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70 Cards in this Set
- Front
- Back
Pain
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"Pain is whatever the person experiencing pain says it is, existing wheneer he/she says it does."
It is one of the body's defense mechanisms that indicates the person is experiencing a problem. |
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Acute Pain
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Generally rapid in onset, varies in intensity from mild to severe. It warns the individual of tissue damage or organic disease. (causes include pricked finder, sore throat, surgery)
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Chronic pain
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May be limited, intermittent, or persistent but that lasts beyond the normal healing period.
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Remission
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When the disease is present but the person does not experience symptoms
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Exacerbation
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The symptoms reappear.
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Intractable Pain
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Does not go away. It is resistant to therapy and persists despite a variety of interventions.
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Cutaneous Pain
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Superficial cut (Paper cut)
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Deep Somatic Pain
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Diffuse or scattered and originates in tendons, ligaments, bones, blood vessels and nerves.
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Visceral Pain
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Poorly localized and originates in body organs in the thorax, cranium, and abdomen.
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Referred Pain
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Can originate in one part of the body but be perceived in an area distant from its point of origin
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Radiating Pain
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Pain that radiates down a direct path.
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Phantom pain
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The pain that is often referred to an amputated leg where receptors and nerves are clearly absent is a real experience.
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Psychogenic pain
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Physical cause for the pain cannot be identified.
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Transduction
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The activation of pain receptors. It involves conversion of painful stimuli into electrical impulses that travel from the periphery to the spinal cord at the dorsal horn.
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Nociceptors
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The peripheral nerve fibers that transmit pain.
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Neurotransmitters
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Substances that either excite or inhibit target nerve cells
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Mechanical stimulants
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Friction from bed linens and pressure from a cast
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Thermal stimulants
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Sunburn and cold water on a tooth
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Chemical stimulant
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An acid burn
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Electrical stimulant
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The jolt of a static charge
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Transmission
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Pain sensations from the site of an injury or inflammation are conducted along pathways to the spinal cord and then on to high centers.
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Protective Pain reflex
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Responsible for withdrawal of an endangered tissue from a damaging stimulus.
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Perception
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Involves the sensory process that occurs when a stimulus for pain is present.
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Pain Threshold
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The lowest intensity of a stimulus that causes a subject to recognize pain. Studies show that women have lower ones than men.
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Modulation
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The process by which the sensation of pain is inhibited or modified.
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Neuromodulators
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The sensation of pain appears to be regulated or modified by these substances, which are endogenous oploid compounds, meaning they are naturally present, mophine-like chemical regulators in the spinal cord and brain.
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Endorphins
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Are produced at neural synapses at various points along the CNS pathway. They are powerful pain-blocking chemicals that have prolonged analgesic effects and produce euphoria..
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Gate Control Theory
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Recognizes the relationship btwn pain and emotions. Explains that excitatory pain stimuli carried by small-diameter nerve fibers can be blocked by inhibiting signals carried by large-diameter nerve fibers. The exciting and inhibiting signals at the gate in the spinal cord determine the impulses that eventually reach the brain, when too much information is sent through, certain cells in the spinal column interrupt the signal as if closing the gate.
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Behavior Responses to pain
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Moving away from pain stimuli, grimacing, moaning, and crying. Restlessness & protecting the painful area & refusing to move
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Physiologic Responses -sympathetic
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Increased BP, Increased pulse & respiratory rate, pupil dilation,"", muscle tension and rigidity, pallor, increased adrenaline output, increased blood glucose. (Increased vital signs only occur briefly in acute pain, may not be present in chronic pain.)
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Physiologic responses-parasympathetic
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nausea & vomiting, fainting or unconsciousness, decreased BP, decreases pulse rate,"", Prostration, rapid and irregular breathing.
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Psychological/Affective responses
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Exaggerated weeping and restlessness, withdrawal, stoicism, anxiety, depression, fear, anger, anorexia, fatigue, hopelessness, powerlessness.
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Factors influencing pain
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Culture & ethnic
Family, gender, and age Religious beliefs Environment & support people Anxiety Past pain experience Fatigue Misconceptions |
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Culture and ethnic
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Be knowledgeable about cultural variations and develop an understanding of cultural influences on pain tolerance, expressions of pain, and alternative practices used to manage pain. Do not stereotype
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African-Americans
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Pain viewed as a sign of illness or disease. Believe pain and suffering are inevitable, spiritual and religious beliefs contribute to a high tolerance for pain, some believe that praying and laying on hands may aid from pain and suffering.
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Arab-Americans
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View pain as unpleasant & something that should be controlled, express pain openly w/family members but more restrained in from of health professionals. Usually expect positive response from medical interventions to control pain.
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Chinese Americans
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Expressions off pain are usually similar to americans. Believe pain is related to imbalances of yin and yang. Cope w/pain with oils and massages, as well as warmth, sleeping on the area of pain, relaxation, and aspirin.
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Greek Americans
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Pain (ponos) viewed as an evil that needs to be eradicated. Shared w/family. Family is considered a resource for pain relief because they act as advocates and provide emotional support.
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Mexican Americans
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Delay seeking medical pain and hope instead that it will go away. consider it a necessary part of life. Seem to experience more pain than other ethnic groups but report it less frequently, often see a relationship btwn pain & suffering and immoral behavior.
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Navajo Indians
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Do not usually openly express their pain or request pain medication. They mask actual intensity of pain, may prefer herbal medicines and use them w/o the knowledge of healthcare provider.
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Family, Gender, and Age Variables
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An individuals response to pain may be affected or influence by the response of family members. Women are more comfortable communicating pain, but this ability may cause some to view the pain as emotionally or psychologically based. Infants and small children are sensitive to and experience pain. Among Older people, pain is often viewed as a natural component of the aging process, being ignored or under treated by HC providers.
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Religious beliefs
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Can be a powerful influence on the indvs experience of pain. In some, pain & suffering can be viewed as a "lack of goodness" in themselves. Patients may refuse relief measures. In others it can be viewed as punishment from a vengeful God. Anger, resentment and depression may compound the pain pain experience.
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Environment and support People
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People in a critical care unity compounds the experience of pain. Depersonalization from a fave pillow, pet or other source may further decrease the person's sense of comfort. For some the presence of a loved one is essential to their sense of well-being, while others prefer to be alone.
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Anxiety
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Is almost always present when pain is anticipated or being experienced, tends to increase the perceived intensity of pain.
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Fatigue
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Pain may be aggravated with fatigue. The rested and relaxed person can often cope with more discomfort than someone who is suffering from fatigue.
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Past Pain Experience
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Some who have never known severe pain and have no fear of pain don't realize how intense the sensation can be. In general, people who have experienced more pain than usual tend to anticipate more pain and exhibit increased sensitivity to pain. Some who have experience severe pain and unable to secure relief can have acute feelings of fear, despair, and hopelessness to the thought of new pain.
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Misconceptions
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If i ask for something for pain, i may become addicted to it.. Sometimes it is better to put up with pain than to deal w/side effects; It is immature to talk about pain; I should wait until the pain gets really bad before I ask for help; It is natural to have pain after surgery.
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Assessment: Focused assessment
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When? On admission, and continued ongoing
How? Physiologic responses, behavior responses. LDQQCA |
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OLD AIR QRST
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Tools
O: onset L: location D: duration A: aggravating/alleviating factors I: intensity R: relief measuresP: what precipitated the pain or pattern Q: what is the quality? R: what is its region? Radiates? S: what is the severity T: what it its timing. When does it begin, how long does it last, and how is it related to other events in your life? |
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ABCDE “Clinical Approach”
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Ask~about pain regularly.~Assess pain systematically.
~Believe~the client and family in their report of pain and what relieves it. Choose~pain control options appropriate for the client, family, and setting. Deliver~interventions in a timely, logical, and coordinated fashion. Empower~clients and their families. Enable them to control their course to the greatest extent possible. |
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Nursing Diagnosis
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Is it Acute or Chronic?
What type of pain? What are the etiologic factors? What type of response? What other factors are affecting pain process? |
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Nursing Planning/Intervention
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Developing a plan of care that, when implemented, demonstrates nursing's commitment to assist the patient to develop effective main management strategies.
Ex. of Patient Outcome: The patient will describe a gradual reduction of pain, using a scale ranging from 0-10. |
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Implementation
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The nurse implements the nursing strategies that are most likely to assist the patient to achieve pain relief outcomes.
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Mind-Body Intervention: using the powers of the mind to produce changes in the body.
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Help with chronic pain by reducing stressful emotions such as panic and fear, and by refocusing attention on subjects other than pain. (meditation, guided imagery, biofeedback, relaxation)
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Nutritional and herbal remedies
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For chronic pain especially abdominal, headaches and inflammatory conditions (RA) Helps by boosting the body's natural immunity, reducing pain-causing inflammation, soothing pain, and decreasing insomnia.
(anti-inflammatory diet, omega-3 fatty acids, ginger, turmeric, MSM) |
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Energy Healing: Manipulating the electric energy
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Helps pain that lingers after an injury heals, as well as pain complicated by trauma, anxiety, or depression by relaxing the body & mind, distracting the nervous system, producing natural painkillers, activating natural pleasure centers, and manipulating. (Acupuncture, Acupressure, Chi gong, Reiki)
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Physical Manipulation: Cutaneous stimulation
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Hands on massage or movement of painful areas Helps muskoskeletal pain and pain from adhesions or scars by restoring mobility, improving circulation, decreasing BP, and relieving stress. (Massage, Chiropractic, Osteopathy)
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Pain tolerance
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The point beyond which a person is no longer willing to endure pain.
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Analgesic
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is a pharmaceutical agent that relieves pain.. Function to reduce the person's perception of pain and to alter the person's responses to discomfort.
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Nonopoid analgesics
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Acetaminophens (Tylenol) & NSAIDs ( (ibuprofen (Motrin); ketorolac (Toradol); naproxen (Naprosyn); celecoxib (Celebrex) )
Side Effects: Gastric side effects |
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Opoid
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all controlled substances morphine,"", codeine,"", meperidine, hydromorphone, methadone.
((Morphine sulfate; Hydrocodone (Vicodin; Lortab); Hydromorphone (Dilaudid); Fentanyl (Duragesic); Oxycodone (OxyContin) ) Side Effects: Sedation, nausea, and constipation. |
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Adjuvant drugs
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Enhance the effects of oploids: lessen side effects (anticonvulsants, antidepressants, multipurpose drugs)
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Administration
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PRN-as needed
Patient-Controlled Analgesia (PCA) Epidural analgesia |
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PRN
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As needed drug regimen has not been proven effective for people experiencing acute pain.
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PCA
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Patient controlled analgesia provides effective individualized analgesia and comfort. Used to manage chronic pain in a HC facility or home. Relieve pain associated with operative procedures such as labor & delivery, trauma, and cancer. (morphine, fentanyl, hydromorphone)
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Epidural analgesia
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Used to provide pain relief during the immediate postoperative phase particlarly after thoracic, abdominal,"", orthopedic, and vascular surgery) Morphine or Fentanyl
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Physical dependence
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A state of adaptation manifested by a drug class-specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist. (American Pain Society)
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Tolerance
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A state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug’s effects over time.( American Pain Society)
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Addiction
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A primary, chronic, neurobiological disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. It’s characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continues use despite harm, and craving. (American Pain Society)
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Evaluation
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Becomes ongoing. Its directed towards the changing nature of the pain experience, the treatment modalities,"", and family's response to the plan of care.
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