pain management c. calzolari 2014. what is pain?
TRANSCRIPT
![Page 1: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/1.jpg)
Pain Management
C. Calzolari
2014
![Page 2: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/2.jpg)
What is Pain?
![Page 3: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/3.jpg)
Why Do We Experience Pain?
It is protective. How?
It is a signal. What?
![Page 4: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/4.jpg)
Cause of Pain
Nociceptive pain(pain receptors) – most common. Respond to stimulation.Visceral – organs , linings of cavitiesSomatic – Skin, muscles, bones, connective
tissue
Neuropathic pain – complex and often chronic.
![Page 5: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/5.jpg)
Classification of Pain
AcuteCan Identify CauseTemporaryActivates SNS - BP, HR, RR, more blood to brain, dilates pupils
![Page 6: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/6.jpg)
Classification of Pain
ChronicLonger Duration – lasts beyond healing phaseInterferes with ADLsRemissions & exacerbationsStimulates PNS - or normal Vital SignsAffective Responses
![Page 7: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/7.jpg)
Classification of Pain
IntractableChronic
Resistant to pain relief
Multi-Disciplinary Approach
![Page 8: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/8.jpg)
Descriptions of Pain
Based on site, cause, duration and quality.
![Page 9: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/9.jpg)
Site of Pain
Cutaneous or superficial pain
Visceral pain
Deep somatic pain
Radiating pain
Referred pain
Phantom pain
Psychogenic pain
![Page 10: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/10.jpg)
Take the Vocabulary Quiz
![Page 11: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/11.jpg)
Application
How would you classify the pain that the following patients are experiencing?
● A patient with metastatic cancer
![Page 12: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/12.jpg)
A patient with back pain that was the result of an automobile injury a year ago
![Page 13: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/13.jpg)
A patient with a broken leg
![Page 14: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/14.jpg)
Quality of Pain
Only the patient can describe the quality of their pain. They may use words such as:
Sharp Dull Throbbing Stabbing Burning Ripping Tingling Intermittent Constant Mild Intense Severe
![Page 15: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/15.jpg)
Factors Which Influence Pain
EmotionsDevelopmental StageCommunication ImpairmentsPain ThresholdCulture
![Page 16: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/16.jpg)
Factors Which Influence Pain
Emotions: Anxiety Fear Guilt Anger Helplessness Exhaustion Irritability Depression
![Page 17: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/17.jpg)
Factors Which Influence Pain
Developmental Stage:Infants and childrenAdultsOlder Adults
![Page 18: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/18.jpg)
Factors Which Influence Pain
Communication Impairment: Those who have had a CVA, speak another language
or are cognitively impaired. You will need to observe nonverbal cues for pain.
Facial expressions Vocalizations Changes in physical activity Change in vital signs Change in routines Mental status changes
![Page 19: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/19.jpg)
Factors Which Influence Pain
Culture:Involves the patient’s expression of pain,
the family’s response to the situation and the nurse’s attitude.
William & Hopper: Box 10.2 – page 143-144
![Page 20: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/20.jpg)
Factors Which Influence Pain
Pain Threshold: The point at which the receptors in the frontal
cortex recognizes and defines a stimulus as pain.
Varies from person to person.
Pain Tolerance: The duration or intensity of pain that a person
is willing to endure.
![Page 21: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/21.jpg)
Pharmacological Pain Relief Measures
Analgesics Nonopioids – acetaminophen, salicylates,
NSAIDS and COX -2 inhibitors
Opioids - morphine, codeine, hydromorphone, methadone, meperdine, oxycodone, sublimaze patch
![Page 22: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/22.jpg)
Analgesics
![Page 23: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/23.jpg)
Routes of Administration
Oral – preferred routeNasalTransdermalRectalSubcutaneousIntramuscular – least preferredIntravenousPCA – patient controlled analgesiaIntraspinal analgesics
![Page 24: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/24.jpg)
Adverse Affects of Pain Medications
Nonopioids – GIB, inhibition of platelet aggregation, renal insufficiency, hypersensitive reactions in persons with asthma, liver necrosis with OD of Tylenol.
Opioids – respiratory depression, hypotension, drowsiness, constipation, nausea, vomiting, constricted pupils.
![Page 25: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/25.jpg)
Analgesic Adjuvants
These medications may potentiate the effects of opioids or nonopioids.
Examples: steroids, benzodiazepines, tricyclic antidepressants, and anticonvulsants.
Able to use less opioid doses when used with these adjuvants.
![Page 26: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/26.jpg)
Antidote
Narcan (naloxone)- counteracts the effect of opioids.
![Page 27: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/27.jpg)
Interpreting MD Orders
Morphine Sulfate 2 mg. IM q 4 hours prn for surgical pain.
Percocet one tab po q 6 hours prn for foot pain
Duragesic patch 25mcg/hr transdermal q 72 hours at 0800.
Oxycontin 20 mg. po BIDOxyIR 5 mg. po q 6 hours prn for
breakthrough pain
![Page 28: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/28.jpg)
Evaluation
Always re-assess your patient after administering pain medications.
At what time interval?
![Page 29: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/29.jpg)
Special Considerations
The Elderly
The Person with Substance Abuse or Addiction
Unrelieved Pain
![Page 30: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/30.jpg)
Nonpharmacological Pain Relief Measures
Cutaneous StimulationTENS – Trancutaneous Electrical Nerve
StimulatorAcupunctureAcupressureMassageHot and Cold TX
![Page 31: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/31.jpg)
Transelectrical Nerve Stimulation
![Page 32: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/32.jpg)
TENS
![Page 33: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/33.jpg)
Acupuncture
![Page 34: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/34.jpg)
Acupressure
Based on the same principles as acupuncture, (but using pressure instead of needles), acupressure works by stimulating specific reflex points located along the lines of energy which run through the body, called meridians.
![Page 35: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/35.jpg)
Massage
![Page 36: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/36.jpg)
Hot & Cold Therapies
![Page 37: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/37.jpg)
Nonpharmacological Pain Relief Measures
Surgery
Immobilization Splints, slings, braces
Cognitive-Behavioral Interventions Distraction Relaxation Techniques Guided Imagery Hypnosis Therapeutic Touch Humor
![Page 38: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/38.jpg)
Guided Imagery
start the day meditation - guided imagery – YouTube
Guided Imagery - Bubble Release - YouTube
![Page 39: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/39.jpg)
REIKI
![Page 40: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/40.jpg)
Biofeedback
Biofeedback Session Demo – YouTube
http://www.youtube.com/watch?v=a53LA7aL2Og
![Page 41: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/41.jpg)
The Nursing Process
Lets Start With You, as a student nurse and health care providers.
![Page 42: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/42.jpg)
The HCW’s Perception of Pain
What are some myths associated with pain management that you have witnessed in the healthcare setting?
![Page 43: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/43.jpg)
Nursing Process: Collect Data
The fifth vital sign.Accept the patient’s report of pain.Obtain a pain history.Perform a physical assessment.Observe for nonverbal indicators of pain.Use WHAT”S UP format and pain
scales.
![Page 44: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/44.jpg)
WHAT”S UP?
W here is the pain? H ow does the pain feel? A ggravating & alleviating factors. T iming. S everity. U seful other data. P erception.
![Page 45: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/45.jpg)
Pain Scales
Visual Analog Scale
Numerical Rating Scale
The Wong-Baker FACES pain Rating Scale
![Page 46: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/46.jpg)
Analgesic Administration
Use resources to check on purposes and actions of pharmacological agents
Reconcile & maintain MAR +/or Patient’s list of medications.
Identify patient’s allergies and intervene as appropriate.
![Page 47: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/47.jpg)
Identify a contraindication to administration of a prescribed medication.
Acetaminophen Caution and Guidance
![Page 48: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/48.jpg)
Planning
Use data collected to plan action with patient’s input.
Teach patient to use pain scales.Set goals for acceptable pain levels.Example: you will ask your patient who is in
pain, “What is an acceptable level of pain for you after we have helped you relieve your pain?”
“What has helped in the past to relieve your pain?”
![Page 49: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/49.jpg)
Drug Calculations
![Page 50: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/50.jpg)
Nursing Diagnoses
Nursing Diagnosis: Pain, acute or chronic,
Impaired Comfort
Others: Self-Care Deficit, Impaired Mobility, Sleep Deprivation, Ineffective Airway Clearance, Ineffective Coping.
![Page 51: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/51.jpg)
Interventions
Apply therapies for comfort.Use alternative/complementary therapies for pain
management.Administer pain medication as prescribed.Identify patient expected response to pain
medication. Reinforce client teaching on possible effects of
medication.
![Page 52: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/52.jpg)
Follow rights of medication administration.
Maintain medication safety practice. Follow protocol for handling controlled
substances.Monitor patient use of medication over
time.Maintain pain control devices.
![Page 53: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/53.jpg)
Evaluation
Monitor and document patient’s response to pharmacological and non – pharmacological interventions.
Notify primary healthcare provider of actual/potential adverse effects of pain medications.
![Page 54: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/54.jpg)
Explain the protocol for withholding pain medication if patient experiences an adverse reaction.
Discuss actions used in the event of adverse reactions with the use of opioids.
![Page 55: Pain Management C. Calzolari 2014. What is Pain?](https://reader036.vdocument.in/reader036/viewer/2022062621/551bdec7550346af588b5d44/html5/thumbnails/55.jpg)
Role Playing & Case Scenarios
Utilize your Medication Research cards and The Joint Commission Handout, “SpeakUP” to perform these excercises.