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Pain Comfort

Ch. 31

What is the nature of pain subjective/individualized, physiological mechanism, warning sign of tissue damage
What is transduction conversion of stimuli into pain impulse. Cellular damage casued by thermal/mechanical/chemical/electrical stimuli, releases histamines,bradykinin, K, cause action potential on nociceptors
What are bradykinins? nerotransmitters
What are nociceptors? receptors that respond to harmful stimuli. It's conversion is called transduction
Transmission of pain pain produces nerve impulses, travel along afferent(to brain) peripheral nerve fibers. Two types: fast, myelinated A-delta(sharp,local), slow,unmyelinated C fibers(visceral, inside body) efferent: from brain
Perception of Pain Impulse ascends to brain, processed by thalamus. Thalamus sends msg to other areas of brain:cerebral cortex, hyptothalamus, limbic system
Common misconceptions about pain drug seekers, no reason for pain if not physical cause, amt of tissue damage indicates pain, pain tolerance same for all, aging means pain, use physical signs for pain, pxt who falls asleep really do not have pain
What are excitatory neurotransmitters? Substance P,Serotonin, prostaglandins
what are inhibitory neurotransmitters? endorphins (body's natural morphine), bradykinin (released from plasma that leaks from surrounding blood vessels at injury site) incr pain stimuli
What is the gate control theory? Pain impulses pass through when gate is open and not when closed. Perceive pain, Lamaze can alter perception...then Reaction: pull hand back, emotional/psych
What is the SNS response to pain? sympathetic nervous system Fight or flight for low/mod pain, incr resp,HR,vasoconstrict,dilate bronchials, incr BP, incr Glucose, dilate pupil, decr gastric b/c nausea/vomiting
What is the PNS response to pain? parasympathetic nervous system severe/deep pain muscle tension, decr HR,BP, rapid breathing, nausea, vomiting becuase body trying to recover
Critical thinking of pxt with pain Knowledge, experience, attitude, essential to describe pxt pain
What is the tolerance of pain? point at which there is an unwillingness to accept pain of greater severity or duration: High/Low
Pain is most common reason seek health care. Three major categories: Acute, Chronic cancer, chronic non-cancer
Describe acute pain rapid onset, self limiting, threatens recovery, exhaustion, sleep depro, move to chronic pain if not treated and can cause complications
Describe chronic pain prolonged, remissions/exacerbations, fatigue, insomnia, anorexia, wt. loss, depression, anger Intractible pain: uncontrolled cancer, diabetic neuropathy, phantom limb Non-Cancer Pain: no id cause
What is the AHCPR? Agency for Health Care Policy and Research and they regulate pain assessment
Who is at risk for inadequate pain medication>? people of color, women, older pxts, children
What does the concept of PCA, pxt controlled analgesia mean? Internal loci have less severe pain: ask ?'s, desire info, control over env. External loci: other factors (nurses) responsible for outcome of events, listen to dir., less demanding, anxious if too much info
What does the assessment of pain entail? Aims to find cause, determine effect of pain on ind. Use PQRSTU as intervention tool
What is the PQRSTU tool of intervention? more for acute pain Precipitating/aggravating factors: avoid activities that make pain Quality: change drugs Relief measures: Region (location) Severity Timing (onset,dur,pattern) U (effect of pain on pxt)
Assessment tool to approach to pain A ask B believe C choose pain control options D deliver interventions timely E Empower pxt/families and Enable them to control outcome
Errors in pain assessment bias, vague ?'s, invalid assessment tools, family estimates not accurate
Describe expression as pain assessment nurse believes pxt will report pain, need to ask watch for change in behavior use words stating, telling, reporting, not complaining
What is the single most reliable factor of the existence and intensity of pain Patient self report
What are classifications of pain Somatic: sharp,aching,throbbing,well localized Ex: osteoarthritis, myofascial pain
What is visceral classification of pain dull, crampy, colicky, poorly localized Ex: mycardial infarction, obstructed bowel
What is teh neuropathic classification of pain? shooting, burning, electric like Ex: trigeminal neuralgia, postherpetic neuropathy
What are concomitant symptoms occur with pain and usually incr in intensity: nausea, headache, dizziness, urge to urinate, constipation, depression restlessness,
Pharmacological pain therapy includes: nonopiod, opioid, adjuvant analgesics, adjuvants:sedatives, steroids, antidepressants. Local anesth, (placebo-unethical), topical, transdermal
Pain of 4 means? 7? 4 or higher is unacceptable, unless short term 7 = medical emerg, immediate action
What is cutaneous stimulation? transcutaneous electrical stimulation TENS stimulate skin, massage, cold/heat applications, through electrodes
Transduction Damaged cells release substances that initiate pain signals sent via afferent nerve endings to spinal cord
Transmission Impulse proceeds to brain
Preception Sensory process through which individual interprets the pain
Modulation Sensation of pain is regulated of changed by neuromodulators
Psychogenic pain No organic structures Mechanism is emotional Little or no physical evidence of organic disease
Algesia Sensitivity to pain
Breakthrough pain Transitory increase in pain to a level greater than the client's well-controlled baseline level
Chronic malignant pain Pain that results from progressive tissue injury such as from cancer; resolves when tissue injury is resolved
Hyperalgesia Excessive sensitivity to pain
Idiopathic pain Chronic pain for which there is no identifiable psychological or physical cause
Intractable pain Pain that is highly resistant to relief, such as an in advanced cancer
Pain threshold: Amount of pain required before individual feels the pain. The lower the threshold, the less pain they can endure; the higher the threshold, the more pain they can endure
Pain tolerance: Maximum amount and duration of pain a person is able to endure. Tolerance varies widely among people and is influenced by emotions and cultural background
Pain syndrome A group of symptoms of which pain is the critical element, such as headaches and post-herpetic neuralgia
Phantom limb pain: Pain that occurs in a limb after it is removed or as a result of severe damage to the affected nerve plexus due to perceptual disruption in the brain
Psychogenic pain Chronic pain with no identified organic explanation
Radiating pain: Pain that begins at its source and extends to nearby tissues
Referred pain: Pain that is felt at a different location than where tissue was damaged
Non-Pharmacologic Pain Management Interventions Cutaneous Stimulation Cognitive-Behavioral Interventions Therapeutic Touch Distraction Prayer Music Therapy Homeopathy
Therapeutic Touch An alternative therapy that involves using ones hands to direct an energy exchange consciously from practitioner to patient to facilitate healing or pain relief
Biofeedback Technique that uses a machine to monitor physiologic responses through electrode sensors Upon seeing painful stimuli the person is taught how to regulate physiologic responses to control pain
Cutaneous Stimulation TENS: Transcutaneous Electrical Nerve Stimulator Battery operated device worn externally. Stimulates A-delta sensory fibers
Cutaneous Stimulation PENS: Percutaneuos Nerve Stimulation Form of acupuncture combines electroacupuncture and TENS Consists of needle probes into soft tissue
Hypnosis Technique that produces a subconscious state accomplished by suggestion made by hypnotist Person’s state of consciousness is altered by suggestion so that pain is not perceived as usual
Pharmacologic Interventions for Pain Management Analgesics Previous exposure to medications Availability Patient disease/Illness Patient’s preferences Renal/liver functions Cost/insurance
The three classes of analgesics are: Non Opioids Adjuvent Opioids
Non-opioid Tx of mild to moderate pain Medications in this classification of analgesics include: (NSAIDs) with analgesic properties: Acetylsalicylic acid (Aspirin) Ibuprofen (Motrin) Analgesic properties only: Acetaminophen (Tylenol) Has no anti-inflamm
Adjuvant Tx for neuropathic pain and enhance effects of non-opioids, help alleviate other symptoms that aggravate pain
Opioids Tx of moderate to severe pain work at the level of the central nervous system decrease the perception of pain onset, peak, duration depend on which medication administered and route used dosage dependent on patient condition and age
Adjuvant drugs Antidepressants: Tricyclics - sleep, enhances mood and analgesic effects Anti-Convulsant drugs: Neuralgic and neuropathic pain (sharp, shooting pain) Antihistamine: Vistaril – pain or nausea
Adjuvant drugs Anxiolytic drugs: Benzodiazepines, buspirone, venlafaxine Anxiety and sedation Lidocaine: Neuralgic pain and diabetic neuropathic pain Steroids: Inflammatory and chronic pain of cancer, malignant cord compression, headaches, and arthritis
Opioid Analgesics Intervention strategies: Used for persistent pain around the clock w/long acting agents breakthrough pain w/short acting agents Titrate dosages to achieve maximum desired level of pain relief Use least invasive ROA first (oral) Anticipate & treat opioid-induced side effects
Three Primary Types of Opioids Full agonist Mixed Agonist-Antagonists Partial Agonists
The gate-control theory suggests that cutaneous stimulation activates larger, faster-transmitting A-beta sensory nerve fibers. This decreases pain transmission through small-diameter A-delta and C fibers.
A common complication of epidural anesthesia is___ hypotension.
Having the client rate his or her pain on a pain scale is a method of measuring the___ intensity of pain
Created by: palmerag