Chapter 7 Care of Patients With Pain PDF

Care of Patients With Chapter 7 Pain Copyright © 2021 by Elsevier, Inc. All rights reserved. Copyright © 2021 by Elsevier, Inc. All rights reserved. Lesson 7.1 Care of Patients With Pai...

Care of Patients With Chapter 7 Pain Copyright © 2021 by Elsevier, Inc. All rights reserved. Copyright © 2021 by Elsevier, Inc. All rights reserved. Lesson 7.1 Care of Patients With Pain Theory Objectives (1 of 2) Review the gate control theory of pain and its relationship Review to nursing care. Discuss how the neuromatrix and central sensitivity Discuss theories help explain types of pain other than those arising from tissue injury. Demonstra Demonstrate an understanding of the current view of pain te as a specific entity requiring appropriate intervention. 2 Theory Objectives (2 of 2) Explain how pain Analyze the major Compare nociceptive perception is differences between pain and neuropathic affected by personal acute and chronic pain and nursing situations and pain and their care for each. cultural management. backgrounds. Give examples of the Demonstrate the use different of the nursing pharmacologic process when caring approaches to pain for patients that include the use experiencing pain. of adjunctive measures. Copyright © 2021 by Elsevier, Inc. All rights 3 reserved. Clinical Practice Objectives 1 2 3 4 Demonstrate use Recognize Employ Demonstrate the of appropriate common side nonpharmacologi use of the pain evaluation effects of c approaches to nursing process tools and analgesics and pain when caring for measures for a describe management patients variety of techniques for with a variety of experiencing patients. addressing them. patients. pain. Copyright © 2021 by Elsevier, Inc. All rights reserved. 4 Theories of Pain (1 of 2) Pain A neurologic response to unpleasant stimuli Gate control theory (GCT) When the gate is open, the pain sensation is allowed through. When the gate is closed, the pain sensation is blocked. Nursing applications of GCT Activity in the small-diameter nerve fibers seems to open the gate Activity in the large-diameter nerve fibers seems to close it. Copyright © 2021 by Elsevier, Inc. All rights reserved. 5 Theories of Pain (2 of 2) The more intense the pain, the greater Pieces of the number of pieces. A greater number of pieces of treatment pain will be required to control pain. Endorphin Endorphins (endogenous morphine) can attach to pain receptors and block pain s sensation. Copyright © 2021 by Elsevier, Inc. All rights reserved. 6 Copyright © 2021 by Elsevier, Inc. All rights reserved. Nociceptive pain Associated with pain stimuli from either somatic (body tissue) or visceral (organs) structures Classificati Neuropathic pain on of Pain Associated with a dysfunction of the nervous system that involves an abnormality in the processing of sensations. Often associated with medical conditions rather than with tissue damage. 7 Four Phases of Nociceptive Pain Transduction begins when tissue damage causes the release of substances that stimulate the nociceptors and initiates the sensation of pain. Transmission involves movement of the pain sensation to the spinal cord. Perception occurs when impulses reach the brain and the pain is recognized. Modulation occurs when neurons in the brain send signals back down the spinal cord by release of neurotransmitters. Copyright © 2021 by Elsevier, Inc. All rights 8 reserved. Perception of Pain Pain is a subjective experience. Pain threshold is the point at which pain is perceived. Pain tolerance is the length of time or the intensity of pain a person will endure before outwardly responding to it. Copyright © 2021 by Elsevier, Inc. All rights reserved. 9 Copyright © 2021 by Elsevier, Inc. All rights reserved. Pain can cause a variety of physiologic responses, including Increased respiratory rate, pulse, or blood Physiologic pressure Responses Muscle tension Sweating to Pain Flushing or pallor Frowning, grimacing, or groaning Although the presence of any of these factors may indicate pain, their absence does not prove the absence of pain. 10 Copyright © 2021 by Elsevier, Inc. All rights reserved. A person’s cultural background influences feelings about pain. In much of Western culture, it is Cultural considered valuable to have a high pain tolerance, particularly among men. Considerati ons Other cultures promote the idea that to endure pain is natural or honorable. Learning to accept without judgment the various ways of coping with and expressing pain is a very necessary process for nurses. 11 Copyright © 2021 by Elsevier, Inc. All rights reserved. Acute pain Usually has a known cause Acute Surgical procedure, minor burn, Versus sprained ankle or other injury Chronic causing tissue trauma. Pain: Hours to days Duration Chronic pain May have a known cause or be a result of central sensitivity syndrome/neuromatrix causes. Months to years 12 Copyright © 2021 by Elsevier, Inc. All rights reserved. Acute pain Acute Versus Good; may resolve Chronic Pain: spontaneously or in response to analgesic Prognosis for therapy Relief Chronic pain Poor unless complicating factors removed; spontaneous relief unusual 13 Copyright © 2021 by Elsevier, Inc. All rights reserved. Acute pain Acute Versus Relatively easy to Chronic identify Pain: Chronic pain Cause Sometimes cause is known, but diagnosis may be complex or undetermined 14 Copyright © 2021 by Elsevier, Inc. All rights reserved. Acute pain Usually transient or none; Acute Versus Chronic Pain: may temporarily disrupt Psychosocial normal activities or Effects routine Chronic pain Can affect ability to earn a living, enjoy social activities, maintain self- esteem 15 Copyright © 2021 by Elsevier, Inc. All rights reserved. Acute pain Medication usually beneficial; Acute Versus surgery often helpful Chronic Pain: Chronic pain Effect of Therapy Medications may be helpful, but patient may become dependent. Multiple medication regimen may be used. Surgery may help but also may worsen the problem. 16 Copyright © 2021 by Elsevier, Inc. All rights reserved. Numbered scale Visual scale Pain Rating Scales Color scale Pieces of pain scale Behavioral pain scale 17 Copyright © 2021 by Elsevier, Inc. All rights reserved. (From Hockenberry MJ, Wilson D, Rodgers CC: Wong's essentials of pediatric nursing, ed. 10, Wong-Baker FACES St. Louis, 2017 Elsevier.) Pain Rating Scale 1 FLACC Scale for Pain Assessment for Cognitively Impaired Person Copyright 2002, reprinted with permission from The Regents of the University of Michigan. Copyright © 2021 by Elsevier, Inc. All rights 1 reserved. Copyright © 2021 by Elsevier, Inc. All rights reserved. Language barriers Data Cultural considerations Collection Pain expression and meaning Difficulties Preferences and action Referred pain and heart pain Outward appearance of pain 20  In determining the patient’s perception of pain, which question(s) would be useful in assessing pain? (Select all that Audience apply.) 1. “Where are you hurting?” Response 2. “What pain control measures have Question worked for you in the past?” 1 3. “How would you describe your pain?” 4. “What were you doing before the onset of the pain?” 5. “Did another person witness your pain?” Copyright © 2021 by Elsevier, Inc. All rights reserved. 1 Prevent Complications (1 of 2) Prominent documentation of any known drug allergies Accurate recording of pertinent information obtained during the initial assessment phase, such as current medications, previous experience with pain, analgesics, and adjuncts to pain relief Patient and family teaching regarding dose, frequency, and the need to consult with the physician or nurse before taking any other medications to avoid dangerous interactions Copyright © 2021 by Elsevier, Inc. All rights reserved. 22 Prevent Complications (2 of 2) Appropriate monitoring of effects of any medications given and prompt notification of the physician if medications fail to relieve pain or should problems occur Accurate and complete documentation of any adverse reactions to treatment and communication of that information to other health care providers, to the patient, and to appropriate family members Copyright © 2021 by Elsevier, Inc. All rights reserved. 23 Copyright © 2021 by Elsevier, Inc. All rights reserved. Accurate documentation Initial pain assessment Location Documentati on (1 of 2) Intensity Duration of the pain Method used to assess Aggravating factors Alleviating factors 24 Copyright © 2021 by Elsevier, Inc. All rights reserved. Measures taken (e.g., analgesic medication, adjunctive measures) Evaluation of effectiveness of measures Documentati on (2 of 2) Physician notification of problems or concerns and physician response, if applicable Related patient or family education 25 Copyright © 2021 by Elsevier, Inc. All rights reserved. Effective pain management is not just a matter of giving the right medicine at the right time. Manageme nt of Pain It is a combination of pharmacologic and nonpharmacologic approaches that together give the individual the greatest possible degree of comfort for the longest possible time. 26 Copyright © 2021 by Elsevier, Inc. All rights reserved. Oral analgesics Pharmacolo Intramuscular gic analgesics Approaches Subcutaneous (1 of 2) analgesics Topical analgesics Transdermal patches Buccal swabs 27 Copyright © 2021 by Elsevier, Inc. All rights reserved. IV analgesics Pharmacolo gic Patient-controlled Approaches analgesia (2 of 2) Epidural analgesic Peripheral nerve catheter 28 Copyright © 2021 by Elsevier, Inc. All rights reserved. Antidepressants Nonanalgesi Chemotherapeutic agents and c immunosuppressants Medications Used for Anticonvulsants Pain Control Muscle relaxants Marijuana 29 Copyright © 2021 by Elsevier, Inc. All rights reserved. Aspirin and Special Considerations anticoagulant in Pain effects Management Acetaminophen and liver toxicity 30 Copyright © 2021 by Elsevier, Inc. All rights reserved. Rights of medication administration Nurse Side effects and Responsibiliti complications es Constipation—fluid and fiber Drowsiness and euphoria Itching and hives Respiratory depression Addiction to narcotics 31 Copyright © 2021 by Elsevier, Inc. All rights reserved. No scientific evidence has proven that opioids can End-of-Life hasten death when used to Narcotic control pain. Health care providers have Pain moral obligation to Control adequately treat pain even at the very end of life. Opioids must be administered for the purpose of relieving pain and not to purposefully hasten death. 32 Nonpharmacologic Approaches Sleep Music Heat and cold Binders Menthol Massage Distraction Acupuncture and Relaxation acupressure Transcutaneous Guided imagery electrical nerve Meditation stimulation Spinal cord stimulator Hypnosis Biofeedback Copyright © 2021 by Elsevier, Inc. All rights 33 reserved. Copyright © 2021 by Elsevier, Inc. All rights reserved. Sympathectomi es Invasive Treatments Rhizotomies Cordotomies 34 Therapies for Pain Complementary and alternative therapies Complementary are used more for pain relief than for and Alternative anything else. Therapies used include relaxation, Copyright © 2021 by Elsevier, Inc. All rights reserved. meditation, biofeedback, yoga, hypnosis, imagery, chiropractic, acupuncture, acupressure, massage, aromatherapy, and herbal preparations and supplements. Relief Research from the National Institutes of Health has proven that acupuncture is effective for many patients for various pain problems. 35 Audience Response Question 2 Which statement(s) by a nurse promote(s) the use of massage in reducing pain? (Select all that apply.) 1. “Family members can perform it safely and effectively.” 2. “It stimulates the circulation in reddened areas.” 3. “It relaxes the muscles.” 4. “It increases the general sense of well-being.” 5. “It uses short, mild strokes.” Copyright © 2021 by Elsevier, Inc. All rights reserved. 1 Copyright © 2021 by Elsevier, Inc. All rights reserved. Nursing Responsibilities (1 of 2) Community care Extended care Social worker Adequate pain Teaching on management to complementary promote rest and and alternative rehabilitation resources 37 Copyright © 2021 by Elsevier, Inc. All rights reserved. Home care Discharge teaching and Nursing resources Responsibiliti Consider adjuncts to es pain management Family involvement Subcutaneous PCA Role of LPN/LVN 38