Basic Nursing: Foundations of Skills & Concepts Chapter 26

1. Basic Nursing: Foundations of Skills & Concepts Chapter 26 PAIN MANAGEMENT

2. 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.

3. 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.

4. Types of Pain • Pain Categorized by Origin. • Pain Characterized by Nature.

5. 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).

6. 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.

7. 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.

8. The Gate Control Theory of Pain • Theorizes that person experiences pain with combination of these processes: • Sensory. • Motivational-Affective. • Cognitive.

9. 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).

10. Factors Affecting Pain Experience • Age. • Previous Experience with Pain. • Cultural Norms.

11. 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.

12. 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).

13. Nursing Diagnoses • Two primary diagnoses used to describe pain are acute and chronic.

14. General Principles of Pain Relief • Individualize the approach. • Use a preventive approach. • Use a multidisciplinary approach.

15. Nursing Interventions • Pharmacological. • Noninvasive. • Invasive.

16. 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.

17. Principles of Administering Analgesics • Preventive approach. • Titrate to effect.

18. 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”).

19. 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.

20. Three Classes of Analgesics • Nonopioid. • Opioid. • Analgesic adjuvants.

21. Trusting Nurse-Client Relationship. Relaxation. Reframing. Distraction. Guided Imagery. Humor. Biofeedback. Cognitive-Behavioral Interventions

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

23. Guided Imagery • Using one’s imagination to provide a pleasant substitute for the pain.

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

25. 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.

26. Transcutaneous Electrical Nerve Stimulation • The process of applying a low-voltage electrical current to the skin through cutaneous electrodes.

27. Other Noninvasive Pain Interventions • Psychotherapy (including hypnosis). • Exercise. • Positioning and Body Alignment.

28. Invasive Pain Interventions • Used when noninvasive and pharmacological measures do not provide adequate relief. • Include: • Nerve block. • Neurosurgery. • Radiation therapy • Acupuncture.