Pain and comfort

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Author:
Prittyrick
ID:
304417
Filename:
Pain and comfort
Updated:
2015-06-25 14:18:56
Tags:
paincomfort
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Description:
pain is not normal part of aging
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  1. Pain is....
    what the pt tells u it is
  2. how might pain be expressed
    • physical
    • loss involved
    • something spiritual
    • decre socialization- changes meaning of life
    • decrease mobility
    • aggreviation
    • depression
    • restlessness
    • withdrawn
    • dont feel right
  3. **Myths r/t pain and aging
    • normal part of aging- f
    • pain sensitivity and preception incre- f elders have more tolerance to pain
    • if they do not report means they don't have pain- f bc sometimes they are scared to loss independence
    • s/e to narcotics too dangerous- no use safely with older adults- longer half life with elders
    • can only use narcotics for short term- no it is used for moderate to severe pain
    • no functional impairment- no maybe stoic to pain and refuse to give in to their pain
  4. Types of pain receptors
    • Nociceptors and pain- associated with injury, due to imflammation of tissue, from trauma burns, infections
    • Neuropathic pain- neurological, sensation maybe off, stroke, DM (peripheral circulation problems), spinal stenosis, shingles, phantom pain (bc nerve endings are still there, limb missing but u can feel it)
    • mixed or unspecified- dont know where the pain comes from. headaches and vasculities
  5. Acute pain
    • episodic
    • surgery, procedure
    • fall
    • also, bereavement and losses
    • can give analgesic with this
  6. Persistent pain
    • most commonly seen in elder
    • 50% have some types of chronic pain higher in nursing home
    • musculotal system
    • pain that doesn't go away
    • lonilness comes from pain and immobility in the elders. they cope very well
  7. Barriers to pain management
    • Health care professional barriers- lack of education, fears of opiod s/e, believe that cognitively impaired have less pain, inability to accept someone pain-objective, personal beliefs and experiences with pain
    • Patient and family barriers- fear of med s/e, concerns related to addition, belief that nothing can be done, fear of being a bad pt if complaining
    • Healthcare system barriers- cost- meds, time, culture bias regarding opiod use
  8. **Pain in elder with cognitive impairment
    • Changes in behavior- restlessness, agitation, repetive movements, physical tension clutching teeth or hands, guarding, unusual movements
    • ADL's- no help from others, decre appetite, decre sleep
    • vocalizations- groans, moans, cries for unknown reason, person incre or decres usual vocalization
    • physical changes- pleading expression, grimacing, pallor or flushing, diaphoresis, incre PP, RR, or BP
    • more confusion
    • if they can do a pain scale let them if not look at behavior
  9. pain cues in older person with communication difficulities
    look at slide about cognitive impairment
  10. Assessment and pain scales
    • pain scale
    • cognitive impairment- use behaviors
  11. Basic pain assessment
    • Old Cart
    • Oneset, location, duration, Charasteristics
    • aggravating factors, relieving factors, treatment previously tried
  12. Additonal factors
    • look at all meds
    • look how pain affects their adl's sleep, relationships
  13. Interventions- non pharm
    • function at the highest function
    • position changes, elevations, turning, pillows, foot and back care, comfort measures, listening to pt, spiritual needs, touch, guided imaginery, be cautious with heat and cold, pain diary
    • give choices, keeping them activity- need to move.
  14. Interventions- pharm
    • Start with tylenol
    • ***NSAID's- be mindful of bleeding, protein binding drug, be mindful over herbal things over the counter cause can cause bleeding, coumadin, platelet drugs)
    • hepatic/nephro toxic-
    • opioids use with cautious- longer half bc of excretion takes longer- smaller amounts over longer periods of time- watch for safety, CNS, constipation, decre RR
  15. community resources
    • team (pt nurse, partictioner)- having a good plan with the pt..
    • good pain control

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