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Pain Management

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Chapter 43 Pain Management NRS_105/320_Collings NRS_105/320_Collings Importance Pain management is a primary nursing responsibility Nurse have a legal and ethical ... – PowerPoint PPT presentation

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Title: Pain Management


1
Chapter 43
  • Pain Management

2
Importance
  • Pain management is a primary nursing
    responsibility
  • Nurse have a legal and ethical duty to
    control/relieve pain
  • Pain relief is a basic human right
  • Patients need to know we CAN and WILL relieve
    their pain

3
Why?
  • Effective pain management
  • Improves quality of life
  • Reduces disability
  • Promotes early mobility and return to work
  • Results in less hospital / office visits
  • Reduces length of stay, complications
  • Reduces health care cost
  • Improves patient satisfaction

4
Nature of Pain
  • Physical
  • Emotional
  • Cognitive
  • Subjective

5
Physiology of Pain
  • Transduction
  • Thermal,chemical,mechanical stimulation
  • ? electrical impulse in nerve fiber
  • Transmission
  • A fibers sharp, localized, distinct sensation
  • C fibers generalized, persistent sensation
  • E.g. Burn finger spot pain ? ache
  • Peripheral ? spinal ? brain

6
Physiology of Pain
  • Perception
  • Brain interprets impulse, perceives as pain
  • Experience, memory, context, knowledge
  • Ascribes meaning to sensation
  • Modulation
  • Body response
  • Endogenous opiods, serotonin, norepinephrine,
    GABA
  • ? transmission of impulse, analgesic effect
  • These deplete over time with continued pain

7
Gate-Control Theory of Pain
  • Gating mechanisms along the CNS
  • Can block transmission of impulses
  • Pain relief measures to close the gate
  • Light touch effleurage
  • Pain threshold
  • Level at which you feel pain
  • Genetic, learned,
  • Runners high, endogenous opiods
  • Individual not transferrable!

8
Physiological Response to Pain
  • Mild moderate pain 1-6 superficial
  • ? autonomic response sympathetic
  • fight or flight, general adaptation
  • ?HR, RR, B/P, BG, diaphoresis, peripheral
    vasoconstriction
  • Severe or deep 7-10, visceral pain
  • ? parasympathetic response
  • ? HR, B/P, muscle tension, immobility, irreg resp
  • may cause harm
  • Physiologic response VS is short-term
  • VS are not reliable pain indicators over time

9
Behavioral responsesto Pain
  • Dependent on context, meaning, culture, pain
    tolerance
  • It is supposed to hurt
  • Men dont cry
  • I dont want to be a complainer, bother
  • Nonverbal indicators
  • Body movements restless or still, holding,
    guarding
  • Facial expression grimace, frown, clenched
    teeth, posture,
  • Lack of expression of pain does not mean it isnt
    there!

10
Types of Pain
  • Acute pain
  • Protective, identifiable cause, short duration,
    limited tissue damage, ? emotional response
  • Causes harm by ? mobility, energy
  • Goal is to control pain so patient can
    participate in recovery
  • ? Pain ? ?Mobility ? decreased complications,
    decreased length of stay

11
Types of Pain
  • Chronic pain
  • Serves no purpose not protective
  • Lasts longer than anticipated
  • May or may not have an identifiable cause
  • Impacts every part of patients life
  • Depression, Suicide
  • Disability, isolation, energy drain, ADLs
  • Pseudoaddiction seeking pain relief
  • not drug-seeking

12
Types of Pain
  • Cancer pain
  • May be acute or chronic, constant or episodic,
    mild to severe
  • Up to 90 of Ca pts have pain
  • Pain by inferred pathology
  • Known cause characteristic pain neuropathic
  • Idiopathic pain
  • No known cause BUT still pain
  • Excessive pain for a condition

13
Knowledge, Attitudes, and Beliefs
  • Subjective nature of pain
  • Pain is what the patient says it is, not what the
    nurse thinks it should be
  • Same procedure, different pain
  • Expectations, context, culture affect perception
    and expression of pain

14
Knowledge, Attitudes, and Beliefs
  • Nurses Response to Pain
  • Bias
  • I go to work with 5/10 pain every day
  • Its only a minor surgery
  • I had three kids and didnt scream
  • Fallacies
  • Infants dont feel pain like we do
  • Regular pain med use causes addiction
  • Older people all are in pain

15
Factors Influencing Pain
  • Physiological
  • Age interpretation/communication
  • Fatigue
  • increases pain,
  • sleep not sign pain is relieved
  • Genes
  • Pain threshold
  • Neurological function
  • Interpretation, communication, reflex

16
Factors Influencing Pain
  • Social
  • Attention/ distraction
  • Previous experience
  • May increase or decrease tolerance
  • Family and social support
  • Spiritual
  • Meaning of pain, suffering
  • Support system

17
Factors Influencing Pain
  • Psychological
  • Anxiety
  • Coping style
  • Control PCA
  • Cultural
  • Meaning of pain
  • Expression of pain
  • Role in Family
  • Ethnicity

18
Assessment of Pain
  • Clients expression of pain
  • Description is most valid indicator
  • Characteristics of pain
  • Onset and duration
  • Location
  • Intensity
  • Quality
  • Pattern

19
Assessment of Pain
  • Characteristics of pain (cont'd)
  • Relief measures
  • Contributing symptoms
  • Behavioral effects on the client
  • Influences on ADLs
  • Client expectations
  • What pain level would allow you to function well?
  • walk the hall, do ADLs, resume job

20
Assessment
  • Can we do a full assessment of pain when the
    client is in severe pain?
  • No!
  • Alleviate severe 7-10 pain before talking it to
    death
  • Pain rated gt7 needs immediate attention

21
Nursing Diagnoses
  • Anxiety
  • Ineffective coping
  • Fatigue
  • Acute pain
  • Chronic pain
  • Ineffective role performance
  • Disturbed sleep pattern

22
Planning
  • Goals and outcomes
  • Client is using pain relief measures safely
  • Pain level reported at lt/___ and congruent
    nonverbal behaviors seen
  • Demonstrate understanding of need to premedicate
    before activity
  • Splint abdomen with cough
  • Setting priorities
  • What is important for the client? What does he
    need to do?
  • Control pain enough to eat, sleep? Be mobile to
    prevent complications? Work? PT? Maintain
    dignity, relationships while dying?
  • Maslow Pain relief is basic need

23
Implementation Health Promotion
  • Client education
  • Expectations, when to seek treatment
  • Preparation before pain
  • Holistic care
  • Whole self physical, emotional, spiritual
  • Education, rest, exercise, nutrition,
    relationships

24
Nonpharmacological Pain Relief
  • Relaxation and guided imagery
  • Distraction
  • Biofeedback
  • Cutaneous stimulationmassage, application of
    hot/cold, TENS
  • Herbals
  • Reducing painful stimuli and perception

25
Controlling Painful Stimuli
  • Managing the clients environmentbed, linens,
    temperature
  • Positioning
  • Changing wet clothes and dressings
  • Monitoring equipment, bandages, hot and cold
    applications
  • Preventing urinary retention and constipation

26
Implementation Pain Management
  • Pharmacological pain relief
  • Administer analgesics as ordered/ reassess pain
    in 30 minutes and hourly
  • Analgesics NSAIDs and nonopioids, opioids,
    adjuvants
  • Patient-controlled analgesia (PCA)
  • Local analgesic infusion pump
  • Topical analgesics and anesthetics
  • Local and regional anesthetics

27
ImplementationPain Management
  • Surgical interventions
  • Procedural pain management
  • Chronic and cancer pain management

28
Implementation Pain Management
  • Barriers to effective pain management pts,
    nurses, doctors, system
  • Fear of addiction - 1 barrier
  • Terms
  • Dependence physical adaptation resulting in
    withdrawal symptoms
  • tolerance physical adaptation resulting in
    diminished drug effect over time
  • Addiction impaired control over use, use despite
    harm
  • pseudoaddiction drug seeking behavior to
    relieve undertreated pain

29
Implementation Pain Management
  • Nursing implications for pain management
  • Accurate safe medication administration
  • Assess effectiveness and side effects
  • Patient education families too
  • Use the appropriate drug when given a choice
  • Treat pain before it gets severe

30
Implementation Restorative Care
  • Pain clinics
  • Palliative care
  • Hospices

31
Evaluation
  • Effectiveness
  • Assess at peak of drug effect
  • 30 minutes IV, 1 hour PO
  • Add complementary therapies for partial effect
  • Talk with M.D. about options if approach is
    consistently ineffective
  • Side effects
  • Document and communicate
  • Most effective relief

32
Evaluation
  • Client expectations
  • Validate experience
  • Relieve the pain
  • Show you care
  • Did client achieve goal?
  • Walk hall w/o pain?
  • Pain lt 3/10 all day except with PT
  • Able to return to work, enjoy visit, T,C,DB?
  • Pain report congruent with nonverbal?
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