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Pain Management

Pain Management . NPN 135 Joyce Smith RN, BSN. Pain Control. Define: “Unpleasant sensory and emotional experience associated with actual or potential tissue damage.” Most common problem nurses experience Is subjective

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Pain Management

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  1. Pain Management NPN 135 Joyce Smith RN, BSN

  2. Pain Control • Define: “Unpleasant sensory and emotional experience associated with actual or potential tissue damage.” • Most common problem nurses experience • Is subjective • Is influenced by the client’s values, beliefs, religion, norms, and customs • Nurses responsibility to assess, give RX, teach pain management, and document

  3. Pain Acute pain: sudden onset, temporary, easily localized, decreases as healing takes place Chronic pain: lasts longer than 3-6 months and is associated with nerve or tissue damage Pain threshold: level of intensity that causes the sensation of pain Pain tolerance: amount of pain a person is willing to endure before taking action to relieve pain

  4. Autonomic Nervous System Responses • When pain receptors are stimulated, impulses are transmitted to the spinal cord and then to the brain, where the cortex interprets the signals as pain • According to the gate-control theory, stimulation of large-diameter fibers in the spinal cord interferes with the transmission of pain impulses to the brain

  5. Responses of Autonomic Nervous System • ^ B/P, pulse, and respiratory rate • Dilated pupils • Perspiration • Pallor • Constipation • Urinary retention

  6. Influencing Factors • Age • Older patients may not report • Think it is a part of aging • Physical activity/nervous system • May help relieve pain • May also cause pain • Diabetics have less sensation • Surgery/Anesthesia • Type of drugs used may delay pain] • Nerve blocks and CNS catheters

  7. Psychological Factors • Culture • Some cultures deny pain exists and are calm, and withdrawn • Some scream and moan • Religious beliefs • Prayer • Some see pain as a punishment • Past experiences and anxiety • Development of coping skills • Some are unable to cope • Situational factors • Reason for pain (cancer or childbirth)

  8. Pain Assessment • Vital signs • Report of the patient – where, how much, when (have patient describe) • Use communication skills to evaluate and interview • Is pain old or knew • Use pain scale (1-10) • What do you do to relieve the pain • Document findings

  9. Interventions • Non-pharmacologic • Relaxation • Imagery • Music • Heat • Cold • Massage • Turn from side to side • Get up out of bed • Change bed linens • TENS

  10. Pharmacologic Interventions • Assess for type of med needed • With post-op pain best results come from scheduled RX • If pain unpredictable may need to give prn • PCA pump

  11. Categories of Drugs • Non-opioid • ASA, Tylenol, NSAIDS • Used for arthritic pain, back pain, headache, cancer, post-op, • Oral or rectal • Have side effects • Stomach irritation • Fluid retention • Prolonged bleeding time

  12. Drug Categories • Opioid • Used for severe, acute pain, chronic cancer pain • Codeine, Morphine, Dilauldid, Demerol, Nubain, Stadol, Talwin • Relieves at the CNS • May need ot reduce dosage in older adults and children • Addiction versus tolerance • Side effects • Constipation, nausea, vomiting, sedation, respiratory depression • Routes of administration • IM, IV, rectally, sug-q, PCA pump, epidural, intrtrathecal

  13. Drug Categories • Adjuvant • Non-analgesics can give pain relief • Muscle relaxants • Antidepressants • Benzodiazepines • Corticosteriods

  14. Step therapy • (Figure 14-7)

  15. Nursing Management of Pain (Figure 14-2)

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