Download Airgas template

Chapter 41
Comfort
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Categories of Pain
• Source
– Nociceptive
– Neuropathic
– Psychogenic
• Area to which it is referred
• Duration
– Acute
– Chronic
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Sources of Pain
• Nociceptive
• Cutaneous
• Somatic
• Visceral
• Neuropathic
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Origin of Pain
• Physical—cause of pain can be identified
• Psychogenic—cause of pain cannot be identified
• Referred—pain is perceived in an area distant from its
point of origin
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Pain Process
• Transduction—activation of pain receptors
• Transmission—conduction along pathways (A-delta and
C-delta fibers)
• Modulation—initiation of the protective reflex response
• Perception of pain—awareness of the characteristics of
pain
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Stimulator of Nociceptors or
Pain Receptors
• Bradykinin
• Prostaglandins
• Substance P
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Gate Control Theory of Pain
• Relationship between pain and emotions
• Small and large diameter nerve fibers conduct and inhibit
pain stimuli
• Gating mechanism determine impulses that reach the
brain
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Perception of Pain
• Pain threshold
• Adaptation
• Modulation of pain
– Neuromodulators
– Endorphins, dynorphins, enkephalins
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Pain Sensation and Relief
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Common Responses to Pain
• Physiologic
• Behavioral
• Affective
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Duration of Pain
• Acute
– Rapid in onset, varies in intensity and duration
– Protective in nature
• Chronic
– May be limited, intermittent, or persistent
– Lasts for 6 months or longer
– Periods of remission or exacerbation are common
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Factors Affecting Pain Experience
• Culture
• Ethnic variables
• Family, gender, and age variables
• Religious beliefs
• Environment and support people
• Anxiety and other stressors
• Past pain experience
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Assessment Parameters for Pain
• Psychological
• Emotional
• Sociologic
• Physiologic
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
General Assessments of Pain
• Patient’s verbalization and description of pain
• Duration of pain
• Location of pain
• Quantity and intensity of pain
• Quality of pain
• Chronology of pain
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
General Assessments of Pain (cont.)
• Aggravating and alleviating factors
• Physiologic indicators of pain
• Behavioral responses
• Effect of pain on activities and lifestyle
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Pain Assessment Tools
• McGill-Melzack pain questionnaire
• Pain scale
• McCaggery method
• WILDA pain measurement scale
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
WILDA Scale
• Words that describe the pain
• Intensity of pain
• Location of pain
• Duration of pain
• Aggravating or alleviating factors
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Diagnosing Pain
• Type of pain
• Etiologic factors
• Behavioral, physiologic, affective response
• Other factors affecting pain process
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Interventions for Pain
• Establishing trusting nurse-patient relationship
• Initiating nonpharmacologic pain relief measures
• Considering ethical and legal responsibility to relieve pain
• Teaching patient about pain
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Manipulating Pain Experience Factors
• Remove or alter cause of pain
• Alter factors affecting pain tolerance
• Initiate nonpharmacologic relief measures
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nonpharmacologic Pain Relief Measures
• Distraction
• Humor
• Music
• Imagery
• Relaxation
• Cutaneous stimulation
• Acupuncture
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nonpharmacologic Pain Relief Measures
(cont.)
• Hypnosis
• Biofeedback
• Therapeutic touch
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Pharmacologic Pain Relief Measures
• Analgesic administration
• Nonopiod analgesics
• Opioids or narcotic analgesics
• Adjuvant drugs
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
The WHO 3-Step Analgesic Ladder
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Numeric Sedation Scale
• 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 © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
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 © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Additional Methods for
Administering Analgesics
• Patient-controlled analgesia
• Epidural analgesia
• Local anesthesia
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Placement of an Epidural Catheter
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
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 © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
Answer: B. Somatic
Rationale:
Deep somatic pain is diffuse or scattered and originates
in tendons, ligaments, bones, blood vessels and nerves.
Cutaneous pain usually involves the skin or subcutaneous
tissue.
Visceral pain is poorly localized and originates in body
organs.
Referred pain is pain that originates in one part of the
body and is perceived in an area distant to that part.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
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 © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
Answer: B. False
The best judge of the existence and severity of a
patient’s pain is the patient.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Which of the following modulators 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 © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
Answer: C. Enkephalins
Rationale:
Enkephalins are thought to reduce pain by inhibiting the
release of substance P from the terminals of afferent
neurons.
Endorphins and dynorphins are released when certain
measures are used to relieve pain.
Nociceptors are the peripheral nerve fibers that transmit
pain.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Which of the following pain assessment tools is
recommended for use with children?
A. McGill-Melzack pain questionnaire
B. McCaggery method
C. WILDA pain measurement scale
D. Wong-Baker FACES
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
Answer: D. Wong-Baker FACES
Rationale:
The Wong-Baker FACES pain rating scale asks children to
compare their pain to a series of faces ranging from a
broad smile to a tearful grimace. This scale is visual and
easy to interpret for young children and older adults.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
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 © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
Answer: D. 3
Rationale:
3 denotes that the patient is frequently drowsy and hard
to awake.
1 means the patient is awake and alert.
2 denotes the patient is occasionally drowsy, but easy to
arouse.
At 4 the patient is somnolent with minimal or no
response to stimuli.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins