Comfort W21 Student PDF

Comfort 10/28/24 D. FILOS RN, MSN Pain Is…… “An unpleasant sensory and emotional experience associated with actual or potential tissue damage” (International Association for the Study of Pain IASP) “Pain is what the person says it is, existing whenever they say it does” (M. McCaffery...

Comfort 10/28/24 D. FILOS RN, MSN Pain Is…… “An unpleasant sensory and emotional experience associated with actual or potential tissue damage” (International Association for the Study of Pain IASP) “Pain is what the person says it is, existing whenever they say it does” (M. McCaffery) Pain is accompanied by Suffering 10/28/24 D. FILOS RN, MSN  Scope of the Problem 75 million Americans suffer chronic pain annually 25 million suffer acute pain Pain costs more than $100 Billion each year in medical expenses, lost wages and lost productivity Inadequate pain relief hastens death (American Pain Society, 2017, www.ampainsoc.org) 10/28/24 D. FILOS RN, MSN  Barriers Preventing Effective Pain Relief By Health Care Providers Poor Assessment of pain Inadequate knowledge of pain management Biases and judgments regarding pain 10/28/24 D. FILOS RN, MSN Barriers Preventing Effective Pain Relief By Patients in Pain: “I might get addicted” Opioids should be saved for when it is really needed Unpleasant side effects “I want a shot” 10/28/24 D. FILOS RN, MSN Crisis reluctance to prescribe opiods 115 people in US die every day from opioid overdose The Midwestern region saw opioid overdoses increase 70 percent from July 2016 -September 2017 About 80 percent of people who use heroin first misused prescription opioids The CDC estimates that the total "economic burden" of prescription opioid misuse in the United States is $78.5 billion a year, includes costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement.2 https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis 10/28/24 D. FILOS RN, MSN  The Pain Process Transduction: activation of pain receptors Transmission Perception:: awareness of the characteristics of pain  Pain Threshold: lowest intensity of a stimulus that causes you to recognize pain Modulation: inhibition or modification of pain https://www.youtube.com/watch? v=Hh79fi4dOP4  Gate Control Theory of Pain Describes the transmission of painful stimuli and recognizes a relationship between pain and emotions Small- and large-diameter nerve fibers conduct and inhibit pain stimuli toward the brain. Gating mechanism determines the impulses that reach the brain. https://www.youtube.com/watch?v=E_W9qTkbozo CATEGORIES OF RESPONSES TO PAIN PAIN Duration Physiologic Acute Behavioral Chronic Affective  Factors Affecting Pain Experience Family, gender, and age variables Environment and support people Anxiety and other stressors Past pain experience Pain Assessment IS……. Asking and believing the patient! 10/28/24 D. FILOS RN, MSN Non Verbal Pain Indicators Moaning Crying Grimacing Guarded Position Increased VS but not always especially with chronic pain Reduced Social Interactions Irritability Difficulty Concentrating Changes in Eating and Sleeping 10/28/24 D. FILOS RN, MSN When Should Pain Be Assessed: At regular intervals With each new report of pain After each pharmacological and non-pharmacological intervention –Assess Pain AND Sedation! 10/28/24 D. FILOS RN, MSN Intensity FLACC IN EPIC 1-10 IN EPIC Baker Wong Faces Checklist of Non Verbal Indicators PAINAD IN EPIP Payen Behavior Pain Scale 10/28/24 D. FILOS RN, MSN  Location(s) Indicate area(s) of pain Different areas may have different types of pain Referred Pain 10/28/24 D.FILOS RN, MSN Quality of Pain based on Source SOMATIC VISCERAL Descriptors: Aching, Descriptors: Cramping, deep, dull, gnawing, squeezing, pressure throbbing, sharp, stabbing (referred to distant sites) Examples: muscle, Examples: gallstones, tendon, bone injuries kidney stones, pancreatitis 10/28/24 D. FILOS RN, MSN Quality of Pain based on Source NEUROPATHIC Descriptors: CUTANEOUS Superficial, skin or Burning, numbness, subcutaneous tissue. radiating, shooting, Sharp with a burning tingling, touch sensation sensitive Examples: Herpes zoster, peripheral neuropathy 10/28/24 D. FILOS RN, MSN Aggravating/Alleviating Factors: What makes the pain better or worse? Is the pain affected by movement or position? Do any non-pharmacological methods help? 10/28/24 D. FILOS RN, MSN What are the Patient Goals? Objective Measure on a scale In Terms of Function ◦Ability to perform ADL’s ◦Ambulate ◦To be able to deep breath after surgery 10/28/24 D.FILOS RN, MSN Pain Assessment is NOT Relying on changes in vital signs Deciding a patient does not “look like he is in pain” Assuming a sleeping patient does not have pain Knowing how much a procedure or disease should hurt Assuming a patient will tell you when they are in pain 10/28/24 D. FILOS RN, MSN Non-pharmacologic Pain Relief Measures Distraction Humor Music Imagery Relaxation Cutaneous stimulation Acupuncture Hypnosis Biofeedback Therapeutic touch Animal-facilitated therapy The WHO 3-Step Analgesic Ladder  Terms Opioids -Controlled substances  Morphine – considered the gold standard COMMON SIDE EFFECT NAUSEA/VOMITING  Codeine  Hydromorphone  Methadone  Fentanyl transdermal patches take up to 12 hours to reach effectiveness. Is 8-10 time more powerful than morphine Adjuvant Drugs  Anticonvulsants, Tricyclic-antidepressants, steroids, anti-anxiety 10/28/24 D. FILOS RN, MSN  PCA Patient Controlled Anesthesia Must be alert and able to IV administration work the pump Maximum dose and lock out Patient is in charge of the settings pain control Can be used for continuous Morphine, Fentanyl, infusion Hydromorphone 10/28/24 D. FILOS RN, MSN 10/28/24 D. FILOS RN, MSN  Typical PCA Orders Drug Concentrati Patient Lockout 4 Hour on Controlled Limit Dose Morphine 5 mg / ml 1 – 3 mg 8 – 15 30 – 70 mg (150 mg in 30 minutes ml) 10/28/24 D. FILOS RN, MSN  Break Through Pain Flare up of moderate to severe pain that occurs even when the patient is taking around the clock (ATC) mediation. 10/28/24 D. FILOS RN, MSN  Physical Dependence The body physiologically adapts to the presence of an opioid and suffers withdrawal symptoms if the opioid is suddenly withdrawn 10/28/24 D. FILOS RN, MSN  Psychological Dependence (Addiction) A pattern of compulsive drug use characterized by continued craving for an opioid and the need to use the opioid for effects other than pain relief 10/28/24 D. FILOS RN, MSN  Tolerance A common physiological result of chronic opioid use, a larger dose of opioid is required to maintain the same level of analgesia 10/28/24 D. FILOS RN, MSN Placebo A harmless pill, medicine, or procedure prescribed more for the psychological benefit to the patient than for any physiological effect. A person unaware of the placebo’s properties may find it to be effective for the relief of pain because of the perception that it will provide comfort and because of belief in the person administering it. CONSIDERED TO BE UNETHICAL 10/28/24 D. FILOS RN, MSN Pain Experience in the Elderly Myth: Pain is a natural component of the aging process. FACT: Pain is often unreported leads to a higher risk for patient experiencing pain FACT: Adverse effects of pain medications are more dramatic in the elderly due to decreased liver and renal function (drugs metabolized and excreted slower) 10/28/24 D. FILOS RN, MSN