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Chapter 43 Pain Management

Chapter 43 Pain Management. Nature of Pain. Involves physical, emotional, and cognitive components Physical and/or mental stimulus Is exhausting and demands energy Interferes with relationships. Physiology of Pain. Types of Pain. Nursing Knowledge Base. Attitude of health care providers

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Chapter 43 Pain Management

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  1. Chapter 43Pain Management

  2. Nature of Pain • Involves physical, emotional, and cognitive components • Physical and/or mental stimulus • Is exhausting and demands energy • Interferes with relationships

  3. Physiology of Pain

  4. Types of Pain

  5. Nursing Knowledge Base • Attitude of health care providers • Malingerer or complainer • Assumptions about clients in pain • Biases based on culture, education, experiences

  6. Factors Influencing Pain • Physiological • Age, fatigue, genes, neurological function • Social • Attention, previous experiences, family and support groups • Spiritual

  7. Factors Influencing Pain (cont.) • Psychological • Anxiety, coping style • Cultural • Meaning of pain, ethnicity

  8. Nursing Process and Pain • Pain management needs to be systematic. • Pain management needs to include the client’s quality of life. • Clinical guidelines are available to manage pain. • American Pain Society • National Guideline Clearing House

  9. Assessment • Client’s expression of pain • Characteristics of pain • Onset and duration • Intensity • Pattern • Contributing symptoms • Behavioral effect

  10. Assessment (cont.) • Location • Quality • Relief measures • Effect of pain • Influence on ADLs

  11. Diagnosis and Planning • Focuses on the specific nature of pain • Mandates a thorough assessment • Selected from NANDA-I–approved list • Interventions selected after client goals and outcomes are identified

  12. Implementation • Nonpharmacological interventions • Relaxation and guided imagery • Distraction • Music • Cutaneous stimulation • Massage, TENS, heat, cold, acupressure • Herbals

  13. Pharmacological Pain Relief • Analgesics • Nonopioids • Opioids • Adjuvants/coanalgesics • PCA • Local/regional anesthesia • Topical agents

  14. Chronic Noncancer and Cancer Pain Management • Cancer pain either chronic or acute • Breakthrough pain • Transdermal and transmucosal fentanyl

  15. Barriers to Effective Pain Management • The client, health care provider, and health care system • Physical dependence, addiction, and drug tolerance • Placebos

  16. Pain Clinics, Palliative Care, and Hospice • Pain centers treat clients on an inpatient or outpatient basis. • The goal of palliative care is to learn how to live life fully . • Hospices are programs for end-of-life care.

  17. Evaluation • Evaluation of pain is considered a major responsibility of nurses. • The client’s response to pain may not be obvious. • Evaluating the appropriateness of pain medication will require nurses to evaluate clients 15 to 30 minutes after administration.

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