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Chapter 55 Client Comfort and Pain Management

Chapter 55 Client Comfort and Pain Management. Pain. The body’s signal of distress Subjective symptom Warning that tissues are being damaged McCaffrey states “Pain is whatever the experiencing person says it is, existing whenever he says it does.”. Causes of Pain.

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Chapter 55 Client Comfort and Pain Management

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  1. Chapter 55Client Comfort and Pain Management

  2. Pain • The body’s signal of distress • Subjective symptom • Warning that tissues are being damaged • McCaffrey states “Pain is whatever the experiencing person says it is, existing whenever he says it does.”

  3. Causes of Pain • Mechanical stress of trauma, surgical incision, or tumor growth • Excesses in pressure, heat and cold • Chemical substances released when tissues are damaged or destroyed • *Lack of oxygen to tissues • Ex. -MI • Muscle spasms

  4. The Pain Cycle

  5. Nociception • Normal pain transmission and interpretation • Four phases • Transduction • Nervous sx changes painful stimuli to impulses • Transmission • Impulses travel from site of pain to brain • Perception • Brain recognizes and responds to pain • Modulation • Body activates inhibitory responses to pain

  6. Types of Pain • The International Association for the Study of Pain (IASP) has identified: • Acute pain or nociceptive pain • Referred pain • Cancer pain • Chronic pain or neuropathic pain • Intractable pain

  7. Chronic Pain (Neuropathic Pain) • Chronic pain (neuropathic pain) • Discomfort that continues for long period—6 months or longer • Sometimes lasts for life • Interferes with normal function of body • Difficult to treat • s/s include constant burning, tingling sensations and/or shooting pain*

  8. Intractable Pain • Intractable pain • Chronic pain that resists therapeutic interventions • Severe, unrelenting pain such as in an inoperable cancerous tumor or even in an uncontrolled tooth infection • May be depressed • s/s-extreme fatigue, inability to sleep or sleeping too much, lack of interest in surroundings, lack of or excessive appetite, guilt feelings, sexual impotence and withdrawal from social activities • Suicidal ideation may occur.

  9. Psychogenic Pain • No physical origin of pain • PHANTOM LIMB PAIN • Results from amputation, client continues to feel pain in the limb that has been amputated

  10. Results of the Chronic Pain Experience • Loss of control • Decreased self-esteem and communication • Inappropriate life goals • Change in relationships, lack of sexual activity, role changes within family • Anger of family and friends over need to do client’s work or “take care of ” client • Decreased activity • Decreased endurance

  11. Factors Affecting Pain Perception • Pain threshold • Lowest intensity of a stimulus that causes the subject to recognize pain • Pain tolerance • The point at which a person can no longer endure pain • Endorphins • Naturally occurring substances produced by the central nervous system to relieve pain *Belief is that intake of certain chemicals and foods, including caffeine, nicotine, alcohol, salt and sugar decrease endorphin production.

  12. Collection of Client Data About Pain • Pain • The fifth vital sign • Patients have the right to appropriate assessment and management of pain • On-going pain assessment should include the nature and intensity of pain • Responses to evaluation of pain should be recorded in a manner that promotes regular reassessment and follow-up • Staff must be oriented and competent in assessment and management of pain

  13. Key Concept • The documentation of pain includes: • Level of pain • Description of pain • Action taken • Results

  14. Pain Rating Scales • Pain Intensity Scale or Pain Distress Scale • The client rates pain by choosing descriptive words, by choosing the appropriate number on a numberical scale from 0-10 • McGill-Melzack Pain Questionnaire • Comprehensive way to obtain info about a clients pain (numerical)* • Wong-Baker Faces Pain Scale • Developed for verbal children ages 3-7, may also be used for adults who have difficulty expressing themselves or people who do not speak the prevailing language in the facility • FLACC • NIPS

  15. Description of Pain • Character • Location/onset • Aching, burning, crushing • Duration • Occasional, intermittent, spasmodic, or constant • Severity • Mild, slight, moderate, severe, or excruciating • Associated factors • What makes it better/worse • Withdrawal, tearful, regression

  16. FLACC SCALE  CATEGORIES SCORING 0 1 2 FACE No particular expression or smile Occasional grimace or frown, withdrawn, disinterested. Frequent to constant quivering chin, clenched jaw. LEGS Normal position or relaxed. Uneasy, restless, tense. *Kicking, or legs drawn up. ACTIVITY Lying quietly, normal position moves easily. Squirming, shifting back and forth, tense. Arched, rigid or jerking. CRY No cry, (awake or asleep) Moans or whimpers; occasional complaint Crying steadily, screams or sobs, frequent complaints. CONSOLABILITY Content, relaxed. Reassured by occasional touching hugging or being talked to, distractable. Difficulty to console or comfort

  17. Teaching Client to Manage Chronic Pain • Medications • Exercise • Nutrition • Recreation • Relaxation • Support • Hobbies • Rest/sleep

  18. Data Gathering • Character • Onset • Location • Duration • Severity • Pattern • Associated factors or related occurrences

  19. Pharmacologic Therapy • Analgesics provide pain relief by slowing or altering the body’s sodium and potassium levels, halting pain transmission. • PCA* • Nonopioid nonsteroidal anti-inflammatory drugs (NSAIDs)* • Mild to moderate pain • Opioids/narcotic analgesics • Morphine • Used to manage pain in clients with moderate to severe pain* • Adjuvant drugs • Anticonvulsants and antidepressants • Ointments and liniments

  20. Surgical Intervention • Surgery may be necessary to alleviate certain types of chronic pain. • Herniated disk • Tumors causing pressure • Pinched nerves • Ablation surgery

  21. Nursing Interventions • Comfort measures • Clean bed, clean face and hands, warm room • *positional changes • Massage/backrub* • Encourage nutritious diet and adequate fluids. • Assist with elimination. • Monitor voiding and bowel patterns. • Offer ordered medications to prevent constipation and diarrhea.

  22. Nursing Interventions (cont’d) • Physical measures • Physical stimulus (cutaneous stimulation) TENS unit • Heat and cold application • Exercise • Cognitive–behavioral measures • *Distraction and diversion • *Music • *Deep relaxation and guided imagery • Support groups and stress management • Suggest gradual participation in group activities*

  23. Alternative Techniques • Chiropractic care • Acupuncture or acupressure • Hypnosis • Biofeedback • Homeopathy • Use of flower essences and aromatic oils • Herbal remedies

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