Pain Management, Rest, and Restorative Sleep
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| Pain | a warning sign indicating that actual damage or potential damage exists
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| Pain can make it difficult to: | - Do ADLs
-Eat
-Rest
-Normal body movements
-Exercise
-Maintain healthy relationships
-Work/maintain a job
-Maintain cognitive abilities
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| Holitically | viewing the physical, mental, social and spiritual aspects of a person as parts of the integrated whole being
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| Gate Control Theory | the transmission of pain impulses to the CNS is controlled by a gate that opens and closes in response to sensory input
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| What kind of sensory input can "open and close the gate" | stress
anxiety
exercise
heat
cold
massage
and TENS units (transmit little shock waves to release pain)
thoughts and emotions
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| TENs | pain management technique that uses low-voltage electrical currents to stimulate nerves and block pain signals
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| Endorphins | natural body chemicals produced by the brain in response to pleasant thoughts or feelings, exercise, laughter, sex, and massage
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| Acute pain | pain that comes suddenly and has a short duration (less than 6 months)
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| Chronic pain | pain that lasts longer than 6 months
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| Intermittent pain | Pain that comes and goes at intervals
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| Intractable pain | pain that cannot be relieved, incurable, or is resistant to treatment
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| Referred pain | pain felt in an area other than where the pain was produced
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| Radiating pain | pain that begins at a specific site and shoots out from or extends to a larger area beyond the site of origin
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| Nociceptive Pain | damage to the nerve itself.
pain is localized within a specific area from which the receptors send impulses to the CNS via afferent nerve pathways
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| Nocieptors | Pain receptors
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| What chemicals, released during injury and damage to the tissue, can stimulate the nerve pain receptors | Substance P and Prostaglandins
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| Substance P | plays a role in eliciting localized tissue reactions similar to inflammation
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| Prostaglandins | hormones that act in the immediate area to initiate inflammation by sensitizing local pain receptors
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| Cutaneous Pain | pain that is more superficial or pertaining to the skins surface
ex. Papercut
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| Visceral Pain | (soft tissue pain) pain experienced from stimulation of deep internal pain receptors
ex. skin, muscle, organ surgery ( your insides hurt)
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| Deep somatic pain | (osteogenic pain) bone, ligament, tendon, and blood vessel pain. More with pain with movement
ex. bone cancer, fractures
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| Neuropathic pain | A nerve pain that occurs as a result of destruction of peripheral nerves or the CNS itself
ex. compression fracture's of the spine. burning, stabbing or sometimes deep ache (pins and needles)
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| Phantom Pain | pain coming from extremities that have been amputated
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| What factors affect pain | -Ethnic and cultural beliefs
-Developmental stage
-Individual values
-Previous pain experience
-Personal support system
-Emotions
-Fatigue
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| NSAIDs | medications that help reduce inflammation and block the production of prostaglandins, thus reducing the pain
ex. Ibuprofen, aspirin
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| What is the difference between nociceptive pain and neuropathic pain? | nociceptive pain is pain due to normal tissue injury, while neuropathic pain is pain due to damaged nerves
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| Physiological Signs of Acute pain | Recent onset
Diminishes with healing
Fight/flight response:
Heart rate increases
Respirations increase
Systolic blood pressure increases
Pupils dilate
As it worsens:
Diaphoresis
Blood pressure drops
Syncope
Pupils constrict
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| Behavioral Signs of Acute Pain | Wincing or facial grimacing
Moaning or crying
Restlessness, such as nervous finger tapping or foot bouncing
Rigid body posture
Slow movement
Holding or guarding the area
Worsens during anxiety/fear
Rocking or pacing
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| Psychological Signs of Acute Pain | Reduced attention span
Focused only on pain
Anger
Fear or anxiety
Irritability
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| Physiological Signs of Chronic Pain | Onset longer than 6 months ago
Few or none
Pupils may constrict
Vital signs may not change
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| Behavioral Signs of Chronic Pain | Lassitude
Impaired mobility/activity
Sleep disturbance
Withdrawal from family and friends
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| Psychological Signs of Chronic Pain | Low self-esteem
Depression
Fatigue
Anger
Irritability
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| Pain Assessment | - Level or extent of pain
-Site of Pain
-Characteristics of Pain
-Acute or Chronic
-What elicits the pain
-Patient's desires in relation to the pain
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| What is the first step in assisting your patient to obtain maximum pain relief? | Acknowledge and Acceptance of their pain
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| Nonpharmaceutical Methods for Pain Relief | Hot/cold packs
Massage and effleurage
TENs
Acupressure and acupuncture
relaxation
distraction
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| When is nonpharmaceutical methods of pain relief appropriate? | When the patient has lower levels of discomfort nd wants to avoid use of medication
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| Adjuvant | To assist or aid anther treatment, therefore increasing the effectivemness
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| Effleurage | the repetitive gentle, gliding stroking of your fingertips over the surface of the skin
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| Progressive Relaxation | a systematic process of using the mind to actually relax the patients muscles from the top of the head to the toes
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| Guided Imagery | using the mind to help control the body and guide the patient toward a more relaxed state. Using verbal suggestions, you direct the patients thoughts to a place that is pictures as comfortable, calming, relaxing, and perfect
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| Visual distraction | watching TV or reading a ook
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| Auditory Distraction | listening to music or some reading aloud
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| Tactile distraction | distraction through touch
ex. back massage, hug
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| Intellectual distraction | conversing with another individual, doing a sudoku, crossword or other type of puzzle
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| Pharmaceutical Methods for Pain Relief | Nonopioid analgesics
NSAIDs
Opiate/opioid Analgesics
Adjuvant Analgesics
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| Nonopioid Analgesics | Nonnarcotic pain relievers used for mild to moderate pain
ex. Tylenol
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| Opiate/ Opioid Analgesics | Analgesics bind with opiate receptors and stimulate the brains production of enkephalin and beta-endorphin compounds that decrease pain perception
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| Adjuvant Analgesics | Something that assists or aids another treatment, thereby increasing the first treatment’s effectiveness
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| Circadian Rhythm | The body's natural 24 hour cyclical pattern
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| REM Sleep | Rapid- eye movement
occurs at the end of NREM cycle. First cycl occurs about 90 minutes after sleep begins. The brain is very active and engaged in vivid dreaming that maybe remembered after awakening occurs
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| Non REM sleep | Non - Rapid eye movement
Involves four stages and is considered the deepest and most restful sleep cyc;le
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| Stage 1 NREM sleep | Relaxation begins
Lightest sleep occurs
Only lasts a few minutes
Individual easily aroused
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| Stage 2 NREM sleep | Relaxation deepens
Individual begins to experience sound sleep
Arousal relatively easy
Lasts 10-20 Minutes
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| Stage 3 NREM sleep | Deep sleep begins
Last 15-30 minutes
Arousal is more difficult
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| Stage 4 NREM sleep | Very difficult to arouse person
deepest sleep
last 15-30 minutes
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| How much sleep does a newborn acquire? | 16-18 hours a day
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| How much sleep does a school aged child acquire? | 10 hours a days
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| How much sleep does a young adult acquire? | 7.5-8 hours a per night
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| How much sleep does older adults acquire? | 5.5-6 hours per night
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| What factors affect rest and restorative sleep? | - lifestyle
- stress and anxiety
- environment
- illness and health problems
- sleep disorders
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| What does restorative sleep allow? | Allows an individual to awaken feeling rested,
refreshed, rejuvenated, and energized, ready to
meet new challenges
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| What happens when one doesn't get restorative sleep? | Cognitive functions are impaired, making
concentration difficult, resulting in poor decision
making
• Immunity decreases
• Tolerance decreases
• Fragile emotions and impatience affect
relationships
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| Interventions to promote restorative sleep | -Prepare the environment
-Comfort
-Relaxation
-Pain relief
-Sleep Medications
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| Hepatotoxicity | damage to the liver caused by exposure to harmful substances, such as medications, toxins, or chemicals.
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| Antiplatelet | medications that prevent platelets from clumping together and forming clots
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| What kind of pain does NSAIDs relieve? | Cutaneous
Visceral
Deep somatic
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| What kind of pain do Opiate/Opioids relieve? | Visceral and deep somatic pain
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| Controlled (scheduled) Substances | A drug or other substance that is tightly controlled by the government because it may be abused or cause addiction
ex. Percocet, dilaudid, Norco, codeine
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| Patient controlled analgesia | Drugs that are administered, within preset boundaries, by the patient, who controls the frequency and administration of their pain medication. Patient presses button for administration
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| Loading Dose (Bolus) | A loading dose is an initial higher dose of a drug that may be given at the beginning of a course of treatment before dropping down to a lower maintenance dose
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| Restorative sleep | sleep that allows an individual to awaken feeling rested refreshed, rejuvenated, and energized
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| Resting | Any time when an individual feels relaxed and free from anxiety
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| Bruxism | grinding of teeth during sleep
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| insomnia | chronic inability to fall asleep or stay asleep
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| narcolepsy | condition causing uncontrollable, recurrent daytime episodes of sleepiness; can hinder driving and operating dangerous equipment
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| night terrors | nightmares in children that cause awakening and fear
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| restless leg syndrome | an intolerable crawling sensation in the legs that results in an irresistible urge to move the legs
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| sleep apnea | inability to maintain breathing while sleeping; the patient usually snores accompanied b periods of apnea lasting 10 seconds to 2 minutes; can be life threatening
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| somnambulism | sleep walking
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| Sundowning | confusion and disorientation in older adults that occurs in the evening hours
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| Classes of medication that either produce pain relief from a mechanism different from traditional analgesics or by potentiating or increasing the effects of opiates, opioids, and non-opioid drugs are known as what? | adjuvant drugs
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| Types of nociceptive pain | - Cutaneous pain
- Visceral pain
-Deep somatic pain (osteogenic pain)
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| Who is the best judge of the severity of a patient's pain? | The patient
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| Acetaminophen is a common over-the-counter medication used by most individuals. What is the maximum dose limit for an adult? | 4000 mg per 24 hours
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