Class 8-Comfort Flashcards
pain is…
-an unpleasant sensory and emotional experience associated with actual or potential tissue damage
-pain is what the person says it is, existing whenever they say it does
-pain is accompanied by suffering
scope of the problem
-75 million americans suffer chronic pain annually
-25 million suffer acute pain
-pain costs more than $100 billion each year in medical expenses, lost wages and lost productivity
-inadequate pain relief hastens death (by psychological stress)
barriers preventing effective pain relief by health care providers
-poor assessment of pain (under assessed)
-inadequate knowledge of pain management
-biases and judgements regarding pain
barriers preventing effective pain relief by patients in pain:
-“I might get addicted”
-opioids should be saved for when it is really needed
-unpleasant side effects
-“I want a shot”
treat pain as soon as pt feels pain
look at slide 6
the pain process
-transduction: activation of pain receptors (touch something hot)
-transmission: pain sensations sent to higher
-perception: awareness of the characteristics of pain
-pain threshold: lowest intensity of a stimulus that causes you to recognize pain
-modulation: inhibition or modification of pain (pain electrical stimuli comes back down spinal cord; natural response for body to help pain)
gate control theory of pain
-describes the transmission of painful stimuli and recognizes a relationship between pain and emotions
-small and large diameter nerve fibers conduct and inhibit pain stimuli toward the brain
-gating mechanism determines the impulses (signals) that reach the brain
categories of pain
-duration
-acute (sudden cause; usually has a distinct cause_
-chronic (lasts longer/beyond normal healing period (can be difficult for pts to describe))
responses to pain
-physiologic
-behavioral
-affective (psychological; my pain has caused fear, anger, etc)
factors affecting pain experience
-family, gender, and age variables (boys don’t cry)
-environment and support people (noise; lack of sleep)
-anxiety and other stressors
-past pain experience
people in and out of room; sense of powerlessness
pain assessment is…
asking and believing the patient! (the right questions!)
nonverbal pain indicators
-moaning
-crying
-grimacing
-guarded position
-increased VS but not always especially with chronic pain
-reduced social interactions (withdrawal)
-irritability
-difficulty concentrating
-changes in eating and sleeping
when should pain be assessed
-at regular intervals (at every shift)
-with each new report of pain
-after each pharmacological and non-pharmacological intervention (every 4 hours to see if intervention worked)
-assess pain and sedation! (how awake are they?)
intensity
-FLACC in epic
-1-10 in epic
-baker Wong faces (usually for kids)
-checklist of nonverbal indicators
-PAINAD in epic
-payen behavior pain scale
location(s)
-indicate area(s) of pain
-different areas may have different types of pain
-referred pain (move some place?)
quality of pain based on source
-somatic
-visceral
-neuropathic
-cutaneous
somatic
descriptors: aching, deep, dull, gnawing, throbbing, sharp, stabbing
ex: muscle, tendon, bone injuries
visceral
descriptors: cramping, squeezing, pressure (referred to different sites)
ex: gallstones, kidney stones, pancreatitis
neuropathic
descriptors: burning, numbness, radiating, shooting, tingling, touch sensitive
ex: herpes zoster, peripheral neuropathy
cutaneous
descriptors: superficial, skin or subcutaneous tissue. short with a burning sensation
phantom limb pain
painful or non painful usually sensations
intractable pain
severe; relentless; no cure; can result in early death
what are the patient goals?
-objective measure on a scale
-in terms of function
-ability to perform ADL’S
-ambulate
-to be able to deep breath after surgery
ask about goals
1-3=mild
4-6=moderate
7-10=severe
pain assessment is NOT
-relying on changes in vital signs
-deciding a patient does not “look like he is in pain”
-assuming a sleeping patient does not have pain
-knowing how much a procedure or disease should hurt
-assuming a pt will tell you when they are in pain
