Pain Flashcards
(27 cards)
Pain; definition
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
Different definitions of pain
-Whatever and wherever the person experiencing pain says it is.
-Unpleasant sensory and emotional experience associated with actual or potential tissue damage.
-Multidimensional and entirely subjective.
-Pain can be experienced in the absence of identifiable tissue damage.
-Pain is not synonymous with suffering.
-Pain is subjective - it is entirely the clients experience and self report is essential.
Pain
-A major problem that causes suffering and reduces quality of life.
-One major reason why people seek health care.
-Nurses have a central role in assessment and management of pain.
-Effective pain relief is a basic human right.
Pain Management; an individuals rights
-Their pain to be acknowledged and expected.
-The best possible personalized evidence-based pain assessment and management including relevant bio-psychosocial components.
-Ongoing information and education about the assessment and management of pain.
-Involvement as an active participant in their own care in collaboration with the inter professional team.
-Communication and documentation among interprofessional team members involved in their care to monitor and manage their pain.
Nursing intervention; pain
-Assess pain, document it, and communicate with other health care providers.
-Ensure delivery of adequate pain relief measures.
-Evaluate effectiveness of interventions.
-Monitor ongoing effectiveness of pain management strategies.
-Provide education to clients and their families.
Consequences of untreated pain…
-Unnecessary suffering.
-Physical and psychosocial dysfunction.
-Impaired recovery from acute illness and surgery.
-Immuno-Suppression
-Sleep disturbances
Dimensions of pain
-Physiological
-Sensory-Discriminative
-Motivational-affective
-Cognitive-evaluative
-Sociocultural
Causes and types of pain; by underlying pathology
Nociceptive
-Somatic
-Visceral
Neuropathic
Causes and types of pain; by duration
-Acute
-Persistent
Acute pain
-Sudden onset
-Usually within the normal time for healing
-Mild to severe
-In general, a precipitating illness or event can be identified
-Lowers over time and goes away as recovery occurs
-Manifestations reflect sympathetic nervous system activation:
•Increased HR
•Increased RR
•Increased BP
•Diaphoresis, Pallor
•Anxiety, agitation, confusion
NOTE: responses normalize quickly owing to adaptation
-Goal is pain control with eventual elimination.
Persistent Pain
-Gradual or sudden
-May start as acute injury but continues past the normal time for healing to occur
-Mild to severe
-cause may not be known; original cause of pain may differ from mechanisms that maintain the pain
-Typically, pain persists and may be ongoing, episodic, or both -predominantly behavioural manifestations:
•Changes in affect
•Decrease in physical movement and activity
•Fatigue
•Withdraw from other people and social interaction
-Goal is minimizing pain to the extent possible; focusing on enhancing function and quality of life
Nursing assessment of pain
Assess for the presence or risk of pain
•on initial assessment and all subsequent assessments
• Each time vital signs are completed
•Prior to, during and after a procedure
•Prior to and following using pharmacological and non-pharmacological treatment for pain
Assessment: the patients pain goal or expectations of comfort and pain relief
Characteristics: intensity, timing, location, quality
Aggravating or reliving factors
Behaviours associated with the pain
Assesment
-PQRST
-Wong-baker FACES pain rating scale
Pain assessment; components
-Effects of pain on clients sleep and daily activities, relationships, physical activity, and emotional well-being should be assessed.
-Past pain experiences, meaning of pain for the client, ways client expresses the pain, and clients pain-Control strategies should all be included.
Pain Treatment: basic principles
-Routine assessment is essential for effective management
-Unrelieved acute pain complicates recovery
-Clients self-report of pain should be used whenever possible
-Health providers have a responsibility to assess pain routinely, to accept clients pain reports, to document them, and to intervene in order to manage pain.
-The best approach to pain management involves clients, families, and health providers.
Pain treatment: basic principles continued
-Many clients at high risk for suboptimal pain management - all clients should have assailants pain relief
-Treatment based on clients and family’s goals for pain treatment
-Combination of drug and non drug therapies
-Multidimensional and interdisciplinary approach
-Evaluation of therapies
-Prevent or manage adverse effects
-Client and caregiver teaching is the cornerstone of the treatment plan.
Drug therapy for pain
-Equianalgesic dose
-Scheduling analgesics
-Titration
Drug therapy for pain: analgesic ladder 1-3
Mild pain
-1-3 on a scale of 1-10
“Step 1” drugs
•nonopioid analgesics (aspirin and other salicylates, other NSAIDs, and acetaminophen (Tylenol))
-ceiling effect: increasing the dose beyond and upper limit provides no greater analgesia, no tolerance or physical dependence, many available without a prescription.
Drug therapy for pain: analgesic ladder 4-6
Mild to moderate pain
-4-6 on a scale of 1-10, or mild but Presistent despite nonopoid therapy
-“step 2” drugs
•Mu: morphine, oxycodone, hydromorohone, methadone
•opioid agonists (morphine)
•antagonists (naloxone)
•mixed (pentazocine, butorphanol)
Drug therapy for pain: analgesic ladder (severe pain)
Opioid analgesics commonly used for severe pain
-Morphine
-Morphine-like agonists (hydromorohone (dilaudid), methadone (metadol), fentanyl (duragesic), meperidine (Demerol) (not recommended))
-Mixed agonists - antagonists (butorphanol (stadol))
Adjuvant analgesic therapy
-used in conjunction with opioids and nonopioids
-Sometimes called coanalgesics
-Enhance pain therapy through one of three mechanisms:
1.enhancing the effects of opioids and non opioids
2.possessing analgesic properties of their own
3. Counteracting adverse effects of other analgesics
Non-pharmacological therapy
-Massage
-Therapeutic exercise
-TENS
-Application of heat
-Application of cold
-Cognitive techniques
•Distraction
•Relaxation strategies
•Self-management
Tolerance
A persons diminished response to a drug, which occurs when the drug is used repeatedly and the body adapts to the continued presence of the drug
Addicition
Addiction is defined as a chronic, relapsing disorder characterized by compulsive drug seeking and sue despite adverse reactions
