This document discusses pain management. It defines different types of pain and outlines objectives for learners to understand pain pathophysiology, assessment, and treatment methods. Pain is categorized as acute, chronic, or cancer-related. Factors influencing pain responses are described. Pharmacological interventions like opioids and NSAIDs are compared with non-pharmacological options. The nursing role in a pain management plan utilizing the nursing process is also summarized.
Pain definition, Pain pathways, pain modulation, the endorphin system, Types of Pain, current trend of Drugs used for pain management. New Drugs for pain
Pain definition, Pain pathways, pain modulation, the endorphin system, Types of Pain, current trend of Drugs used for pain management. New Drugs for pain
To improving postoperative pain management, we need to;
- Always applies multi-modal analgesia. (get the advantages of multimodal analgesia)
- Implementation of the existing EB regarding the use of non-opioid + opioid on as needed basis.
- Use available specific evidence for optimizing multimodal pain management procedure (PROSPECT Web site).
Post operative pain management has no specific criteria. Lots of methods and procedures are suggested with various types of drugs. It is just a guideline for management of pain after surgery.
INADEQUATE PAIN TREATMENT STILL A FACT IN INDONESIA HEALTH SERVICES
PAIN AS A COMPLEX PROBLEM NEED MULTIDISCIPLINARY APPROACH FOR BETTER RESULT BASED INDIVIDUALLY PATIENT NEEDED
THERE IS A BIG ROLE OF PHYSICIAN AND HOSPITAL FOR BETTER PAIN MANAGEMENT
CHANGE PARADIGM TO MULTIDISCIPLINARY PAIN TREATMENT IS AN OBLIGATE FOR ALL PHYSICIAN
To improving postoperative pain management, we need to;
- Always applies multi-modal analgesia. (get the advantages of multimodal analgesia)
- Implementation of the existing EB regarding the use of non-opioid + opioid on as needed basis.
- Use available specific evidence for optimizing multimodal pain management procedure (PROSPECT Web site).
Post operative pain management has no specific criteria. Lots of methods and procedures are suggested with various types of drugs. It is just a guideline for management of pain after surgery.
INADEQUATE PAIN TREATMENT STILL A FACT IN INDONESIA HEALTH SERVICES
PAIN AS A COMPLEX PROBLEM NEED MULTIDISCIPLINARY APPROACH FOR BETTER RESULT BASED INDIVIDUALLY PATIENT NEEDED
THERE IS A BIG ROLE OF PHYSICIAN AND HOSPITAL FOR BETTER PAIN MANAGEMENT
CHANGE PARADIGM TO MULTIDISCIPLINARY PAIN TREATMENT IS AN OBLIGATE FOR ALL PHYSICIAN
Pharmacotherapy of PAIN - Bigin Gyawali BiGs.pptxBigin Gyawali
Pharmacotherapy for pain involves the use of medications to alleviate or manage pain. The choice of pharmacological agents depends on the type, severity, and duration of pain, as well as individual patient factors such as age, comorbidities, and medication tolerances. Here is a comprehensive description of pharmacotherapy for pain, considering various classes of medications:
1. **Nonsteroidal Anti-Inflammatory Drugs (NSAIDs):**
- NSAIDs, such as ibuprofen and naproxen, work by inhibiting the enzymes involved in inflammation and pain.
- They are effective in managing mild to moderate pain, particularly that associated with inflammation, such as arthritis or musculoskeletal injuries.
- However, long-term use may be associated with gastrointestinal side effects, so caution is advised.
2. **Acetaminophen:**
- Acetaminophen is a pain reliever and fever reducer that is generally considered safer for the stomach than NSAIDs.
- It is commonly used for mild to moderate pain and is often recommended for individuals who cannot tolerate NSAIDs.
- Excessive use, however, can lead to liver damage, so dosing recommendations should be followed carefully.
3. **Opioids:**
- Opioids, such as morphine, oxycodone, and hydrocodone, are potent analgesics that can be effective for moderate to severe pain.
- They work by binding to opioid receptors in the brain and spinal cord, altering the perception of pain.
- Due to the risk of tolerance, dependence, and addiction, opioids are typically reserved for short-term use or for chronic pain that has not responded to other treatments.
4. **Adjuvant Medications:**
- Certain medications originally developed for other purposes, such as anticonvulsants (e.g., gabapentin, pregabalin) and antidepressants (e.g., amitriptyline, duloxetine), can be used as adjuvants in pain management.
- These medications can help manage neuropathic pain and may enhance the effects of other analgesics.
5. **Corticosteroids:**
- Corticosteroids, such as prednisone, may be used for short-term relief of pain and inflammation, particularly in conditions like rheumatoid arthritis or certain inflammatory disorders.
- Prolonged use is generally avoided due to the risk of side effects.
6. **Topical Analgesics:**
- Topical formulations, including creams, patches, and gels, containing analgesic agents like NSAIDs, lidocaine, or capsaicin, can be applied directly to the affected area for localized pain relief.
7. **Muscle Relaxants:**
- Muscle relaxants, such as cyclobenzaprine or baclofen, may be prescribed to alleviate pain associated with muscle spasms or tension.
It's important for healthcare professionals to conduct a thorough assessment of the patient's pain and medical history to tailor the pharmacotherapy approach. The goal is to achieve adequate pain control while minimizing the risk of side effects and considering the overall well-being of the patient. Regular monitoring and communication.
The presentation enhances the reader to get comprehensive view about Pain ( physiology of pain, assessment of pain and Management of pain). This will help you to management pain effectively.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
2. Objectives
At the end of an evocative lecture discussion, the learners will be able to acquire the necessary knowledge
essential in the care of clients with pain.
Specifically, the learners will be able to:
1. Define pain.
2. Identify the basic categories of pain.
3. Describe the pathophysiology of pain.
4. Recognize factors influencing pain responses.
5. Demonstrate appropriate use of pain measurement instruments.
6. Compare pharmacologic, non pharmacologic and neurological methods of pain control.
7. Utilize the nursing process as a framework in the care of patients with pain.
3. • Pain is an unpleasant sensory and emotional experience
associated with actual or potential tissue damage.
• It is the most common reason for seeking health care.
• “The fifth vital sign”
• Joint Commission (2005) standards: “pain is assessed in all
patients,” “patients have the right to appropriate
assessment and management of pain.”
What is Pain?
4. 3 Basic Categories of Pain
I. Acute Pain
II. Chronic Pain (nonmalignant)
III. Cancer related Pain
5. I. Acute Pain
This is usually recent onset and commonly associated with a
specific injury.
It indicates that damage or injury has occurred. If no lasting
damage occurs, it usually decreases along with healing.
It can be described as lasting from seconds to 6 months.
6. II. Chronic (Nonmalignant) Pain
Is constant or intermittent that persists beyond the expected healing
time and can seldom be attributed to a specific cause or injury.
It may have a poorly defined onset and often difficult to treat.
This type of pain lasts for 6 months and is usually accompanied by
problems related to the pain itself.
7. III. Cancer-related Pain
This type of pain is associated with cancer. It may be acute or chronic.
This is the second most common fear of newly diagnosed cancer patients.
Pain in the patient suffering from cancer can be directly associated with the
cancer (nerve compression), a result of cancer treatment (surgery or radiation) ,
or not associated with cancer ( trauma)
8. EFFECTS OF PAIN
Impairs the patient’s ability to sleep.
Acute Pain effects: Endocrine, immunologic and inflammatory changes as a response to stress
which includes increased metabolic rate and cardiac output, impaired insulin response,
increased production of cortisol, and increased retention of fluids.
Unrelieved acute pain may affect the pulmonary, cardiovascular, gastrointestinal, endocrine
and immune system
Chronic Pain effects: Adverse effects of chronic pain includes the suppression of the immune
function which may promote tumor growth. It can also results in depression and disability.
11. Pain Transmission
Nerve mechanisms and structures involved in the transmission of
pain perception to and from the area of the brain:
A. Nociceptors
B. Pain Receptors
C. Chemical Mediators
12. Pathophysiology of Pain
Pain begins in the presence of an intense and potentially damaging
stimuli. Stimuli can be mechanical, thermal, or chemical in nature.
This triggers a response from the Nociceptors (free nerve endings in the
skin). Nociceptors’ nerve fibers branch very near to the origin and sends
fibers to the local blood vessels, mast cells, hair follicles and sweat glands.
When fibers are stimulated, histamine is released from the mast cells
causing vasodilation.
13. Chemical Substances
Algogenic ( pain – causing) substances affect sensitivity of nociceptors released from the
extracellular tissue because of tissue damage.
Prostaglandin - increases the sensitivity of pain receptors by enhancing the pain provoking
effect of bradykinin.
Endorphins, enkephalins (suppress pain reception) - reduce or inhibit the transmission or
perception of pain.
19. Instruments used for Assessing the
Patient’s Perception of Pain
Visual Analogue Scales
Faces Pain Scale, Revised
20. Pharmacologic Interventions
Opioid analgesics act on CNS to inhibit activity of ascending
nocioceptive pathways
NSAIDS decrease pain by inhibiting cyclo-oxygenase
(enzyme involved in production of prostaglandin)
Local anesthetics block nerve conduction when applied to
nerve fibers
21. Pharmacological Pain relief Interventions
Balanced anesthesia
“PRN” medications
Routine administration: around the clock (ATC) or preventive
approach
PCA: patient-controlled analgesia
Local anesthetics
Topicals, patches
Intraspinal administration
22. Non - pharmacological Interventions
1. Cutaneous stimulation, massage
Promotes comfort as it produces muscle relaxation
2. Thermal therapies ( heat and cold application)
Ice and heat stimulate the non-pain receptors in the same receptor field
as the injury.
3. Transcutaneous electrical nerve stimulation (TENS)
This uses a battery-operated unit with electrodes applied to the skin to produce a tingling, vibrating, or
buzzing sensation in the area of pain. Decreases pain by stimulating the non-pain receptors in the same area
as the fibers that transmit the pain.
23. Non-pharmacological interventions
4. Distraction
Involves focusing the patient’s attention on something other than the pain, may be the
mechanism responsible for other effective cognitive techniques. Perception of pain is reduced
by stimulating the descending control system, resulting in fewer painful stimuli being
transmitted to the brain.
5. Relaxation techniques
Relaxing tense muscles reduces pain through abdominal breathing at a slow, rhythmic
rate.
6. Guided imagery – consists of combining slow, rhythmic breathing with a mental
image of relaxation and comfort.
24. Non-pharmacological interventions
7. Hypnosis
Usually, hypnosis must be induced by a specially skilled person (a psychologist or a nurse
with specialized training in hypnosis). Its effectiveness depends on the hypnotic susceptibility of
the individual.
25. Neurologic and Neurosurgical Methods
for Pain Control
A. Stimulation procedures
a. Electrical stimulation – a method of suppressing pain by applying a controlled low voltage
electrical pulses to different parts of the nervous system
b. Spinal cord stimulation – a technique used for relief of chronic, intractable pain, ischemic
pain and pain from angina through a surgically implanted device.
c. Deep brain stimulation – performed for special pain problems when the patient does not
respond to the usual techniques of pain control of pain pathways.
B. Interruption
◦ Cordotomy -
◦ Rhizotomy
26. Nurses Role in Pain Management
I. Help relieve pain by administering pain-relieving interventions ( both
pharmacologic and nonpharmacologic approaches).
II. Assess effectiveness of interventions.
III. Monitoring of adverse effects.
IV. Educate the patient and family to enable them to manage the prescribed
intervention themselves when appropriate.
27. Nursing Diagnosis
Acute Pain related to physical injury, reduction of blood supply, process of giving birth
Chronic Pain related to the malignancy
Anxiety related to pain that is felt
Ineffective individual coping
related to chronic pain
Impaired physical mobility
related to musculoskeletal pain
Risk for injury related to lack of perception of pain
28. Nursing Process Framework for Pain
Management
Identify goals for pain management
Establish nurse-patient relationship, teaching
Provide physical care
Manage anxiety related to pain
Evaluate pain-management strategies
Reference: Brunner and Suddarth’s Textbook of Medical Surgical Nursing 12th
Edition.
