concepts related to the care of individuals pain concepts of nursing nur 123
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Concepts Related to the Care of IndividualsConcepts Related to the Care of Individuals
PAINPAIN
Concepts of Nursing NUR 123
PainPain
Is a highly unpleasant and very personal Is a highly unpleasant and very personal sensation that cant be shared with other.sensation that cant be shared with other.
It is considered the fifth vital sign.It is considered the fifth vital sign.
It is one of the human body defence It is one of the human body defence mechanisms that indicates the person is mechanisms that indicates the person is experiencing problem. experiencing problem.
Sources of PainSources of Pain
NociceptiveNociceptive: pain that is usually transmitted : pain that is usually transmitted after normal processing of noxious stimuli after normal processing of noxious stimuli
NeuropathicNeuropathic: results from injury or abnormal : results from injury or abnormal functioning of peripheral nerves or CNS functioning of peripheral nerves or CNS
PsychogenicPsychogenic: unknown physical cause : unknown physical cause
PHYSIOLOGY OF PAIN
SOURCES
Chemical/Thermal
Injury, Inflammation Heat, Cold
PAIN RECEPTORS
(Nociceptors)
DISCHARGE IMPULSES
Electrical Activity to spinal cord and onto the Brain
BRAIN = Electrical activity becomes the experience of
PAIN
Duration of pain Duration of pain
Acute pain: generally rapid in onset, varies in Acute pain: generally rapid in onset, varies in intensity from mild to severe, lasts from brief intensity from mild to severe, lasts from brief period to less than 6 months period to less than 6 months
Duration of painDuration of pain
Chronic pain: may be limited, intermittent or Chronic pain: may be limited, intermittent or persistent but lasts for 6 months or longer and persistent but lasts for 6 months or longer and interferes with normal functioning. interferes with normal functioning.
Remission: when the pain present but the patient does Remission: when the pain present but the patient does experience symptomsexperience symptoms
Exacerbation: reappearance of symptoms Exacerbation: reappearance of symptoms
Intractable pain: resistant pain to therapy, and persists Intractable pain: resistant pain to therapy, and persists despite a variety of interventionsdespite a variety of interventions
Origin of PainOrigin of Pain
Physical cause — cause of pain can be Physical cause — cause of pain can be identifiedidentified
Psychogenic — cause of pain cannot be Psychogenic — cause of pain cannot be identifiedidentified
Referred — pain is perceived in an area Referred — pain is perceived in an area distant from its point of origindistant from its point of origin
Pain thresholdPain threshold
Is the lowest intensity of stimulus that causes Is the lowest intensity of stimulus that causes the subject to recognize pain the subject to recognize pain
Common Responses to PainCommon Responses to Pain
Physiologic: ↑BP, ↑HR,↑RR, pupil dilation, Physiologic: ↑BP, ↑HR,↑RR, pupil dilation, muscle tension and tension rigidity, pallor, muscle tension and tension rigidity, pallor, ↑adrenaline level, ↑blood glucose ↑adrenaline level, ↑blood glucose
Behavioral: grimacing, moaning, crying, Behavioral: grimacing, moaning, crying, restlessnessrestlessness
Common Responses to PainCommon Responses to Pain
Affective: exaggerated weeping, Affective: exaggerated weeping, withdrawal, anxiety, depression, fear, anger, withdrawal, anxiety, depression, fear, anger, anorexia, fatigue, hopelessness, anorexia, fatigue, hopelessness, powerlessness.powerlessness.
Factors Affecting Pain ExperienceFactors Affecting Pain Experience
CultureCulture Ethnic variablesEthnic variables Family, gender, and age variablesFamily, gender, and age variables Religious beliefsReligious beliefs Environment and support peopleEnvironment and support people Anxiety and other stressorsAnxiety and other stressors Past pain experiencePast pain experience
General Assessments of PainGeneral Assessments of Pain
Patient’s verbalization and description of painPatient’s verbalization and description of pain
Duration of painDuration of pain
Location of painLocation of pain
Quantity and intensity of painQuantity and intensity of pain
Quality of painQuality of pain
General Assessments of PainGeneral Assessments of Pain
Chronology of pain Chronology of pain
Aggravating and alleviating factorsAggravating and alleviating factors
Behavioral responsesBehavioral responses
Effect of pain on activities and lifestyleEffect of pain on activities and lifestyle
Pain assessment tools Pain assessment tools
WILDA Scale WILDA Scale
WWords that describe the painords that describe the pain IIntensity of painntensity of pain LLocation of painocation of pain DDuration of painuration of pain AAggravating or ggravating or AAlleviating factorslleviating factors
Diagnosing PainDiagnosing Pain
Type of painType of pain
Etiologic factorsEtiologic factors
Behavioral, physiological, affective responseBehavioral, physiological, affective response
Other factors affecting pain processOther factors affecting pain process
Nursing Diagnosing Diagnosing
NANDA includes the following diagnostic labels for clients experiencing pain or discomfort:
Acute pain Chronic pain
When writing the diagnostic statement, the nurse should specify the location (e.g, left frontal headache)
Nursing DiagnosingDiagnosing
Pain may be the etiology of other nursing diagnosis. e.g:
-Disturbed sleep pattern related to increased pain perception at night
Nursing Interventions for PainNursing Interventions for Pain
Establishing trusting nurse-patient relationshipEstablishing trusting nurse-patient relationship
Initiating nonpharmacologic pain relief measuresInitiating nonpharmacologic pain relief measures
Considering ethical and legal responsibility to relieve Considering ethical and legal responsibility to relieve painpain
Teaching patient about pain and home careTeaching patient about pain and home care
Manipulating Pain Experience FactorsManipulating Pain Experience Factors
Remove or alter cause of painRemove or alter cause of pain
Alter factors affecting pain toleranceAlter factors affecting pain tolerance
Initiate nonpharmacologic relief measuresInitiate nonpharmacologic relief measures
Nonpharmacologic Pain Relief MeasuresNonpharmacologic Pain Relief Measures
DistractionDistraction HumorHumor MusicMusic ImageryImagery RelaxationRelaxation Acupuncture Acupuncture HypnosisHypnosis Therapeutic touchTherapeutic touch
Pharmacologic Pain Relief MeasuresPharmacologic Pain Relief Measures
Analgesic administrationAnalgesic administration
Nonopiod analgesics e.g. NSAIDsNonopiod analgesics e.g. NSAIDs
Opioids or narcotic analgesicsOpioids or narcotic analgesics
Adjuvant drugs e.g. anticonvulsants, Adjuvant drugs e.g. anticonvulsants, antidepressants, .. antidepressants, ..
Why clients may be reluctant to reportWhy clients may be reluctant to report pain:pain:
Fear of injectable route of analgesic administrationFear of injectable route of analgesic administration
Belief that pain is to be expected as apart of the recovery Belief that pain is to be expected as apart of the recovery processprocess
Belief that pain is a normal part of agingBelief that pain is a normal part of aging
Belief that expression of pain reveal weaknessBelief that expression of pain reveal weakness
Concerns about side effects and risks especially of opioid Concerns about side effects and risks especially of opioid drugs drugs
Additional Methods for Administering Additional Methods for Administering AnalgesicsAnalgesics
Patient controlled analgesiaPatient controlled analgesia
Epidural analgesiaEpidural analgesia
Local anesthesiaLocal anesthesia