Chapter 16 Pain and Comfort PDF

Ebersole and Hess' Gerontological Nursing & Healthy Aging in Canada 3rd Edition Veronique Boscart, Lynn McCleary, Linda Sheiban Taucar, Theris A. Touhy, Kathleen Jett Chapter 16 Pain and Comfort  Learning Objectives (1 of 2) Upon completion of this chapter, t...

Ebersole and Hess' Gerontological Nursing & Healthy Aging in Canada 3rd Edition Veronique Boscart, Lynn McCleary, Linda Sheiban Taucar, Theris A. Touhy, Kathleen Jett Chapter 16 Pain and Comfort  Learning Objectives (1 of 2) Upon completion of this chapter, the reader will be able to: Define the concept of pain and recognize the older adult’s interpretation of pain. Differentiate acute from persistent pain. Identify data to include in a pain assessment. Describe pharmacological and nonpharmacological measures to promote the comfort of the person in pain. 1-3  Learning Objectives (2 of 2) Upon completion of this chapter, the reader will be able to: Discuss the goals of pain management for the older adult. Develop a nursing care plan for an older adult in acute or persistent pain. 1-4  Pain and Comfort Comfort: a personal and intrinsic balance of the most basic physiological, emotional, social, and spiritual needs Without some level of comfort, wellness is beyond reach. Pain: a sensation of distress, and can occur at a physical, psychological, and spiritual level Any type of pain can result in reduced socialization, impaired mobility, and a reconsideration of the meaning of life and self. 16-5 Communication of Pain & Discomfort How pain is expressed is highly influenced by the unique history of the individual and the meaning ascribed to the pain. Spiritual and psychological pain may be expressed as “not feeling well.” Response to pain reflects an individual’s cultural expectations and understanding of acceptable behaviour. Understanding what the person is trying to communicate through his or her behaviour is an essential skill in caring for older people with and without communication difficulties. Hearing loss, depression, sedating medications (which do not necessarily ease pain), the individual’s personality, and the way discomfort is acceptably expressed may also affect the communication of pain. 16-6  Implications for Gerontological Nursing and Healthy Aging Pain is now considered the fifth vital sign. Patients who are older adults, from a minority group, and/or live in a LTC home are at greater risk for inadequate pain assessment and treatment. Nurses have a responsibility to set aside their own expectations and promote comfort for those who are suffering, regardless of the cause and manner of expression. See Box 16-1: Facts and Myths about Pain in the Older Adult 16-7  Acute and Persistent Pain Acute Pain Temporary Postoperative, procedural, and traumatic pain Easily controlled by analgesic medications Can be physical, psychological, or spiritual in nature Persistent Pain (Chronic Pain) Not time-limited Persistent at varying levels of intensity It is estimated that between 33% and 83% of LTC residents experience chronic pain. Conditions that are degenerative or pathological are a common cause. 16-8  Osteoarthritis The destruction of the inner joint surfaces The most common form of joint disease; majority of adults by age 50 have some level of degenerative abnormalities of the lower spine Joint pain and stiffness are initially intermittent, and then become persistent. Pain is characterized by aching in the joints with inactivity and discomfort or acute pain with activity. 16-9  Varicella Zoster Also known as shingles A viral infection of the nerves Characterized by the sensations of itching, stinging, burning pain along the dermatome An acute episode lasts from days to weeks; a chronic episode can last much longer. A vaccination may be offered to older adults (50+) to prevent/reduce risk of developing shingles. 16-10  Implications for Gerontological Nursing and Healthy Aging (1 of 4) The nurse is usually the person most attuned to the needs of patients. Through the nursing record, the nurse is in a key position to work with the older adult in the management of pain. Assessment Patient’s self-report of pain Written or visual analogue scale Particularly challenging with patients who are cognitively impaired Detailed description of pain intensity, frequency, quality, location, and aggravating and alleviating factors Use Best Practice Guidelines (e.g., RNAO) or evidence- informed resources (e.g., Try This, Hartford Institute) 16-11  Implications for Gerontological Nursing and Healthy Aging (2 of 4) Refer to Fig. 16.1 Refer to Fig. 16.2 Refer to Fig. 16.3 16-12  Implications for Gerontological Nursing and Healthy Aging (3 of 4) Interventions Nonpharmacological measures of pain relief Touch Cutaneous nerve stimulation Transcutaneous electrical nerve stimulation Biofeedback Distraction Relaxation, meditation, and imagery Pharmacological pain control Non-narcotic analgesics: often adequate for mild-to-moderate pain relief Narcotic analgesics: used effectively to treat both acute and persistent pain 16-13  Implications for Gerontological Nursing and Healthy Aging (4 of 4) Evaluation Frequency and intensity of pain Behavioural signs and symptoms that suggest pain Response to pharmacological and nonpharmacological interventions Impact of pain on mood, ADLs, sleep, function, and other quality-of-life measures 16-14