)

    substance increases pain - inflammatory these are chemical mediators

    • Substance P
    • Protaglandins
    • bradykinin
    • histamine
  4. Neuroanatomy of Pain decrease pain
    Substances that decrease pain transmission and procedures analgesia

    • Neuromodulators
    •   - endorphins
    •   - enkephalins
    •   - serotonin (ATI)

    think about runners- after u ran u feel better
  5. Dorsal Horn
    spinal cord that helps to transmit signal of pain
  6. the pain process
    • Transduction- activation of pain receptors
    • * transmission- msg to the brain (conduction along pathways a delta and c delta fibers)

    perception of pain- awareness of the characteristics of pain (pt perception)

    modulation- (fyi) inhibition or modification of pain
  7. Transmission
    routing the pain sensation from the site of injury or inflammation to the spinal cord and then to the brain

    • mechinal- injury
    • thermal- heat hot/cold
    • chemical- burn, acid
    • eletrical agent

    pain is someways is diagnostic- u have to always check it out
  8. Protective pain reflex
    if u touch a hot stove and u move ur hand. u are protecting urself

    elders may not have these receptors though
  9. perception
    - person interpretation of pain
  10. Pain Threshold
    the lowest intensity of stimulas that causes the person to recognize pain. the first time the pt recognizes that they are in pain
  11. Pain tolerance
    duration or intensity of the pain that the pt is willing to endure. 

    how much pain can u take
  12. Modulation of Pain
    initiation of protective reflex response 

    Nueromodulators- endogenous opioid compound

    • endorphins
    • dynorphins
    • enkephalins
  13. Responses to pain
    • behavioral (voluntary response)
    • - moving away from pain stimuli, moaning and grimacing, crying, restlessness, protecting the area and refusing to move

    • Physiological (involuntary)
    • - sympathetic response- increase BP, P, RR, (with acute pain), pupil dilation, muscle tension, regidity pallor, increase adrenalin outputm increase glucose

    • parasympathic
    •  decrease BP, P, and rapid and irregular breathing, nausea and vomiting, fainting, or unconscious, prostation

    • Psychological 
    • exaggerated weeping and restlessness, withdrawal, stoicism, anxiety, depression, fear, anger, anorexia, fatigue, hopelessness, powerlessness
    • -
  14. Origin of Pain
    Physical- cause of pain can be identified- headache, broken leg

    Psychogenic- cause of pain cannot be identified

    referred pain- is pain is in an area that is distant to where the actual place heart attack is felt is jaw and neck
  15. Types of Pain
    • Classification
    •  duration
    •  location or source
    •  mode of transmission
    •  etiology
  16. Duration of pain
    How long does the pain last

    Acute pain- rapid in onset, varies in intensity. identifiable cause, protective (broke leg, sunburn, incision)

    • chronic pain- maybe limited, intermitted, or persistent
    • interferes with ADL's and quality of life
    • periods of exarcerbation and remission
    • can be malignant or non malignant
  17. Acute v chronic pain
    • Acute
    • Physiological response
    • behavioral response
    • intervention
    • (pain meds)

    • Chronic 
    • physiological response
    • behavioral response
    • intervention
    • (rehab, more than just meds lifestyle change)
  18. Source or location of pain
    • nociceptive pain; usually described as throbbing aching and localized 
    • typically response to opiods and non opioids meds
    • 3 classification
    • Cutaneous (superficial)- involves the skin or subcutaneous tissues

    deep somatic pain- originates in the ligaments, tendon, nerves, blood vessels and bone

    Visceral- originates in the body organs, thorax, cranium and abdomen. it can cause referred pain

    this type of pain will responded to ur typical pain meds
  19. Etiology Neuropathic pain
    results from an injury to or abnormal functioning of peripheral nerves on the CNS

    can be short in duration or lingering

    usually described as intense, burning, shooting or pins and needles

    characterized by allodynia

    numerous pain syndromes associated with neuropathic pain

    treat pt with pain meds and other things ie psych meds.
  20. Etiology Intractable pain
    • it doesn't go away. u do everything u can but it still last
    • ie appendicitis- unless u get rid of u will still feel the pain
    • nerve injury like back pain
  21. Etiology Phantom pain
    pain that is perceived from an area that has been surgically or traumatically removed like loss leg
  22. Pain syndromes (not to obess
    when someone is diagnosed with complex regional pain (causalgia)-fibromyalgia 

    postherpectic neuralgia- shingles

    phantom limb pain

    • trigminal neuralgia
    • diabetic neuropathy

    pt can have these has diagnoses
  23. Gate Control theory of Pain
    • all of the messages for pain go to the brain
    • is there something we can do to intercept what goes to the brain

    the body response to painful stimuli by either opening or closing these gates

    dorsal horn

    • only one pain receptor can go thru (small fibers)
    • blocking pain from going to the brain (large diameter fibers) by doing something else like massaging, distraction, tens

    pain emotions and past experience
  24. Factors affecting pain experience
    • Culture- take pain differently
    • ethnic variables
    • family gender age variables
    • religious beliefs- prayer
    • environment and support people- sitting down with someone
  25. Components of Pain assessment
    • verbalization description of pain
    • duration of pain
    • location of pain
    • quantity and intensity of pain
    • quality of pain
    • chronology of pain
    • aggravating and alleviating factors
    • physiologic indicators of pain
    • behavioral responses
    • effect of pain on activities and lifestyles
    • patients expectation of pain relieve
  26. assessment of individual's pain
    • pt self report
    • report from family, caregiver, other close people to the patient
    • non verbal grimacing
    • physiological measures V/S
  27. Pain Assessment
    location, duration, intensity, description
    Location- where is ur pain and does it radiate from the affected area

    Duration- how long have u had the pain

    • intensity/quantity
    • pain tools
    • indicates the degree and amount of pain

    • descriptive/quality 
    • what words would u use to describe your pain
    • what aggrevates it what makes it better
  28. pain assessment 
    chronology, aggrevating/alleviated factos, associated phenomena
    • Chronology
    • how does the pain develop and progress? has it changed since it started?

    • aggravating and alleviating factors
    • what makes the pain more intense
    • what makes the pain lessen

    • associated phenomena
    • are there other things related to ur pain? any other symptoms that occur before, during and after ur pain ie nausea
  29. Pain assessment 
    pain management goal, functional goal
    • pain management
    • what is an acceptable level of pain for you

    • functional goal
    • what would u like to do that u can't do because of your pain
  30. Pain assessment
    nonverbal behavioral, physiological
    • non verbal
    • restlessness, facial expression, grimacing, wrinkle face, moaning, crying clenching fist, protecting the painful area, descreased attention span

    • physiological measure
    • changes in bp, pulse, respiratory rate, perspiration, pupil size, nausea, muscle tension, anxiety
  31. Pain tools
    crying scale n-pass- infants

    faces- toddlers 3yrs old

    numerical scale- 7yrs old
  32. diagnosing
    • Pain as the problem
    • pain: acute post op pain
    •         chronic pain

    • pain as etiology
    • ineffective airway clearance r/t incisional pain
    • risk for injury r/t to decrease pain sensation
    • fatigue r/t to lack of relief from chronic pain
  33. Related pt outcomes
    • Pain acute post op
    • short term- the pt will report pain has diminished/decreased 1 hr after receiving prescribed pain med

    • pt will demonstrate competent execution of successful pain managemnt ie self care, ambulation, post op turning, coughing, deep breathing
    • pain control

    • chronic 
    • long term goal- by 12/25 the pt will demonstrate satisfactory use of relaxation technique to relieve pain

    • describe alternative methods of pain relief, pain control
    • meeting with a pain management team or clinic
  34. implementation
    • identify nursing strategies to achieve pain relief outcomes
    • establishing a trusting relationship with pt
    • manipulating factors affecting pain- removing things that cause pain, altering factors affecting pain tolerance
    • initiating non pharm
    • managing pharm relief measure
  35. non pharm
    • distraction
    • relaxation
    • humor
    • listening to music
    • using guided imaginary
    • biofeedback- having control over something u usually do not have control over
    • reiki (thera touch)
    • cutaneuous stimulation
    • massage 
    • application of hot and cold
    • TENS
    • hypnosis
  36. Phamacologic
    • Admin analgesic- relieves pain
    • non opioids- tylenol acetaminophen, nonsteriodal anti-inflammatory (NSAID;s), advil, motrin, ibuprofen

    • opioids 
    • morphins, codiene oxycontin

    • adjuvant drug
    • anticonvulsants, antidepressants and multipurpose drug
  37. other pharm drugs
    • topical anesthesia
    • oral anesthesia
    • intramusclar injection
    • intravenous administration (PCA)
    • intranasal admin
    • local anesthesia
    • epidural anesthesia
  38. nursing responsibility for opioid admin
    • observe respiratory rate before and after meds
    • assess for respiratory depression, decreased depth and character and rate, (hold for less than 8)
    • observe sedation level
    • assess using
    • patients pain rating
    • sedation level
    • pt;s comfort- function goal (pain rating that allows a patient to perform necessary or desire activity)
  39. health topics 
    Safety- no drinking and driving while on meds. no smoking unless someone watches u, have help while ambulating, keep pain diary

    diet- do not take meds on empty stomach, increase fiber and fluid intake (opioids make u constipated) 

    anxiety- teach anxiety reducing method

    miscellaneous- do not breast feed without consulting md
  40. evaluation
    outcome met

    pain- acute post op

    short term goal- the pt will report pain is diminshed or decreased 1 hr after receiving prescribed pain meds using numerical scale of 1-10 (date)

    Patients states pain has decreased from 7 on numerical scale to 2 one hour after medication