Chapter 41 Comfort

1. Chapter 41 Comfort

2. Categories of Pain • Source • Nociceptive • Neuropathic • Psychogenic • Area to which it is referred • Duration • Acute • Chronic

3. Sources of Pain • Nociceptive • Cutaneous • Somatic • Visceral • Neuropathic

4. Origin of Pain • Physical—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

5. The 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

6. Stimulator of Nociceptors or Pain Receptors • Bradykinin • Prostaglandins • Substance P

7. Gate Control Theory of Pain • Relationship between pain and emotions • Small and large diameter nerve fibers conduct and inhibit pain stimuli • Gating mechanism determine impulses that reach the brain

8. Perception of Pain • Pain threshold • Adaptation • Modulation of pain • Neuromodulators • Endorphins, dynorphins, enkephalins

9. Pain Sensation and Relief

10. Common Responses to Pain • Physiologic • Behavioral • Affective

11. Duration of Pain • Acute • 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

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

13. Assessment Parameters for Pain • Psychological • Emotional • Sociologic • Physiologic

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

15. General Assessments of Pain (cont.) • Aggravating and alleviating factors • Physiologic indicators of pain • Behavioral responses • Effect of pain on activities and lifestyle

16. Pain Assessment Tools • McGill-Melzack pain questionnaire • Pain scale • McCaggery method • WILDA pain measurement scale

17. WILDA Scale • Words that describe the pain • Intensity of pain • Location of pain • Duration of pain • Aggravating or alleviating factors

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

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

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

21. Nonpharmacologic Pain Relief Measures • Distraction • Humor • Music • Imagery • Relaxation • Cutaneous stimulation • Acupuncture

22. Nonpharmacologic Pain Relief Measures (cont.) • Hypnosis • Biofeedback • Therapeutic touch

23. Pharmacologic Pain Relief Measures • Analgesic administration • Nonopiod analgesics • Opioids or narcotic analgesics • Adjuvant drugs

24. The WHO 3-Step Analgesic Ladder

25. Numeric 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 opioid, consider use of naloxone

26. Pain Management Regimens for Cancer or Chronic Pain • Give medications orally if possible • Administer medications ATC rather than prn • Adjust the dose to achieve maximum benefit with minimum side effects • Allow patients as much control as possible over the regimen

27. Additional Methods for Administering Analgesics • Patient-controlled analgesia • Epidural analgesia • Local anesthesia

28. Placement of an Epidural Catheter

29. Question A patient who has bone cancer is most likely experiencing which of the following types of pain? A. Cutaneous B. Somatic C. Visceral D. Referred

30. Answer Answer: B. Somatic Rationale: Deep somatic pain is diffuse or scattered and originates in tendons, ligaments, bones, blood vessels and nerves. Cutaneous pain usually involves the skin or subcutaneous tissue. Visceral pain is poorly localized and originates in body organs. Referred pain is pain that originates in one part of the body and is perceived in an area distant to that part.

31. Question Tell whether the following statement is true or false. The best judge of the existence and severity of a patient’s pain is the physician or nurse caring for the patient. A. True B. False

32. Answer Answer: B. False The best judge of the existence and severity of a patient’s pain is the patient.

33. Question Which of the following modulators of pain is thought to reduce pain sensation by inhibiting the release of substance P from the terminals of afferent neurons? A. Endorphins B. Dynorphins C. Enkephalins D. Nociceptors

34. Answer Answer: C. Enkephalins Rationale: Enkephalins are thought to reduce pain by inhibiting the release of substance P from the terminals of afferent neurons. Endorphins and dynorphins are released when certain measures are used to relieve pain. Nociceptors are the peripheral nerve fibers that transmit pain.

35. Question Which of the following pain assessment tools is recommended for use with children? A. McGill-Melzack pain questionnaire B. McCaggery method C. WILDA pain measurement scale D. Wong-Baker FACES

36. Answer Answer: D. Wong-Baker FACES Rationale: The Wong-Baker FACES pain rating scale asks children to compare their pain to a series of faces ranging from a broad smile to a tearful grimace. This scale is visual and easy to interpret for young children and older adults.

37. Question A sedated patient is frequently drowsy and drifts off during his conversation with the nurse. What number on the sedation scale best describes this patient? A. 1 B. 2 C. 3 D. 4

38. Answer Answer: D. 3 Rationale: 3 denotes that the patient is frequently drowsy and hard to awake. 1 means the patient is awake and alert. 2 denotes the patient is occasionally drowsy, but easy to arouse. At 4 the patient is somnolent with minimal or no response to stimuli.