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Comfort Ch 41
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Pain Considered the 5th Vital Sign Is what the patient says it is
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Pain Basics Source Area to which it is referred Duration
Nociceptive – sensory Neuropathic – from nerves Psychogenic – mental Area to which it is referred Duration Acute Chronic
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Sources of Pain Nociceptive Cutaneous Somatic Visceral Neuropathic
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Types of Pain Physical cause — cause of pain can be identified
Psychogenic — cause of pain cannot be identified Referred — pain is perceived in an area distant from its point of origin
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Duration of Pain Acute Chronic
Rapid in onset, varies in intensity and duration Protective in nature Chronic May be limited, intermittent, or persistent Lasts for 6 months or longer Periods of remission or exacerbation are common
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Pain Process Transduction — activation of pain receptors
Transmission — conduction along pathways (A-delta and C-delta fibers) Modulation — initiation of the protective reflex response Perception of pain — awareness of the characteristics of pain
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Chemicals of Pain Bradykinin Prostaglandins – send stimuli to CNS
Powerful vasodilator Constricts smooth muscle Involved in pain awareness Prostaglandins – send stimuli to CNS Substance P Sensitizes nerve receptors Increases rate of firing
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Gate Control Theory Relationship between pain and emotions
Small and large diameter nerve fibers conduct and inhibit pain stimuli Gating mechanisms determine impulses that reach the brain
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Pain Perceptions Pain threshold – lowest intensity at which pain is perceived Adaptation Modulation of pain – regulation or modified by: Neuromodulators- natural, resemble morphine Endorphins – pain blockers, prolonged effect Dynorphins – most potent Enkephalins – less potent, inhibit release of sub.P
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Pain Responses Physiologic – automatic (involuntary) responses
Behavioral – change in behavior Affective – emotional response Box 41-1, p 1203
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Factors in Pain Culture Ethnic variables
Family, gender, and age variables Religious beliefs Environment and support people Anxiety and other stressors Past pain experience
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Assessing Pain Psychological Emotional Sociologic Physiologic
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Assessing Pain, cont’d Patient’s verbalization and description of pain
Duration of pain Location of pain Quantity and intensity of pain Quality of pain Chronology of pain
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Assessing Pain, cont’d Patient’s verbalization and description of pain
Duration of pain Location of pain Quantity and intensity of pain Quality of pain Chronology of pain
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More Assessing Aggravating and alleviating factors
Physiologic indicators of pain Behavioral responses Effect of pain on activities and lifestyle
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Assessment Tools McGill-Melzack pain questionnaire Pain scale
Faces McCaggery method WILDA pain measurement scale
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WILDA Scale Words that describe the pain Intensity of pain
Location of pain Duration of pain Aggravating or alleviating factors
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Diagnosing Pain Type of pain Etiologic factors
Behavioral, physiological, affective response Other factors affecting pain process
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Nursing Interventions
Establishing trusting nurse-patient relationship Initiating non-pharmacologic pain relief measures Considering ethical and legal responsibility to relieve pain Teaching patient about pain
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Nursing Plan Remove or alter cause of pain
Alter factors affecting pain tolerance Initiate non-pharmacologic relief measures
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Non-Drug Comfort Measures
Distraction Humor Music Imagery Relaxation Cutaneous stimulation Acupuncture Hypnosis Biofeedback Therapeutic touch
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Drug-Related Treatments
Analgesic administration Non-opioid analgesics Opioids or narcotic analgesics Adjuvant drugs
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Administering Analgesics
Patient controlled analgesia Epidural analgesia Local anesthesia
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Sedation Scale 1 — awake and alert, no action necessary
2 — occasionally drowsy, but easy to arouse, no action necessary 3 — frequently drowsy, drifts off to sleep during conversation, reduce dosage 4 — somnolent with minimal or no response to stimuli, discontinue opiod, consider use of naloxone (Narcan)
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Managing Chronic Pain Give medications orally if possible.
Administer medications ATC (around-the-clock) rather than prn. Adjust the dose to achieve maximum benefit with minimum side effects. Allow patients as much control as possible over the regimen.
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