1. Pain
Chapter 46

2. Identifying Types of Pain
Location
Referred
Visceral
Duration
acute pain
chronic pain
Intensity – mild/moderate/severe

4. Etiology Nociceptive pain Neuropathic pain Phantom pain Visceral
Somatic
Neuropathic pain
Phantom pain

5. Concepts Associated with Pain
Pain threshold
Pain tolerance

6. Physiology of Pain
Nociceptors
Mechanical
Thermal
Chemical

7. Gate-Control Theory

8. Responses to Pain Psychological and psychosocial effects
Fight or flight triggered
Unrelieved pain negatively impacts health
“Windup phenomenon”

9. Factors Affecting Pain Experience
Ethnic and cultural values
Developmental stage
Environment and support people
Past pain experiences
Meaning of pain

10. Assessing Fifth vital sign Pain history
Self report
Pain history
Why might clients not accurately report pain?

11. Assessing Direct observation Pain diary Nonverbal
Physiological responses
Pain diary

14. Figure 46- 6 An 11 point pain intensity scale with word modifiers

15. Neonatal Infant Pain Scale (NIPS)

16. Nursing Diagnoses Acute Pain and Chronic Pain Specify the location
Related factors, when known, can include physiologic and psychologic factors

17. Nursing Process
Acute abdominal pain R/T surgical incision AEB verbalization of pain level = 8 (on 0-10 pain scale), BP 185/102, HR 103.
Verbalize pain level of less than or equal to 4 (on a 0-10 pain scale) thirty minutes after each pain intervention.
By post-op day 2, will require only oral analgesics.

18. Nursing Process
Chronic joint pain R/T joint inflammation AEB report of chronic pain and the inhibits ability to perform activities of daily living (dressing self).
Report that chronic pain does not prevent her from performing activities of daily living throughout lifespan.
Verbalizes ability to cope with chronic pain throughout lifespan.

19. Opioids
Addiction
Physical Dependence
Tolerance

20. Implementing: Strategies for Pain Management
Acknowledge and accept pain
Assist support persons
Reduce misconceptions about pain
Reduce fear and anxiety
Prevent pain (preemptive analgesia)

21. Implementing: Pharmacological Measures
Nonopioids
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Opioids
Coanalgesics

22. Nonopioids NSAIDs Acetaminophen (Tylenol) Aspirin Ibuprofen
Unique characteristic
Ibuprofen
Acetaminophen (Tylenol)

23. Opioids Strong opioids have no ceiling effect May build up tolerance
Often combined with a nonopioid

24. Opioid Side Effects Respiratory depression Sedation Constipation
Nausea & vomiting (N/V)
Pruritus (itching)

25. Patient Scenario
Mr. Buck scenario

26. Coanalgesics Not classified as pain medication
Help to manage pain alone or in combination with other analgesics
May increase effect of pain medication

27. Routes for Opiate Delivery
Oral
Transnasal
Transdermal
Transmucosal
Rectal
Topical

28. Routes for Opiate Delivery
Subcutaneous
Intramuscular
Intravenous
Intraspinal
PCA

29. Implementing: Nonpharmacologic Pain Control
Consists of variety of pain management strategies
Physical
Cognitive-behavioral
Lifestyle pain management
Targets body, mind, spirit, and social interactions

30. Implementing: Nonpharmacologic Pain Control
Massage
Hot/cold applications
Acupressure
Contralateral stimulation
Transcutaneous electrical nerve stimulation
Immobilization/Bracing

31. Implementing: Nonpharmacologic Pain Control
Cognitive behavior interventions
Distraction
Relaxation interventions (also discussed in Stress)
Therapeutic relationship
Spiritual interventions

32. Group Work
Break into groups of two and discuss the following questions.
What has been your experience with using non-pharamacological pain relief measures to manage your own pain?
How would you incorporate these methods into your nursing practice?

33. Documentation Expected outcome Present pain level Intervention
Adverse reaction
Evaluation
Changes in plan (if needed)

34. QUESTIONS????