Pain Notes Flashcards
What is pain?
-It’s universal and Physiologic need on Maslow’s. It’s the fifth vital sign.
-An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. It is highly personal & subjective (whatever the patient says it is).
What are ways we experience pain?
-Pathologic condition-including an injury(break arm or stub toes), illness, or somatosensory-injury in system that deals with touch and perception of pain are all instances we can experience pain.
What is comfort? What are some things that affect comfort?
Being comfortable.
-Things that would affect comfort (in position for so long-changing positions will help), temp. of room, interactions with people, procedures, hungry/thirsty, elimination (not coming when pt. calls or not changing on time), hygiene (not bathing or brushing teeth).
*-If they are not comfortable, increases pain level. You want them comfortable to decrease pain level & for them to be able to tolerate the pain.
What is the somatosensory system?
-Somatosensory system-which receives, transmits, and interprets sensory information.
-Specialized sensory receptor cells carry specific types of sensory information (vision, hearing, touch, heat/cold, proprioception, and pain) along different anatomical pathways depending on the information carried.
What is the Amercian Nursing Association? What do they do?
-ANA-Provides standards & care we should do as RN. Legal & ethical ways to assess pain.
*Pain is under recognized & not treated nationally (mostly seen in elderly (nursing home pt.)
What is OUD (Opioid Use Disorder)?
-Chronic brain disease characterized by continuing opioid use despite harmful consequences.
*People use opioids for back pain & chronic pain.
Some biases & misconceptions from Box 41.2
- Patients who abuse substances (e.g., use drugs or alcohol) overreact to discomfort.
- Patients with minor illnesses have less pain than those with severe physical alteration.
- Administering analgesics regularly leads to drug addiction.
- The amount of tissue damage in an injury accurately indicates pain intensity.
- Health care personnel are the best authorities on the nature of a patient’s pain.
- Psychogenic pain is not real.
Chronic pain is psychological. - Patients who are hospitalized experience pain.
- Patients who cannot speak do not feel pain. (Like stroke/vent pts.)
-Dementia pt.(indicator of pain)-grimace, clinch teeth, impaired movement-what’s hurting them (guarding or holding affected limb)
What are some misconceptions about pain in infants? Table 44.3
-Infants can’t feel pain(preterm babies actually may be more sensitive to pain then full-term baby)
-Infants can’t express pain (going to grimace, cry, flex arms & legs, may not eat & inconsolable)
-Infants are less sensitive to pain than older children and adults.
-Infants must learn about pain from previous painful experiences.
-You cannot accurately assess pain in infants.
-You can’t safely give analgesics to newborns or infants because of their immature capacity to metabolize and eliminate drugs and their sensitivity to opioid-induced respiratory depression. You can for 6 month old (like with chest tubes) in them.
*All meds for pediatric pts. Are weight-based.
*Physiological signs (vital signs)
Look at table 44.4 Misconceptions about pain in older adults (Look at rest in fundamentals)
-Pain is a natural outcome of growing old. (elderly are at more risk for pain than young people & Everyone want experience it. (Physiological changes can increase conditions of pain (stomach problems & etc.)
-Pain perception, or sensitivity, decreases with age.
-If the older patient does not report pain, the patient does not have pain.
-Older pt. report more pain as they get older-They actually report less pain.
*Start low & go slow with opioids in elderly. Elderly metabolize slower & may have excretion problems (Liver problems, kidney problems) At risk for toxicity & overdose.
What are the four processes of pain?
-Transduction-Hands touch iron (initial painful impulse)
-Transmission-Impulses transmitted to brain
-Perception-Brain goes I just touched iron
-Modulation-Causes you to pull your hand away from
*Nociceptors pick up on pain & not in sensory nervous system (they are everywhere else).
Physiological factors that influence a client’s pain.
-Age-younger people have problems expressing themselves
-Fatigue-Makes pain worse-heightens the perception of pain & decreases coping ability
-Genes- Passed on by parents possibly increases or decreases a person’s sensitivity to pain and determines pain threshold or tolerance.
-Neurological-Any factor that interrupts or influences normal pain reception or perception (e.g., spinal cord injury, peripheral neuropathy, or neurological disease) affects a patient’s awareness of and response to pain.
Social factors that influence a client’s pain.
1. Previous experience
2. Family/social network
3. Spiritual factors
- Previous experience. Each person learns from painful experiences. Prior experience does not mean that a person accepts pain more easily in the future. Previous frequent episodes of pain without relief or bouts of severe pain cause anxiety or fear. If a person repeatedly experiences the same type of pain that was relieved successfully in the past, the person finds it easier to interpret the pain sensation. As a result, the patient is better prepared to take necessary actions to relieve the pain.
- Family/Social network. People in pain often depend on family members or close family & friends for support, assistance, or protection. Family can make experience less stressful.
- Spiritual factors. Spiritual beliefs affect the way patients view or cope with pain. Patients look to higher power for strength/support to adjust better to pain & have significantly better mental health. Providing support for patients to utilize their spiritual practices is essential for pain management.
What psychological factors influence pain?
1. Attention
2. Anxiety/Feat
3. Coping Style
- Attention-Degree of pt. focuses attention on pain influences the patient’s perception. Increased attention is associated with increased pain, whereas distraction is associated with diminished pain response. Nurses use relaxation, guided imagery, and massaged. Focusing on other things decreases pain.
- Anxiety/Fear-Pain is perceived differently if it suggest a threat, loss, punishment, or challenge. Pain is influenced by a pt.’s perception of the degree and quality of pain. Anxiety/fear often increase the perception of pain, & pain causes feelings of anxiety/fear. Pharmacological & nonpharmacological approaches to the management of anxiety are appropriate.
- Coping style-Pain is a lonely experience that often causes patients to feel a loss of control. Then coping style influences the ability to deal with pain.
Cultural factors that influence pain.
A person associates pain with affects the experience of pain & how one adapts to it. Closely associated with one’s cultural background, including age, education, race, & familial factors. Cultural beliefs/values affect how individuals cope with pain. They learn what is expected/accepted by their culture, including how to react to pain.
Define nociception.
Observable activity in the nervous system that allows one to detect pain; Protective physiological series of events—- transduction, transmission, perception, and modulation— that brings awareness of actual or potential tissue damage; the normal pain process.
