Transcript Pain SEx
Managing the Patient’s Environment: Promoting Sleep and Comfort. Chapter 31 Learning Objectives Theory 1) Discuss the application of The Joint Commission pain standards in planning patient care. 2) Give the rationale for why pain is considered the “fifth vital sign.” 3) Illustrate the physiology of pain using the gate control theory. 4) Describe the use of a variety of nursing interventions for pain control, including biofeedback, distraction, guided imagery, massage, and relaxation. Slide 2 Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Learning Objectives Clinical Practice 1) Assist the patient in accurately describing sensations of pain and discomfort. 2) Accurately and appropriately record the patient’s report of pain using clear, descriptive terms. 3) Assist the patient in using a transcutaneous electrical nerve stimulation (TENS) unit. 4) Evaluate the effects of various techniques used for pain control. 5) Assist with the care of patients receiving patient-controlled analgesia (PCA) or epidural analgesia. 6) Evaluate the effects of pain medication, and report and record observations appropriately. Slide 3 Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Pain • Pain is the feeling of distress and discomfort • Affects or interferes with normal activity • No accurate objective measurement of pain • Pain assessment is performed along with each assessment of vital signs and is considered the “fifth vital sign” Slide 4 Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Pain (cont’d) • Surgical patients experience postoperative pain • Many medical conditions cause pain Headache, myocardial infarction Cancer, fractures Cuts and abrasions Slide 5 Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. The Joint Commission: Pain Control Standards • Patients have the right to appropriate assessment and management of pain • Pain is assessed in all patients • Patients are educated about pain and managing pain as part of the treatment, as appropriate • The discharge process provides for continuing pain care based on the patient’s needs at the time of discharge Slide 6 Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Theories of Pain • Pain defined as a feeling of distress or suffering caused by the stimulation of nerve endings • Pain serves as a warning of tissue damage and allows sufferer to withdraw from the source of the pain • Pain is transmitted through the nervous system Slide 7 Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Pain Descriptions • • • • • Type of pain Severity of pain based on a pain scale Quality of pain Location of pain Duration of pain Slide 8 Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Types of Pain • • • • • Acute: short-term Chronic: long-term Nociceptive: injury to tissues Neuropathic: sensitivity to stimuli Phantom: after loss of body part Slide 9 Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Type of Pain: Acute Pain • Usually associated with injury, medical condition or surgical procedure • Short duration, lasting a few hours to a few days • May be described as aching or throbbing • Patient may be restless or agitated • Usually controlled with analgesics Slide 10 Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Type of Pain: Acute Pain (cont’d) • Causes include: – Burns, bone fractures, muscle strains – Pneumonia, sickle cell crisis, angina – Herpes zoster, inflammations, infections • May worsen in the presence of anxiety or fear • Usually relieved once the cause is removed Slide 11 Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Type of Pain: Chronic Pain • Pain that may continue for months or years • Often associated with conditions such as: – Arthritis – Chronic back pain • May be dull, constant, shooting, tingling, or burning • May be treated with both pharmacologic and nonpharmacologic interventions Slide 12 Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Type of Pain: Nociceptive Pain • Involves injury to the tissue in which receptors called nociceptors are located • May be found in skin, joints, or organ viscera • Four phases associated with nociceptive pain – – – – Transduction Transmission Perception Modulation Slide 13 Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Type of Pain: Nociceptive Pain (cont’d) • Treatments are aimed at one or all four phases • NSAIDs work at blocking transduction • Opioids block transmission • Distraction and guided imagery block perception • Drugs that block neurotransmitter uptake work on modulation Slide 14 Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Type of Pain: Neuropathic Pain • Associated with dysfunction of the nervous system – Pain receptors in the body become more sensitive to stimuli and send signals more easily – As nerve endings grow new branches, the signals become stronger • Often associated with Guillain-Barré syndrome, cancer, and HIV • Treated with NSAIDs, tricyclic antidepressants, anticonvulsants, or corticosteroids Slide 15 Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Type of Pain: Phantom Pain • Occurs with loss of a body part from amputation – Patient may feel pain in the amputated part for years after the amputation • Not controlled by conventional methods • May be treated with TENS units implanted in the thalamus Slide 16 Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Figure 31-6: TENS unit blocks pain signal transmission Slide 17 Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Severity of Pain: Pain Scales • Pain scales – Number scale • Rate the level of pain: 0 is pain-free; 10 is worst pain imaginable – Picture scale • Shows faces in varying degrees of pain – NIPS (Neonatal Infant Pain Scale) – CRIES (Crying, Requires oxygen to maintain saturation, Increased vital signs, Expression, and Sleeplessness) – PIPP (Premature Infant Pain Profile) Slide 18 Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Slide 19 Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Wong-Baker FACES Pain Rating Scale for children Slide 20 Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Quality of Pain: Perception of Pain • Assessment of pain: whatever the person says it is • Observable indicators (may not always be present) – – – – – – Moaning Crying Irritability Grimacing Frowning Rigid posture in bed • Described as rushing, throbbing, pulsating, twisting, pulling, burning, searing, stabbing, tearing, biting, blinding, nauseating, debilitating Slide 21 Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Location of Pain • Area of pain – Name of affected body part (e.g., foot, hand, leg, or upper/lower abdomen) – Localized, radiating, generalized • Frequency of pain – Constant, intermittent, occasional Slide 22 Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Pain Control: Nonmedicinal Methods • • • • • • • • • • • Transcutaneous electrical nerve stimulation (TENS) Percutaneous electrical nerve stimulation (PENS) Binders Application of heat and cold Relaxation Biofeedback Distraction Guided imagery and meditation Music Hypnosis Massage Slide 23 Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Medicinal Pain Control: Medicinal Methods • Analgesic medications – Oral – Topical – Injected – Intravenous • Patient-controlled analgesia • Epidural analgesia Slide 24 Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.