1. Concepts Related to the Care of Individuals PAIN Concepts of Nursing NUR 123

2. Pain Is a highly unpleasant and very personal sensation that cant be shared with other. Is a highly unpleasant and very personal sensation that cant be shared with other. It is considered the fifth vital sign. It is considered the fifth vital sign. It is one of the human body defence mechanisms that indicates the person is experiencing problem. It is one of the human body defence mechanisms that indicates the person is experiencing problem.

3. Sources of Pain Nociceptive: pain that is usually transmitted after normal processing of noxious stimuli Nociceptive: pain that is usually transmitted after normal processing of noxious stimuli Neuropathic: results from injury or abnormal functioning of peripheral nerves or CNS Neuropathic: results from injury or abnormal functioning of peripheral nerves or CNS Psychogenic: unknown physical cause Psychogenic: unknown physical cause

4. PHYSIOLOGY OF PAIN SOURCES Chemical/Thermal Injury, InflammationHeat, Cold PAIN RECEPTORS (Nociceptors) DISCHARGE IMPULSES Electrical Activity to spinal cord and onto the Brain BRAIN = Electrical activity becomes the experience of PAIN

5. Duration of pain Acute pain: generally rapid in onset, varies in intensity from mild to severe, lasts from brief period to less than 6 months Acute pain: generally rapid in onset, varies in intensity from mild to severe, lasts from brief period to less than 6 months

6. Duration of pain Chronic pain: may be limited, intermittent or persistent but lasts for 6 months or longer and interferes with normal functioning. Chronic pain: may be limited, intermittent or persistent but lasts for 6 months or longer and interferes with normal functioning. Remission: when the pain present but the patient does experience symptoms Remission: when the pain present but the patient does experience symptoms Exacerbation: reappearance of symptoms Exacerbation: reappearance of symptoms Intractable pain: resistant pain to therapy, and persists despite a variety of interventions Intractable pain: resistant pain to therapy, and persists despite a variety of interventions

7. Origin of Pain Physical cause — cause of pain can be identified Physical cause — cause of pain can be identified Psychogenic — cause of pain cannot be identified Psychogenic — cause of pain cannot be identified Referred — pain is perceived in an area distant from its point of origin Referred — pain is perceived in an area distant from its point of origin

9. Pain threshold Is the lowest intensity of stimulus that causes the subject to recognize pain Is the lowest intensity of stimulus that causes the subject to recognize pain

10. Common Responses to Pain Physiologic: ↑BP, ↑HR,↑RR, pupil dilation, muscle tension and tension rigidity, pallor, ↑adrenaline level, ↑blood glucose Physiologic: ↑BP, ↑HR,↑RR, pupil dilation, muscle tension and tension rigidity, pallor, ↑adrenaline level, ↑blood glucose Behavioral: grimacing, moaning, crying, restlessness Behavioral: grimacing, moaning, crying, restlessness

11. Common Responses to Pain Affective: exaggerated weeping, withdrawal, anxiety, depression, fear, anger, anorexia, fatigue, hopelessness, powerlessness. Affective: exaggerated weeping, withdrawal, anxiety, depression, fear, anger, anorexia, fatigue, hopelessness, powerlessness.

12. Factors Affecting Pain Experience Culture Culture Ethnic variables Ethnic variables Family, gender, and age variables Family, gender, and age variables Religious beliefs Religious beliefs Environment and support people Environment and support people Anxiety and other stressors Anxiety and other stressors Past pain experience Past pain experience

13. General Assessments of Pain Patient’s verbalization and description of pain Patient’s verbalization and description of pain Duration of pain Duration of pain Location of pain Location of pain Quantity and intensity of pain Quantity and intensity of pain Quality of pain Quality of pain

14. General Assessments of Pain Chronology of pain Chronology of pain Aggravating and alleviating factors Aggravating and alleviating factors Behavioral responses Behavioral responses Effect of pain on activities and lifestyle Effect of pain on activities and lifestyle

15. Pain Assessment Tools

17. Pain assessment tools WILDA Scale Words that describe the pain Words that describe the pain Intensity of pain Intensity of pain Location of pain Location of pain Duration of pain Duration of pain Aggravating or Alleviating factors Aggravating or Alleviating factors

18. Diagnosing Pain Type of pain Type of pain Etiologic factors Etiologic factors Behavioral, physiological, affective response Behavioral, physiological, affective response Other factors affecting pain process Other factors affecting pain process

19. Diagnosing Nursing Diagnosing NANDA includes the following diagnostic labels for clients experiencing pain or discomfort: Acute pain Chronic pain When writing the diagnostic statement, the nurse should specify the location (e.g, left frontal headache)

20. Diagnosing Nursing Diagnosing Pain may be the etiology of other nursing diagnosis. e.g: -Disturbed sleep pattern related to increased pain perception at night

21. Nursing Interventions for Pain Establishing trusting nurse-patient relationship Establishing trusting nurse-patient relationship Initiating nonpharmacologic pain relief measures Initiating nonpharmacologic pain relief measures Considering ethical and legal responsibility to relieve pain Considering ethical and legal responsibility to relieve pain Teaching patient about pain and home care Teaching patient about pain and home care

22. Manipulating Pain Experience Factors Remove or alter cause of pain Remove or alter cause of pain Alter factors affecting pain tolerance Alter factors affecting pain tolerance Initiate nonpharmacologic relief measures Initiate nonpharmacologic relief measures

23. Nonpharmacologic Pain Relief Measures Distraction Distraction Humor Humor Music Music Imagery Imagery Relaxation Relaxation Acupuncture Acupuncture Hypnosis Hypnosis Therapeutic touch Therapeutic touch

24. Distraction

25. Imagery

26. Relaxation

27. Acupuncture

28. Hypnosis

29. Therapeutic touch

30. Pharmacologic Pain Relief Measures Analgesic administration Analgesic administration Nonopiod analgesics e.g. NSAIDs Nonopiod analgesics e.g. NSAIDs Opioids or narcotic analgesics Opioids or narcotic analgesics Adjuvant drugs e.g. anticonvulsants, antidepressants,.. Adjuvant drugs e.g. anticonvulsants, antidepressants,..

31. Why clients may be reluctant to report pain: Fear of injectable route of analgesic administration Fear of injectable route of analgesic administration Belief that pain is to be expected as apart of the recovery process Belief that pain is to be expected as apart of the recovery process Belief that pain is a normal part of aging Belief that pain is a normal part of aging Belief that expression of pain reveal weakness Belief that expression of pain reveal weakness Concerns about side effects and risks especially of opioid drugs Concerns about side effects and risks especially of opioid drugs

32. Additional Methods for Administering Analgesics Patient controlled analgesia Patient controlled analgesia Epidural analgesia Epidural analgesia Local anesthesia Local anesthesia

33. Patient controlled analgesia

34. Epidural analgesia

35. Local anesthesia