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Pain Management
Module E (Lecture)
Objectives
 Identify types and categories of pain to
location,etiology, and duration
 Identify subjective and objective ...
Objectives
 Identify barriers to effective pain
management
 Describe non-pharmacologic pain
control interventions
 Desc...
Nature of Pain
 “An unpleasant sensory and emotional
experience associated with actual or
potential damage or described i...
Types of Pain
 Acute Pain- pain lasting only through
the expected recovery period.
 Chronic Pain- lasts beyond the usual...
Continued
 Pain can be categorized according to
its origin:
 Cutaneous
 Deep somatic
 Visceral
Continued
 Radiating
 Referred
 Intractable
 Neuropathic
 Phantom
Pain Syndromes
 Central Pain Syndromes
 Trigeminal neuralgia
 Peripheral Pain Syndromes
 Post-herpetic Neuralgia
 Pha...
Pain with Underlying Pathology
Syndromes
 Headache- common somatic pain either
intracranial or extra-cranial.
 Cancer Pa...
Concepts Associated with Pain
 Pain Threshold
 Pain Sensation
 Pain Reaction
 Pain Tolerance
Gate Control Theory
 According to theory, peripheral nerve
fibers carrying pain to the spinal cord
can have their input m...
Continued
 Ascending Modulation
 Large diameter sensory fibers, message,
heat and cold applications
 Transcutaneous ele...
Factors Affecting the Pain
Experience
 Ethnic and Cultural Values
 Developmental Stage
 Environment and Support People
Continued
 Past Pain Experience
 Meaning of Pain
 Anxiety and Stress
Why clients may be reluctant to
report pain
 Unwillingness to trouble staff
 Fear of injectable route of analgesic
admin...
Continued
 Fear about cause of pain or that reporting
pain will lead to further tests and expenses
 Concern about unwant...
Pain Assessment
 Accurate pain assessment is essential
for effective pain management. Pain is
subjective and experienced ...
Pain History
 Previous pain treatment and
effectiveness
 When and what analgesics were last
taken
 Allergies to medicat...
Continued
 Location (abdomen)
 Intensity (scale of 0-10)See figures 43-
7 and 43-8, pgs 1090-1091)
 Quality (perceiving...
Continued
 Precipitating Factors (Environmental factors,
heat or cold)
 Alleviating factors (herbal teas, rest, t.v., pr...
Continued
 Coping resources (prayer or other
religious practices)
 Affective Responses (nurse to explore
feelings)
 Obs...
Barriers to Pain
 Misconceptions and biases
 Clients respond to pain based on their culture,
personal experiences and th...
Key Factors in Pain Management
 Acknowledging and accepting
 Assisting Support Persons
 Reduce misconceptions about pai...
Individualizing Care for Clients
with Pain
 Establish a trusting relationship
 Consider the clients ability and willingn...
Continued
 Use pain relieving measures that the client
believes are effective
 Base the choice of pain relief measure on...
Continued
 Maintain an unbiased attitude about
what might relief the pain
 Keep trying
 Prevent harm to the client
 Ed...
Pharmacologic Pain Management
 Involves the use of opioids (narcotics)
 Nonopioids/NSAIDS (nonsteroidal
antiinflammatory...
Opioid Analgesics
 Opium derivatives (M.S., and Codeine)
 Relieve pain and provide a sense of
euphoria binding to opiate...
Types of Opioids
 Full agonist- MS, Demerol, Codeine,
Darvon, Dilaudid- their doses can be
increased to relieve pain.
 M...
NONPHARMOCOLOGIC PAIN
MANAGEMENT
 Physical Interventions-Provide Comfort
 Cutaneous Stimulation-Massage,
application of ...
Transcutaneous Electrical Nerve
Stimulation
 TENS is a method of applying low voltage
electrical stimulation directly ove...
Pain Evaluation
 The nurse and client must determine if
overall goals and outcomes are achieved.
 Flow sheet records and...
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Pain Module (E) Lecture Cont

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  • See table 43-6 on Misconceptions about pain.
  • Transcript of "Pain Module (E) Lecture Cont"

    1. 1. Pain Management Module E (Lecture)
    2. 2. Objectives  Identify types and categories of pain to location,etiology, and duration  Identify subjective and objective data to collect and analyze when assessing pain  Identify examples of nursing diagnosis for clients with pain  State outcome criteria by which to evaluate a clients response to interventions for pain.
    3. 3. Objectives  Identify barriers to effective pain management  Describe non-pharmacologic pain control interventions  Describe pharmacologic interventions for pain
    4. 4. Nature of Pain  “An unpleasant sensory and emotional experience associated with actual or potential damage or described in terms of such damage” (International Association for the Study of Pain, 1979).
    5. 5. Types of Pain  Acute Pain- pain lasting only through the expected recovery period.  Chronic Pain- lasts beyond the usual course for recovery (six months duration).
    6. 6. Continued  Pain can be categorized according to its origin:  Cutaneous  Deep somatic  Visceral
    7. 7. Continued  Radiating  Referred  Intractable  Neuropathic  Phantom
    8. 8. Pain Syndromes  Central Pain Syndromes  Trigeminal neuralgia  Peripheral Pain Syndromes  Post-herpetic Neuralgia  Phantom Limb Pain
    9. 9. Pain with Underlying Pathology Syndromes  Headache- common somatic pain either intracranial or extra-cranial.  Cancer Pain Syndrome – Progression of the disease or from efforts to cure or control disease. Myofacial Pain Syndrome
    10. 10. Concepts Associated with Pain  Pain Threshold  Pain Sensation  Pain Reaction  Pain Tolerance
    11. 11. Gate Control Theory  According to theory, peripheral nerve fibers carrying pain to the spinal cord can have their input modified at the spinal cord level before transmission to the brain.
    12. 12. Continued  Ascending Modulation  Large diameter sensory fibers, message, heat and cold applications  Transcutaneous electrical nerve stimulation (TENS) unit, electrical stimulation is applied to skin  Descending modulation
    13. 13. Factors Affecting the Pain Experience  Ethnic and Cultural Values  Developmental Stage  Environment and Support People
    14. 14. Continued  Past Pain Experience  Meaning of Pain  Anxiety and Stress
    15. 15. Why clients may be reluctant to report pain  Unwillingness to trouble staff  Fear of injectable route of analgesic administration  Belief that pain is to be expected as part of recovery  Concern about addiction
    16. 16. Continued  Fear about cause of pain or that reporting pain will lead to further tests and expenses  Concern about unwanted side effects, especially of opioid drugs  Difficulty expressing personal discomfort
    17. 17. Pain Assessment  Accurate pain assessment is essential for effective pain management. Pain is subjective and experienced uniquely by every individual, nurses need to assess all factors affecting the pain experience.
    18. 18. Pain History  Previous pain treatment and effectiveness  When and what analgesics were last taken  Allergies to medications, other medications being taken
    19. 19. Continued  Location (abdomen)  Intensity (scale of 0-10)See figures 43- 7 and 43-8, pgs 1090-1091)  Quality (perceiving like a knife)  Pattern (onset, duration, and recurrence of intervals without pain.
    20. 20. Continued  Precipitating Factors (Environmental factors, heat or cold)  Alleviating factors (herbal teas, rest, t.v., prayer)  Associated Symptoms (N/V, dizziness, diarrhea)  Effects on ADL’S (Sleep, appetite, concentration, school, work, driving, walking)
    21. 21. Continued  Coping resources (prayer or other religious practices)  Affective Responses (nurse to explore feelings)  Observation of Behavioral and Physiologic Responses
    22. 22. Barriers to Pain  Misconceptions and biases  Clients respond to pain based on their culture, personal experiences and the meaning the pain has for them.  Clients may not report pain because they expect nothing to be done, they think it is not severe enough, or because they feel it would distract or prejudice the healthcare provider.
    23. 23. Key Factors in Pain Management  Acknowledging and accepting  Assisting Support Persons  Reduce misconceptions about pain  Reducing fear and anxiety  Preventing Pain
    24. 24. Individualizing Care for Clients with Pain  Establish a trusting relationship  Consider the clients ability and willingness to participate actively in pain relief measures  Use a variety of pain relief measures  Provide measures to relieve pain before it becomes severe.
    25. 25. Continued  Use pain relieving measures that the client believes are effective  Base the choice of pain relief measure on the client’s report of he severity of the pain  If a pain relief measure is ineffective encourage the client to try it once or twice before abandoning it
    26. 26. Continued  Maintain an unbiased attitude about what might relief the pain  Keep trying  Prevent harm to the client  Educate the client and support people about pain.
    27. 27. Pharmacologic Pain Management  Involves the use of opioids (narcotics)  Nonopioids/NSAIDS (nonsteroidal antiinflammatory drugs)  Adjuvants or Coanalgesic Drugs (See box on pg 1098)
    28. 28. Opioid Analgesics  Opium derivatives (M.S., and Codeine)  Relieve pain and provide a sense of euphoria binding to opiate receptors and activating endogenous pain suppression in the CNS.  MU, Delta, and Kappa receptors (opiate receptors)
    29. 29. Types of Opioids  Full agonist- MS, Demerol, Codeine, Darvon, Dilaudid- their doses can be increased to relieve pain.  Mixed agonist-antagonist  Partial agonists
    30. 30. NONPHARMOCOLOGIC PAIN MANAGEMENT  Physical Interventions-Provide Comfort  Cutaneous Stimulation-Massage, application of heat or cold, acupressure  Contralateral Stimulation  Immobilization  Distraction (visual, auditory, tactile, intellectual)
    31. 31. Transcutaneous Electrical Nerve Stimulation  TENS is a method of applying low voltage electrical stimulation directly over identified pain areas, at an acupressure point, along peripheral nerve areas that innervate the pain area, or along the spinal column.
    32. 32. Pain Evaluation  The nurse and client must determine if overall goals and outcomes are achieved.  Flow sheet records and diaries are helpful in this process, to evaluate the effectiveness of an analgesic.
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