Textbook Of Basic Nursing (Rosdhal) Ch. 55 Client Comfort And Pain Management

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Margo McCaffery

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"pain is whatever the experiencing person says it is, existing whenever he says it does"

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the definition of pain in a medical dictionary

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a feeling of distress, suffering or agony caused by stimulation of specialized nerve endings it purpose is chiefly protective...

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regardless of cause nursing care is directed at

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relieving pain

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physical causes of pain include

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trauma, surgical incision, tumor growth, excesses in heat, cold, pressure, certain chemical substances
released when tissues damaged or destroyed

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tissues released when tissues damaged or destroyed

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histamines, bradykinin, acetylcholine

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lack of oxygen to tissues

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causes pain as tissues suffer from oxygen deprivation

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pain cycle

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1. injury, insult
2. fear, stress, conflict, lower pain threshold
3. fatigue makes it difficult to manage pain
4. lack of knowledge predisposes to more pain

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the nervous system changes painful stimuli in the nerve endings to impulses

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transduction

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the impulses travel from their original site to the brain

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transmission

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the brain recognizes, defines and responds to pain

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perception

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the body activates needed inhibitory responses to the effects of pain

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modulation

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pain that occurs abruptly, exists for a short period, 6 months or less, normal processing of trauma to the skin, muscles and visceral organs

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acute pain (nociceptive pain)

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pain that originates in one body part, but is perceived in another part of the body

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referred pain

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pain as a result of ome malignancy

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cancer pain

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pain continues for 6 months or longer, interferes with a person's normal functioning

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chronic pain (neuropathic pain)

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neuropathic pain syndromes are difficult to treat, some manifestations include

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burning, tingling sensations, and/or shooting pain

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pain that resists therapeutic interventions, with known cause (i.e. tumor) or unknown cause

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intractable pain

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when a person fails to express feelings, suppressed anger may turn inward and cause depression, whose symptoms include

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extreme fatigue, inability to sleep or sleeping too much, lack of interest in surroundings, lack of or excessive appetite, guilt feelings, sexual impotence and withdrawal from social activities

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lowest intensity of a stimulus that causes the subject to recognize pain

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pain threshold

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the point at which a person can no longer endure pain

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pain tolerance

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the body has internal mechanism that help control pain, such as ______, a naturally occurring substance that relieves pain

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endorphins

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released with exercise and other forms of physical stimulation, inhibited by the intake of caffeine, nicotine, alcohol, salt and sugar

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endorphins

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expressions of pain are often related to

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culture
ethnicity
beliefs
manner of expressing
gender
traditional vs. non-traditional
imbalances
pain as punishment
spiritual and religious beliefs

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Joint Commission Standards

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appropriate assessment and management, ongoing assessment on nature and intensity, recorded to promote follow up, competent staff, rules and regs in place, education, discharge planning addresses pain

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Documentation of pain includes

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level, description, action taken, results

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verbal scale for children older than 7 and adults

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Pain Intensity Scale or Pain Distress Scale

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comprehensive way in which to obtain information about a client's pain

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McGill-Melzack Pain Questionaire

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nonverbal scale for children 3-7, or audluts with language barrier

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Wong-Baker Faces Pain Scale

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aching, burning, cramping, crushing etc.

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character of pain

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occasional, intermittent, spasmodic

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duration of pain

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mild, slight, severe

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intensity or severity of pain

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nauses, visual disturbances, fatigue, muscle spasms

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associated factors with pain

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COLDSPA

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Character, Onset, Location, Duration, Severity, Pattern, Associated factors

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preventative approach works best with this class of drugs

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analgesics

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analgesics provide pain relief by...

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altering the body's sodium and potassium levels, thus slowing or halting pain transmission

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asprin, ibuprofen, naproxen, acetaminophen

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nonopioid nonsteriodal anti-inflammatory drugs (NSAIDS), mild to moderate pain

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morphine and derivatives,

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opioids, moderate to sever pain

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anti-convulsants and anti-depressants

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Adjuvant, improve mood, assist with muscle relaxation...endorphins

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contain local anesthetics, may draw blood to painful areas to increase temp. and improve circulation

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ointments and liniments

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nerves transmitting pain may be cut

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ablation surgery

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nursing interventions

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changing client's position, bathing the client, giving a backrub or hand masssage

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comfort measures

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clean bed, clean face, semilighted room

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physical measures

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physical stimulus, heat and cold applications, exercise

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cognitive behavior measures

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distraction and diversion, support groups, stress management

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alternative and complimentary techniques

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nonpharmacologic, chiropractic care, acupuncture, acupressure, hypnosis, biofeedback