Transcript FINAL Presentation

PAIN
KATE BLACK
KATE BRAZZALE
LISA MOLONY
PAIN
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Aetiology
Disorder/Disease
Clinical Manifestations
Pathophysiology
Diagnosis
Pharmacological Management
Non-Pharmacological Management
Complications
Implications for Nursing Practice
Pain Case Study
WHAT IS PAIN?
According to the International Association for the Society of
Pain,
Pain is “an unpleasant sensory and emotional experience
associated with actual or potential tissue damage, or
described in terms of such damage”.
(Loeser, 2011)
AETIOLOGY: WHAT CAUSES PAIN?
• “Pain can be due to a wide variety of
diseases, disorders and conditions
that range from a mild injury to a
debilitating disease”
(Williams, 2011)
EXAMPLES OF PAIN
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Injury (Broken bone)
Disease (Cancer)
Condition (Arthritis)
Illness (Influenza)
Surgery (Caesarean Section)
ACUTE PAIN
“The terms acute and chronic refer exclusively to the time course of
the pain, irrespective of aetiology” (Craft, Gordon, and Tiziani, 2011, p.144).
Acute Pain:
•Usually lasts less than 3 months
•Sudden onset
•Usually know the cause of the pain
•Usually well defined
•Predicable ending (healing)
•Can lead to chronic pain if left untreated
•Examples: cut to the finger, broken bone
CHRONIC PAIN
Chronic Pain:
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Persistent or recurring pain
Continues for more than 3 months
May last for months or even years
Can be difficult to diagnose and treat
Primary goal is not total pain relief but reducing pain relief
• Examples include: arthritis and back pain
CATEGORIES OF PAIN
Another way to categorise pain is on the basis of
origin:
• Nociceptive
• Neuropathic
• Psychogenic
NOCICEPTIVE PAIN
Nociceptive pain is directly related to tissue damage and can be
either external (somatic) or internal (visceral)
External / Somatic
• Most common type of pain
• Can be superficial -in the skin but may extend to the underlying
tissues.
• Usually described as: sharp, shooting, throbbing, burning, stinging
• well defined area
• Usually lasts from a few seconds to a few days
• Examples include: paper cut, sprained ankle
NOCICEPTIVE PAIN
Internal / Visceral (Deep)
Less common and usually more severe
Originates in the walls of visceral organs
Poorly defined area
Described as: deep, aching, pressing or aching
Usually lasts a few days to weeks
Virtually a symptom of all diseases at some point during disease
progression.
• Often associated with feeling sick
• Examples include: Major surgery, labour pain, irritable bowel.
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NEUROPATHIC PAIN
• Injury or disease of the central nervous system
rather than the peripheral tissue.
• May be due to nerve compression,
inflammation or trauma
• Usually lasts between a few months to many
years.
• Difficult to treat due to the lack of knowledge
of the underlying cause.
• Often associated with paraesthesia,
hyperalgesia and allodynia
• Burning, shooting or pins and needles (not
sharp like nociceptive).
PSYCHOGENIC PAIN
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Psychological, psychiatric or psychosocial are the primary causes
Severe and persistent pain
Appears to have no underlying pathology.
Less common now due to medical technology
Pain experienced (Headaches, abdominal pain, back pain) is
indistinguishable from that experienced by people with identifiable
injuries or diseases.
• This kind of pain can be very
frustrating to sufferers and can
interfere with their ability to function
normally.
CLINICAL MANIFESTATIONS
“No two people are likely to experience the same level of pain for a given
painful stimulus” (Craft et al., 2011, p.150).
Pain Tolerance:
The maximum level of pain that a person is able
to tolerate without seeking avoidance of the
pain or relief
What affects Pain Tolerance?
• Fatigue, anger, boredom, apprehension,
sleep deprivation. Alcohol consumption,
medication, hypnosis, warmth, distracting
activities and strong beliefs or faiths.
CLINICAL MANIFESTATIONS
Pain tolerance is influenced by a number of factors
including;
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Age
Cultural perceptions
Expectations
Gender
Physical and mental health
CLINICAL MANIFESTATIONS
Age:
•Different reaction to pain
•Understanding of pain
Gender:
•“Females display greater sensitivity to pain than males do. There are
differences in the way women cope with pain, report pain and respond
to pain” (Crisp & Taylor, 2009, p.1096).
Physical & Mental Health
•Physical mobility
•Depression, difficulty coping, fatigue.
CULTURAL VARIATIONS
Cultures vary in the meaning of pain, how if it expressed
and how it is treated:
• Meaning
• Expression
• Treatment
PAIN THRESHOLD
• Pain Threshold is the lowest point at which pain can be felt
• Entirely subjective
• May vary from person to person but changes little in the same
individual over time.
LOCATION
It is important record a patients pain location to be able to
monitor any changes.
Pain can feel like it is
coming from one part
of the body but in fact it
is another, this type of
pain is called referred
pain.
SIGNS AND SYMPTOMS:
Signs:
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Change in temperature
Blood pressure
Respiratory rate
Heart rate
Short of breath
Sweating
Pallor
Dilated pupils
Swelling
Symptoms:
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Fatigue
Feeling sick
Weakness
Numbness
Tenderness
Change in behaviour
Unable to sleep
PATHOPHYSIOLOGY
• Pain is not a disorder or disease.
• A consequential reaction by the body to
noxious stimuli.
• Injury
• Disease
• Pain incorporates
• Cognition
• Emotion
• Behaviour
• Simple pathway to the brain;
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Transduction
Transmission
Perception
Modulation
PATHOPHYSIOLOGY
• Transduction
• Process by which afferent nerve endings participate in translating
noxious mechanical, chemical or thermal impulses into
nociceptive impulses.
• Strong physical stimuli and disease processes cause chemical
release.
• Once activated the chemicals bind to specific receptors.
• chemicals such as bradykinin, cholecystokinin and prostaglandins,
activate or sensitize nearby nociceptors
• Lead to the generation of Action Potentials (AP)
TRANSDUCTION
PATHOPHYSIOLOGY
• Transmission
• 1st Order Sensory Neurons
• Located in the dorsal root ganglia in the posterior of the spinal
cord.
• AP’s are conducted to the CNS primarily via two types of
primary afferent neurons
• A delta Fibres "Epricritic Pain"
• C Fibres "Protopathic Pain"
• 2nd Order Sensory Neurons
• The impulse crosses the spinal cord and ascends to the
thalamus and branches to the brainstem nuclei via central
transmission.
• Messages cross the cord and ascend to the thalamus via the
Spinothalamic pathway, heading to the somatosensory cortex,
the insula, frontal lobes and limbic system.
A-DELTA AND C FIBRES
Nerve fibre
Aδ
C
Appearance
Type of Pain
Epicritic
Protopathic
Information
carried
•Sharp pain
(‘fast pain’)
•Temperature
•Dull pain
(‘slow pain’)
•Temperature
•Itch
Diameter
1-5
(micrometres)
0.2-1.5
Speed of
signal
conduction
0.5-2.0 m/sec
5-35 m/sec
A delta Fibres
• "Epricritic Pain"
• Mechanical message
• Sharp, Fast pain
• Thin Myelinated fibres
increase speed of processing
C Fibres
• "Protopathic Pain"
• Mechanical and Thermal
Stimuli
• Slow, dull, long lasting pain
• Unmyelinated fibres, slower
response
PERIPHERAL TRANSMISSION
Peripheral transmission
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An electron micrograph showing
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large myelinated Aβ
small lightly myelinated Aδ fibres
unmyelinated fibers C Fibres.
SYNAPTIC TRANSMISSION
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Synaptic transmission
• Action potential synapse at
the dorsal horn of the spinal
cord
• Neuroactive excitatory and
inhibitory neurotransmitters
are released
• Lead to generation of
action potentials and
central transmission of pain
signals to higher centres.
PATHOPHYSIOLOGY
• Perception
• When noxious stimuli is recognised.
• Multiple areas of the brain
• 3rd Order Sensory Neurons
• To the higher brain centres of
Limbic system
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• Frontal cortex, primary sensory cortex of the post central gyrus of
parietal lobe
• Sensory-Discriminative Response
• result of activity in the somatosensory and the insular cortex
• allows the person to identify the type, intensity and bodily location of the
noxious event.
• Affective-Emotional Response
• Mediated by the limbic system.
• Defines the response and associated behaviour.
PATHOPHYSIOLOGY
• Modulation
• Dampening or amplifying pain-related neural signals.
• Descending input from the brainstem influences central nociceptive
transmission in the spinal cord.
• Descending inhibition of nociception through the release of
neurotransmitters such as serotonin, norepinephrine and endogenous
opioids.
• Gate Control Theory (Melzack and Wall, 1965)
• The body can reduce or increase the degree of perceived pain through
modulation of incoming impulses at a gate located in the dorsal horn of the
spinal cord.
• The integration determines whether the gate will be opened or closed,
either increasing or decreasing the intensity of the ascending pain signal.
• Psychological variables in the perception of pain, including motivation to
escape pain, and the role of thoughts, emotions, and stress reactions in
increasing or decreasing painful sensations.
DIAGNOSIS
• Diagnosis of Pain
is complicated.
• To diagnose pain,
Nurses rely on
• Objective Data.
• Visual signs.
• Subjective Data.
• Patients
descriptions.
• Characteristics of
Pain.
DIAGNOSIS
• Characteristics of Pain
• OPQRST Mnemonic
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Onset
Provocation
Quality
Region/Radiation
Severity
Time
DIAGNOSIS
1. Onset
• What was the patient doing at the time?
• What precipitated the pain?
• Is there any history of this pain in the patient?
2. Provocation
• Aggravating Factors:
• What causes the Pain to increase?
• Alleviating Factors:
• What makes it better or worse?
DIAGNOSIS
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Quality
• Get the patient to describe their pain to you in specific terms.
• What does it feel like?
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Region/Radiation
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Where is the pain?
Where does the pain radiate?
Is it in one place?
Does it go anywhere else?
Did it start elsewhere and now localised to a different spot?
DIAGNOSIS
5.
Severity
• Pain Rating
• On a scale of 1 to 10, 10 being the worst pain you have experienced,
what number would you assign to your discomfort?
• Does their pain change with medication?
• Wong-Baker Faces Pain Rating Scale.
• Used for
• Children
• People whose first language is not English.
DIAGNOSIS
DIAGNOSIS
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Time
• When did the pain start?
• How long has the patient has this pain?
• Are there any Associated Phenomena?
• Factors consistent with pain e.g. Anxiety
• Physiological responses
• Sympathetic stimulation
• Parasympathetic stimulation
• Vital signs, skin colour, perspiration, pupil size, nausea, muscle tension,
anxiety
• Behavioural Responses
• Posture, gross motor activities
DERMATOMES
• 3 Categories
• Dermatomes
• Connective Tissue and Dermis
• Myotome
• Skeletal Muscle
• Sclerotome
• Vertebrae
• Dermatomes in relation to pain
• An area of skin in which sensory nerves derive from a single
spinal nerve root.
DERMATOMES
• Spinal Cord Dermatomatic Relationships
• Trigeminal Nerves
• V1Ophthalmic Division – Eye
• V2 Maxillary Division – Top of Jaw
• V3 Mandibular Division – Bottom of Jaw
• Cervical (C-2 - C-7)
• fingers, neck, funny bone, and the scalp.
• Thoracic (T-1 - T-12)
• nipples, chest, belly button area, pubic bone, and lower
sternum.
• Lumbar (L-1 - L-5)
• hips, the front of the legs, the shins, knee caps, and most of the
feet.
• Sacral (S-1 - S-5)
• genitals, buttocks, back of the legs, and calves
DERMATOMES
DIAGNOSTIC TESTS
Tests to verify pain.
•Ultrasound Imaging
• High frequency sound waves to develop an
image of the affected area.
•CT/CAT scan
• Computed Tomography or Computed Axial
Tomography
• X-rays to produce an image of a crosssection of the body.
•MRI Scan
• Large magnet, radio waves and a computer
produces detailed images of the body.
DIAGNOSTIC - TESTS
• Discography/Myelograms
• A contrast dye is injected into the spinal disk
to enhance the X-Ray.
• EMG (Electromyography)
• Evaluate the activity of the muscles.
• Bone Scans
• Diagnose and monitor
infection and fracture of
the bone
DIAGNOSIS
• Psychological Assessment
• Pain Questionnaires
• Determine Psychological Involvement.
• Brain functions governing behaviour and decision making,
including expectation, attention and learning.
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Fear
Anxiety
Depression
Coping
• Psychosocial involvement.
• Plays a large role in pain perception.
• Age, Sex, Culture, previous experiences.
PHARMACOLOGICAL MANAGEMENT
• The management of pain through analgesics
• Analgesic: a compound that relieves pain by
altering perception of nociceptive stimuli without
producing anaesthesia or loss of consciousness
• Three types of analgesics:
1. Opioids (narcotic) analgesics
2. Non-opioid analgesics (NSAIDs)
3. Adjuvants
PHARMACOLOGICAL MANAGEMENT
• Routes of administration:
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Oral
Continuous infusion (via SC or IV routes)
PCA (patient controlled analgesia)
Epidural
Rectally
Transdermal administration
Inhalation
GENERAL PRINCIPLES
OF PAIN MANAGEMENT
• Treat the cause of pain where possible, not just the
symptom
• Make accurate diagnosis and assessment of pain
extent and type
• Keep the patient pain free
• Dose at regular specified intervals
• Avoid the chronic pain stress cycle
• Prevent adverse effects of opioids
• Develop a patient management plan
• Follow the WHO analgesia ladder
PHARMACOLOGICAL MANAGEMENT
• WHO has developed a
three-step ladder for pain
relief
• If pain occurs, the use of
oral of drugs should be
administered in the
following order:
1. non-opioids
2. mild opioids
3. strong opioids
Image: World Health Organization
http://www.who.int/cancer/palliative/painladder/en/
OPIOIDS
•Generally prescribed for moderate – severe pain
•Act on CNS by binding with opiate receptors to
modify perception and reaction to pain
•The most commonly used opioid is
morphine
COMMON OPIOIDS
Drug
Description
Morphine
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The ‘gold standard’ analgesic, used for severe acute and chronic pain
Codeine
Fentanyl
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Methadone
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Pholcodine
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Absorbed well orally or parentally
Very potent with a short duration of action which can be taken via IM, slow IV,
lozenge (lollipop) or patch dosage
Analgesic properties similar to morphine, but has extended half life and better oral
bioavailability
Virtually no analgesic effects, but good for treatment of nausea, cough suppression
Tramadol
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Synthetic analgesic used in the treatment of moderate - severe pain, but is less
effective and more expensive than morphine.
Pethidine
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Effective for short term use but is not suitable orally due to low bioavailibility
Hydromorphone
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Oxycodone
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Semi-synthetic opioid with a faster onset but a shorter duration of action than
morphine
Potent synthetic opioid up to 10 times more potent than codeine. It is effective as a
night time suppository dosage in patients unable to swallow.
Dextropropoxyphene 
Synthetic analgesic suitable for treatment of mild to moderate pain with significant
side effects including accumulation and cardiotoxicity.
Heroin
Classified as a schedule 9 drug, and is a popular drug of abuse
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OPIOIDS
• Adverse drug reactions may include:
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respiratory depression
excessive sedation
constipation
nausea
vomiting
tolerance
dependence
dysphoria (a mood of general dissatisfaction, restlessness,
anxiety)
NSAIDS
• Non-steroidal anti-inflammatory drugs
• Used to treat mild – moderate pain
• Work by acting on peripheral nerve receptors to
reduce transmission and reception of pain stimuli
• Common NSAIDs include:
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Paracetamol
Aspirin
Ibuprofen
Naxopren (arthritis)
NSAIDS
• Adverse reactions may include:
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gastrointestinal tract disorders
renal damage
asthma attacks
skin reactions
sodium retention and consequent heart failure and
hypertension
• Large overdoses of paracetamol can cause fatal
acute liver damage if not promptly treated.
NSAIDS
Aspirin vs Paracetamol
•Aspirin is readily available OTC. It can be used in stroke
prevention due to its anti-platelet qualities.
•In normal doses, paracetamol is a safer OTC analgesic than
aspirin for the following reasons:
• adverse effects and allergic reactions are rare
• there is low risk of gastric upset, renal impairment or peptic ulceration
compared with aspirin
• few serious adverse drug interactions
• may be used by children
• safe to use during pregnancy and lactation
PHARMACOLOGICAL MANAGEMENT
Other drugs useful for analgesic effects
• GABA analogues
• Capsaicin
• Local anaesthetics
• General anaesthetics
• Ethanol or phenol
• Cannabinoids
• Specific anti-migraine drugs
• Herbal remedies
NON-PHARMACOLOGICAL
MANAGEMENT
• Management of pain without the use of analgesia
• Useful for patients who:
find such interventions appealing
express anxiety and/or fear
may benefit from avoiding or reducing drug therapy
need to cope with a prolonged interval of post-operative
pain
• have incomplete pain relief after use of pharmacological
interventions
• are able to use the intervention without assistance (TENS,
heat packs)
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NON-PHARMACOLOGICAL
MANAGEMENT
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RICE (rest, ice, compression, elevation)
Physiotherapy
TENS
Acupuncture
Psychotherapeutic methods
Surgery
Community support groups
Complementary and alternative medicine aromatherapy, herbal medicines, spinal
manipulation
HOT AND COLD THERAPY
• Heat
• increase circulation and oxygen and nutrient flow to an
area by vasodilation of the arterioles, reduced blood
viscosity and increased capillary permeability.
• Reduces swelling, inflammation and ischaemia.
• reduces muscle spasm and induces muscle relaxation.
• Cold
• promotes vasoconstriction
• reduces oedema and bleeding in an area
• reduces the inflammatory process and decreases
contractility of muscles and cellular metabolism.
PSYCHOTHERAPEUTIC
• Psychotherapeutic methods include
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Hypnosis
behaviour modification
biofeedback techniques
assertiveness training
art and music therapy
the placebo effect
TENS MACHINE
• Transcutaneous Electronic Nerve Stimulation
• Form of electroanalgesia
• Works in three ways to relieve pain:
1. Hormone release
2. Gating effect
3. Broken brain pathways
• Commonly used during labour, post-ceasarean,
and for back pain and sciatica
• Can also be used to treat post-natal depression
TENS MACHINE
TENS MACHINE
COMPLICATIONS
• Many people believe pain is something “…you have to live with”
• Research has indicated that women have a higher prevalence of
chronic pain syndromes and diseases associated with chronic pain
than men.
• Untreated pain is a serious ailment
• Total pain relief is desirable, but
sometimes reducing pain to a
tolerable level is more realistic.
UNTREATED ACUTE PAIN
“symptom of injury or disease at the tissue level, tends to resolve as the injury or disease does ”
These symptoms are dependant on the area affected.
•Cardiovascular
• Increased blood pressure and heart rate as a result of Injury or Infection.
•Immune
• Increased Immune response
•Respiratory
• Increased respirations as a result of fear or pain.
•Musculoskeletal
• Tensing of muscles to counteract pain.
• Risk of pressure ulcers whilst in hospital if unable to move from the bed.
•Cognitive/Psychological
• Possible Fear or Anxiety surrounding injury and healing process.
• Short term implications for work and social life.
• Anger, Irritability.
UNTREATED CHRONIC PAIN
“no physical cause for the pain can be found or pain persists long after the injury has healed”
• Cardiovascular
• Increase in Heart Rate and Blood
pressure
• Lead to an increased risk of Heart
Disease
• Immune
• Impaired immune responses
• Delayed healing
• Respiratory
• Risk of Respiratory Depression due
to some medications
• Genitourinary/Gastrointestinal
• Impaired functioning
• Constipation or abdominal pains
due to ongoing medication
• Changes in appetite
• Incontinence
• Musculoskeletal
• Tense muscles
• Limited mobility
• A lack of energy
• Cognitive/Psychological
• Depression, Anger and Anxiety
• Affected emotional responses due to
depression.
• Fear of re-injury.
• Long term implications for work and
social life.
• Sleeping Disorders
• Hormonal Imbalances
• Sexual Dysfunction
• Lack of concentration and mental clarity
• Dependence on medication
IMPLICATIONS FOR
NURSING PRACTICE
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Nurses role in pain management
Administer pain-relieving interventions
Assess the effectiveness of these interventions
Monitor for adverse effects
Be an advocate for the patient when the
prescribed intervention is ineffective in relieving
pain
Serve as an educator to the
patient and family
IMPLICATIONS FOR
NURSING PRACTICE
Establishing a nurse-patient relationship
•Positive nurse-patient relationships and teaching are KEY
•Communication and patient cooperation
•Believe and acknowledge that the patient is in pain –
reduces anxiety
•‘I know you have pain' often eases the patients mind
•Education is important
•Provide information
•Establish goals for the
patient
IMPLICATIONS FOR
NURSING PRACTICE
Providing physical care
• Ensure the patient is as comfortable as possible and
that physical and self-care needs have been met
• Opportunity to reassess and comfort the patient
• Assess skin integrity (patches, IV lines)
IMPLICATIONS FOR
NURSING PRACTICE
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Managing anxiety related to pain
A patient who anticipates pain may become
increasingly anxious.
Patients who are more anxious are likely to be less
tolerant.
Educate the patient on pain and pain
management
Gives a sense of control
Good nurse-patient relationship is crucial
IMPLICATIONS FOR
NURSING PRACTICE
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Interventions - Who else may be involved?
Oncology nurse
Physiotherapist
Occupational therapists
Doctor or pharmacist
The family or caregiver
People in the community: visiting nurses,
pharmacists, general practitioner, palliative care
nurses
CASE STUDY
• Name: David
• Age: 30
• Admitted to hospital due to injured Calcanium caused by injury at work where
he fell 3 metres.
Previous Medical History:
• Already had previous soft tissue injury in his ankle from playing football a year
ago.
• Suffered from migraines for past 15 years.
Upon Admission Doctor prescribes:
Entenox gas (initially to examine David's foot)
Ibuprofen
Pethidine
Tramadol
Maxalon
Intravenous normal saline
CASE STUDY
• David’s new foot injury is acute, nociceptive internal (visceral) pain
• Migraine is chronic, psychogenic pain
Signs:
• B/P: 120/70
• Temperature: 36.6
• Pulse: 120
• Respirations: 22
• Sao2: 100%
• Pain 9/10
• Sweating
• Pallor
Symptoms:
•Slight agitation
•Moaning
•Scored pain 9/10
•1 hour of “throbbing’ sensation pain in left
foot
•Tingling sensation in his metatarsal and
tarsals
•Swelling and bruising over calcanium
•Unable to bare weight
PATHOPHYSIOLOGY
• Acute trauma to the Calcinium.
• Pain is Transduced by the Spinal Nerves located near the L5 Dermatome.
• The messaged is first Transmitted via the Adelta fibres then the C fibres.
• A delta Fibres "Epricritic Pain"
• Mechanical message
• Sharp, Fast pain
• Myelinated fibres increase speed of processing
• Impulses conducted at around 20m/sec
• C Fibres "Protopathic Pain"
• Mechanical and Thermal Stimuli
• Slow, dull, long lasting pain
• unmyelinated fibres, slower response
• Impulses conducted at around 2m/sec
PATHOPHYSIOLOGY
• The message is Perceived in the Frontal cortex and the primary sensory cortex
of the post central gyrus of parietal lobe. The message is interpreted and an
appropriate response is formulated - in Davids case, to release
neurotransmitters
• Modulation.
• release of neurotransmitters such as serotonin, norepinephrine and
endogenous opioids to counter the pain
DIAGNOSIS
• Onset
• Fell on Right Calcanium falling from a 3m height at work.
• Previous Soft Tissue Injury from football on the same calcanium one year
ago.
• Provocation
• Unable to bear weight on his foot
• Quality
• 1 hour of Throbbing pain in right foot
• Tingling sensation in Metatarsals and Tarsals
• Odema and Contusions over Calcanium
• Region/Radiation
• Right Calcanium
• Not noted as radiating.
DIAGNOSIS
• Severity
• Patient Pain Score - 9/10
• Time
• This injury - Short amount of time
• But precipitated by a previous injury on the same location
• Associated Phenomena
• Physiological Manifestations
• Pallor
• Sweating
• Behavioural Manifestations
• Agitated
• Moaning
• Nauseous
TREATMENT
• Non Pharmacological
• The doctor has prescribed the R.I.C.E. treatment to help with David's
pain.
• Hot and/or cold therapy
• Relaxation and distraction techniques
• Pharmacological:
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Ibuprofen
Pethidine
Tramadol
Maxolon
COMPLICATIONS
Acute
• Cardiovascular
• Increased Blood Pressure and heart rate as a result of Injury
• Immune
• Increased immune response
• Respiratory
• Increased respirations as a result of pain.
• Musculoskeletal
• Tensing of muscles to counteract pain
• Pressure Ulcers whilst in Hospital if unable to move from the bed
• Cognitive/Psychological
• Possible Fear or Anxiety surrounding injury and healing process
• Short term implications for work and social life
• Anger, Irritability
COMPLICATIONS
Chronic
• Cardiovascular
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Chronic Stress reaction can lead to an increase in Heart Rate and Blood pressure
• Respiratory
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Risk of Respiratory Depression due to Tramadol Use
• Genitourinary/Gastrointestinal
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Constipation or abdominal pains due to ongoing medication
Changes in appetite
• Musculoskeletal
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Tense muscles
Limited mobility
A lack of energy
• Cognitive/Psychological
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Depression, Anger and Anxiety
Affected emotional responses due to depression.
Fear of re-injury.
Long term implications for work and social life
Dependence on medication (Pethidine)
IMPLICATIONS FOR NURSING
PRACTICE
• For David, being a 30 year old male who is coherent, we would most
likely use the numerical scale.
• Pain should be assessed throughout David's treatment.
• By using the pain scale with David, we should be able to gauge
quantifiable changes in his pain over time, rather than by simply
asking him 'how are you feeling' once in a while.
• Include his family in the education process, as they may need to
assist in managing David's pain once he is discharged.
REFERENCES
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