caring for individuals experiencing pain nurs 2016
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PainPain
• An unpleasant An unpleasant sensory and sensory and emotional emotional experienceexperience
• Associated with Associated with actual or potential actual or potential tissue damagetissue damage
• Tells us that Tells us that something is wrong something is wrong with our boddywith our boddy
Pain PerceptionPain Perception
Subjective Subjective ExperienceExperience
• Past experiencePast experience• Anxiety/depressionAnxiety/depression• Culture and Culture and
ethnicityethnicity• AgeAge
PainPain
• Pain is now considered another VITAL Pain is now considered another VITAL SIGNSIGN
• 3 main types of pain3 main types of pain– AcuteAcute– ChronicChronic– Chronic (malignant)Chronic (malignant)
• It is important to listen to what It is important to listen to what patients tell you about their painpatients tell you about their pain– VerballyVerbally– NonverballyNonverbally
Acute PainAcute Pain
• Recent onsetRecent onset• Associated with a specific causeAssociated with a specific cause• Decreased with healingDecreased with healing• Duration of seconds to 6 monthsDuration of seconds to 6 months
Chronic PainChronic Pain
• Constant or intermittentConstant or intermittent• Last beyond expected healing timeLast beyond expected healing time• Origin is unclear: person can not Origin is unclear: person can not
easily identify where pain is coming easily identify where pain is coming fromfrom
• Duration longer than 6 monthsDuration longer than 6 months• No useful purposeNo useful purpose
Malignant or Cancer-Malignant or Cancer-related Painrelated Pain
• Acute or chronicAcute or chronic• Associated with tumor formation, Associated with tumor formation,
treatment or traumatreatment or trauma• 22ndnd most common fear for people dx most common fear for people dx
with cancerwith cancer• Cyclic: pain, anxiety, fear, . . . painCyclic: pain, anxiety, fear, . . . pain
Breakthrough Pain
Drug Addiction
Drug Dependence
Drug Tolerance Analgesic
Analgesia
Opioids
Pain Threshold
Pain Tolerance
Painful Terms
Physiological Basis of Physiological Basis of PainPain
• Nociceptive System: the system involved Nociceptive System: the system involved in the transmission and perceptions of in the transmission and perceptions of painpain
• Nociceptors: free nerve endings in the Nociceptors: free nerve endings in the skin that respond only to intense, skin that respond only to intense, potentially damaging stimuli potentially damaging stimuli (mechanical, thermal, chemical)(mechanical, thermal, chemical)– Joints, skeletal muscle, fascia, tendons, and Joints, skeletal muscle, fascia, tendons, and
cornea also have pain receptors.cornea also have pain receptors.
Physiology of PainPhysiology of Pain
• Referred PainReferred Pain– Results from intense stimulation of the Results from intense stimulation of the
visceral branch of a nerve fibre, leading visceral branch of a nerve fibre, leading to vasodilation and pain in the area of the to vasodilation and pain in the area of the body associated with that fibre.body associated with that fibre.
• Chemical mediators of painChemical mediators of pain– Prostoglandins increase the sensitivity to Prostoglandins increase the sensitivity to
painpain– Endorphins or enkephalins decrease the Endorphins or enkephalins decrease the
sensitivity to painsensitivity to pain
Nursing Process related Nursing Process related to Painto Pain
• AssessmentAssessment• PlanningPlanning• InterventionIntervention• EvaluationEvaluation
Assessing PainAssessing Pain
Perception of PainPerception of Pain• Verbal descriptionVerbal description
– IntensityIntensity– LocationLocation– Timing: onset, durationTiming: onset, duration– Factors that relieveFactors that relieve– Personal meaningPersonal meaning
• Impact on activitiesImpact on activities• Concerns about painConcerns about pain
Pain Assessment ToolsPain Assessment Tools
• Pain Intensity Pain Intensity ScalesScales– Visual analoguesVisual analogues– Rating 1-10Rating 1-10– Smiley facesSmiley faces
Physiological Responses Physiological Responses to Painto Pain
Very individualVery individual• Increased heart rateIncreased heart rate• Increased BPIncreased BP• PallorPallor• DiaphoresisDiaphoresis
Chronic pain sufferers may show no Chronic pain sufferers may show no phys signs of painphys signs of pain
Behavioural Responses Behavioural Responses to Painto Pain
• Facial expressionsFacial expressions• Body movementsBody movements• MoaningMoaning• Clenching fistsClenching fists• WithdrawingWithdrawing• Etc.Etc.
Factors Influencing Pain Factors Influencing Pain ResponseResponse
• Past ExperiencePast Experience• CultureCulture• AgeAge• Anxiety & DepressionAnxiety & Depression
PlanningPlanning
• Consider Consider assessment dataassessment data
• Nursing DiagnosisNursing Diagnosis
• In collaboration In collaboration with clientwith client
Develop Pain Develop Pain Management GoalsManagement Goals
Pain Management Pain Management Strategies and Nursing Strategies and Nursing
InterventionsInterventions• Non-pharmacolgicalNon-pharmacolgical
– Cutaneous Stimulation and MassageCutaneous Stimulation and Massage– Transcutaeous Electrical Nerve StimulationTranscutaeous Electrical Nerve Stimulation– Ice and HeatIce and Heat– Relaxation techniquesRelaxation techniques– DistractionDistraction– HypnosisHypnosis– Emotional supportEmotional support– Trusting relationship: encourage Trusting relationship: encourage
communicationcommunication
Pain Management Pain Management Strategies and Nursing Strategies and Nursing
InterventionsInterventionsPharmacologicalPharmacological• Balanced Analgesia: opioids, NSAID, Balanced Analgesia: opioids, NSAID,
anestheticsanesthetics• Regular medication administration: Regular medication administration:
maintain steady reliefmaintain steady relief• Pro Re Nata: traditional standard – Pro Re Nata: traditional standard –
often leaves clients sedated or in painoften leaves clients sedated or in pain
*Preventative approaches**Preventative approaches*
Pain Management Pain Management Strategies and Nursing Strategies and Nursing
InterventionsInterventionsPharmacologicalPharmacological• Local Anesthetics: block nerve Local Anesthetics: block nerve
conductionconduction• NSAIDs: inhibit production of NSAIDs: inhibit production of
prostoglandins from inflamed or prostoglandins from inflamed or injured tissue.injured tissue.
• Opioids: act as agonists at specific Opioids: act as agonists at specific opioid receptors in the CNS. Mimick opioid receptors in the CNS. Mimick endorphinsendorphins
Evaluation of Pain Evaluation of Pain ManagementManagement
Intervention
Post-intervention data
Pre-intervention data
Triple Whammy EffectTriple Whammy Effect
• Clients under-Clients under-report their painreport their pain
• Physicians under-Physicians under-prescribeprescribe
• Nurses under-Nurses under-administeradminister
What impact does What impact does unrelieved pain have on unrelieved pain have on
people?people?PositivePositive NegativeNegative