Transcript Acute/transient pain

Pain Management
Nature of Pain
Involves physical, emotional, and cognitive
components
Results from physical and/or mental stimulus
Reduces quality of life
Not measurable objectively
Subjective and highly individualized component
Types of Pain
Acute/transient pain
Protective, identifiable,
short duration; limited
emotional response
Chronic/persistent
noncancer
Is not protective, has no
purpose, may or may not have
an identifiable cause
Chronic episodic
Cancer
Occurs sporadically over
an extended duration
Can be acute or chronic
Inferred pathological
Idiopathic
Musculoskeletal,
visceral, or neuropathic
Chronic pain without identifiable
physical or psychological cause
Nursing Knowledge Base
• Attitude of health care providers
– Malingerer or complainer
• Assumptions about patients in pain
– Biases based on culture, education,
experiences
– Acknowledge pain through patient’s
experiences
– Limit your ability to help the patient
Factors Influencing Pain
• Physiological
– Age, fatigue, genes, neurological function
• Fatigue increases the perception of pain and can
cause problems with sleep and rest.
• Social
– Attention, previous experiences, family and
support groups, spiritual
– Spirituality includes active searching for
meaning in situations, with questions such as
“Why am I suffering?”
Factors Influencing Pain (cont’d)
• Psychological
– Anxiety
– Coping style
• Pain tolerance
– The level of pain a person is willing to accept
• Cultural
– Meaning of pain
– Ethnicity
Nursing Process and Pain
• Pain management needs to be systematic.
• Pain management needs to consider the
patient’s quality of life.
• Clinical guidelines are available to manage
pain:
– American Pain Society
– National Guideline Clearing House
(www.guideline.gov)
– Agency for Healthcare Research and Quality
(AHRQ)
Assessment
• Patient’s expression of pain
• Characteristics of pain
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Onset and duration
Location
Intensity
Quality
Pattern
Relief measures
Contributing symptoms
Effects of pain on the patient
Assessment
• Effects of pain on the patient
– Behavioral effects
• Assess verbalization, vocal response, facial
and body movements, and social interaction.
• For patients unable to communicate pain, it is
vital for you to be alert for indicative behaviors.
– Influence on activities of daily living
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Physical deconditioning
Sleep disturbances
Sexual relationships
Ability to work (outside of and in the home)
Pain Assessment and Management:
• A: Ask about pain regularly. Assess pain systematically.
• B: Believe the patient and family in their report of pain
and what relieves it.
• C: Choose pain control options appropriate for the patient,
family, and setting.
• D: Deliver interventions in a timely, logical, and
coordinated fashion.
• E: Empower patients and their families. Enable them to
control their course to the greatest extent possible.
Nursing Diagnosis
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Acute Pain
Chronic Pain
Self care deficit: dressing/grooming r/t pain
Impaired physical mobility r/t pain
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Planning
• Determine with the patient what the pain has
prevented the patient from doing.
• Then agree on an acceptable level of pain that allows
return of function.
• For example, for the goal, “The patient will achieve a
satisfactory level of pain relief within 24 hours,”
possible outcomes are as follows:
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Reports that pain is a 3 or less on a scale of 0 to 10
Identifies factors that intensify pain
Uses pain relief measures safely
Level of discomfort does not interfere with activities of daily
living (ADLs).
Implementation: Health Promotion
• Nonpharmacological pain relief
interventions
– Relaxation, guided imagery
– Biofeedback
– Distraction, music
– Cutaneous stimulation
• Massage, transcutaneous electrical nerve
stimulation (TENS), heat, cold, acupressure
– Herbals
– Reducing pain perception
Implementation: Health Promotion (cont’d)
• Pharmacological pain relief
– Acute pain management
– Analgesics
• Nonopioids
• Opioids
• Adjuvants/co-analgesics
– Delivery systems
• Patient-controlled analgesia (PCA)
• Local/regional anesthesia
• Topical agents
Patient-Controlled Analgesia
Implementation
• Nursing implications
– You maintain responsibility for providing
emotional support to patients receiving local or
regional anesthesia.
– After administration of a local anesthetic,
protect the patient from injury until full
sensory and motor function return.
– Nursing implications for managing epidural
analgesia are numerous.
– Nurses monitor IV sites, lines, and controllers.
Barriers to Effective Pain Management
• Physical dependence: A state of adaptation that is manifested by a
drug class–specific withdrawal syndrome produced by abrupt
cessation, rapid dose reduction, decreasing blood level of the drug,
and/or administration of an antagonist
• Addiction: A primary, chronic, neurobiological disease with genetic,
psychosocial, and environmental factors influencing its development
and manifestations
• Drug tolerance: A state of adaptation in which exposure to a drug
induces changes that result in a diminution of one or more effects of
the drug over time
• Placebos
Checklist for
Communication with Colleagues
• What is the pain rating now? Over the past
period of time?
• Which pain rating is acceptable to the patient?
• How do you recommend that the patient’s
treatment be changed to reduce the pain
rating?
• Which professional reference can be used, if
needed, to support this recommendation?
Evaluation
• Evaluation of pain is one of many nursing
responsibilities that require effective critical
thinking.
• The patient’s response to pain may not be
obvious.
• Evaluating the appropriateness of pain
medication will require nurses to evaluate
patients’ responses after administration.
Safety Guidelines
• The patient is the only person who
should press the button to administer
the pain medication when PCA is used.
• Monitor the patient for signs and
symptoms of oversedation and
respiratory depression.
Study Guide for Pain Chapter
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Physiological Responses pg 964
Behavioral Responses
Types of Pain
Knowledge, Attitudes, and Belief pg 966
Factors influencing Pain
Physiological Factors
Psychological Factors
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Study Guide for Pain Chapter
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Nursing Process
Assessment
Planning
Implementation
Not!: Nonpharmacological pain relief interventions or
Cutaneous Stimulation, but massage and cold and heat
applications; TENS
Acute pain managaement
Pharmacological pain-relief interventions
PCA—Stop until Barriers to effective pain Management pg 988
Evaluation
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