Chapter 36 - Comfort and Pain Management Std-1 PDF

CHAPTER 36 COMFORT AND PAIN MANAGEMENT Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins KEY TERMS Copyright © 2023 Wolters Kluwer All Rights Reserved KEY TERMS Copyright © 2023 Wolters Kluwer All Rights Reserved KEY TERMS Copyright © 2023 W...

CHAPTER 36 COMFORT AND PAIN MANAGEMENT Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins KEY TERMS Copyright © 2023 Wolters Kluwer All Rights Reserved KEY TERMS Copyright © 2023 Wolters Kluwer All Rights Reserved KEY TERMS Copyright © 2023 Wolters Kluwer All Rights Reserved KEY TERMS Copyright © 2023 Wolters Kluwer All Rights Reserved KEY TERMS Copyright © 2023 Wolters Kluwer All Rights Reserved DEFINITIONS OF PAIN WHATEVER THE PATIENT SAYS THAT IT IS, WHENEVER IT IS A PERSONAL EXPERIENCE INFLUENCED BY BIOLOGIC, PSYCHOLOGICAL, AND SOCIAL FACTORS PAIN AND NOCICEPTION ARE DIFFERENT LEARNED THROUGH AN INDIVIDUAL’S LIFE EXPERIENCES SERVES AN ADAPTIVE ROLE EXPRESSED IN MANY WAYS—NOT JUST VERBALLY Copyright © 2023 Wolters Kluwer All Rights Reserved 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 EXERCISE, WARM COMPRESS AND MASSAGE STIMULATE THE BROAD NERVE FIBERS TO SHUT THE GATE WHICH RESULTS IN PAIN RELIEF. Copyright © 2023 Wolters Kluwer All Rights Reserved FIGURE 36-1. AN ILLUSTRATION OF THE GATE CONTROL THEORY OF PAIN. Copyright © 2023 Wolters Kluwer All Rights Reserved THE PAIN PROCESS TRANSDUCTION: ACTIVATION OF PAIN RECEPTORS (NOCICEPTORS) TRANSMISSION: CONDUCTION ALONG PATHWAYS (A-DELTA AND C-DELTA FIBERS) PERCEPTION OF PAIN: AWARENESS OF THE CHARACTERISTICS OF PAIN MODULATION: INHIBITION OR MODIFICATION OF PAIN Copyright © 2023 Wolters Kluwer All Rights Reserved STIMULATOR OF NOCICEPTORS OR PAIN RECEPTORS BRADYKININ: A POWERFUL VASODILATOR THAT INCREASES CAPILLARY PERMEABILITY AND CONSTRICTS SMOOTH MUSCLE PROSTAGLANDINS: IMPORTANT HORMONE-LIKE SUBSTANCES THAT SEND ADDITIONAL PAIN STIMULI TO THE CNS SUBSTANCE P: SENSITIZES RECEPTORS ON NERVES TO FEEL PAIN AND ALSO INCREASES THE RATE OF FIRING OF NERVES Copyright © 2023 Wolters Kluwer All Rights Reserved PAIN SENSATION AND RELIEF Copyright © 2023 Wolters Kluwer All Rights Reserved PERCEPTION OF PAIN PAIN THRESHOLD ADAPTATION MODULATION OF PAIN NEUROMODULATORS ENDORPHINS, DYNORPHINS, ENKEPHALINS Copyright © 2023 Wolters Kluwer All Rights Reserved QUESTION #1 WHICH MODULATOR OF PAIN IS THOUGHT TO REDUCE PAIN SENSATION BY INHIBITING THE RELEASE OF SUBSTANCE P FROM THE TERMINALS OF AFFERENT NEURONS? A. ENDORPHINS B. DYNORPHINS C. ENKEPHALINS D. NOCICEPTORS Copyright © 2023 Wolters Kluwer All Rights Reserved  TYPES OF PAIN PAIN MAY BE CLASSIFIED ACCORDING TO DURATION, LOCATION, OR ETIOLOGY. DURATION ACUTE CHRONIC LOCALIZATION/LOCATION LOCALIZED SOMATIC VISCERAL CUTANEOUS REFERRED Copyright © 2023 Wolters Kluwer All Rights Reserved DURATION OF PAIN ACUTE RAPID IN ONSET, VARIES IN INTENSITY AND DURATION PROTECTIVE IN NATURE CHRONIC MAY BE LIMITED, INTERMITTENT, OR PERSISTENT LASTS BEYOND THE NORMAL HEALING PERIOD PERIODS OF REMISSION OR EXACERBATION ARE COMMON Copyright © 2023 Wolters Kluwer All Rights Reserved  ETIOLOGY NOCICEPTIVE NEUROPATHIC NOCIPLASTIC INTRACTABLE PHANTOM Copyright © 2023 Wolters Kluwer All Rights Reserved QUESTION #2 A PATIENT WHO HAS BONE CANCER IS MOST LIKELY EXPERIENCING WHICH OF THE FOLLOWING TYPES OF PAIN? A. CUTANEOUS B. SOMATIC C. VISCERAL D. REFERRED Copyright © 2023 Wolters Kluwer All Rights Reserved RESPONSES TO PAIN BEHAVIORAL (VOLUNTARY) PHYSIOLOGIC (INVOLUNTARY) AFFECTIVE (PSYCHOLOGICAL) Copyright © 2023 Wolters Kluwer All Rights Reserved FACTORS AFFECTING THE PAIN EXPERIENCE CULTURAL AND ETHNICITY VARIABLES FAMILY, BIOLOGIC SEX, GENDER, AND AGE VARIABLES RELIGIOUS BELIEFS AND SPIRITUALITY ENVIRONMENT AND SUPPORT PEOPLE ANXIETY AND OTHER STRESSORS PAST PAIN EXPERIENCE Copyright © 2023 Wolters Kluwer All Rights Reserved TERMS USED TO DESCRIBE PAIN QUALITY PERIODICITY SHARP CONTINUOUS DULL INTERMITTENT DIFFUSE BRIEF OR TRANSIENT SHIFTING SEVERITY SEVERE OR EXCRUCIATING MODERATE SLIGHT OR MILD Copyright © 2023 Wolters Kluwer All Rights Reserved ASSESSMENT PARAMETERS FOR PAIN PSYCHOLOGICAL SOCIOCULTURAL SPIRITUAL PHYSIOLOGIC Copyright © 2023 Wolters Kluwer All Rights Reserved GENERAL ASSESSMENTS OF PAIN PATIENT’S VERBALIZATION AND DESCRIPTION OF PAIN ONSET AND DURATION OF PAIN ETIOLOGY OR MECHANISM OF INJURY, IF KNOWN LOCATION OF PAIN QUALITY, CHARACTER, AND INTENSITY OF PAIN AGGRAVATING OR CAUSAL FACTORS ALLEVIATING OR RELIEVING FACTORS EFFECT ON FUNCTION PAIN MANAGEMENT GOAL Copyright © 2023 Wolters Kluwer All Rights Reserved  QUESTION #3 TELL WHETHER THE FOLLOWING STATEMENT IS TRUE OR FALSE. THE BEST JUDGE OF THE EXISTENCE AND SEVERITY OF A PATIENT’S PAIN IS THE PHYSICIAN OR NURSE CARING FOR THE PATIENT. A. TRUE B. FALSE Copyright © 2023 Wolters Kluwer All Rights Reserved  BASIC METHODS OF ASSESSING PAIN PATIENT SELF-REPORT (PASERO & MCCAFFERY, IDENTIFY PATHOLOGIC CONDITIONS OR 2011) PROCEDURES THAT MAY BE CAUSING PAIN; CONSIDER PHYSIOLOGIC MEASURES (INCREASED BLOOD PRESSURE AND PULSE) REPORT OF FAMILY MEMBER, OTHER PERSON CLOSE TO THE PATIENT OR CAREGIVER FAMILIAR WITH THE PERSON NONVERBAL BEHAVIORS: RESTLESSNESS, GRIMACING, CRYING, CLENCHING FISTS, PROTECTING THE PAINFUL AREA PHYSIOLOGIC MEASURES: INCREASED BLOOD PRESSURE AND PULSE ATTEMPT AN ANALGESIC TRIAL AND MONITOR THE RESULTS Copyright © 2023 Wolters Kluwer All Rights Reserved PAIN ASSESSMENT TOOLS #1 0–10 NUMERIC RATING SCALE ADULT NONVERBAL PAIN SCALE (NVPS) BEHAVIORAL PAIN SCALE (BPS) CHECKLIST OF NONVERBAL INDICATORS COMFORT BEHAVIOR SCALE CRIES INSTRUMENT Copyright © 2023 Wolters Kluwer All Rights Reserved  PAIN ASSESSMENT TOOLS #2 CRITICAL-CARE PAIN OBSERVATION TOOL (CPOT) FACES PAIN SCALE—REVISED (FPS-R) FLACC BEHAVIORAL SCALE IOWA PAIN THERMOMETER (IPT) AND REVISED (IPT-R) OUCHER PAIN SCALE PAIN ASSESSMENT IN ADVANCED DEMENTIA SCALE (PAINAD) WONG–BAKER FACES Copyright © 2023 Wolters Kluwer All Rights Reserved QUESTION #4 WHICH FOLLOWING PAIN ASSESSMENT TOOL IS RECOMMENDED FOR USE WITH NEONATES AGES 0 TO 6 MONTHS? A. OUCHER PAIN SCALE B. WONG-BAKER FACES C. FLACC PAIN SCALE D. CRIES PAIN SCALE Copyright © 2023 Wolters Kluwer All Rights Reserved  FLACC PAIN SCALE F—FACES L—LEGS A—ACTIVITY C—CRY C—CONSOLABILITY http://marshfieldclinic.libguides.com/ld.php?content_id=46985203 Copyright © 2023 Wolters Kluwer All Rights Reserved DIAGNOSING PAIN TYPE OF PAIN ETIOLOGIC FACTORS BEHAVIORAL, PHYSIOLOGIC, AFFECTIVE RESPONSE OTHER FACTORS AFFECTING PAIN PROCESS Copyright © 2023 Wolters Kluwer All Rights Reserved NURSING INTERVENTIONS FOR PAIN ESTABLISHING TRUSTING NURSE–PATIENT RELATIONSHIP MANIPULATING FACTORS AFFECTING PAIN EXPERIENCE INITIATING COMPLEMENTARY HEALTH APPROACHES AND INTEGRATIVE HEALTH CARE MANAGING PHARMACOLOGIC RELIEF MEASURES ENSURING ETHICAL AND LEGAL RESPONSIBILITY TO RELIEVE PAIN UNDERSTANDING THE PLACEBO CONTROVERSY TEACHING PATIENT ABOUT PAIN Copyright © 2023 Wolters Kluwer All Rights Reserved MANIPULATING PAIN EXPERIENCE FACTORS REMOVE OR ALTER CAUSE OF PAIN ALTER FACTORS AFFECTING PAIN TOLERANCE Copyright © 2023 Wolters Kluwer All Rights Reserved COMPLEMENTARY HEALTH APPROACHES AND INTEGRATIVE HEALTH CARE DISTRACTION HEALING/THERAPEUTIC HUMOR TOUCH MUSIC ANIMAL-ASSISTED IMAGERY INTERVENTION MASSAGE MINDFULNESS PRACTICE TOUCH CUTANEOUS STIMULATION POSITIONING (ACUPRESSURE) HEAT/COLD THERAPY ACUPUNCTURE HYPNOSIS BIOFEEDBACK Copyright © 2023 Wolters Kluwer All Rights Reserved PHARMACOLOGIC PAIN RELIEF MEASURES ANALGESIC ADMINISTRATION OPIOID OR NARCOTIC (E.G. MORPHINE, OXYCODONE, FENTANYL, CODIENE) ADJUVANT (E.G. ANTIDEPRESSANTS, STEROIDS) NONOPIOID (E.G. ACETAMINOPHEN, NSAIDS- ASPIRIN, IBUPROFEN) Copyright © 2023 Wolters Kluwer All Rights Reserved THE WHO 3-STEP ANALGESIC LADDER Copyright © 2023 Wolters Kluwer All Rights Reserved QUESTION #5 A SEDATED PATIENT IS FREQUENTLY DROWSY AND DRIFTS OFF DURING HIS CONVERSATION WITH THE NURSE. WHAT NUMBER ON THE SEDATION SCALE BEST DESCRIBES THIS PATIENT? A. 1 B. 2 C. 3 D. 4 Copyright © 2023 Wolters Kluwer All Rights Reserved NUMERIC SEDATION SCALE S: SLEEP, EASY TO AROUSE: NO ACTION NECESSARY 1: AWAKE AND ALERT; NO ACTION NECESSARY 2: OCCASIONALLY DROWSY, BUT EASY TO AROUSE; NO ACTION NECESSARY 3: FREQUENTLY DROWSY, DRIFTS OFF TO SLEEP DURING CONVERSATION; REDUCE DOSAGE 4: SOMNOLENT WITH MINIMAL OR NO RESPONSE TO STIMULI; DISCONTINUE OPIOID, CONSIDER USE OF NALOXONE Copyright © 2023 Wolters Kluwer All Rights Reserved GENERAL PRINCIPLES FOR ANALGESIC ADMINISTRATION ONGOING ASSESSMENT MANAGEMENT OF BREAKTHROUGH PAIN CONCERN ABOUT PRESCRIPTION ANALGESIC ABUSE Copyright © 2023 Wolters Kluwer All Rights Reserved PAIN MANAGEMENT REGIMENS FOR CANCER OR CHRONIC PAIN GIVE MEDICATIONS ORALLY IF POSSIBLE ADMINISTER MEDICATIONS ATC RATHER THAN PRN ADJUST THE DOSE TO ACHIEVE MAXIMUM BENEFIT WITH MINIMUM SIDE EFFECTS ALLOW PATIENTS AS MUCH CONTROL AS POSSIBLE OVER THE REGIMEN Copyright © 2023 Wolters Kluwer All Rights Reserved PAIN TREATMENT IN SPECIAL POPULATIONS CHILDREN OLDER ADULTS COMMUNICATION DIFFICULTIES DENIAL OF PAIN ALTERED PHYSIOLOGIC RESPONSE TO ANALGESICS Copyright © 2023 Wolters Kluwer All Rights Reserved ADDITIONAL METHODS FOR ADMINISTERING ANALGESICS PATIENT-CONTROLLED ANALGESIA EPIDURAL ANALGESIA AND PERIPHERAL NERVE BLOCKS TOPICAL ANESTHESIA Copyright © 2023 Wolters Kluwer All Rights Reserved PLACEMENT OF AN EPIDURAL CATHETER Copyright © 2023 Wolters Kluwer All Rights Reserved TEACHING ABOUT PAIN SHOULD INCLUDE FAMILY MEMBERS OR CAREGIVERS EXPLANATION ABOUT PAIN SCALES SAFETY: AVOID DRIVING, OPERATING MACHINERY, ALCOHOL OR OTHER CNS DEPRESSANTS KEEP DIARY OF PAIN AND MEDICATIONS TAKEN DIET: DO NOT TAKE ON AN EMPTY STOMACH DO NOT BREASTFEED WITHOUT CHECKING WITH PROVIDER Copyright © 2023 Wolters Kluwer All Rights Reserved APPROACHES PAIN MANAGEMENT INVOLVES A MULTIMODAL, MULTIDISCIPLINARY, AND CLIENT-CENTERED APPROACH. CLIENTS HAVE A RIGHT TO QUALITY PAIN MANAGEMENT AND SHOULD BE INVOLVED IN DISCUSSIONS WITH THE INTERPROFESSIONAL TEAM ABOUT HOW BEST TO TREAT THEIR PAIN. Copyright © 2023 Wolters Kluwer All Rights Reserved