Presentation on pain and insomnia
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Presentation on pain and insomnia Presentation Transcript

  • 1. SONY GEORGE
  • 2.  PAIN IS DEFINED AS AN UNPLEASANT , SUBJECTIVE, SENSORY AND EMOTIONAL EXPERIENCE ASSOCIATED WITH ACTUAL OR POTENTIAL TISSUE DAMAGE , OR DESCRIBED IN TERMS OF SUCH DAMAGE
  • 3. PHYSIOLOGY OF PAIN
  • 4.  Pain stimuli(Mechanical,chemical,thermal)  Triggers nociceptors and generate impulse Afferent peripheral nerve fibers to dorsal horn of s.c Peripheral nerve to spinothalamic tract and to spinal cord From spinal cord to higher centers of brain
  • 5. Perception is the point at which a person is aware of pain,and it occurs when pain stimuli reaches the brain.
  • 6. REACTION
  • 7. MALZACK AND WALL Suggested that pain impulse can be regulated or even blocked by gating mechanism which occurs in s.c,thalamus and limbic system Closing the gate is the basis of pain relief
  • 8. ACUTE PAIN DURATION CHRONIC PAIN CANCER RELATED
  • 9. ACUTE PAIN  Sudden onset,commonly associated with specific injury  Usually relieved when healing occurs  Usually last for seconds up to 3 months  Characterised by increased heart rate,bp,respiration,anxiety,aggitaion and diaphorasis  Goal of treatment is pain control  Eg… Post surgical pain,labour pain
  • 10. CHRONIC PAIN  Persistant pain  May have a poorly defined onset  It varies in intensity,often difficult to treat because the cause or origin may be unclear  Usually lasts for more than 3 monts  Characterised by decreased physical mobility,fatigue,withdrawal from others..  Reduction of pain will be the goal of treatment  Eg…..low back pain,rheumatoid arthritis
  • 11. CANCER RELATED  Also called as malignant pain  It is considered to have qualities of both acute and chronic pain
  • 12. NOCICEPTIVE PAIN PATHOLOGY NEUROPATHIC PAIN PSYCHOGENIC PAIN
  • 13. Nociceptive pain is caused by stimulation of peripheral nerve fibers that responds to pain CUTANEOUS PAIN Injury to skin and subcutaenious tissue Sharp,stinging,burning quality SOMATIC PAIN Arises from bone,muscle,joints etc Aching and throbbing type pain VISCERAL PAIN Arises from deep visceral organs Intermitting and cramping pain,diffused..
  • 14. Caused by damage to peripheral nerve or cns Common cause – Severe trauma or inflamation of nerves Pain characterised by numbnss,burning,stabbing,electric shock . Also called as somatoform pain
  • 15. FACTORS AFFECTING PAIN AGE GENDER CULTURE ATTENTION ANXIETY FATIGUE PREVIOUS EXPERIENCE COPING STYLE FAMILY AND SOCIAL SUPPORT
  • 16. PHYSIOLOGICAL REACTIONS TO PAIN SYMPATHETIC STIMULATION PARASYMPATHETIC STIMULATION
  • 17. SYMPATHETIC STIMULATION  Dialation of bronchial tubes ,increased respiratory rate  Increased heart rate  Peripheral vasoconstriction  Increased blood glucose level  Diaphoresis  Increased muscle tension  Dialatation of pupils  Decreased gastrointestinal motility
  • 18. PARASYMPATHETIC STIMULATION  Pallor  Decreased muscle tension  Decreased heart rate and BP  Rapid irregular breathing  Nausia and vomiting  Weaknes and exhaution
  • 19. ASSESSMENT OF PAIN  HISTORY COLLECTION 1) CHARACTERISTICS OF PAIN a)onset b)duration c)location d)quality of pain e)pain pattern f)relief measure g)pain expectancy g)severity of pain
  • 20. ASSESSMENT OF PAIN SEVERITY  PAIN RATING SCALES VERBAL DESCRIPTIVE P.S NEUMERICAL RATING SCALE VISUAL ANALOG PAIN SCALE FACES PAIN RATING SCALE
  • 21. VERBAL DESCRIPTIVE P.S
  • 22. NEUMERICAL RATING SCALE
  • 23. VISUAL ANALOG PAIN SCALE
  • 24. FACES PAIN RATING SCALE
  • 25. ASSESSMENT…… a)SYMPATHETIC RESPONSE b)PARASYMPATHETIC RESPONSE c)BEHAVIORAL CHARACTERISTICS
  • 26. MANAGEMENT OF PAIN a)PHARMACOLOGICAL MGMNT b)INTERVENTIONAL THERAPY c)NON PHARMACOLOGICAL MGMT
  • 27. PHARNACOLOGICAL MGNT…
  • 28.  ANESTHETIC AGENTS * General anesthesia * local anesthesia * Topical anesthesia * Regional anesthesia
  • 29. PHARMACOLOGICAL MGNT
  • 30. PHARMACOLOGICAL MGMT… 1)NON OPIOIDS * Acetaminophen *salicylate salts *NSAIDS
  • 31. ANALGESIC  OPOIDS … a)OPIOD AGONIST eg>morphine ,fentanyl b)MIXED AGONIST ANTAGONIST eg> pentazocine c)PARTIAL AGONIST eg> buprenorphine
  • 32. PHARMACOLOGICAL MGMNT...  ADJUVANT ANALGESIC THERAPY a)CORTICOSTEROIDS b)ANTIDEPRESSANTS c)ANTISEIZURE DRUGS d)MUSCLE RELAXANT
  • 33. W.H.O PAIN LADDER
  • 34.  THERAPUTIC NERVE BLOCK  NEUROABLATIVE TECHNIQUES  NEUROAUGMENTATION
  • 35. NON PHARMACOLOGICAL MGNT PHYSICAL THERAPY
  • 36. PHYSICAL THERAPY * TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION
  • 37. PHYSICAL THERAPY PERCUTANEOUS ELECTRICAL NERVE STIMULATION
  • 38. * DISTRACTION * HYPNOSIS * RELAXATION STRATEGIES }MEDITATION }MUSIC THERAPY }HUMOR }YOGA
  • 39. NURSING MANAGEMENT ASSESMENT DIAGNOSIS INTERVENTIONS
  • 40.  INSOMNIA IS A SLEEP DISORDER EXPERIENCED BY AN INDIVIDUAL,CHARACTERISED BY DIFFICULTY IN INITIATING AND MAINTAINING SLEEP
  • 41.  MEDICAL ILLNESS >any painfull condition >heart disease >respiratory disease >rheumatic or musculoskeletal disease >brain stem or hypothalamic lesions >delirium > periodic limb movement disorder >sleep apnoea
  • 42.  ALCOHOL OR DRUG USE >chronic alcoholism >stimulants like caffene >drug or alcohol withdrawl syndrome  MEDICATIONS Eg- steroids,propranolol,theophylline  PSYCHATRIC DISORDER >mania >depression >anxiety disorder >stessfull life situation
  • 43.  INADEQUATE SLEEP HYGIENE  IDOPATHIC INSOMNIA
  • 44. TRANSIENT INSOMNIA ACUTE INSOMNIA CHRONIC INSOMNIA
  • 45.  Adjustmental insomnia or short term insomnia  Caused by situational stress  Lasts up to one week  Usually resolves when stressor is removed, or when individual adapts to the stressor
  • 46.  It is seen associated with more persistent stressfull factors which may be situational or environmental >eg- death,illness,noise  It may last up to 6 months
  • 47. • It is usually seen associated with a wide variety of medical or psychatric conditions • It may last for more than 6 months • Patient may report reduced quality of life,impaired social and occupational function
  • 48. DIAGNOSTIC EVALUATION HISTORY COLLECTION Medical history psychatric history alcoholism or drug abuse medication history sleep history - sleep schedule - timing of insomnia -sleep environment - day time sleep
  • 49. PHYSICAL EXAMINATION  For sleep apnea -large sized neck -enlarged tonsils -low lying palate  POLYSOMNOGRAPHY  used for the diagnosis of obstructive sleep apnoea  It records multiple physiologic parameters related to sleep and wakefullness
  • 50.  TREATMENT OF UNDERLYING CAUSE  WITHDRAWEL FROM MEDICATIONS,IF ANY  DIETARY MODIFICATION  ADEQUATE SLEEP HYGIENE >regular exercise >avoid regular use of alcohol >avoid fluid intake,heavy meals just before sleep >avoid reading or watching tv on bed >avoid day time sleep.
  • 51. 1)benzodiazepams >eg-lorazepam,nitrazepam 2)non benzodiazepine hypnotics >eg-zopiclone
  • 52. NURSING MANAGEMENT  ASSESMENT  DIAGNOSIS  INTERVENTIONS