Special Needs of the Patient. Pain

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Meeting the Special Needs of the Patient. Pain Management

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Special Needs of the Patient. Pain

  1. 1.  Pain is a unpleasant sensation. Nurse can neither feel nor see a client‟spain. Effective pain management is an importantaspect of nursing care. Pain presents both physiologic andpsychological dangers to health andrecovery. Severe pain is viewed as an emergencysituation.
  2. 2. "An unpleasant sensory andemotional experienceassociated with actual orpotential tissue damage, ordescribed in terms of suchdamage. {IASP}
  3. 3.  Pain is universal, subjective, and it isone of the body‟s defensemechanisms. Unrelieved pain possess bothphysiologic and psycho logic dangersto health and recovery.
  4. 4.  Pain may be described in terms of duration,location and etiology, Acute pain / Chronic pain Cutaneous pain / Deep Somatic Pain/ VisceralPain. Radiating Pain / Referred Pain Intractable pain Neuropathic pain / Phantom pain
  5. 5.  Acute Pain – When pain lasts onlythrough the expected recovery period..Whether it has sudden or slow onset andregardless of the intensity. Chronic Pain – Is Prolonged, usuallyrecurring or persisting over 6 months orlonger, and interferes with functioning.Chronic PainChronic Malignant Pain / Chronic Non – Malignant Pain
  6. 6. Cutaneous Pain- Originates in theskin or subcutaneous tissue. Eg.Paper cutDeep Somatic Pain – Arises fromligaments, tendons, bones, bloodvessels, and nerves. Eg. Ankle sprainVisceral Pain – Results fromstimulation of pain receptors in theabdominal cavity, cranium andthorax. Eg. Ischemia or MuscleSpasm.
  7. 7. Radiating Pain – is perceived asthe source of the pain andextends to nearby tissues. Eg.Cardiac PainRefered Pain – is felt in a part ofthe body that is considerablyremoved from the tissues causingthe pain.Intractable Pain – is a pain that ishighly resistant relief.
  8. 8. Neuropathic Pain – Is the result ofcurrent or past damage to theperipheral or central nervoussystem and may not have astimulus such as tissue or nervedamage, for the pain.Phantom Pain – Which is a painfulsensation perceived in a body partthat is missing.
  9. 9.  3 Components of pain are Reception,Perception and Reaction.Cellular Damage (due to stimuli)•Release of pain producing substancesPain producing substances combines with receptor sites onNociceptors to initiate neural transmission associated with a pain
  10. 10. Nerve impulse travel through afferent nerve• Nerve impulse travel from periphery to the dorsal horns of thespinal cordExcitatory neurotransmitter substance P is released• Pain stimulus travel through spinothalamic tract, cross toopposite side of the spinal cord and travels upto spinal cordFrom spinal cord impulse is quickly send to highercenters in the brain.
  11. 11. A Protective reflexresponse with painreception.
  12. 12. Perception is the point at which aperson is aware of pain.ReactionThe reaction to pain is the physiological andbehavioral responses that occur after pain isperceived, eg. Crying or moving away fromthe painful stimulus.
  13. 13.  Mc Lazack and Wall’s Gate ControlTheory (1965).
  14. 14.  Pain - an unpleasant sensory and emotionalexperience associated with actual or potentialtissue damage. Analgesia - the selective suppression of painwithout effects on consciousness or othersensations. Nociceptors - sensory receptor whosestimulation causes pain Pain threshold: the point at which a stimulus isperceived as painful. Phantom limb pain – feelings of pain in a limbthat is no longer there and has no functioningnerves. Sensation – the process of receiving,converting, and transmitting information fromthe external and internal world to the brain.
  15. 15.  The three systems located in the spinalcord act to influence perception of pain, viz;1. The substantia gelatinosa inthe dorsal horn,2. The dorsal column fibers, and3. The central transmission cells.
  16. 16.  The noxious impulses are influenced by a“gating mechanism. ” Stimulation of the large-diameter fibersinhibits the transmission of pain, thus“closing the gate.” Whereas, when smaller fibers are stimulated,the gate is opened. When the gate is closed signals from smalldiameter pain fibres do not excite the dorsalhorn transmission neurons. When the gate is open pain signals excitedorsal horn transmission cells. The gating mechanism is influenced by nerveimpulses that descend from the brain.
  17. 17.  Gate is opened by› Physical Factors - Bodily injury› Emotional Factors - Anxiety & Depression› Behavioural Factors - Attending to the injury andconcentrating on the pain Gate may be closed by:› Physical Pain - Analgesic Remedies› Emotional Pain - Being in a „good‟ mood› Behavioural Factors - Concentrating on thingsother than the injury
  18. 18.  Pain assessment is very essential sincepain is considered as a Fifth Vital Sign. Nurses needs to assess all factorsaffecting the pain experience. Pain assessment varies according to theclient situation. Pain assessment consists of two maincomponents.
  19. 19. Pain History & Direct observation ofphysiologic and Behavioral response ofthe client are the two components ofpain assessments.Pain HistoryClient must explain the pain in her ownwords.
  20. 20. OLDCARTO – OnsetL – LocationD – DurationC – CharacteristicsA – Aggravating FactorR – RadiationT - Treatment
  21. 21.  Acute Pain related to physical injury,reduction of blood supply, process of givingbirth Chronic Pain related to the malignancy Anxiety related to pain that is felt Ineffective individual copingrelated to chronic pain Impaired physical mobility related tomusculoskeletal pain Risk for injuryrelated to lack of perception of pain
  22. 22. Increase knowledge Explain the causes of pain to the individual, ifknown. Linking how long the pain will last, if known. Explain diagnostic tests and procedures indetail with a connecting discomfort andsensation will be felt, and the estimatedduration of pain occur.
  23. 23.  Provide accurate information to reducefear. Connect your acceptance ofindividual response to pain.› Recognizing the existence of pain.› Listen with full attention on the pain.› Shows that the pain you are because youwant to understand better (not todetermine if the pain is really there).
  24. 24.  Provide opportunities for individuals to restduring the day and time of uninterruptedsleep at night. Talk with individuals and families usedistraction therapy, along with othermethods to reduce pain. Teach methods of distraction for acutepain, with regular breathing. Teachnoninvasive pain reduction
  25. 25. Give the individual the opportunityto talk about fear, anger, andfrustration in place, difficultyunderstanding the situation.Give encouragement ofindividuals to talk about the painexperience.
  26. 26.  Use of Opioids {Narcotics}, Non-opioids /Non-steroidal anti-inflamatory drugs(NSAIDS) Opioids – e.g., Morphine Sulfate Non –Opioids – e.g., Diclofenac Sodium Adjuvants – e.g., Diazepam
  27. 27.  Physical Interventions – Massage,Application of heat and Cold,Accupressure etc. Immobilization Transcutaneous Electrical NerveStimulation (TENS) Distraction -

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