Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Pain Management
PNSG 1202 Nursing 1 unit 3
| Topic: Pain Management | Information: Pain Management |
|---|---|
| "Pain Management" What is "pain"? | Pain is whatever the patient says it is, existing whenever they say it does. |
| Pain is always a _________ phenomena. | subjective |
| Cultural Influences | Lack of pain expression does not mean lack of pain. |
| Cultural Influences | Western culture tend to value high pain tolerance. Nurses can be "stingy" with analgesics! |
| What is "pain"? | A Protective Mechanism |
| What is "pain"? A Protective Mechanism | Warning that tissues are being damaged. |
| What is "pain"? A Protective Mechanism | Prompts us to withdraw from source of pain stimuli. |
| What is "pain"? A Protective Mechanism | Prompts us to seek relief. |
| What is "pain"? A Protective Mechanism | Helps us keep injury to a minimum. |
| Physiology of Pain | Nociceptors are stimulated by: chemicals, swelling, edema, muscle spasms, & ischemia. |
| Nociceptors | Pain receptors that are stimulated by chemicals such as histamine, bradykinins, substance P, and prostaglandins... |
| Nociceptors | ... swelling or edema, muscle spasms, ischemia. |
| Ischemia | ischemia (ĭs-kē′mē-ă) [Gr. ischein, to hold back, + haima, blood] A temporary deficiency of blood flow to an organ or tissue |
| Edema | edema, oedema (ĕ-dē′mă) (pl. edemas or edemata) [Gr. oidema, swelling] A local or generalized condition in which the body tissues contain an excessive amount of tissue fluid. |
| Pain Conduction | Transduction - noxious stimuli triggers electricl activity in the afferent nerve fibers (nociceptors) |
| Noxious | noxious (nŏk′shŭs) [L. noxius, injurious] Harmful; not wholesome |
| Afferent | afferent (ăf′ĕr-ĕnt) [L. ad, to, + ferre, to bear] Transporting toward a center, such as a sensory nerve that carries impulses toward the central nervous system; opposite of efferent. |
| Pain Conduction (above mentioned transduction, then transmission ----> ) | Transmission - impulse travels to the spinal cord and to the thalamus & somatosensory cortex via afferent (sensory) pathways. The motor reaction to the stimuli occurs from the brain down to the efferent pathways. |
| Pain Conduction (above mentioned transduction, next transmission, and then Modulation ----> ) | Modulation - CNS pathway that inhibits pain transmission by sending signals back down to the dorsal horn of the spinal cord and substance P is blocked by serotonin & endorphins (the body's way of limiting the pain) |
| Physiology of Pain Stimuli ='s | (Nerve Conduction & Reflex Arcs) |
| A pin prick on the skin for example: | Stimulates a sensory nerve ending |
| Stimulated sensory nerve ending sends the | stimuli traveling up the peripheral nerve, through the dorsal root to the dorsal horn (gray matter) of the spinal cord. |
| From there a synapse occurs with a motor neuron which triggers the movement away from the stimuli (reflex arc). | At the same synapses, a sensory (afferent) neuron receives the message and this travels up the spinal cord to the thalamus then to the cortex for interpretation. |
| Psychological Perceptions and | Reactions to Pain involve the following |
| Complex mind/body interaction involving: | previous experience |
| Complex mind/body interaction involving: | coping mechanisms |
| Complex mind/body interaction involving: | culturally based |
| Complex mind/body interaction involving: | state of health |
| Complex mind/body interaction involving: | fatigue |
| Complex mind/body interaction involving: | anxiety levels |
| Complex mind/body interaction involving: | distractions |
| Theories of Pain & Pain Control | Gate Control Theory |
| Gate Control Theory | cuaneous stimulation, increased sensory input, inhibitory impulses, laughter, & medications. |
| Gate Control Theory | Melzack and Wall (1965) |
| Gate Control Theory | Views pain transmission as being controlled by a gate mechanism in the central nervous system. |
| Gate Control Theory | Simply stated, opening the gate allows transmission of pain sensation and closing the gate blocks this transmission. |
| The Gate Control Theory offers the following ideas that apply to nursing practice: | The gate may b opened by activity in the small-diameter nerve fibers from such things as tissue damage. However, activity in the large - diameter nerve fibers seems to close the gate. Examples of this would include massage and vibration. |
| The Gate Control Theory offers the following ideas that apply to nursing practice: | Brainstem impulses causd by a high sensory input seem to close the gate; lack of this input allows the gate to open. This may be why people who are bored or lonely can experience a greater intensity in their pain than when they are occupied or distracted |
| The Gate Control Theory offers the following ideas that apply to nursing practice: | ... by such things as visitors or a particualrly interesting program or activity. |
| The Gate Control Theory offers the following ideas that apply to nursing practice: | The cerebral cortex & thalamus play a role by opening the gate with impulses originating from an increase in anxiety, or by closing it with implulses originating from a decrease in anxiety. For example, fear that the pain will get worse and not be |
| The Gate Control Theory offers the following ideas that apply to nursing practice: | ... controlled may increase the intensity; knowing that pain can and is being controlled may reduce the inensity. |
| Theories Today: | Endorphins, endorphin (ĕn-dor′fĭns) (ĕn′dor-fĭns) A polypeptide produced in the brain that acts as an opiate and produces analgesia by binding to opiate receptor sites involved in pain perception. |
| Theories Today: | Serotonin, serotonin (sēr″ō-tōn′ĭn) A chemical, 5-hydroxytryptamine (5-HT), found in platelets, the gastrointestinal mucosa, mast cells, carcinoid tumors, and the central nervous system. |
| Theories Today: | Prostaglandins, prostaglandin (prŏs″tă-glăn′dĭn) (PG) Any of a large group of biologically active, carbon-20, unsaturated fatty acids that are produced by the metabolism of arachidonic acid through the cyclooxygenase pathway. |
| Theories Today: | Nociceptive, nociceptive impulse (nō″sĭ-sĕp′tĭv) Impulse giving rise to sensations of pain / nociceptive reflex A reflex initiated by a painful stimulus / nociceptive stimulus A painful and usually injurious stimulus. |
| Theories Today: | Neuropathic, neuropathic pain Pain that originates in nerves themselves rather than in other damaged organs that are innervated by them. |
| Acute Pain | <6 mo duration, generally an identifiable cause, Travel via A-delta (myelinated) fibers of the afferent pathway, Rapid transmission, Associated with SNS response "fight or flight" |
| Chronic Pain | >6 mo duration, Assoc. c chronic disease, Travels via C-fibers (unmyelinated), Slower transmission, No fight/flight Sx's, Freq. assoc. c other Sx's such as depression, fatigue, hopelessness, listlessness, decreased libido & weight, Increase suicide risk. |
| Referred Pain | Referred pain is pain experienced in an area of the body other than where it is actually occurring. Instead, the pain is perceived at the spot where the organs were located during fetal development. |
| Pharmacological Interventions (General Considerations) | Pain relievers are called analgesics, Key: Comfort measures will enhance the effects of medications. Pain distorts percepion of time passage. Different kinds of analgesics effect different sites along the neural pathway, pain that is allowed to continue |
| Pharmacological Interventions (General Considerations) | ... is harder to get under control. Key: "Preventive" pain management rather than "crisis management" will lead to better pain control and less overall medication usage. Titrate dosage (adjust within physician's order) to achieve desired effect; one |
| Pharmacological Interventions (General Considerations) | ... size does NOT fit all! |
| Pharmacological Interventions (Nonopioid Analgesics) | Same as "non-narcotics", mild to moderate pain, combined with narcotics for intense pain, salicylates are the most commonly used group (ASA, NSAIDs), works at the peripheral nervous system level. |
| Non-opioid | 1st Class of drugs used for Tx of pain, Used for acute and chronic pain, Ceiling effect - A dose beyond which there is no improvement in the analgesic effect and there may be an increase in side effects. Don't produce tolerance; physical or psychological |
| Non-opioid | ... dependence, Antipyretic effects. Work primarily at the site of injury or peripherally. EX: NSAIDs |
| Pharmacological Interventions (Nonopioid Analgesics) | Examples: Ibuprofen (Advil, Motrin, Nuprin) Dolobid, Lodine, Nalfon, Orudis, Meclomen, Naproxen (Aleve, Anaprox, Naprosyn), Indocin, Feldene, Clinoril, Tolectin, Toradol - only 5 days total. |
| Pharmacological Interventions (Nonopioid Analgesics) | Actions: analgesic, anti-inflammatory, antipyretic, anticoagulant. |
| Pharmacological Interventions (Nonopioid Analgesics) | Adverse effects: allergy, GI upset, ulceration & bleeding. tinnitus, over dose is a medical emergency, not recommended for children (Reye's Syndrome) |
| Pharmacological Interventions (Nonopioid Analgesics) | Ecotrin, Ascriptin alternatives to ASA, NSAIDs should be given with meals, Acetaminophen (Tylenol, K-Nol, Panadol) * analgesic/antipyretic, * slight anti-inflammatory effects, * safe for children. |
| COX2 Inhibitors (Newer class of anti-inflammatory agents) | Celebrex, Vioxx, Benefits are generally more effective than NSAIDs, Generally better tolerated than NSAIDs, Fewer GI side effects, Contraindicated for people who have ASA allergies or history of GI bleeding. |
| Pharmacological Interventions (Narcotic Agonists (Opioids) | General Considerations: an agonsit is a drug that has an affinity for the receptors of another drug producing the actual physiological effect, the opiates are derived from naurally occurring substances but also come in synthetic form, used for moderate to |
| Narcotic Agonists (Opioids) | ... sever pain. Side Effects: Respiratory Depression, Depressed Coughing, Sedation/Delirium, Nausea & Vomiting, Decreased Peristalsis/Constipation, Hypotension |
| Narcotic Agonists (Opioids) | Morphine Sulfate (MS) |
| Narcotic Agonists (Opioids) | Codeine {Tylenol #3, Percocet/Tylox/Roxicet}[Acetominophen & Oxycodone], {Percodan}[ASA & Oxyxodone] |
| Narcotic Agonists (Opioids) | Dilaudid |
| Narcotic Agonists (Opioids) | Meperdine (Demerol) |
| Narcotic Agonists (Opioids) | Fentanyl (Duragesic) |
| Narcotic Agonists-Antagonist | an antagonist is a drug that binds to the recptors of another drug blocking the action (no physiological effect), agonist-antagonist can act either way! can be combined with non-narcotics for pain relief at both the peripheral and CNS levels without |
| Narcotic Agonists-Antagonist | ... increasing side effects of narcotic, even less likely to develop an addiction than wih opiates. |
| Narcotic Agonists-Antagonist | Examples: Nubain, Talwin, Stadol, Buprenex. |
| Narcotic Antagonist | definition (blocks the action of opiates) Narcan is the agent used for narcotic toxicity, administer if resp. rate falls below 8-9/minute, has a shorter t1/2 than most narcotics-be alert {Naloxone HCI (Narcan) 0.2mg IVP; take PCA button away; & call MD. |
| Adjuncts to Pain Relief (Adjuvant Medications) | Corticosteroids - decrease inflammation (Decadron), Sedatives - anxiolytic effects; promotes rest (Valium). Antidepressants - decreases pain perception (Tricyclics). Potentiators - enhance narcotic effect; anxiolytic (Vistaril). Anticonvulsants (Tegretol) |
| Analgesic Ladder | * Chronic pain management according to WHO guidelines involves the use of the analgsic ladder concept. * The ladder recommend different analgesic approaches depending on the level of pain being experienced. |
| Analgesic Ladder - Step 1 {Pain} | Non-opioid + Adjuvant |
| Analgesic Ladder - Step 2 {Pain persisting or increasing} | Opioid for moderate pain + Non-opioid + Adjuvant |
| Analgesic Ladder - Step 3 {Pain persisting or increasing} [Freedom from cancer pain] | Opioid for moderate to severe pain + Non-opioid + Adjuvant |
| Medication Routes: | Intravenous (IV) - rapid onset & peak action; short duration |
| Medication Routes: | Intramuscualr (IM) - fast onset; peaks in 1-2 hours; last longer than IV route |
| Medication Routes: | Oral (po) - slow onset; can take hours to peak; unpredictable absorption |
| Medication Routes: | Transdermal (TD) - slow onset; long duration |
| Medication (Other Considerations) | Sometimes MD's prescribe a drug range (give 50-75 mg); the nurse makes the dosing decision based on assessment and tolerance of prior doses, not legal to decrease dose of analgesics without MD order, different routes will change a drugs onset duratiion |
| Addiction to Pain Meds (a rare occurence when used to treat acute pain episodes) | Drug abuse. Addiction: psychological, physical, withdrawal symptoms. Drug tolerance, Incidence of addiction (<1% of patients) |
| Other Pain Interventions | Patient Controlled Analgesia (PCA) - patient push a button (as shown) to self-administer an IV dose of narcotic; safety parameters are programmed into a computerized pump. |
| Other Pain Interventions | Epidural/Intrathecal routes may also be used for pain management |
| Other Interventions | Radiation therapy, Chemotherapy, Lidocaine/prilocaine, Metastron |
| Pain Intervention (Nerve Blocks) | Temporary (local and regional anesthetics such as Xylocaine and Marcaine) Permanent (neurolytics such as Phenol and Alchol) |
| Pain Intervention (Nerve Blocks, Surgical Interruption, Etc.) | Nerve block - injecting a local anethetic or neurolytic agent into the nerve |
| Pain Intervention (Nerve Blocks, Surgical Interruption, Etc.) | Neurosurgery - implanting electrical stim devices to interrupt pain signal; rhizotomy (transection of a nerve root); cordotomy (severing pain-conducting tracts in the dorsal horn of the spinal cord) |
| Pain Intervention (Nerve Blocks, Surgical Interruption, Etc.) | Radiation Therapy - palliative measure for cancer pain, etc. |
| Pain Intervention (Nursing Role) | Key: Nursing measusres should include attention o the simple things that promote physical comfort. Key: Anticipate what may psychological factors may cause anxiety. Medications, Feeling safe, Lessen anxiety, Back rub, Repositioning, Cleanliness. |
| Pain Intervention (Cognitive Behavioral Interventions) | Trusting nurse-client relationship, relaxation techniques, reframing, distraction/music therapy, guided imagery, humor, biofeedback, stress management, prayer/mediatation, yoga. |
| Pain Intervention (Cutaneous Stimulation) | Hot applications, ultrasound, diathermy, hydocollator packs, mentholated rubs. Cold applications. Acupressure & massage. TENS units. |
| Pain Intervention (Alternative Therapies) | Acupunture, reflexology, chiropractics, hypnosis, osteopathy, homeopathy. |
| Pain Intervention (Planning) | "To each his own", Prevention is key. Use a multidisciplinary approach. |
| Nursing Process | Assessment; Believe the patient, Pain history - Use tools, Patints description, Complete physical assessment. |
| Pain history - WHAT'S UP? | Pain analysis: (WHAT'S UP acronym) - pg 111 Williams and Hopper |
| W | Where? |
| H | How does it feel? |
| A | Aggravating/Alleviating factors |
| T | Timing |
| S | Severity |
| U | Useful other data |
| P | Perception |
| Pain Assessment (Subjective Info) | Intensity evaluation (see scales p. 111); children require special developmentally appropriate scales to rate their pain (see the Wong/Baker Faces scale on p. 112 of Williams & Hopper) |
| Pain Scale 0 -10, 0 = No pain and 10 = Worst pain | Mild = 2, Moderate = 5 or higher and Severe = 9 or higher. |
| Wong Baker Faces | Explain to the child that each face is for a person who feels happy because he or she has no pain (hurt or whatever word the child uses) or feels sad because he or she has some or a lot of pain. |
| Point to the appropriate face and state "This face is..." | 0 - "very happy because he doesn't hurt at all." |
| Point to the appropriate face and state "This face is..." | 1 - "hurts just a little bit." |
| Point to the appropriate face and state "This face is..." | 2 - "hurts a little more." |
| Point to the appropriate face and state "This face is..." | 3 - "hurts even more." |
| Point to the appropriate face and state "This face is..." | 4 - "hurts a whole lot." |
| Point to the appropriate face and state "This face is..." | 5 - "hurts as much as you can imagine, although you don't have to be crying to feel this bad." |
| Wong-Baker faces | Ask the child to choose the face tha best describes hoe he or she feels. Be specific about which pain (e.g., "shot" or incision) and what time e.g., now? earlier before lunch?). |
| Pain Assessment (Objecgtive Information) | Key: The presence or absence of observable sighns of pain does not indicate the presence or absence of pain. |
| Pain Assessment (Objecgtive Information) | Physiologic signs of acue pain; elevated VS, diaphoresis, pallor, muscles tension, dialated pupils. |
| Pain Assessment (Objecgtive Information) | Note: the physiologic signs of pain in patients with chronic pain are generally absent. |
| Nursing Process | Planning and Implementation, pain control goal, patient options and control. |
| Nursing Process | Patient Education, Evaluation, have the goals been met? |
Created by:
2banurse
Popular Nursing sets