Pain Management in Healthcare

Pain Management

• Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

Types of Pain

• Acute pain: a complex, unpleasant experience that occurs in response to body trauma, usually easy to identify, and lasts for a few days or weeks until healing has occurred.
• Chronic pain: pain that lasts for more than three months, or beyond normal healing time, and can disrupt sleep, mood, and normal living.

Causes of Pain

• Trauma
• Surgery
• Cancer
• Arthritis
• Neuropathy

Risk Factors for Pain

• Cultural and societal attitudes
• Lack of knowledge
• Fear of death
• Exaggerated fear of respiratory depression
• Populations at risk: infants, children, older adults, clients with substance abuse problems

Information Gathering for Pain Management

• Location of pain
• Character and quality of pain
• Duration of pain
• Aggravating/relieving factors

Physical Therapies

• Mild to moderate exercise, including massage and topical heat/cold therapy, can improve function and reduce pain.

Pharmacological Therapies

• Three main types of medicines used to manage pain:
  • Simple analgesics (e.g., paracetamol)
  • NSAIDS (non-steroidal anti-inflammatory drugs) (e.g., aspirin, ibuprofen, diclofenic)
  • Opiates (e.g., codeine, tramadol, morphine)

Importance of Pain Management

• Proper pain management is crucial to prevent chronic pain syndrome and improve quality of life.
• Unmanaged pain can lead to anxiety, fear, depression, and poorly managed acute pain.

Neurologic Observation: Glasgow Coma Scale

• Provides an objective measurement of three essential components of neurologic examinations: spontaneity of eye opening, best verbal response, and best motor response.
• The total score ranges from 3 to 15.
• A patient who is unresponsive to painful stimuli, does not open their eyes, and is flaccid has a score of 3.
• A patient who is oriented, opens their eyes spontaneously, and follows commands scores 15.
• A score of 7 or less is equal to Coma.

Components of the Glasgow Coma Scale

• Eye opening:
  • Spontaneous (4)
  • Response to speech (3)
  • Response to pain (2)
  • None (1)
• Verbal response:
  • Oriented (5)
  • Confused (4)
  • Inappropriate words (3)
  • Incomprehensible sounds (2)
  • None (1)
• Motor response:
  • Obeys commands (6)
  • Localizes to pain (5)
  • Withdraws from pain (4)
  • Flexion in response to pain (3)
  • Extension to pain (2)
  • None (1)

Roles of the Nurse in Critical Care Unit

• Critical care nurses are part of a multidisciplinary team that provides care to critically ill patients who have life-threatening or potentially life-threatening health problems.
• The nurse's role involves continuous monitoring and intervention to prevent complications and restore health.
• A nurse coordinator supports the patient and family in setting realistic goals and respects their informed decision-making.
• The nurse helps the patient obtain necessary care and respects their values, beliefs, and rights.
• The nurse educates the patient on their right to choose and ensures quality care.

Planning of Critical Care Unit

• A critical care unit is a specially designed facility staffed by skilled personnel to provide effective and safe care for patients with life-threatening health problems.
• Critical care services require specialized facilities, equipment, and nursing staff, as well as a wide range of support services.
• An integrated plan is essential to provide optimal care at the lowest possible cost.
• Critical care units can be generalized or specialized, such as:
  • Burn unit
  • Neonatal unit
  • Coronary care unit
  • Postoperative cardiothoracic unit
  • Renal unit