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Explore the nature, types, and physiology of pain, along with assessment, nursing interventions, and principles of pain relief. Learn about analgesics administration, preventive approaches, trust in nurse-client relationships, innovative techniques like biofeedback, and noninvasive and invasive interventions.
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Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 14 PAIN MANAGEMENT
Pain • An unpleasant sensory sensory and emotional experience associated with actual or potential tissue damage. • Whatever the client says it is, existing whenever the client says it does.
Nature of Pain • A major function of pain is to signal ongoing or potential tissue damage. • Pain can also be a protective mechanism against further injury.
Types of Pain • Pain Categorized by Origin. • Pain Characterized by Nature.
Pain Characterized by Origin • Cutaneous Pain (caused by stimulation of the cutaneous nerve endings in the skin). • Somatic Pain (nonlocalized and originates in support structures such as tendons, ligaments, and nerves). • Visceral Pain (discomfort in the internal organs). • Referred Pain (originating from the abdominal organs).
Pain Characterized by Nature • Acute Pain: Sudden onset, relatively short duration; mild to severe intensity; steady decrease in intensity over days to weeks. • Chronic Pain: Long-term (lasting six months or longer), persistent, nearly constant, or recurrent pain that produces significant negative changes in the client’s life.
Physiology of Pain • The body cannot sustain the extreme stress response of pain for more than short periods of time. • The body will conserve its resources by adapting even in the face of continuing pain of the same intensity.
The Gate Control Theory of Pain • Theorizes that person experiences pain with combination of these processes: • Sensory. • Motivational-Affective. • Cognitive.
Conduction of Pain Impulses • Transduction (stimulus triggered). • Transmission (impulse travels to spinal cord). • Perception (neural message converted into subjective experience). • Modulation (pain transmitters selectively inhibited).
Factors Affecting Pain Experience • Age. • Previous Experience with Pain. • Cultural Norms.
Assessment: Subjective Data • Location of pain. • Onset and duration. • Quality. • Intensity (on a scale of 1 to 10). • Aggravating and relieving factors. • How pain affects the activities of daily living.
Assessment: Objective Data • Physiologic (Acute pain involves elevated respiratory rate and blood pressure; pallor; dilated pupils, etc. Chronic pain shows adaption). • Behavioral (Acute pain behaviors include crying, moaning, clenched fists, etc. Chronic pain behaviors include depression, listlessness, loss of libido and weight).
Nursing Diagnoses • Two primary diagnoses used to describe pain are acute and chronic.
General Principles of Pain Relief • Individualize the approach. • Use a preventive approach. • Use a multidisciplinary approach.
Nursing Interventions • Pharmacological. • Noninvasive. • Invasive.
Nurse’s Role in Administering Analgesics • Determine whether or not to give the analgesic. • Assess the client’s response to the analgesic. • Report to the physician when a change is needed. • Teach the client and family regarding the use of analgesics.
Principles of Administering Analgesics • Preventive approach. • Titrate to effect.
Preventive Approach • Pain is much easier to control if treated when it is anticipated or at a mild intensity. • Two methods of preventive approach are ATC (around the clock) and PRN (“as required”).
Titrate to Effect • The analgesic regimen needs to be titrated until the desired effect is achieved. • This involves adjusting the following: • Dosage. • Interval. • Route . • Choice of drug.
Three Classes of Analgesics • Nonopioid. • Opioid. • Analgesic adjuvants.
Trusting Nurse-Client Relationship. Relaxation. Reframing. Distraction. Guided Imagery. Humor. Biofeedback. Cognitive-Behavioral Interventions
Reframing • Teaching clients to monitor their negative thoughts and replace them with ones that are more positive.
Guided Imagery • Using one’s imagination to provide a pleasant substitute for the pain.
Biofeedback • A process through which individuals learn to influence their physiological responses to stimuli.
Cutaneous Stimulation • The technique of stimulating the skin to control pain. • Includes: • Heat and cold application. • Cryotherapy (cold applications) • Acupressure and massage. • Mentholated rubs. • Electrical Nerve Stimulation.
Transcutaneous Electrical Nerve Stimulation • The process of applying a low-voltage electrical current to the skin through cutaneous electrodes.
Other Noninvasive Pain Interventions • Psychotherapy (including hypnosis). • Exercise. • Positioning and Body Alignment.
Invasive Pain Interventions • Used when noninvasive and pharmacological measures do not provide adequate relief. • Include: • Nerve block. • Neurosurgery. • Radiation therapy • Acupuncture.