NURS1067 Week 10 Pain, Falls, and Restraints PDF

***Content related to Assessment and Management of Pain:*** **1. Common Misconceptions about Pain** +-----------------------------------+-----------------------------------+ | **Misconception** | **Fact** | +============================...

***Content related to Assessment and Management of Pain:*** **1. Common Misconceptions about Pain** +-----------------------------------+-----------------------------------+ | **Misconception** | **Fact** | +===================================+===================================+ | ***Infants don't feel pain*** | -Infants have fully developed | | | nervous systems and are capable | | | of feeling pain. | | | | | | -Pain in infants can have lasting | | | effects if not managed properly. | +-----------------------------------+-----------------------------------+ | ***Pain is always visible*** | -Pain may not always show | | | physical signs. Clients may not | | | exhibit outward expressions, **so | | | self-report is considered the | | | "gold standard" for assessing | | | pain.** | +-----------------------------------+-----------------------------------+ | ***Pain decreases with age*** | -Older adults may actually | | | experience higher pain levels due | | | to chronic conditions. | | | | | | -Age does not lessen the | | | intensity of pain, though it may | | | affect how it is expressed. | +-----------------------------------+-----------------------------------+ | ***Opioid use for pain management | -With appropriate medical | | leads to addiction*** | guidance, opioids can be safely | | | used to manage pain. | | | | | | -Misconceptions about opioids | | | often prevent effective pain | | | management. | +-----------------------------------+-----------------------------------+ | ***Pain is proportional to the | -The severity of pain does not | | severity of the injury*** | always correlate with tissue | | | injury; factors like | | | psychological state and previous | | | experiences influence pain | | | perception. | +-----------------------------------+-----------------------------------+ | ***People should expect | -Effective pain management is | | unrelieved pain after surgery*** | possible and is a priority in | | | care; | | | | | | -Clients do not need to endure | | | high pain levels post-surgery. | +-----------------------------------+-----------------------------------+ **2. Different [physiology and types of pain] and examples for each** (Potter & Perry, starting p. 576) +-----------------------+-----------------------+-----------------------+ | **Type of Pain** | **Description** | **Example** | +=======================+=======================+=======================+ | **Physiology of | | | | Pain** | | | +-----------------------+-----------------------+-----------------------+ | **Nociceptive Pain** | -Experiences of pain | -Somatic: bone | | | that occurs in | fractures, sprained | | | response to **tissue | ankle, arthritis | | | damage or injury** | pain, burns, bumps, | | | (non-neural tissue) | bruises | | | and activates pain | | | | receptors | -Visceral: pelvic | | | (nociceptors) in a | pain due to bladder | | | normally functioning | infection, abdominal | | | nervous system. | pain due to a bowel | | | | disorder, pain from a | | | -**Somatic**: bones, | gallstone or | | | joints, muscles, | pancreatitis | | | connective tissue, | | | | skin | | | | | | | | -**Visceral**: | | | | internal organs | | | | (obstructions, | | | | inflammation or | | | | tumours) | | +-----------------------+-----------------------+-----------------------+ | **Neuropathic Pain** | -Caused by **damage | -Phantom limb pain: | | | from a lesion or | painful sensations in | | | disease affecting the | a limb that has been | | | somatosensory nervous | amputated, as if it | | | system**, **often | were still there | | | chronic and | | | | complex**. | -Diabetic neuropathy: | | | | type of nerve damage, | | | -Involves the | leading to symptoms | | | abnormal processing | like pain, tingling, | | | of stimuli due to a | and numbness, | | | lesion or disease in | typically in the | | | the peripheral or | hands and feet | | | central nervous | | | | system | -Carpal tunnel | | | | syndrome: compression | | | -Usually described by | of the median nerve | | | pts as "**burning | in the wrist, causing | | | sensation, tingling, | hand pain, numbness, | | | numb feeling**" | and tingling | | | | | | | -Often does not | | | | respond well to | | | | opioids, which may be | | | | commonly used for | | | | nociceptive pain. | | +-----------------------+-----------------------+-----------------------+ | **Types of Pain** | | | +-----------------------+-----------------------+-----------------------+ | **Acute Pain** | -Short-term **pain | -Often a nociceptive | | | related to an | pain: tissue damage | | | identifiable cause**, | or injury (somatic or | | | typically resolves as | visceral) | | | the injury is | | | | treated/heals. | | | | | | | | -Usually less than 6 | | | | months; Predictable | | | | ending or healing | | +-----------------------+-----------------------+-----------------------+ | **Chronic Pain** | -Intermittent or | -Osteoarthritis pain. | | | persistent **pain | | | | lasting over six | | | | months**, often | | | | difficult to treat, | | | | may occur without a | | | | clear cause. | | | | | | | | -Pts often get | | | | frustrated with | | | | chronic pain because | | | | it is hard to | | | | describe or predict | | | | how they feel from | | | | one day to the next | | +-----------------------+-----------------------+-----------------------+ | **Cancer** | -Can be a mix of | -Any pain associated | | | acute, chronic, | with the cancer- | | | nociceptive or | could be acute, | | | neuropathic | chronic, nociceptive | | | | or neuropathic and | | | -Pain can occur at | can occur either at | | | the site of the tumor | the site of the tumor | | | or at a distant site | or at a distant site | | | in the body | | | | (**referred pain**) | | +-----------------------+-----------------------+-----------------------+ | **Breakthrough Pain** | -An occasional, | -Pain during movement | | | sudden, intense spike | in cancer patients. | | (Potter & Perry p. | in pain, often | | | 579) | occurring | | | | unexpectedly. | | | | | | | | -Can be triggered by | | | | an incident (bathing, | | | | movement), or | | | | idiopathic (unknown | | | | cause) | | +-----------------------+-----------------------+-----------------------+ **3. Factors Affecting Pain Experience** +-----------------------------------+-----------------------------------+ | **Factor** | **Effect on Pain Experience** | +===================================+===================================+ | **Physiological** | **Age:** Younger people may have | | | a higher pain tolerance, while | | | older adults often experience | | | heightened pain sensitivity due | | | to physiological changes and | | | comorbidities, making pain | | | interpretation more complex. | | | | | | Fatigue: Tiredness can lower pain | | | tolerance, making pain feel more | | | intense | | | | | | **Heredity**: Genetic factors can | | | affect pain tolerance and | | | sensitivity, and research shows | | | there is also a genetic component | | | influencing how effectively | | | different pain medications are | | | metabolized | | | | | | **Neurological Function:** | | | Conditions like multiple | | | sclerosis (MS) and diabetic | | | neuropathy can increase pain | | | sensitivity or cause **pain | | | insensitivity**. For patients | | | with pain insensitivity, such as | | | those with certain neuropathies, | | | **preventive nursing care with | | | regular sensory assessments and | | | protective measures is crucial to | | | prevent unnoticed injuries**. | +-----------------------------------+-----------------------------------+ | **Social** | **Attention:** how much focus is | | | placed on the pain; ↑ focus on | | | pain = ↑ sensation of pain | | | (usually) | | | | | | Previous experience: shapes how | | | we experience pain | | | | | | Family support: Having family | | | nearby can provide emotional | | | support, which can help distract | | | from pain and lower its perceived | | | intensity | +-----------------------------------+-----------------------------------+ | **Spiritual** | Pain may have personal meanings, | | | such as being seen as a test of | | | faith, affecting how pain is | | | tolerated; Patients who are | | | religious, spiritual, hopeful, or | | | seeking spiritual support often | | | **report lower pain experiences** | +-----------------------------------+-----------------------------------+ | **Psychological** | Anxiety and fear: Fear or worry | | | can heighten the perception of | | | pain by increasing muscle tension | | | and focusing attention on the | | | pain | | | | | | Meaning of pain: seeing pain as | | | purposeful or a test of faith can | | | reduce perceived intensity, while | | | viewing it as pointless can | | | increase suffering | +-----------------------------------+-----------------------------------+ | **Cultural** | -Some cultures encourage open | | | pain expression, while others | | | value **stoicism**, influencing | | | both display and perception of | | | pain. | | | | | | -Cultural beliefs also shape | | | acceptance of pain management | | | methods and influence treatment | | | preferences based on | | | culturally-rooted meanings of | | | pain | +-----------------------------------+-----------------------------------+ **4. Physiological and Behavioral Responses to Pain with Examples** +-----------------------+-----------------------+-----------------------+ | **Response Type** | **Description** | **Example** | +=======================+=======================+=======================+ | **Behavioral** | Voluntary actions or | \- Grimacing, | | | visible expressions | clenched teeth, lip | | | due to pain, may | biting, tightly | | | include vocalizations | closing eyes\ | | | and protective | - Rubbing, guarding, | | | behaviors. | or immobilizing the | | | | affected area\ | | | | - Moaning, groaning, | | | | grunting, sighing\ | | | | - Avoidance of social | | | | interaction, | | | | appearing despondent | +-----------------------+-----------------------+-----------------------+ | **Physiological** | Involuntary physical | -Vital signs: | | | responses due to | Increased heart rate | | | pain, often related | (HR), blood pressure | | | to the autonomic | (BP), respiratory | | | nervous system. | rate (RR)\ | | | | - Pallor (may look | | | | pale)\ | | | | - Diaphoresis | | | | (sweating) | | | | | | | | **\*\*Caution:** | | | | Physiological | | | | responses should be | | | | used carefully when | | | | assessing or | | | | diagnosing pain, as | | | | they may not always | | | | be reliable | | | | indicators. | +-----------------------+-----------------------+-----------------------+ **5. Potential Complications Related to Pain** **Complication** **Impact of Unmanaged Pain** ---------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------- **Mental Health** Chronic pain can lead to or worsen depression, anxiety, and mood disorders due to prolonged discomfort. **Quality of Life** Persistent pain limits the ability to engage in everyday activities (ADLs), affecting mobility, sleep, and social relationships; lose ability to work **Delayed Recovery** Unmanaged pain can lead to slower healing and longer rehabilitation, as pain can inhibit mobility and overall recovery. **Economic Burden** Chronic pain may result in loss of productivity and increased health-care costs, impacting both individuals and society. **Pain negatively affects all aspects of a pts' life** (unrelieved acute pain can lead to increased hospitalization, delayed healing and may also turn into chronic pain) **6. Nursing Assessments for Clients Experiencing Pain** +-----------------------------------+-----------------------------------+ | **Nursing Assessment** | **Details** | +===================================+===================================+ | **Pain as the 5th Vital Sign** | Recognize pain as an essential | | | assessment, monitoring it | | | routinely along with other vital | | | signs. | +-----------------------------------+-----------------------------------+ | **Routine Pain Screening** | Conduct pain assessments upon | | | admission, during changes in | | | medical status, and before or | | | after procedures. | +-----------------------------------+-----------------------------------+ | **Self-Report as the Gold | Encourage clients to self-report | | Standard** | pain, as it is considered the | | | most reliable measure of pain | | | (nurse-initiated pain assessment) | +-----------------------------------+-----------------------------------+ | **Nurse-Initiated Pain | -Nurses should actively assess | | Assessment** | pain rather than waiting for | | | clients to report it. | | | | | | -Each person experiences and | | | displays pain uniquely, so nurses | | | must assess pain to understand | | | the patient\'s baseline and | | | individual response. Many | | | factors, such as social, cultural | | | beliefs, personality, and values | | | (e.g., viewing pain as weakness), | | | may prevent patients from | | | disclosing pain. | +-----------------------------------+-----------------------------------+ | **Awareness of Beliefs and | Nurses should be aware of their | | Values** | own beliefs and values to avoid | | | bias in pain assessment. | +-----------------------------------+-----------------------------------+ | **Assessing Vital Signs** | Monitor for physiological | | | responses to pain, such as | | | increased heart rate or blood | | | pressure. | +-----------------------------------+-----------------------------------+ | **Behavioral Indicators** | Observe for nonverbal cues of | | | pain, including grimacing, | | | guarding, or signs of discomfort. | +-----------------------------------+-----------------------------------+ | **Assessing Pain | **Use the OPQRSTUV framework to | | Characteristics** | evaluate pain, helping to | | | identify its cause and | | | appropriate interventions.** | +-----------------------------------+-----------------------------------+ **7. OPQRSTUV Pain Assessment Components** Potter & Perry Box 31.6 **Acronym Component** **Description** ------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- **O - Onset** When did the pain begin? How long does it last? How often does it occur? **P - Provoking/Palliating** What brings the pain on? What makes it better? What makes it worse? **Q - Quality** What does the pain feel like? Can you describe it? **R - Region/Radiation** Where is the pain located? Does it spread anywhere? **S - Severity** What is the intensity of the pain on a scale from 0 to 10? Rate it at its best, worst, and on average. **T - Timing/Treatment** Is the pain constant or intermittent? Does it worsen at a particular time? What treatments are currently used, and how effective are they? Any side effects? **U - Understanding/Impact on You** What do you believe is causing the pain? Are there other symptoms? How is the pain affecting you and your family? **V - Values** What is your **goal** (cultural, spiritual or familial considerations) for this pain? What is your comfort or acceptable level for this pain (0--10 scale)? Are there any other views or feelings about this pain that is important to you or your family? Is there anything else you would like to say about your pain that has not been discussed or asked? **8. Pain Assessment Tools and Suitable Populations** +-----------------+-----------------+-----------------+-----------------+ | **Category** | **Pain | **Description** | **Suitable | | | Assessment | | Population** | | | Tool** | | | +=================+=================+=================+=================+ | **Non-Verbal | **FLACC Scale** | **Observes five | Infants and | | Communication | | categories:** | children unable | | Tools** | | Face, Legs, | to verbally | | | | Activity, Cry, | communicate | | | | and | | | | | Consolability | | | | | to assess pain | | | | | levels. | | +-----------------+-----------------+-----------------+-----------------+ | | **PAINAD | Observes | Older adults | | | Scale** | behaviors like | with cognitive | | | | breathing, | impairments | | | | vocalization, | | | | | facial | | | | | expression, | | | | | body language, | | | | | and | | | | | consolability. | | +-----------------+-----------------+-----------------+-----------------+ | | **Faces Pain | -Uses facial | Children and | | | Scale - | expressions to | individuals | | | Revised** | depict pain | with limited | | | | intensity, | verbal | | | | allowing | communication | | | | clients to | | | | | point to the | | | | | face that | | | | | matches their | | | | | pain. | | | | | | | | | | -Uni-dimensiona | | | | | l | | +-----------------+-----------------+-----------------+-----------------+ | **Uni-dimension | **Numeric | **Measures pain | Adults and | | al | Rating Scale | intensity** on | adolescents | | Tools** | (NRS 0-10)** | a 0-10 scale, | capable of | | (looking only | | with 0 as no | self-reporting | | at ONE aspect | | pain and 10 as | | | of pain) | | the worst pain | | | | | possible. | | +-----------------+-----------------+-----------------+-----------------+ | | **Categorical | Provides | Clients who can | | | Scale** | descriptive | understand and | | | | pain levels | choose from | | | | (e.g., mild, | descriptive | | | | moderate, | options | | | | severe) for | | | | | clients to | | | | | select. | | +-----------------+-----------------+-----------------+-----------------+ | **Multi-dimensi | **Brief Pain | Assesses pain | Adults with | | onal | Inventory | intensity, its | chronic pain | | Tools** (two or | (BPI)** | impact on daily | | | more aspects of | | functions, and | | | pain) | | the | | | | | effectiveness | | | | | of pain | | | | | management. | | +-----------------+-----------------+-----------------+-----------------+ | | **McGill Pain | Evaluates | Adults with | | | Questionnaire | sensory, | complex pain | | | (MPQ)** | affective, and | experiences | | | | evaluative | | | | | components of | | | | | pain through | | | | | descriptive | | | | | words and | | | | | intensity | | | | | ratings. | | +-----------------+-----------------+-----------------+-----------------+  **9. Nursing Diagnoses and Expected Outcomes for Pain\*** **Diagnosis** **Description** **Expected Outcome/Goal** -------------------------------- ----------------------------------------------- --------------------------------------------------------------------------------------------------------- **Acute Pain** Pain related to a recent procedure or injury. Pain level will decrease to a tolerable level (e.g., by 50%) within an hour after receiving medication. **Chronic Pain** Pain that has persisted for over six months. Client will identify and use non-drug pain management techniques (e.g., relaxation, heat). **Impaired Physical Mobility** Due to pain, mobility is restricted. Client will demonstrate increased range of motion with pain control within two weeks of treatment. **10. Nursing, Medical and Alternative Interventions for Pain Management** +-----------------------------------+-----------------------------------+ | **Intervention Type** | **Interventions** | +===================================+===================================+ | **Nursing Interventions** | \- Assess and monitor pain status | | | regularly\ | | (Nurse | - Provide support for Activities | | independent/nurse-initiated | of Daily Living (ADLs) and | | interventions) | positioning as needed for | | | comfort\ | | | - Address anxiety related to | | | pain\ | | | - Educate patient and family on | | | different pain management | | | strategies, techniques and | | | support available\ | | | - Advocate for effective pain | | | management for all clients | | | (sometimes pts have difficulty | | | advocating for themselves or they | | | give up when they feel like | | | they've exhausted all possible | | | options)\ | | | - Consult with the pain | | | management team if available | +-----------------------------------+-----------------------------------+ | **Medical Interventions** | \- **Administer medications | | | before pain becomes severe:** | | (Nurse-dependent/physician-initia | Assessment and education are key! | | ted | Educate patients to seek help as | | interventions) | pain begins to increase, so it | | | remains manageable, as severe | | | pain is harder to control\ | | | - Maintain steady serum levels of | | | medication (keeping consistent | | | levels of medication in the | | | body)\ | | | - Use various types, routes, and | | | dosages of medication as needed\ | | | - PRN (as-needed) medications for | | | breakthrough pain\ | | | - Assess effectiveness and watch | | | for side effects after medication | | | administration | | | | | | \- **[Specific | | | Medications:]**\ | | | \* **Acetaminophen** (e.g., | | | Tylenol)**:** Used for mild to | | | moderate pain or combined with | | | opioids for severe pain; Hard on | | | liver, can lead to hepatoxicity.\ | | | \* **NSAIDs** (non-steroidal | | | anti-inflammatory drugs; e.g., | | | Ibuprofen, Aspirin): Used for | | | mild to moderate pain; act on | | | peripheral nerve receptors; | | | Chronic use may lead to GI | | | bleeding and renal issues.\ | | | \* **Adjuvant Therapy or | | | co-analgesics** (e.g., Tricyclic | | | antidepressants, certain | | | anticonvulsants like gabapentin): | | | Enhances therapeutic effects of | | | other pain medications | | | | | | \* **Opioids** (Narcotics; e.g., | | | morphine, codeine, meperidine, | | | oxycodone, CBD oil): Used for | | | moderate to severe pain; act on | | | central nervous system; Monitor | | | for side effects: respiratory | | | depression (RR\