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Pain PDF
Pain PDF
r the Study of Pain (IASP) : Pain is an unpleasant sensory and emotional experience with actual or potential tissue damage, or described in terms of damage
Physiology of Pain
2. Transduction 3. Transmission 4. Perception 5. Modulation
PHYSIOLOGY
Sensitization nociceptors
Spinothalamic tract
PHYSIOLOGY
1. Transduction 2. Transmission
Substance P, assist transmission of impulses across the synapse in the Spinothalamic Tract
Origins and Causes of Pain 1. Cutaneous Pain Ex. Paper cut 1st degree burn 2. Deep Somatic Pain 3. Visceral Pain Ex. Obstructed bowel Myocardial Infarction
CHARACTERISTICS
Often described as dull -Diffused and aching Normal VS No diaphoresis Normal Pupils May have weight loss Physical Immobility Hopelessness Listlessness Loss of Libido Exhaustion and Fatigue Complains of Pain only when asked Depressed and Withdrawn Mild to Severe
PHYSIOLOGIC SIGNS
BEHAVIORAL SIGNS
INTENSITY
2. Referred pain
-Felt from the part that is remote from the tse causing the pain
4. Phantom pain
-pain percieved in a part that is missing
5. Neuropathic pain
-Damage to the NS & may not have a stimuli (Current/Pass)
CONCEPTS ASSOCIATED WITH PAIN 1. Pain Threshold A.K.A. Pain Sensation -Hyperalgesia
2. Pain Tolerance
3. Pain reaction
TYPES OF PAIN STIMULI A. Mechanical 1. trauma to body tissue- tissue damage, direct irritation of the pain receptors (Nociceptors); inflammation
B. Thermal 1. Extreme temperature- tissue destruction, stimulation of the thermosensitive pain receptors
C. Chemical 1. Tissue ischemia stimulation of pain receptors because of accumulated lactic acid (Anaerobic Met.) in tissues and chemical mediators like bradykinin and enzymes 2. Muscle spasm tissue ischemia release enzymes which would irritate nociceptors
Theories of pain:
1. Gate Control Theory- Peripheral nerve fibers carrying pain towards the spinal cord can have their inputs modified before transmission to the brain.
2. Sensory or Specificity theory involvement of sensory receptors in specific body parts or organs
Pain History:
Location where is your pain? Intensity
3. Quality how does you pain feels like? 4. Pattern a) time of onset (when did/does the pain start?); b) duration (how long have you had it?, how long does it last?); c) constancy (do you have pain free periods? when? for how long?)
5. Precipitating factors what triggers the pain or makes it worst? 6. Alleviating factors what measures or methods have you found helpful in lessening or relieving the pain? What pain medication do you use? 7. Associated symptoms do you have other symptoms before, during, after pain?
8. Effects on ADL How does it affect your daily life? 9. Past pain experiences Tell me about your past pain experiences that you have had and the effectiveness of pain relief measures. 10. Meaning of pain how do you interpret your pain? What outcomes do you expect from this pain? What do you fear most about this pain? 11. Coping resources what do you usually do to help cope with pain? 12. Affective response How does the pain make you feel? Anxious? Depressed? Frightened? Tired? Burdensome?
PQRST
P provoked Q quality R region/radiation
COLDERRA C Characteristics O Onset L Location D Duration E Exacerbation R Radiation R Relief A Associated signs and symptoms
pain Respond to pain w/ increased sensitivity Older infants tries to avoid pain awaythe and physically resist pain Develops Toddler (turns ability to describe and and its intensity and location prescho Often responds w/ crying and anger oler because child perceives pain as a threat to security Reasoning w/ child at this stage is not always successful May consider pain as punishment Feels sad May learn there are gender differences in pain expression Tends to hold someone accountable for the pain
pacifier Use tactile stimulation. Play music or tapes of a heartbeat Distract the child w/ toys, books, picture. Involve the child in blowing bubbles as a way of blowing away the pain Appeal to the childs belief in magic by using a magic blanket or glove to take away pain Hold the child to provide comfort Explore misconceptions about pain
to behave when facing pain Rationalizes in an attempt to explain the pain Responsive to explanations Can usually identify the location and describe the pain W/ persistent pain, may regress to an earlier stage of development
imagery to turn off pain switches Provide a behavioral rehearsal of what to expect and how it will look and feel Provide support and nurturing
Provide
Adolescen May be slow to acknowledge pain t Recognizing pain or giving in may be considered weakness Wants to appear brave in front of peers and not report pain
opportunities to discuss pain Provide privacy Present choices for dealing w/ pain. Encourage music or TV for distraction
Age Pain perception and Behavior grou p Adult Behaviors exhibited when experiencing pain may be gender-based behaviors learned as a child May ignore pain because to admit it is perceived as a sign of weakness or failure Fear of what pain means may prevent for taking action. May adults Elder some have multiple conditions
w/ any misconception of pain Focus on the clients control in dealing with the pain Allay fears and anxiety when possible
presenting w/ vague symptoms May perceive pain as part of the aging process May have decreased sensations or perceptions of the pain Lethargy, anorexia, and fatigue may be indicators of pain May withhold complaints of pain because of fear of the treatment, of any lifestyle changes that may be involved or becoming dependent
Cont.
May
describe pain differently, that is, as ache, hurt, or discomfort May consider it unacceptable to admit or show pain
Clarify
PAIN MANAGEMENT
4. Reducing fear and anxiety encouraging verbalization, being honest and sincere, promptly attending to their needs and giving accurate information
1. PCA pump
Advantages
Good pain control Relieves anxiety of patient when waiting for nurse to give the pain meds Promotes clients independence and control over the situation Lower doses of opioids are given compared to PRN Report more analgesia with fewer S/E As pain lessens, client adjust to doses eventually stop taking the analgesic
3. Transdermal analgesia
4. Local Anesthesia
c. Accupressure
d. Contralateral stimulation
IV. Placebo any medication or procedure that produces an effect because of its implicit or explicit intent and not because of its specific physical or chemical properties. A.K.A. Water Pill
2. Massage
4. Active listening
5. Guided imagery
Types of Distraction:
B. Visual Distraction - reading or watching T.V - watching a ball game - guided imagery
C. Tactile distraction - slow, rhythmic breathing - massage - holding or stroking a pet or toy
Example of NURSING DIAGNOSIS FOR PAIN: Acute Pain Chronic Pain Ineffective airway clearance r/t weak cough secondary to postoperative incisional abdominal pain Hopelessness r/t continual pain Anxiety r/t past experiences of poor control of pain and to anticipation of pain Ineffective coping r/t prolonged continuous back pain, ineffective management and inadequate support system Ineffective health maintenance r/t chronic pain and fatigue Self care deficit (specify) r/t poor control to pain Deficient knowledge (pain control measures) r/t lack of exposure to information resources Impaired physical mobility r/t arthritic pain in knee and ankle joints Disturbed sleep pattern r/t increased pain perception at night