Medical surgical nursing

2. PAIN
Presented by –
Shubhrima Khan

3. DEFINITION
Pain has been defined as an unpleasant sensory and emotional
experience associated with actual or potential tissue damage.
International Association for study of pain (IASP)

4. NATURE OF PAIN
• Pain is subjective and highly individualized.
• Its stimulus is physical and psychological in nature.
• Multidimensional experience.

5. TYPES OF PAIN
BASED ON DURATION
• Acute pain (< 6 months)
• Chronic pain ( > 3 – 6 months)
• Chronic non cancer pain: due to non-cancer disease conditions
• Chronic cancer pain: tumor progression and related pathological process
• Chronic episodic pain: occurs sporadically over an extended period of time

6. CONT..
BASED ON LOCATION
• The site where pain is located
• Referred pain
BASED ON INTENSITY
• Mild pain (1 – 3 )
• Moderate pain (4 – 6 )
• Severe pain (7 – 10 )

7. CONT..
BASED ON ETIOLOGY
• Nociceptive pain
• Somatic pain: originating from the skin, muscles, bone, or connective tissue.
• Visceral pain: results from the activation of nociceptors of the thoracic, pelvic
or abdominal viscera. Examples: labor pain, angina pectoris.
• Neuropathic pain
• Peripheral neuropathic pain: phantom limb pain
• Central neuropathic pain: spinal cord injury

8. PHYSIOLOGY OF PAIN
• Transduction
• Transmission
• Modulation
• Perception

9. FACTORS INFLUENCING PAIN
• Developmental factors
• Age
• Physiological
• Genes
• Fatigue
• Psychological factors
• Anxiety
• Coping style

10. CONT..
• Social factors
• Attention
• Previous experience
• Family and social support
• Cultural factors

11. EFFECTS OF PAIN
• Increased respiratory rate
• Increased heart rate
• Peripheral vasoconstriction
• Elevated BP
• Diaphoresis
• Dilated pupils
• Moaning
• Restlessness
• Irritability

12. PAIN ASSESSMENT
By ‘PQRST’
• P recipitating/Alleviating Factors
• Q uality of Pain
• R adiation
• S everity
• T iming

13. CONT..
Objective signs
• Facial expressions – facial grimacing, frowning, sad face.
• Vocalizations - crying, moaning.
• Body movements – guarding, resistance to moving

14. PAIN ASSESSMENT TOOLS
• Numeric rating scale
• Visual analogue scale
• Wong baker’s pain scale

16. VISUALANALOGUE SCALE

18. MANAGEMENT
• Pharmacological
• Non opioids (NSAIDS): paracetamol, aspirin
• Opioids: morphine, codeine
• Adjuvants: Tri-cyclic antidepressants, Anti epileptics, Cortico
steroids.
• Patient controlled analgesia
• Topical analgesics
• Local anesthesia
• Regional anesthesia

19. WHO PAIN LADDER

21. CONT..
• Non pharmacological
• Heat & cold application
• Progressive muscle relaxation
• Distraction
• TENS application
• Massage
• Yoga
• Acupuncture
• Herbal therapy (garlic, ginseng)

22. NURSING MANAGEMENT
 Assess and record pain & its characteristics, condition, quality, frequency and
duration.
 Document severity of patient pain on chart.
 Identify and encourage patient to use strategies that have been successful with
previous pain.
 Eliminate the factors that increase the pain.
 Teach the use of nonpharmacological therapy techniques.
 Administer analgesics as prescribes to promote optimal pain.
 Educate patient and family about the effects of analgesic agents and the goal of
care, explain how adverse effects will be prevented and treated.

23. COMPLICATIONS
Deconditioning
1. Decreased mobility
2. Obesity
3. Muscle atrophy
4. Neuropathies
Hormonal
1. Excess catecholamine production
2. Glucocorticoid excess or deficiency
3. Insulin - Lipid abnormalities
4. Immune suppression

24. CONT..
Neuropsychiatric
1. Nerve degeneration
2. Shock
3. Cerebral atrophy
4. Depression/suicide
5. Insomnia
6. Attention deficit
7. Memory loss
8. Cognitive decline

25. SENSORY DEPRIVATION

26. SENSORY ORGANS
• External: visual, auditory, tactile, olfactory, gustatory
• Internal
• Kinesthetic
• visceral

27. COMPONENTS OF SENSORY
EXPERIENCE
• Sensory reception
• Sensory perception

28. ASPECTS OF SENSORY PROCESS
• Stimulus
• Receptor
• Impulse conduction
• Perception

29. SENSORY DEPRIVATION
• It results when a person experiences decreased sensory input or input
that is monotonous or meaningless.
• with decreased sensory input the RAS is no longer able to project a
normal level of activation to the brain.

30. REPONSIBLE FACTORS
• An environment with decreased or monotonous stimuli.
• Impaired ability to receive environmental stimuli.
• Inability to process environmental stimuli.

31. TYPES
• Visual deprivation
• Auditory deprivation
• Tactile deprivation
• Gustatory deprivation

32. EFFECTS
Cognitive
• Reduced capacity to learn
• Inability to think or solve problem
• Poor task performance
• Disorientation
• Bizarre thinking
• Regression

33. CONT..
Affective
• Boredom
• Restlessness
• Increased anxiety
• Emotional liability
• Panic

34. CONT..
Perceptual
• Altered visual/motor coordination
• Altered color perception
• Altered tactile accuracy
• Altered ability to perceive size and shape
• Altered time judgment

35. MANAGEMENT
Visual Stimulation
• Pictures, flowers, greeting cards, etc. in the room.
• Minimizing glare.
• Wearing sunglasses before going outside.
• Clients with reduced visual acuity may need corrective lenses.
• Use pocket magnifiers.
• clock with large number magnifying glass.

36. CONT..
Auditory Stimulation
• Call the person by his or her name.
• Reorient the patient.
• Speak slowly, clearly. maintain eye-to-eye contact.
• Use sensory aids.
• Allow time for the client to express himself/herself.
• Avoiding background noise.

37. CONT..
Gustatory and Olfactory Stimulation
• Attention to the oral hygiene
• Food of different textures, colors served attractively
• Smell food before eating.
• Seasonal foods or favorite foods brought from home.
• Removal of unpleasant odor from the environment.
• Client's room should be clean, empty bedpans or urinals, remove and dispose
of soiled dressings and bathroom.

38. CONT..
Tactile Stimulation
• Provide touch therapy.
• Hair brushing, combing, a back rub, and touching of the arms or shoulders.
• When invasive procedures are being performed. it is important to use touch
by holding client’s hands.
• Minimize irritating stimuli.

39. CONCLUSION
Alteration in sensory perception is a great challenge to care in hospital setting and
other areas. Safety is always a special concern for patients with sensory alterations.
Nurse are responsible for ensuring that the patient’s environment is as free of
danger and for assisting the patient to develop new self-care behaviors to
compensate for sensory impairments.