PREPARED BY: Simacon, Peps Iriel Tabañag, Donnabelle Tagadiad, Leah Tan, Danielle Therese Tangog, Charmy Fe Turtoga, Jonessa Ungod, Jean Rose Taer,Godfrey Bryan BSN-III BLOCK 4


 All patients have the right to have their pain relieved as much as


The patient's age; gender; race or ethnic background; religious beliefs; lifestyle choices; stage of illness; underlying diagnoses; and/or history of substance abuse do not change this right. Some groups, including children, the elderly, the mentally or physically disabled, and those with a history of addictions need to have special care to be sure their pain is well-treated.

 Because pain is such a personal experience, the patient's report of

pain is the "gold standard", and all treatment is based on that report.
 The goal of treatment is to relieve as much of the patient's pain as is


Sometimes, it may not be possible to relieve the entire patient's pain. If this is the case, the goal should be to reduce the pain to the level that the patient says is his/her goal. For the best pain relief, doctors, nurses, and other professionals must watch out for side effects and their treatment; the goal is to achieve the best pain relief with the least side effects.

 A complete review of the patient's pain should be done at the start of

treatment, and pain should be reviewed each time the patient is seen by a health care professional after that.

Pain should be considered the fifth vital sign, along with pulse, breathing rate, blood pressure, and temperature. The review of the patient's pain should include a review of how much pain the patient has; what the pain feels like; side effects of the pain and medicines for it; mood; and how the pain affects the patient in all areas of his/her life.


2.  Do not give analgesics only by ordered schedules.  Use nonnarcotic analgesics or milder narcotics for mild to moderate pain.  Determine whether relief was obtained.  Remember that doses at the upper end of normal are generally needed for severe pain.  Adjust doses. acute pain within 1 hour and that oral medication may take as long as 2 hours to relieve pain.  Ask whether a nonnarcotic was as effective as a narcotic. as appropriate. 4.  In older adults. PAIN ASSESSMENT .  Use a narcotic with a nonnarcotic analgesic for severe pain because such combinations treat pain peripherally and centrally.  Know that nonnarcotics can be alternated with narcotics. routes of administration to avoid  Determine whether the client has allergies.  Give analgesics before pain-producing procedures or activities. Select proper medications when more than one is ordered.  Know the average duration of action for a drug and the time of administration so that the peak effect occurs when the pain is most intense. Remember that an around-the-clock (ATC) administration schedule is usually best.  Remember that morphine and hydromorphone are the narcotics of choice for long-term management of sever pain.  Administer analgesics as soon as pain occurs and before it increases in severity. Assess the right time and interval for administration. II. avoid combinations of narcotics.1.  Identify previous doses and undertreatment. Know the client’s previous response to analgesics. for children and older clients. Know the accurate dosage. 3.  Know that injectable medications act quicker and can relieve severe.

Given the highly subjective and individually unique nature of pain. PROCEDURE/STEPS: 1. c. PQRST Tool Precipitating / palliative / provocative  What were you doing when the pain started?  Does anything make it better. shocklike. or aching. Subjective in nature. Visceral pain is dull. Superficial somatic pain is sharp. emotional. pain is a symptom.  How often are you experiencing it?  To what degree is the pain affecting your ability to perform your usual daily activities? . Neuropathic pain is burning. pricking.Although pain is referred to us the fifth vital sign. The strategy of linking pain assessment to routine vital sign assessment and documentation represents a push to make pain assessment a routine aspect of care for all clients. pain is “whatever the person says it is whenever he or she says it does” (McCaffery. such as movement or breathing? Quality / quantity  What does it feel like? a. or cramping d. Consider the patient’s age and developmental status along with his or her cultural background when selecting a pain scale. and sociocultural) provides the necessary foundation for optimal pain control. squeezing. EQUIPMENTS/MATERIALS NEEDED: Pain Assessment has various instruments. or burning b. 1999). psychologic. a comprehensive assessment of the pain experience (physiologic. Deep somatic pain is dull or aching. aching. behavioral. jabbing. 2006) PURPOSE: Accurate assessment of pain in the first step in developing and effective treatment plan to deal with pain. Pain has also been defined as an “unpleasant sensory and emotional experience associated with actual or potential tissue damage” (International Association for the Study of Pain. such as medication or a certain position?  Does anything make it worst.

Plateau pain: pain that rises the plateaus such as angina e. Timing  When did the pain begin?  How did it last? a. Paroxysmal pain: such as neuropathic pain  How often does it occur? a. Rhythmic pulsation: pulsating as with migraine or toothache c. e. Projected pain is transmitted along a nerve. Dermatomal pattern is as with peripheral neuropathic pain. Severity  Use appropriate pain scale. such as shoulder pain with acute cholecyctitis or jaw pain associated with angina. such as cutaneous pain. Brief flash: Quick pain as with needle stick. c. b.  Do you have times when you are pain free? . Nondermatomal pattern is as with central neurophatic pain. d. Long duration rhythmic: as with intestinal colic d. Continuous fluctuating pain: as with musculoskeletal pain. such as with herpes zoster or trigeminal neuralgia.Region / radiation / related symptoms  Can you point to where it hurts?  Does the pain occur or spread anywhere? a. Referred pain is referred to a distant structure. Localized pain confined to the sight of origin. b.

Characteristics: What does it feels like? A . No pain.Location: Where does it hurt? Can you point to where it hurts? D . 10 cm (worst pain) . PAIN SCALE FOR ADULTS 1. very severe pain.Duration: How long does it last? C . moderate pain. worst possible pain. The patient selects the descriptor that she or he feels best represents the current pain level. [______________________________________] 0 cm (no pain) 3. Visual Analogue Scale The Visual Analogue Scale utilizes a vertical or horizontal 10-cm line with anchors. excruciating. Categorical Scales Categorical Scales use verbal or visual descriptors to identify pain intensity. OLDCART O – Onset: When did the pain begin? L .Radiation: Does the pain go anywhere else? T heat?) Treatment: Did anything make it better? (Pain medication. The patient marks his or her current pain level on the line. distressing. Numeric Rating Scale The Numeric Rating Scale rates pain on a scale of 0 (no pain) to either 5 or 10 (worst pain) by asking the patient to rate her or his current pain level. severe pain. horrible. mild pain.Aggravating factors: Does anything make it worse? R . discomforting. One end of the line is labeled “No Pain” and the opposite end of the line is labeled “Worst Pain”. Verbal descriptors include: • • Mild.2. 2. ice.

Neuropathic Pain Scale The Neuropathic Pain Scale assesses the type and degree of sensations associated with neuropathic pain. type. It assesses characteristics of pain. The patient rates eight common qualities of neuropathic pain (sharp. This assessment tool includes a diagram to not pain location. The patient is asked to select the face that best represents his or her current pain level. which utilized illustrated faces with facial expressions ranging from happy (no pain) to sad and crying (worst pain). sleep. . relationships. McGill Pain Questionnaire The MPQ uses descriptive words to assess pain on three levels. 6. deep. and the patient’s expression of pain. The FPS has eight faces to select current pain level. It assesses pain intensity. It can be used with other tools and is available in short and long forms. Initial Pain Assessment Inventory The IPAI is used for initial assessment of pain. and effectiveness of treatment over the last 24 hours. and space to document additional comments and the treatment plan. cold. effects of pain on the patient’s life. 8. sensory. Benefits of the BPI include that it is quick and easy to use and available in multiple languages. McGill Pain Questionnaire (MPQ). effects on life. sensitive. 7. such as daily activities. and the Neuropathic Pain Scale. hot. appetite. or surface pain) on a scale of 0 (no pain) to 10 (worst pain). Brief Pain Inventory (BPI). and evaluative. affective. Brief Pain Inventory The BPI is used to quantify pain intensity and associated disability. but early testing holds diagnostic and therapeutic promise. dull. location. 4. 5. itchy.Visual descriptors include the Faces Pain Scale for Adults and Children (FPS). and emotions. a scale to rate pain intensity. Multidimensional Pain Scales These scales assess pain characteristics and its effects on patient’s activities of daily living and include such scales as the Initial Pain Assessment Inventory (IPAI). This scale is still in the developmental stages.

although you do not have to be crying to feel this bad. Face 2 hurts a little more. Face 4 hurts a whole lot. Face 0 is very happy because he doesn’t hurt at all. The photographic scale uses six photographs of children ranging from a child with “no hurt” to a child with “a lot of hurt. Faces Pain Rating Scale The FACES Pain Scale assesses pain for children ages 3 years and up. Oucher The Oucher scale assesses pain for children ages 3 to 13 years with photos or a numeric scale. Numeric Scale . 3. Face 5 hurts as much as you can imagine. Face 3 hurts even more. Ask the person to choose the face that best describes how he is feeling. 2. with 0 (no hurt) on the bottom and 5 (lot of hurt) on the top. This scale also has photographs of black and Hispanic children available.PAIN SCALE FOR CHILDREN 1. Rating scale is recommended for persons age 3 and older. Explain to the person that each face is for a person who feels happy because he has no pain (hurt) or sad because he has some or a lot of pain.” The photographs are arranged vertically from 0 to 5. The Wong-Baker has five faces from which the child can select her or his current pain level.

It uses words on a horizontal linear scale to assess pain.” The child is asked to identify his or her current pain level on the scale.” She then asks the child to select how many pieces of hurt he or she has. Word-Graphic Rating Scale The Word-Graphic Rating Scale assesses pain in children ages 4 to 17 years. No pain Worst pain [_________________________________________________] 0 1 2 3 4 5 7. Numeric Scale The Numeric Scale assesses pain for children ages 5 years and older. Although similar to a scale used for adults. The nurse places red poker chips horizontally in front of the child. this provides the child with a visual to help assess his or her pain. with the poker chips denoting “pieces of hurt. Poker Chip Tool The Poker Chip Tool assesses pain in children 4 years of age and up. 5. It uses a horizontal linear scale with numbers from 0 to 5 or 10. [__________________________________________________] No Pain Little Pain Medium Pain Large Pain Worst Pain 6. The child is asked to identify her or his current pain level on the scale.The numeric scale ranges vertically from 0 to 100. Visual Analogue Scale . with 0 being “no pain” and 5 or 10 being “worst pain. • • • • • 0 = no hurt 1-29 = little hurt 30-69 = middle hurt 70-99 = big hurt 100 = biggest hurt 4. with 0 being “no hurt” and 100 being “biggest hurt”.

” the second represents “little hurt. 5th Edition. “I’m sorry you are hurting. Acknowledging and Accepting Client’s Pain. The child selects four colors. pp 97-100 Fundamentals of Nursing. c. Edition 2. . I want to help you feel better” lets the client know you believe the pain is real and intend to help. nurses have a duty to ask clients about their pain and to believe their reports of discomfort. Color Tool The Color Tool assesses pain for children as young as 4 years by having the child create a body outline using colored markers or crayons. According to the professional standards of conduct. restating understanding of the reported discomfort. 2. Patricia M. 8.The Visual Analogue Scale. Vol. The child is asked to identify her or his pain level by marking the line in the area that represents her or his level of pain. Challenging the client’s report of discomfort undermines the environment of trust that is an essential component in the therapeutic relationship. it must be very upsetting.” Using all four colors. is similar to that used for adults. The first color represents “most hurt. GENERAL PAIN MANAGEMENT STRATEGIES 1.) Convey that you need to ask about the pain because. the child identifies areas and degree of hurt on the body outline. A Critical Thinking Studies Approach. Example: Adding an empathetic statement like.” the third represents “least hurt.) Acknowledge the possibility of the. which assesses pain in children age 4 ½ and older. everybody’s experience is unique. Are you experiencing any leg discomfort? What does it feel like? How concerned/upset are you about it?” your b. Potter and Perry. Dillon.) Listen attentively to what the client says about the pain. despite some similarities. Consider these four ways of communicating this belief: a.” and the last represents “no hurts. Nursing Health Assessment. Example: “Many people with your condition are bothered by leg pain. pp III. SOURCE: Case 1311.

3. although others can understand and empathize. anger.g. Reducing Misconceptions about pain. A preventive approach to pain management involves the provision of measures to treat the pain before it occurs or before it becomes severe. feeling mistreated in the past. their perceptions and reactions to the pain can be intensified. and feelings of inadequacy. these emotions are related to uncertainty about the future.1206-1208. 5. This strategy prevents the windup and sensitization described earlier that spreads. Do you have any pain or other discomforts now?” d. or having unmet expectations. which may include anger. It is important to help relieve strong emotions capable of amplifying pain (e. and prolongs pain. Nurses can help by giving them accurate information about the pain and providing opportunities for them to discuss their emotional reactions. intensifies. reassurance. fear. frustration. 2. anxiety. and perhaps access to resources that will help them cope as they add the caregiver role to an already stressful life circumstance. When clients have no opportunity to talk about their pain and associated fears. pp. of Example: “Now that you have stated the site of pain and the intensity pain. It is unconscionable to believe the client’s report of pain and then do nothing.. Reducing a client’s misconceptions about the pain and its treatment will remove one of the barriers to optimal pain relief. Reducing fear and anxiety. Eight Edition. After determining the client has pain. Support persons also may need the nurse’s understanding. Often. discuss options and plan actions for providing relief. Assisting support persons. 4.” 2. Support persons often need assistance to respond in a helpful manner to the person experiencing pain. SOURCE: Kozier and Erb’s Fundamentals of Nursing. .Example: “Many people with you condition report having some discomforts. Vol. we are now going to intervene you as much as we could.) Attend to the client’s needs promptly. and fear). Preventing pain. The nurse should explain to the client that pain is a highly individual experience and that it is only the client who really experiences the pain.

PCA provides stable pain relief in most situations. and epidural routes are increasingly being used. and narcotic theft. The oral route for PCA is most common. IV. . abusive use. decreasing after the second or third postoperative day. position changes. During the initial postoperative period. but the subQ. PCA pumps are designed with built-in safety mechanisms to prevent client overdosage. Patient-Controlled Analgesia (PCA) It is an interactive method of pain management that permits clients to treat their pain by self-administering doses of analgesics. An anti-inflammatroy agent such as ibuprofen or ketorolac (Toradol) is often administered in conjunction with a narcotic analgesic to enhance pain relief. patient-controlled analgesia (PCA) or continuous analgesic administration through an intravenous or epidural catheter is often prescribed. There is no injection of needles into your muscle. usually in your arm. pain in the surgical client has little protective value. and notifies the primary care provider if the client is experiencing unacceptable side effects or inadequate pain relief. The nurse monitors the infusion or amount of analgesic administered by PCA. Pain is usually greatest 12 to 36 hours after surgery. diversional activities. POST OPERATIVE PAIN Pain Management in patient post operatively Although pain is a sensory and emotional experience that serves to alert us to harm and initiate responses to avoid or minimize harm. Types of Pain-Control Treatments: 1. Many patients like the sense of control they have over their pain management.1V. assesses the client’s pain relief. Patient-controlled analgesia (PCA) is a computerized pump that safely permits you to push a button and deliver small amounts of pain medicine into your intravenous (IV) line. Clients need to be reminded that analgesics are most effective when taken on a regular basis or before pain becomes severe. nurses need to use nonpharmacologic measures in addition to prescribed analgesia. Because muscle tension increases pain perception and responses. and adjunctive measures such as imagery. These include ensuring that the client is warm and providing back rubs.

4. Spinal anesthesia Some surgeries can be done with spinal anesthesia. For longer pain relief.2. 3. such as morphine or fentanyl — can be delivered through the catheter to control pain. pain medications are injected through a long. but it doesn't last as long because there is no catheter to allow the administration of additional medication. thin tube (catheter) inserted into the epidural space within your spinal canal but outside your spinal fluid. Nerve block A nerve block provides targeted pain relief to an area of your body such as an arm or leg. your anesthesiologist may use a single injection of local anesthetic around the appropriate nerves related to your surgery. and sometimes before a major operation such as joint replacement or lung surgery. If you need only a few hours of pain relief. this form of pain relief involves medications injected directly into the spinal fluid. A continuous infusion of pain relievers — including numbing medications (local anesthetics) and opioid medications. Unlike epidural analgesia. The epidural catheter can be left in place for several days if needed to control postoperative pain. It prevents pain messages from traveling up the nerve pathway to your brain. Spinal anesthesia is easier and faster than epidural analgesia. Your doctor can add a long-acting opioid to the spinal medication that can relieve post-surgical pain for up to 24 hours. Patient-Controlled Epidural Analgesia In epidural analgesia. your . An epidural catheter is often used for labor and delivery.

The risk of becoming addicted is extremely rare. itching. constipation. Tylenol ®) Indication: Effective for moderate to severe pain. fentanyl. PAIN MEDICATIONS TAKEN BY MOUTH 1.anesthesiologist may place a catheter into that area to deliver a continuous infusion of pain medications. itching. Darvocet®. constipation. Opioids (Narcotics) at home (Percocet®. Should not drive or operate machinery while taking these . and Contraindication: May cause nausea. drowsiness. Opioids (Narcotics) after surgery (medications such as morphine. Stomach upset can be lessened if the drug is taken with food. hydromorphone): Indication: Strong pain relievers. Vicodin®. Many options are available if one is causing significant side effects. 2. Many options available. vomiting. drowsiness. vomiting. Contraindication: Nausea.

a history of stomach ulcers. but you should ask your doctor about taking them. They may reduce the amount of opioid analgesic you need. Contraindication: The most common side effects of nonsteroidal antiinflammatory medication (NSAIDS) are stomach upset and dizziness. Concepts. pp.medications. possibly reducing side effects such as nausea. You should not take these drugs without your doctor's approval if you have kidney problems. vomiting. Nonsteroidal Anti-inflammatory Drugs (NSAIDS) ibuprofen (Advil®). which may reduce the incidence side effects. Volume 2.counter). there are no restrictions on driving or operating machinery. or Plavix®. 3. They have very few effects and are safe for most patients. Be sure to tell your doctor about all medications (prescribed and overthe. Note: These medications often contain acetaminophen (Tylenol®). side of Contraindication: Liver damage may result if more than the recommended daily dose is used. Process. naproxen sodium (Aleve®). vitamins and herbal supplements you are taking. heart failure or are on "blood thinner" medications such as Coumadin® (warfarin). Lovenox® injections. Ibuprofen and naproxen sodium are available without a prescription. Feverall®) Indication: Effective for mild to moderate pain. 4. They often decrease the requirement for stronger medications. SOURCE: Kozier & Erb’s Fundamentals of Nursing. If taken alone. Non-Opioid (Non-narcotic) Analgesics (Tylenol®. This may affect which drugs are prescribed for your pain control. as too much of it may damage your liver. and Practice.1216 . Make sure that other medications that you are taking do not contain acetaminophen. and drowsiness. Eight Edition. celecoxib (Celebrex®) Indication: These drugs reduce swelling and inflammation and relieve mild to moderate pain. 962. Patients with pre-existing liver disease or those who drink significant quantities of alcohol may be at increased risk.

Assessment and intervention for pain in older adults should begin with the assumption that all neurophysiological processes involved in nociception are unaltered by 4. Pain is a natural outcome of growing old. or otherwise distracted from pain he or she does not have pain.riversideonline. The absence of a report of pain does not mean the absence of pain. pain. asleep. anger. Older clients often believe it is unacceptable to show pain and have learned to use a variety of ways to cope with it. being fearful of losing their independence. no scientific basis exists for the assertion that a decrease in perception of pain occurs with age or that age dulls sensitivity to pain. 2. If an older client appears to be occupied. or sensitivity. PAIN MANAGEMENT FOR ELDERLY MISCONCEPTIONS 1. CORRECTIONS It is true that older adults are at greater risk (as much as twofold) than younger adults for many painful conditions. or bother caregivers. Sleeping may be a coping strategy or indicate . This assumption is unsafe. he or she does not have pain. pain is not an inevitable result of aging. not wanting to alarm loved ones. Pain perception. 3.cfm V. decreases with age.http://www. not wanting to distract. and believing caregivers know they have pain and are doing all that can be done to relieve it. however. Although there is evidence that emotional suffering specifically related to pain may be less in older than in younger clients. Reasons include expecting to have pain with increasing age. If the older client does not report Older clients commonly underreport pain.

” Potentially dangerous opioidinduced side effects can be prevented with slow titration. The best approach is to accept the client’s report of pain. osteoporosis. progressive deficits of cognition. have been heavily influenced by the “Just Say No” to drugs campaign. such as arthritis. than younger clients. and agnosia. If necessary. regular. suffer significant unrelieved pain and discomfort. this does not justify withholding the use of them in the management of pain in this population. The potential side effects of Opioids may be used safely older opioids make them too dangerous to adults. older adult may be more sensitive to opioids. and adjustment of dose and interval between doses when side effects are detected. 6. Assessment of pain in these clients is challenging but possible. Many elderly clients grew up valuing the ability to “grin and bear it.exhaustion. The key to use of opioids in older adults is to “start low and go slow. particularly those in long-term care facilities. 7. peripheral vascular disease. No evidence exists that cognitively impaired older adults experience less pain or that their reports of pain are less valid than those of individuals with intact cognitive function. . 5.” and. studies have shown that they underreport pain. apraxias. clinically significant respiratory depression can be reversed by an opioid antagonist drug. Clients with Alzheimer’s disease and others with cognitive impairment do not feel pain. and cancer. not pain relief. frequent monitoring and assessment of the client’s response. Even though older clients experience a higher incidence of painful conditions. and their reports of pain are most likely invalid. It is probable that clients with dementia. Although the opioid-naïve use to relieve pain in older adults. unfortunately. Older clients report more pain as they age.

altering physiologic responses to reduce pain perception.are another physical way to help your body relax. This stress and upset cycle causes you more pain. proximal to the pain or distal to the pain (along the nerve path or dermatome). a. laughter. PHYSICAL INTERNVENTIONS The goals of physical intervention include providing comfort. This breaks the whole cycle and may decrease your pain. but work along with your medicines. Your heart beats faster and your blood pressure goes higher. When you are tense. and optimizing functioning. to the pain. Teaching your body to relax. . Potter and Perry. Scientists are learning that common things like music. Contraindication: Being tense and upset causes pain to become worse.) NON-PHARMACOLOGIC PAIN MANAGEMENT Definition: Non-pharmacological or natural therapies are things you can do or think about that help decrease your pain. your muscles get tight which decreases blood flow in your body. and contralateral (exact location. Fundamentals of Nursing. Certain ways to relax help loosen muscles. These therapies do not involve taking medicines. the Chinese learned that putting special needles in areas of the body could decrease pain. 2. opposite side of the body). Your brain begins to make chemicals. Indication: A long time ago.SOURCE: pp. Breathing in and out very slowly is all you do. The following are the common non pharmacologic managements: 1. exercise and good smells cause our brains to make special chemicals. Vol. helps make the pain less. Indication:  It can provide effective temporary pain relief. People have used "natural" ways to help with pain and healing from the very beginning of time. Your breathing also gets faster and shallower. 2. These special chemicals may help us to feel less pain.) Breathing exercises. 2. including ones that may cause pain. 5th Edition. CUTANEOUS STIMULATION – this can be applied directly to the painful area. Music has also a very important part of healing the sick over time. 1292. Women have used breathing exercise for many years to decrease the pain of childbirth.

Indication:  It aids relaxation. Equipments:  Ointments. or infections.  It eases anxiety because the physical contact communicates caring. ice bags. Massage can involve the back and neck. liniments.  It decreases muscle tension. d. c.  It interferes with the transmission and perception of pain by stimulating the large-diameter A-beta sensory nerve fibers that activate the descending mechanisms that can reduce the intensity of pain.) Massage – a nonpharmacologic management technique that uses ointments or liniments that provide localized pain relief with joint or muscle pain. and warm or cold sitz baths in general relive pain and promote healing of injured tissues.g. This method is particularly useful when the painful area cannot be . or treated with cold packs or analgesic ointments. b. stimulating the left knee if the pain is in the right knee). Contraindication:  In the areas of skin breakdown. It distracts the client and focuses attention on the tactile stimuli. suspected clots. or feet.) Accupressure – It was developed for the ancient Chinese healing system of acupuncture. massaged for cramps. Contraindication:  In the areas of skin breakdown or impaired neurological functioning. a. ice massage. The therapist applies finger pressure to points that correspond tomany of the points used in acupuncture.) Contralateral Stimulation – it can be accomplished by stimulating the skin in an area opposite to the painful area (e.. extra towel. etc. activate the endorphin system of pain control. away from the painful sensations. hands and arms.) Heat and Cold Application – a warm bath. The contralateral area may be scratched for itching. hot or cold compresses. and thus diminish conscious awareness of pain. thus reducing pain perception. heating pads.  It decreases pain intensity by increasing superficial circulation to the area.

Indication:  To activate large-diameter fibers that modulate the transmission of the nociceptive impulse n the peripheral and CNS (closing the pain “gate”). IMMOBILIZATION/BRACING – immobilizing or restricting the movement of a painful body part (e.  It alters psychologic responses to reduce pain perception. along peripheral nerve areas that innervate the pain area. TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) – is a method of applying low-voltage electrical stimulation directly over identified pain areas. when it is inaccessible by a cast or bandages.g. Contraindication:  Contraindicated for clients with pacemakers or arrhythmias  In areas of skin breakdown. etc.touched because it is hypersensitive.  It is generally not used on the head or over the chest. clients should be encouraged to participate in selfcare activities and remain as active as possible. Indication:  To help manage episodes of acute pain. Equipments:  Splints. COGNITIVE-BEHAVIORAL INTERVENTIONS Indication:  It provides comfort. 4. brace. with frequent ROM exercises. at an acupressure point. Therefore. traumatized limb). muscle atrophy. or when the pain is felt in a missing part. Contraindication:  Prolonged immobilization can result in joint contracture. battery operated device with lead wire and electrode pads that are applied to the chosen area of skin. tractor. and cardiovascular problems. resulting in pain relief. 5. arthritic joint..  It causes a release of endorphins from the CNS center. or along the spinal column. . Splints or supportive devices should hold joints in the positions of optimal function and should be removed regularly in accordance with agency protocol to provide ROM exercises. The TENS unit consists of a portable. 3.

teaches your body to respond in a different way to the stress of being in pain. Then take it while making your mind think about "slowing down" your pulse. In some instances. To optimize functioning. Learn to take your pulse. You may feel less hopeless and helpless because you are doing something to decrease the pain. Teaching your body to relax. It is not known exactly how hypnosis helps pain. distraction can make a client completely unaware of pain. c.) Distraction – this draws the person’s attention away for the pain and lessens the perception of pain. Music also may cause your brain to make special chemicals like endorphins. But. hypnosis can give long-lasting relief of pain without affecting your normal activities. These are all parts of chronic pain. often you may not need any machines. This can work with breathing. Caregivers may use a biofeedback machine so that you know right away when your body is relaxed. Scientists are learning that it increases energy and helps change your mood.It has been said that "10 minutes of belly laughter gives 2 hours of pain-free sleep! Laughter helps you breathe deeper and your stomach digest (break down) food. Music increases blood flow to the brain and helps you take in more air.) Laughter . This means that by focusing your attention you can move away from your does not matter whether you listen to it. sing. temperature. Laughter can also help change your moods. It lowers blood pressure and may cause your brain to make endorphins. People who use music often say it decreases their need of medicines for pain and anxiety. . Self-hypnosis gives you better control of your body.teaches you to put pictures in your mind that will make the pain less intense.) Music . e. It helps you relax and let go of stress.) Guided imagery . But.) Biofeedback . Endorphins are a natural body chemical like morphine that decrease pain. b. fear. hum or play an instrument. and hopelessness. helps make the pain less. Distraction makes the person unaware of the pian only for the amount of time and to the extent that the distracting activity holds his or her “undivided” attention.) Self-hypnosis . With guided imagery. you learn how to change the way your body senses and responds to pain. anger. and blood pressure too. Imagine floating in the clouds or remembering favorite place. d. depression. a. Guided imagery seems to help people with chronic lower back a way to change your level of awareness. You make yourself open to suggestions like ignoring the pain or seeing the pain in a positive way. f.

airborne transmission through tiny droplets of infectious agents suspended in the air. Vol. and. 1217-1221 3. animal-to-human contact. especially in hospitals and health care facilities. by a common vehicle such as food or water. Process. If the infectious disease can be transmitted directly from one person to another. the infection is symptomatic. human contact with an infected surface. the infection is asymptomatic. it is a communicable. These diseases are usually caused by bacteria or viruses and can be spread by human-tohuman contact.) INFECTION CONTROL An infection is the entry and multiplication of an infection agent in the tissues of a host. 2pp. Equipments:  Antimicrobial or regular soap  Clean orangewood sticks or toothpick (optional)  Paper towel or hand towel  Easy to reach sink with warm running water Procedure: HANDWASHING . Concepts. If the infectious agent (pathogens) fails to cause injury to cells or tissues. and Practice. - Purpose: To reduce the occurrence of infectious diseases. finally. Eight Edition. disease Infection control refers to policies and procedures used to minimize the risk of spreading infections. or contagious.SOURCE: Kozier & Erb’s Fundamentals of Nursing. If the pathogens multiply and cause clinical signs and symptoms.

wrists. concentration of microorganism 2. Turn faucet on or push knee pedals laterally or press pedals with foot to regulate flow and temperature. Remove wristwatch and avoid wearing rings 4. 6.PROCEDURES RATIONALE 1. and wrist.) 5. Inspect surface of hands for breaks Open cuts or wounds can harbor high or cuts in skin or cuticles. (If hands touch sink during hand washing repeat. Turn on water. hands. Microorganisms travel and grow in moisture. Open cuts or wounds can harbor high concentration of microorganism Nails should be short and filled because most microbes of hands came from beneath the fingernails Provide complete access to fingers. 3. Wearing of rings can increase numbers of microorganism and the hands Provides complete access to fingers. Stand in front of the sink. hands. keeping hands and uniform away from the sink surface. 1. To let the water flow over the hands and facilitate in washing. Wearing of rings increases number of microorganisms on hands. . Avoid splashing water against uniform.

Rinse hands and wrists thoroughly. If used. 10. The decision whether to use an antiseptic should depend on the procedure to be performed and the client’s immune status. Wash hands using plenty of lather and friction for at least 10 to 15 seconds. lathering thoroughly. 11. Drying from cleanest (fingertips) to least clean (forearm) area avoids contamination. 13. Friction and rubbing mechanically loosen and remove dirt and transient bacteria. Keep hands and forearms lower than elbows during washing.7. Hands are the most contaminated parts to be washed. Keep fingertips down to facilitate removal of microorganisms. 12. Regulate flow of water so that temperature is warm. Prevents transfer of microorganisms. Dry hands thoroughly from fingers to wrists and forearms with paper towel. Interlacing fingers and thumbs ensures that all surfaces are cleansed. Area under nails can be highly contaminated. 8. Areas underlying fingernails are often soiled. 14. Warm water removes less of the protective oils than hot water. . rinsing microorganisms into the sink. Apply a small amount of soap or antiseptic. or warm air dryer Rinsing mechanically washes away dirt and microorganisms. Drying hands prevents chapping and roughened skin. 9. Soap cleanses by emulsifying fat and oil and lowering surface tension. Wet hands and wrists thoroughly under running water. which will increase the risk of infection for the nurse or the client. discard paper towel in proper receptacle. Water flows from least to most contaminated area. Use of antiseptic exclusively can be drying to hands and can cause skin irritations. 2. Clean them with fingernails of other hand and additional soap or clean orangewood stick. keeping hands down and elbows up. Soap granules and leaflet preparations may be used. Interlace fingers and rub palms and back of hands with circular motion at least 5 times each. single-se cloth.

explaining that it should be done before and after all treatments and when infected body fluids are contacted. Turn off water with foot or knee pedals. Determines if hand washing is adequate. Instruct client about signs and symptoms of wound infection Instruct clients to place contaminated dressing and their disposable items containing infectious body fluids in impervious plastic bags. Clean noticeably solid linen separate from other laundry. Nursing Responsibility: - Encourage hand washing before and after eating and going to the comfort room Instruct clients about cleaning equipments using soap and water and disinfecting with an appropriate disinfectants Demonstrate proper hand washing. refillable containers have been associated with nosocomial infections. 16. a small amount of lotion or barrier cream can be applied. Wash in water that is as hot as the fabric will tolerate - Evaluation: As client or family member to describe techniques used to reduce transmission of infection. Wet towel and hands allow transfer of pathogens by capillary action. dry paper towel.15. avoid touching handles with hands. Have client demonstrate select techniques Ask client to explain risk for infection based on the condition. . use clean. 18. individual-use container of lotion because large. If hands are dry or chapped. 17. Inspects hands for dermatitis or cracked skin. Place needles in metal containers such as soda cans and tape the opening shuts. Use small. Indicates complications from excessive hand washing. Inspects surfaces of hands for obvious signs of soil or other contaminants. To turn off hand faucet.

Vol. 5th Edition. pp 835864 . Potter and Perry. 2.Source: - Fundamentals of Nursing.

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