1. Pain Lecture1. Pain Lecture1. Pain Lecture.ppt
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The document covers pain assessment and management, detailing types of pain (acute, chronic, and cancer-related), their harmful effects, and the pathophysiology of pain. It emphasizes the importance of thorough nursing assessment, defining pain, and utilizing various pain management strategies, including pharmacologic and nonpharmacologic interventions. Additionally, it highlights the factors influencing pain response and the critical role of nurses in managing and alleviating pain.
1. Pain Lecture1. Pain Lecture1. Pain Lecture.ppt
- 2. Outlines Introduction. Types and classifications of pain. Harmful effects of pain (acute and chronic pain ). Pathophysiology of pain. Factors influencing pain response. Nursing Assessment of Pain Roles of the Nurse in Pain Management Pain Management Strategies. Pharmacologic Interventions. Nonpharmacologic approaches
- 3. Introduction Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain occurs as the result of many disorders, diagnostic tests, and treatments. Pain is the most common reason for seeking health care. Pain is the fifth vital sign and should be assessed and documented as automatic as taking a “traditional” vital signs (temperature, respiration, blood pressure).
- 4. Types of Pain Pain is categorized according to its duration, location, and etiology. Pain Classified by Duration into three basic categories: Acute pain. Chronic (nonmalignant) pain. Cancer-related pain.
- 5. Types of Pain (Cont.) Acute Pain. Usually of recent onset and commonly associated with a specific injury. Indicates that damage or injury has occurred. A useful signal that something is wrong. Last from seconds to 6 months. Chronic (nonmalignant) Pain. It is constant or intermittent pain that persists beyond the expected healing time and that can seldom be attributed to a specific cause or injury. Lasts for 6 months or longer.
- 6. Types of Pain (Cont.) Cancer-related Pain. The pain associated with cancer and is often called “malignant pain” or “cancer pain.” May be acute or chronic. A direct result of tumor involvement (e.g., bony infiltration with tumor cells or nerve compression). But it may a result of cancer treatment (e.g., surgery or radiation).
- 7. Types of Pain (Cont.) Pain Classified by Location (e.g., pelvic pain, headache, chest pain). This type of categorization aids in communication about and treatment of the pain. Pain Classified by Etiology (e.g., burn pain and postherpetic neuralgia). Clinicians often can predict the course of pain and plan effective treatment using this categorization.
- 8. Effects of Acute Pain Patient with severe pain may be unable to take a deep breath and may experience increased fatigue and decreased mobility. The unrelieved acute pain produce stress response such that occurs with trauma. Stress response generally consists of increased metabolic rate and cardiac output, impaired insulin response, increased production of cortisol, and increased retention of fluids. Stress response can affect the pulmonary, cardiovascular, gastrointestinal, endocrine, and immune systems.
- 9. Effects of Acute Pain (Cont.) Changes that occur with stress response can have significant harmful effects. These effects may hamper recovery and increase patient’s risk for physiologic disorders (e.g., myocardial infarction, pulmonary infection, paralytic ileus and thromboembolism). Particularly in patients whose health is already compromised by age, illness, or injury (in elderly, debilitated, or critically ill people). Effective pain relief may result in faster recovery and improved outcomes.
- 10. Effects Of Chronic Pain Chronic pain often results in suppression of the immune function (which promote tumor growth), anger, fatigue, depression, and disability. Disabilities may range from an impaired ability to participate in physical activities and interpersonal relationships to an inability to take care of personal needs, such as dressing or eating.
- 11. Pathophysiology of Pain Pain Transmission. Neurologic transmission of pain is also referred to as nociception. Nociceptors, or pain receptors, are neuronal receptors involved in the transmission of pain perceptions to and from the brain. It respond to biochemical mediators or noxious stimuli. Nociceptors are free nerve endings in the skin that respond only to intense, potentially damaging stimuli. Such stimuli may be mechanical, thermal, or chemical in nature.
- 12. Pathophysiology of Pain (Cont.) The joints, skeletal muscle, fascia, tendons, and cornea also have nociceptors that have the potential to transmit stimuli that produce pain. The large internal organs (viscera) do not contain nerve endings that respond only to painful stimuli. Pain originating in these organs results from intense stimulation of receptors that have other purposes. For example, inflammation, stretching, ischemia, dilation, and spasm of the internal organs all cause an intense response in these multipurpose fibers and can cause severe pain.
- 14. Factors Influencing Pain Response There are factors may increase or decrease perception of pain, increase or decrease tolerance for pain, and affect responses to pain. 1. Past experiences with pain and expectations about pain relief. 2. Anxiety related to pain increase the perception of pain Anxiety that is unrelated to the pain may distract patient and decrease the perception of pain. 3. Culture (age, education level, income, and beliefs about pain). 4. Gender (women consistently reported higher pain intensity)
- 15. Nursing Assessment of Pain Pain assessment begins by observing the patient carefully, noting the patient’s overall posture and presence or absence of overt pain behaviors. Then ask the person to describe, in his or her own words, the specifics of the pain. A detailed history should follow the initial description of pain.
- 16. Nursing Assessment of Pain Characteristics of Pain. The factors to consider in a complete pain assessment are: A. Intensity. B. Timing. C. Location. D. Quality. E. Aggravating and alleviating factors. F. Personal meaning. G. Pain behaviors.
- 17. Nursing Assessment of Pain A. Intensity of Pain: The reported pain intensity is influenced by: A.Person’s Pain Threshold: the smallest stimulus for which a person reports pain. B.Person’s Pain Tolerance: the maximum amount of pain a person can tolerate. Only the patient can accurately describe his pain. Remember pain is, “whatever the person says it is, existing whenever the experiencing person says it does”.
- 18. Nursing Assessment of Pain A. Intensity of Pain (Cont.). Pain assessment tools used to assess the patient’s perception of pain, document the need for intervention, to evaluate the effectiveness of the intervention, and to identify the need for alternative or additional interventions. Examples of the pain assessment tools are: 1. Simple descriptive pain intensity scale (Word Scale). 2. 0-10 numeric pain intensity scale. 3. Visual Analogue Scales (VAS) 4. Faces Pain Scale–Revised
- 19. Tools (scales) For Assessing Intensity of Pain
- 20. • Explain to the patient that this face (point to left-most face) shows no pain. The faces show more and more pain (point to each from left to right) up to this one (point to right-most face) it shows very much pain. • Ask the patient to point to the face that most closely resembles the intensity of his pain (right now). • Score the chosen face 0, 2, 4, 6, 8, or 10, counting left to right, so 0 no pain and 10 very much pain. Do not use words like “happy” or “sad.” • This pain scale is especially suited for helping children describe pain. This scale is intended to measure how children feel inside, not how their face looks. Faces Pain Scale – Revised .
- 21. Nursing Assessment of Pain A. Intensity of Pain (Cont.). Using a written scale to assess pain may not be possible if the person is seriously ill, is in severe pain, or has just returned from surgery. In these cases, use the 0 to 10 numeric pain intensity scale, 0 being no pain and 10 being pain as bad as it can be, how bad is your pain now?” Ideally, the nurse teaches the patient how to use the pain scale before the pain occurs (e.g., before surgery).
- 22. Nursing Assessment of Pain B. Timing of Pain: include the onset, duration, relationship between time and intensity (e.g., at what time the pain is the worst), and changes in rhythmic patterns. Ask patient if the pain began suddenly or increased gradually. Sudden pain that rapidly reaches maximum intensity is indicative of tissue injury, and immediate intervention is necessary.
- 23. Nursing Assessment of Pain C. Location: best determined by having the patient point to the area of the body involved. D. Quality: ask patient to describe the pain in his own words without offering clues. The patient is asked to describe what the pain feels like (e.g., burning, aching, throbbing, or stabbing). It is important to document the exact words used by the patient to describe the pain.
- 24. Nursing Assessment of Pain E. Personal Meaning of Pain: Pain means different things to different people; as a result, patients experience pain differently. Meaning of pain helps understand how patient’s daily life is affected and assists in planning treatment. Some people with pain can continue to work or study, whereas others may be disabled, thus affecting their financial situation. For some patients, recurrence of pain may mean worsening of disease, such as the spread of cancer.
- 25. Nursing Assessment of Pain F. Aggravating and Alleviating Factors Ask the patient what, if anything, makes pain worse and what makes it better. o Ask about the relationship between activity and pain. o Ask whether environmental factors influence pain. o Ask whether the pain is influenced by or affects the quality of sleep or anxiety. o Ask about patient’s use of medications (including amount and frequency), herbal remedies, nonpharmacologic interventions, or alternative therapies.
- 26. Nursing Assessment of Pain G. Pain Behaviors: People express pain with many different behaviors. Patients may grimace, cry, or patient my rub, guard or immobilize the affected area. Others may moan, groan, or sigh. Not all patients exhibit the same behaviors, and there may be different meanings for the same behavior. Remember, the nonverbal and behavioral expressions of pain are not consistent or reliable indicators of the quality or intensity of pain.
- 27. Roles of the Nurse in Pain Management Perform pain assessment. Identify goals for pain management. Provide patient teaching. Perform physical care. Help relieve pain by administering pain-relieving interventions (including both pharmacologic and nonpharmacologic approaches). Assess the effectiveness of those interventions. Monitor for adverse effects. Serve as an advocate for patient when the prescribed intervention is ineffective in relieving pain.
- 28. Pain Management Strategies A. Pharmacologic Interventions. B. Nonpharmacologic approaches. These approaches are selected on the basis of the requirements and goals of particular patients.
- 29. Pharmacologic management of pain is accomplished in collaboration with physicians, patients, and often families. A physician prescribes specific medications for pain or insert an epidural catheter for administration of such analgesic agents. The nurse maintains the analgesia, assesses its effectiveness, and reports whether the intervention is ineffective or produces side effects. A. Pharmacologic Interventions
- 30. A. Pharmacologic Interventions (Cont.) A. Pharmacologic Interventions. 1. Opioid Analgesic Agents (Narcotics), such as Morphine, Codeine, and Meperidine, and Tramadol. Interfere with pain perception centrally (at the brain) 2.Nonsteroidal Anti-inflammatory Drugs (NSAIDs), such as, diclofenac (Voltaren), ibuprofen, indomethacin, ketoprofen, piroxicam, and naproxen. Alter the neurotransmission at the peripheral level. 3.Local Anesthetic Agents. a. Topical Application. b. Intraspinal Administration (by through an epidural catheter)
- 31. A. Pharmacologic Interventions (Cont.) Approaches for Using Analgesic Agents. Balanced Analgesia : refers to the use of more than one form of analgesia concurrently to obtain more pain relief with fewer side effects. Preventive Approach: analgesic drugs are given at set time intervals rather than on the basis of the patient’s report of pain, so that medication acts before pain becomes severe and before serum drug level falls to a subtherapeutic level. Patient-Controlled Analgesia (PCA): patients control the administration of their own medication within predetermined safety limits. This approach used with oral analgesic agents and with continuous infusions of opioid analgesic agents by IV, subcutaneous, or epidural routes.
- 32. A. Pharmacologic Interventions (Cont.) Premedication Ask the patient about allergies to medications and the nature of any previous allergic responses. Obtains the patient’s medication history (e.g., current, usual, or recent use of prescription or OTC medications or herbal agents). Because certain medications may affect the analgesic medication’s effectiveness or the metabolism and excretion of analgesic agents. Assess patient’s pain status, including the intensity of current pain, and changes in pain intensity after the previous dose of medication.
- 33. A. Pharmacologic Interventions (Cont.) Postmedication Monitor the effects of opioid analgesic medications and record patient’s blood pressure, respiratory and pulse rates especially when the first dose is given or when the dose is changed or given more frequently. When opioids administered, anticipate side effects and take steps to minimize them and to increase the likelihood that patient will receive adequate pain relief without interrupting therapy to treat these effects. Record the time, date, the patient’s pain rating (scale of 0 to 10), the analgesic agent, side effects, and patient activity.
- 34. A. Pharmacologic Interventions (Cont.) Side effect of the Opioids: 1. Respiratory depression and sedation 2. Nausea and vomiting. 3. Constipation. 4. Pruritus. Tolerance: the need for increasing doses of opioids to achieve the same therapeutic effect. Develop in patients taking opioids over an extended period. Addiction: a behavioral pattern of substance use characterized by a compulsion to take the substance (drug or alcohol) primarily to experience its psychic effects.
- 35. B. Nonpharmacologic Interventions 1.Cutaneous Stimulation and Massage (rubbing the skin) on the back and shoulders stimulate fibers that transmit nonpainful sensations can block or decrease the transmission of pain impulses. Massage also promotes comfort because it produces muscle relaxation.
- 36. 2. Thermal Therapies (Ice and heat therapies) Application of ice on the injury site immediately after injury or surgery reduce pain and reduce the amount of analgesic medication required. Application of dry and moist heat increases blood flow to area and contributes to pain reduction by speeding healing Both ice and heat therapy must be applied carefully and monitored closely to avoid injuring the skin. Neither therapy should be applied to areas with impaired circulation or with impaired sensation. It is believed that ice and heat stimulate the nonpain receptors in the same receptor field as the injury. B. Nonpharmacologic Interventions (Cont.)
- 37. 3. Transcutaneous Electrical Nerve Stimulation (TENS) TENS uses a battery-operated unit with electrodes applied to the skin to produce a tingling, vibrating, or buzzing sensation in the area of pain. It decrease pain by stimulating the nonpain receptors in the same area as the fibers that transmit the pain. For example, when TENS is used in a postoperative patient, the electrodes are placed around the surgical wound. B. Nonpharmacologic Interventions (Cont.)
- 38. 4. Distraction: which involves focusing the patient’s attention on something other than the pain. Distraction is thought to reduce the perception of pain by stimulating the descending control system, resulting in fewer painful stimuli being transmitted to the brain. Effectiveness of distraction depends on the patient’s ability to receive and create sensory input other than pain. B. Nonpharmacologic Interventions (Cont.)
- 39. 4. Distraction (Cont.). Distraction techniques involves watching TV, watching an action-packed movie on a large screen through headphones, games and activities (e.g., chess, crossword puzzles) that require concentration and visits from family and friends. The stimulation of sight, sound, and touch is likely to be more effective than is the stimulation of a single sense. Severe pain may prevent patients from concentrating well enough to participate in complex physical or mental activities. B. Nonpharmacologic Interventions (Cont.)
- 40. 5. Relaxation Techniques: Skeletal muscle relaxation is believed to reduce pain by relaxing tense muscles that contribute to the pain. A simple relaxation technique consists of abdominal breathing at a slow, rhythmic rate. The patient may close both eyes and breathe slowly and comfortably. A constant rhythm can be maintained by counting silently and slowly with each inhalation (“in, two, three”) and exhalation (“out, two, three”). B. Nonpharmacologic Interventions (Cont.)
- 41. 6. Guided Imagery : Guided imagery for relaxation and pain relief may consist of combining slow, rhythmic breathing with a mental image of relaxation and comfort. Instructs patient to close both eyes and breathe slowly in and out. With each slowly exhaled breath, the patient imagines muscle tension and discomfort being breathed out, carrying away pain and tension and leaving behind a relaxed and comfortable body. With each inhaled breath, the patient imagines healing energy flowing to the area of discomfort. B. Nonpharmacologic Interventions (Cont.)