Pain

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Credits to Ma'am Evangeline Teruel

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Pain

  1. 1. ermteruel
  2. 2. DeFiNiTiOnS oF pAiN
  3. 3. Pain is anunpleasant sensory and emotional experience associated withactual or potential tissue damage.
  4. 4. a personal private sensation of hurt. a harmful stimulus that signal current or impending tissue damage. a pattern of responses to protect the organism from burn.
  5. 5. whatever the experiencing person says it is existing wheneverthe person say it is
  6. 6. 1. Pain is a part of aging2. If a person is asleep, they are not in pain3. If pain is relieved by non- pharmaceutical pain relief techniques, the pain was not real anyway4. Real pain has an identifiable cause5. It is better to wait until a client has pain before giving medications
  7. 7. 6. Very young or very old people do not have as much pain7. Some clients lie about the existence or severity of their pain8. Addiction occurs with prolonged use of morphine or morphine derivatives9. The same physical stimulus produces the same pain intensity, duration and distress in different people
  8. 8. 10. Clients experience severe pain only when they have had major surgery.11. The nurse or other health care professionals are the authorities about a client’s pain12. Visible or physiologic or behavioral signs accompany pain and can be used to verify its existence.
  9. 9. tErMiNoLoGiEs
  10. 10.  Radiating pain  perceived at the source of the pain and extends to the nearby tissues Referred pain  felt in a part of the body that is considerably removed or far from the tissues causing the pain
  11. 11. Excessivesensitivity to pain
  12. 12.  the amount of pain stimulation a person requires before feeling pain least level of pain that the patient is able to detect
  13. 13.  Includes the ANS and behavioural responses to paintypes:ANS response  autonomic reaction of the body that often protect the individual from further harm. (automatic withdrawal of hand from hot object.)Behavioural response  is a learned response used as a method of coping with pain.
  14. 14.  maximum amount and duration of pain that an individual is willing to endure greatest level of pain that the patient is able to tolerate
  15. 15. thepointwhich the personbecomesaware ofthe pain
  16. 16. tRiAd Of PaiNpErCePtiOn
  17. 17. 1.Pain Receptor2.Pain Stimuli3.Pain Fibers
  18. 18. pain receptorsFree nerve endingin the skin thatrespond only tointense, potentiallydamaging stimuli.
  19. 19. 1. Mechanical2. Thermal3. Chemical
  20. 20. Pain Fibers Fibers PainThere are twoseparate pathwaysthat transmit painimpulses to thebrain:(1) Type A-delta fibersare associated with fast, sharp, acute pain and2) Type C fibersare associatedwith slow, chronic,aching pain
  21. 21. pAiNsYnDrOmEs
  22. 22. 1.Referred Pain2.Radiating Pain3.Psychogenic Pain4.Neurologic Pain5.Phantom Limb Pain6.Intractable Pain
  23. 23.  no pathologic causeCaused: Mental Emotional Behavioral factorsinduced by social rejection, broken heart, grief, love sickness, or other such emotional events.
  24. 24.  s/s:  Headache,  back pain  stomach pain
  25. 25. MAIN PROBLEM: neurologicsystem
  26. 26. DamagePNS & CNSNerve fibers
  27. 27.  Alcoholism Amputation Back, leg, and hip problems Chemotherapy Diabetes Facial nerve problems HIV infection or AIDS Multiple sclerosis Spine surgery
  28. 28.  Painful perception perceived in a missing body part or in a body part paralyzed from a spinal cord injury
  29. 29.  Thistype of pain is achronic pain that is resistant tocure or relief.
  30. 30. pAtHoPhYsiOLoGy oF pAiN
  31. 31. 1.Transduction2.Transmission3.Perception4.Modulation
  32. 32. 1. Transduction2. Transmission3. Perception4. Modulation
  33. 33.  cerebral cortex Somato sensory cortex association cortex limbic system
  34. 34.  endogenous opioids (endorphins & enkephalins  chemical substances ▪ spinal and medullary dorsal horn ▪ periaqueductal gray matter ▪ hypothalamus ▪ amygdala in the CNS) serotonin 5HT norepinephrine gamma amino butyric acid (GABA)
  35. 35. TyPeS oF pAiN
  36. 36. Categories of pain according to its1. Origin2. Onset3. Cause or etiology
  37. 37. 1. Superficial Cutaneous Pain  occurs over body surface or skin segments.2. Deep Somatic Pain  occurs in the skin, muscles and joints (musculoskeletal – muscle, bone, periosteum, cartilage, ten dons, deep fascia, ligaments, joints, blood vessels and nervous)3. Visceral Pain
  38. 38.  Acute pain  following acute injury, disease or some type of surgery Chronic malignant pain  associated with cancer or other progressive disorder Chronic nonmalignant pain  in the persons whose tissue injury is non progressive or healed
  39. 39. Mechanical trauma blockage of body duct tumor muscle spasmThermal or cold extreme heatChemicalTissue ischemia Blocked artery Stimulation of pain receptors accumulation of lactic acid
  40. 40. gAtE cOnTroL ThEoRy Melzack and Wall
  41. 41. Factors influencing reaction to painPsychological Physiological Cultural
  42. 42. Infant:  perceive pain and respond to its increasing sensitivityToddler:  respond by crying and anger because they perceive it as a threat to security or sense that pain is a punishmentSchool age:  try to be brave and not to cry or express much pain so parents and nurse will not be angry with themAdolescent:  may not want to report pain in front of peers because they perceive complaints of pain as weaknessAdult:  may not report pain for fear that it indicates poor diagnosis. Nurse may mean weakness and failure
  43. 43. PainManagement
  44. 44. Pharmacologic Treatment
  45. 45.  Analgesics :  Non opioids/ non- narcotic analgesics  NSAIDs  Narcotic analgesics / opioids  Adjuvants / co- analgesics  Local anesthesia  Patient controlled analgesia  Epidural analgesia
  46. 46. Ex. Acetaminophen acetyl salicylic acid
  47. 47. Ex :IbuprofenNaproxenIndomethacinPiroxicamKetoralac
  48. 48. Ex:meperidinemethylmorphinemorphine sulphatefentanyl
  49. 49.  Sedatives, anti-anxiety agents, muscle relaxants Ex:AmitriptylineHydroxyzinediazepam
  50. 50.  A drug delivery system which is a safe method for post operative, trauma & obstetrics, burns, terminal care pediatrics and cancer pain management Involves self IV drug administration Goal : to maintain a constant plasma level of analgesic so that the problems of client with needed dosing (PRN) are avoided Client preparation & teaching is important Check IV line & PCA device regularly
  51. 51.  Easy access for clients for medication Allows self administration with no risks Pain relief without depending on nurses Small doses of medications at short intervals for sustained pain relief Stabilized serum drug levels Decreased anxiety
  52. 52.  Patient becomes dependent on PCA If mobility is contraindicated, client may move due to decreased or no pain by PCA Respiratory depression Side effect may be constipation Mechanical failure of pump Relatives may press button for client Wrong programming parameters Incorrect placing of syringe can cause infusion of excessive drug doses Costly & if client may not understand the system
  53. 53. 6. Local7. Spinal anesthesia8. Epidural anesthesia
  54. 54. SURGICALTREATMENT
  55. 55. NON-PHARMACOLOGIC
  56. 56. A.Cognitive Behavioral Approaches:1. Distraction
  57. 57. 2.Reducing PainPerception
  58. 58. 3. Bio-feed back
  59. 59. Goals: to provide comfort to correct physical dysfunctions to alter physiological responses to reduce fears associated with pain related immobilityExamples:1. Acupressure / acupuncture2. Cutaneous stimulation (massage, heat application, TENS)3. Binders, Chiropractic
  60. 60. Pain History
  61. 61. LOCATION: “Where is your pain?”INTENSITY:
  62. 62. Visual Score 0 1-2-3 4-5-6 7-8 9-10 Verbal Score No Hurts Hurts a lot Really hurts Extremely pain little a lot hurtsObserver Appears Comfortable Uncom- Distressed Distressed scoring pain free except on fortable can be movement comforted

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