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PAIN

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Review vocabulary words listed at the beginning of the chapter ... Barriers to Assessment in Geriatrics. Belief that pain is a normal part of aging ... – PowerPoint PPT presentation

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Title: PAIN


1
PAIN
  • Deborah Cary, MSN
  • Professor Nursing
  • Broward Community College

2
General Study Habits
  • Review vocabulary words listed at the
    beginning of the chapter
  • Answer the critical thinking questions/review
    questions at the end of the chapter
  • Pay attention to tables/illustrations
  • Highlight and take additional notes

3
Statistics
  • Pain is the 5th vital sign
  • The most common sx prompting office visits
  • Second leading cause of work related
  • absenteeism 50 million lost
    workdays annually
  • Leading cause disability in working-age
    population
  • Significant concerns among elderly and expected
    to increase with aging of the population

4
Definition
Pain is whatever the person experiencing
pain says it is, existing whenever the
person says it does.Margo McCafferty
5
Basic Principle
  • ALWAYS BELIEVE PATIENT

6
Causes of Pain
  • ACUTE
  • SURGERY
  • INJURY
  • CHRONIC
  • HEADACHES
  • BACK PAIN
  • CANCER

7
Consequences of Pain
  • IMPAIRED RECOVERY
  • SUPPRESSED IMMUNE SYSTEM
  • SLEEPLESSNESS

8
S/S Unrelieved Pain
  • Resp/cardiac dysfunction
  • Decreased gastric motility
  • Increased muscle contraction
  • Increased catabolism

9
Nonreporting
  • Fear of addiction
  • Side Effects
  • Pain is inevitable
  • Fatalism

10
International Association for the Study of Pain
definition
  • Pain is an unpleasant sensory and emotional
    experience associated with actual or potential
    tissue damage

11
Nociception
  • Activation of primary afferent nerves with
    peripheral terminals that respond
    differently to noxious stimuli

12
  • Suffering state of severe distress associated
    with events that threaten the intactness of the
    person can occur in or out of pain presence and
    pain can occur with or without suffering
  • From Lewis, 6th edition

13
Dimensions of Pain
  • Physiologic
  • Sensory
  • Affective
  • Behavioral
  • Cognitive

14
Pathway of Nociceptive Pain
  • Transduction
  • Transmission
  • Perception
  • Modulation

15
Drug Therapies
  • NSAIDS Advil, Motrin, Aleeve (Naprosyn)
  • Corticosteroids Decadron,
    methylprednisolone, Cortisone
  • Neurontin, MS Contin, Opiods, Time-released
    patches (Lidocaine, Fentanyl)
  • Pumps epidural, intrathecal
  • Epidural Injections
  • Local analgesics

16
Sensation of Pain
  • Dermatomes
  • Referred Pain
  • Sensitization

17
Perception
  • Perception is the pain that is responded to by an
    individual
  • RAS responsible for ANS response
  • Strategies directed toward behavior are
    distraction, relaxation and imagery

18
Modulation
  • Evaluation of descending pathways that either
    facilitate or inhibit the effects of transmission
  • Norepinephrine and serotonin
  • GABA-endogenous opioids can inhibit pain
    transmission

19
Responses to Pain
  • Affective anger, fear, depression and
  • anxiety
  • Behavioral observable actions
  • facial expression, posturing
  • chronic pain affects function

20
  • Beliefs, attitudes, memories, meaning
  • attributed to pain
  • Coping distraction, negative thoughts
  • Sociocultural demographics
  • Age, Gender, Education, Socioeconomic
    status, support systems, social roles/cultures

21
Types Pain
  • Neuropathic Pain
  • Nociceptive Pain
  • Somatic Pain
  • Visceral Pain

22
Types Acute Pain
  • Cutaneous superficial
  • Somatic Pain - originates SC tissue, joints,
    tendons, muscles and fascia
  • Visceral Pain from compression, distention or
    stretching of viscera

23
Assessment
  • History
  • Description
  • Aching and soreness
  • Burning, stabbing, dull,
    throbbing

24
Sensory
  • P Pattern
  • A Area
  • I Intensity
  • N Nature

25
Area of Pain
  • Helps in determining possible cause and
    treatment
  • Referred from origin to another site
  • Radiates ex sciatica
  • Ask pt to point to the site and describe exact
    area of pain on a map

26
Intensity of Pain
  • Assesses the severity
  • Use numerical scale of 0-10 with communicative
    patients
  • Children - use the faces chart (Wong) Visual
    Analog
  • Comatose or Unresponsive - FLACC

27
Nature of Pain
  • Quality or characteristics of pain
  • McGill Pain Questionnaire
  • Neuropathic pain (pain over damaged nerves)
    burning, cold, shooting, stabbing or itchy
  • Nociceptive (pain over intact nerves) sharp,
    aching, throbbing, cramping

28
Breakthrough Pain
  • Transient, moderate to severe pain
  • Occurs above the pain treatment by analgesics
  • Common with Ca patients
  • Rapid in onset, brief in duration with variable
    intensity and freq. of occurence

29
Risks for Inadequate Control
  • Racial minorities
  • Elderly
  • Past or current substance abusers

30
Procedural Pain
  • Episodic
  • Procedural or incident
  • Occurs during painful procedures

31
Scheduling
  • Prevent or control pain
  • Premedication
  • Around-the-clock

32
WHO Guidelines
  • ANALGESIC LADDER
  • Step I mild pain
  • Step II moderate pain
  • Step III Mod to severe pain

33
Mild Pain
  • 1-3 on scale
  • Nonopioids
  • Ceiling effect
  • Use of adjuvant drugs

34
Moderate Pain
  • 4-6 on 0-10 scale
  • Step II drugs - Opoids
  • Mu Agonists
  • Mixed Agonists-Antagonists

35
Moderate to Severe Pain
  • 7-10 LEVEL
  • STEP III POTENT DRUGS
  • NO ANALGESIC CEILING
  • MANY DELIVERY ROUTES
  • M/S STANDARD FOR COMPARISON
  • CHECK RESPIRATORY RATE!!!

36
Adjuvant Therapy
  • Tricyclic antidepressants
  • Antiseizure
  • Useful neuropathic pain
  • A2-adrenergic agonists
  • Corticosteroids

37
Methods of Delivery
  • Intravenous most common
  • Continuous, bolus, PCA
  • PCA uses infusion pump
  • Altered LOC precludes use
  • Monitor carefully with
    alterations
  • in clearance drug from system

38
Epidural Pain Control
  • Post major abdominal, thoracic, orthopedic
    surgery
  • Common side effects
  • Complications
  • Nerve Blocks local anesthetics or neurolytic
    agents

39
Nonpharmacologic
  • MASSAGE
  • VIBRATION
  • TENS UNITS
  • ACUPUNCTURE
  • HEAT AND COLD
  • ULTRASOUND
  • RELAXATION MUSIC
  • GUIDED IMAGERY

40
Barriers
  • Tolerance chronic exposure
  • Treatment increase dose, substitute drug,
  • augment
  • NO CEILING effect with agonist drugs
  • Communication

41
Barriers to Assessment in Geriatrics
  • Belief that pain is a normal part of aging
  • Nothing can be done to relieve the pain
  • Fears re reporting pain label them as a burden
    or a bad patient
  • Greater fear of opiods

42
Barriers
  • Physical Dependence
  • Withdrawal
  • Addiction
  • Concerns re side effects
  • Forgetting to take medication
  • Biases of nursing
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