Ch 35: Comfort And pain management Flashcards
(38 cards)
What are 2 ways to define pain
- Pain is whatever the patient says whenever the patient says pain is present
- Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage
Give the categories of pain classification
Give the difference between acute and chronic pain
What is a common misconception about pain meds
Categories of pain:
- Duration
- localization/location (generalized the local)
- etiology (cause)
Acute: -RAPID onset autonomic response (f v f) -protective and nature warns of tissue damage • MI • appendicitis •ectopic pregnancy •AAA
Chronic:
- Limited, intermittent, or persistent
- last beyond normal healing period (1-6 months)
- periods of remission or exacerbation (reappearance)
Common misconception:
-pain meds do not take away pain🚫
allow patient to tolerate and manage pain✅
Give the sources (types) of pain
- Nociceptive
-define

2.Cutaneous
-A.k.a.
-where is pain
-sensation - Somatic
- where is pain - Visceral
- Most what?
- What is it based on
- Poorly what? - Neuropathic pain
- I.E.
- describe the pain
1.Nociceptive: peripheral nerve fibers
- Cutaneous: “ superficial pain”
- skin and subcutaneous tissue
- Sharp pain with burning sensation - Somatic:
- in BONES, tendons, ligaments, blood vessels ,nerves - Visceral: “ splecanic pain”
- MOST COMMON AS ORGANS BECOME DISTENDED, ISCHEMIC, INFLAMM
- of the abdominal ORGANS
- poorly localized - Neuropathic pain: phantom pain
-Injury or lesion to nerve causing abnormal peripheral function
-
 describe the Origins of pain
Physical
psychogenic
referred pain
-Give examples of referred pain
Physical: identified cause
Psychogenic: unidentified cause
Referred pain: pain perceived in area away from origin
- MI: jaw, neck, left arm
- gallbladder: right shoulder
- Liver: right chest/older
- bladder: rectal area
Give the 4 physiologic pain process steps
1.
- definition
- activation
- directional process
- 
- definition
- two fibers involved - Definition
4.
- definition
- Who is involved
1. Transduction
: activation of pain receptors
(with injury, chemical is released and activate/exciting nerve endings)
-Painful stimuli turns into electrical impulses starting with nociceptors in the periphery going to the cord

2. Transmission
: conduction of pain along pathways to spinal cord By afferent pathway
-involves A delta and C fibers

3. Perception of pain
: awareness of pain characteristics
- Modulation
: inhibition or modification of pain
 Inhibited by Nero modulators (endorphins, and enkephalins)

Under transmission
-differentiate A delta V C fibers
Under modulation:
-what are neuromodulators
-give the 3 types and their slight differences

A delta: larger fibers
-Acute well localized pain
C fibers: smaller
-diffuse, longer-lasting
Modulation: Nuromodulators are natural hormones and chemicals that alter pain and block pain releasing substances 1. endorphins: most potent 2. enkephalins: less potent 3. Dynorphin‘s
What are the substances released that stimulate nociceptors (pain receptors)
Bradykinin:
-powerful vasodilator that ⬆️ capillary permeability and constrict smooth muscle
Prostaglandins:
-Hormone like substance that since additional pain stimuli to CNS
Substance P:
-sensitizers receptors of nerves to feel pain and increases firing of nerves
What does a gate control theory of pain describe and recogn
What does a gating mechanism determine
What conducts and inhibits pain stimuli to brain
Can you control theory describes the transmission of painful stimuli
-recognizes relationship between pain and emotions
Getting mechanism determines the impulse that reaches the brain
Small and large diameter nerve fibers conduct and inhibit pain stimuli to brain

Describe nociceptors
Describe paint threshold
Describe pain tolerance
Describe adaptation
Specifically what do the three Nuro modulators inhibit and from where

Nociceptors:
-Peripheral nerves the transmit pain

Pain threshold:
-The point at which you feel pain
• lowest intensity
Pain tolerance:
-Maximum level patient can tolerate
Adaptation:
-⬆️ in tolerance by regular exposure to paint
The 3 Nuro modulators inhibit substance P from the afferent neuron (especially enkephalins)
Briefly describe the pain sensation and relief process
- Pain path begins in the nerve ending
- Electrical chemicals impulse goes to the dorsal horn
-  impulse Travels to Hypothalamus: sensory Center
- Impulse goes to cerebral cortex where intensity and location is perceived
- Pain relief signal goes to the dorsal horn
- Endorphins released
Common response is the pain:
Give physiologic responses to pain
Give behavioral responses to pain
Give affective responses to pain
Physiologic: involuntary response
- ⬆️BP AND PULSE
- ⬆️ in glucose
- pupils dilate
- muscles tense
- sweating
- N/V
Behavioral :
- Grimacing
- moaning/crying
- guarding
- flinching
- restless
- Gross motor activities
Affective: person becomes withdrawal from pain
- Anxious
- depressed
- fear/anger
- stoic
- pain in way of ADL
- perception/ meaning of pain
- treatment at home
What is pain regardless of what
- What must nurse due to patient’s pain
- As a nurse what must we do to be able to manage patient’s pain
Pain is whatever the patient says it is regardless of actions
- Nurses must believe patients about pain
- nurses must be able to be aware of their own feelings to pain and Factors that affect pain to be able to manage patient pain

If physiologic pain is severe and deep what may it lead to and what does it mean
What pain is not exhibited in chronic pain What is exhibited
If physiologic pain is severe and deep
-person may have N/V, fainting
Which is a sign they cannot tolerate the pain
In chronic pain physiologic pain may be decreased or not exhibited
✅ so you may see you affective (anxious)
What are considerations to have for older adults and addressing age and comfort with pain
- issues with what (what do you want to do)
-  Who do you want to include
- Monitor what after medications
- How may pain be affected
- what do you want the patient to do regarding the assessment and what do you want to evaluate
- Term, not normal
- What do you want to ensure and why
- what are we monitoring what are we discouraging

-older may have issues communicating
• observe behaviors carefully
-Include family and caregiver when gathering information
• how older has dealt with pain
- Monitor behavior and confusion after medications
- consider pain perception is affected by boredom and depression
- Ask &involve patient in the pain assessment and evaluate their willingness to help and get help
Use a different term to pain and explain pain is not normal with aging
Ensure dose and frequency to avoid over sedation and toxicity
Monitor for respiratory depression and discourage driving and self-medicating after medications

What are manifestations of pain you will see in your elder
Manifestations of pain for older:
- change an activity level
- don’t wanna do anything
- grimacing
What do you need to consider when providing pain relief
Give factors that can affect the pain experience
When providing pain relief consider responses to pain and individualized care
Culture
-cultural norms influence behavior, attitudes, values, responses to pain
ethnic variables
-Share set up beliefs and values that are characteristic to individuals in generations
family, sex, gender, age variables
-Girls ✅ cry, boys 🚫
religious beliefs
-Idea that pain is a punishment (lack of goodness),purification,
environmental and support
- Family⬇️ pain
- patient feels powerless in hospital and gets poor sleep
anxiety and other stressors
past pain experiences
-any good relief with medications or treatments
What Populations are least likely to get the recommended treatment for pink and what is the recommended treatment
Hispanics and African-Americans get less pain medication
How do you want to complete your assessment
Give assessment parameters for pain (areas to consider and look into)
- Psychological
2.Emotional
-give an example
3.Socioeconomic
-what may patient be
-what may result from medical treatment
 - Physiologic 
Assess using open ended questions
Psychological: pain is whatever patient says
Emotional:
-I.E: patient with chronic pain may be depressed/suicidal
Excessively sleep
Impaired coping skills
Socioeconomic:
- is patient isolated from family
- is there an impaired real performance due to medical causing financial restraints
Physiologic
- ⬆️ BP/pulse/RR
- Pallor
- muscle tension
- sweat
- dizziness
Give the considerations for assisting pain
- Specific assessment
- how to locate
- chronology
- indicators responses effects of pain
- responses
- what does pain affect
- 2 goals
- For pain assess OLDCARTS
- Have patient POINT to location of pain
- chronology: progression
- physiologic indicators (⬆️ BP/Pulse)
- behavioral responses
- Effects of pain on ADL
- Assess what pain means to patient
- get pain goal
Give the components about the basic method of assessing pain
Patient self report
ID pathological conditions/procedures that may cause pain
• consider physiologic measures
Report of a family member and others close (caregiver)
Nonverbal behaviors
-restless, grimacing crying clenching fists
Physiologic measures
-⬆️ BP and pulse
Attempt an analgesic trial and monitor results
Give age and specifics to the following pain assessment tools
Wong baker FACES Beyer oucher pain scale CRIES pain scale FLACC scale COMFORT scale
Wong baker FACES
-in children 3+ YOA
Beyer oucher pain scale
- point to face
- crying, physical movement
CRIES pain scale
- 0 to 6 months
- neonates to infants
FLACC scale
- 2 months to 7YOA 
- Face, legs, activity, crying, consolability
COMFORT scale
-Assess his pain in distress in critically ill Peds pt 
What is another population you can use the FLACC pain scale for
How long do you want to observe for and what are you observing
FLACC assess in:
- 2 months to 7 YOA
- vegetative state (cannot speak)
Observe for 2 to 5 minutes
- observe legs/body
- observe indications of uncomfort
What must you take into account when diagnosing pain
Type of pain
-A, C, malignant, neuropathic, Phantom
Etiologic factors
-R/T
Behavioral, physiologic, affective responses
Other factors such as opioids clouding patients judgment
- codeine
- fentanyl
- hydromorphone
- hydrocodone
When do you want to reasses PO drugs
When do you want to reassess IV drugs
What are nursing interventions you can do for pain to help the patient
- establish
- manipulate
- initiate measures
- interventions
- review additional measures
- consider responsibilities
- teach
Reassess PO: 30 minutes after
Reassess IV: 15 minutes after
-both for effectiveness
INTERVENTIONS for pain:
-establish a trusting relationship with patient
 manipulating factors affecting pain experience
-what’s been used before that’s affective
initiating nonpharmacological pain relief measures
-I.E: humor, laughter, music, imagery, TNS, healing touch, pet therapy
managing pharmacological interventions
-May have to ⬆️ meds if tolerance
reviewing additional pain control measures (complementary and alternative relief measures)
consider ethical and legal responsibilities to relieve pain
teach patient about pain
-Misconception of addiction
