ms1 comfort and pain

7/27/2019 Ms1 Comfort and Pain

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COMFORTAND PAIN


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introduction

Pain is an unpleasant sensory andemotional experience associated with actualor potential tissue damage It is sometimesre!erred to as the FIFT" #ital sign In many

aspects$ pain is the most common reason !orsee%ing health care &ecause pain emanates!rom #arious modalities such as diagnosticstests$ diseases and treatment procedures$

nurses must 'e %nowledgea'le a'out thepathophysiology o! pain and its management


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introductionNurses encounter pain in a #ariety o!

setting$ including acute are$ outpatient$and long term care settings as well as inthe home The nurse has daily encounterswith pain who anticipate pain or who arein pain (nderstanding the phenomenon o!pain and contemporary pain theories helpsthe nurse to inter#ene e!!ecti#ely


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Pain

This is a subjective sensation to which

people respond in different ways. It candirectly impair health and prolong recoveryfrom surgery, disease and trauma. Pain is ahighly unpleasant and very personal

sensation that cannot be shared with others.It can occupy all a persons thinking, direct

all activities, and change a persons life.


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It is the noxious or unpleasant stimulationof threatened or actual tissue damage.This pain sensation is a different sensationbecause the purpose of pain is not to

inform the !" of the #uality of thestimulus but rather to indicate that thestimulus is causing damage or injury to the

tissues. It is the result of a complex patternof stimuli generated at the pain site andtransmitted to the brain for interpretation.


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Common Misconception about Pain

Misconception Correctionlients experience severe painonly when they have had majorsurgery

$ven after minor surgery,clients can experience intensepain

The nurse or the other health

professionals are theauthorities on clients pain.

The person who experiences

the pain is the only authorityon its existence and nature.%dministering analgesicsregularly for pain will lead toaddiction

lients are unlikely to becomeaddicted to an analgesicprovided to treat pain

The amount of tissue damageis directly related to theamount of pain

Pain is a subjective experienceand the intensity and durationof pain vary considerablyamong individuals

&isible physiologic orbehavioral signs accompany

pain and can be used to verify

$ven with severe pain, periodsof physiologic and behavioral

adaptation can occur


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Origin and Causes o! Pain

I Category o! pain according to its origin

A.Cutaneous pain'originates in the skin or subcutaneous tissue

B.Deep somatic pain'arises from ligaments, tendons, bones,blood vessels, and nerves

C.Visceral Pain'results from stimulation of pain receptors in theabdominal cavity, cranium and thorax. It tends to appear diffuseand often feels like deep somatic pain that is, burning aching, orfeeling of a pressure. It is fre#uently caused by stretching of thetissues, ischemia or muscle spasm


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II Category o! pain according to its cause

A.Acute pain'following acute injury,disease or some type of surgery

B. Chronic malignant pain'associatedwith cancer or other progressive disorder

C. Chronic nonmalignant pain'pain inthe persons whose tissue injury is nonprogressive or healed


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*eneral Types o! PainI. Acute pain'may have sudden or slow

onset( it varies from mild to severe, somemay last up to ) months and subsides ashealing takes place. It occurs within *.+second after application of stimulus. Itmay be called fast pain, sharp pain, or

initial pain. Impulses usually travelthrough the type % delta fibers and thispain is easily localied.


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II. Chronic pain'last ) months or longer and oftenlimits normal functioning. It is sometimes calleddull pain, slow pain and delayed pain. Impulses

travel in the type fibers and are not easilylocalied. -npleasant autonomic signs andsymptoms like nausea, sweating and generaliedhypotonia, usually accompany this pain.

III. Cancer-related pain


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Comparison of Acute and Chronic Pain

Acute Pain Chronic PainMild to severe Mild to severe

Sympathetic nervous systemresponse: Increased pulse rate Increased respiratory rate Elevated blood pressure Diaphoresis Dilated pupils

Parasympathetic nervous systemresponse: Vital signs normal Dry warm skin Pupils normal or dilated

Related to tissue inury! resolves withhealing

"ontinues beyond healing

"lients appears restless and an#ious "lients appears depressed andwithdrawn

"lients reports pain "lients o$ten not mention pain unlessasked

"lients behavior indicative o$ pain!

crying% rubbing area% holding area


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Terms (sed in the Context o! Pain

1. Radiating pain'perceived at the source of thepain and extends to the nearby tissues

. Referred pain' pain is felt in a part of the bodythat is considerably removed from the tissues

causing the pain

!. Intractable pain'pain that is highly resistant torelief

". Phantom pain'painful perception perceived ina missing body part or in a body part paralyedfrom a spinal cord injury


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#. Phantom sensation'feeling that themissing body part is still present

$. %&peralgesia'excessive sensitivity to pain'. Pain threshold'is the amount of pain

stimulation a person re#uires in order tofeel pain

(. Pain sensation'can be considered thesame as pain threshold


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). Pain reaction'includes the autonomicnervous system and behavioral responsesto pain

1*.Pain tolerance'maximum amount andduration of pain that an individual is willingto endure

11.+ociceptors'pain receptors

1.Pain perception'the point which theperson becomes aware of the pain


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Pain threshold is similar in all people, but pain istolerance and response vary considerably

Painful sensations are sensed by receptors. e call thereceptors NOCIC+PTOR,. -sually they are free nerveendings located widespread in the superficial layers ofthe skin, peritoneal surfaces, periosteum, arterial walls,

pleural surfaces, joint surfaces and the falx andtentorium of the cranial vault. These nociceptors arenon/adapting to keep us constantly informed of thecontinuous presence of the painful stimulus that can

damage the tissues.


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For pain to 'e percei#ed$ nociceptors must'e stimulated These pain receptors can 'estimulated 'y-

+. "erotonin

0. 1istamine

2. potassium ions

3. %cids

4. some enymes


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In general$ there are . types o! stimuli

that can stimulate pain receptors/Mechanical$ Thermal and Chemical

1. Mechanical stimulus/ pressure, s#ueee, pin prick

. ,hermal stimulus/ heat and freeing temperature

!. Chemical stimulus/ collectively called the 5P6 factors/bradykinin, serotonin, histamine, prostaglandin andsubstance P. These are released when the tissue is injuredor inflamed. They also make the mechanoreceptors verysensitive to pain.


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7887! P%I! "9!:;78$"

0 Post herpetic neuralgia-

.%n episode of herpes has two phases< avesicular eruption and neuralgic pain that

encircles the body. The pain ranges frommild to severe. In the post herpeticsyndrome, severe pain persists formonths or years with lightning/like pain

in the areas of the original eruption.


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1 "eadache-

.This common somatic pain can be caused

by either intracranial or extracranialproblems. To establish a plan to prevent ortreat headache, the nurse needs to assessthe #uality, location, onset, duration, and

fre#uency of the pain, as well as any signsand symptoms that precede the headache.


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. Cancer pain syndrome-

.These syndromes can result from the

progression of the disease or fromefforts to cure or control the disease.


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&asically$ there are three types o! pain stimuli-

+. 8echanical

0. Thermal

2. hemical


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T9P$" 7= P%I! "TI8->ISTIMULUS TYPE PHYSIOLOGIC BASIS

Mechanical &rauma to the body tissues 'e(g(

surgery) *lterations in body tissues 'e(g(

edema) +lockage o$ a body duct &umor Muscle spasm

&issue damage! direct irritation o$ the painreceptors! in$lammation

Pressure pain receptors Distention o$ the lumen o$ the duct Pressure on pain receptors: irritation o$

nerve endings Stimulation o$ pain receptors 'also see

chemical stimuli)

Thermal E#treme heat or cold 'e(g( burns) &issue destruction! stimulation o$

thermosensitive pain receptors

Chemical &issue ischemia 'e(g( blocked

coronary artery Muscle spasm

Stimulation o$ pain receptors because o$accumulated lactic acid 'and otherchemicals such as bradykinin anden,ymes) in tissues

Secondary to mechanical stimulation 'seeabove)% causing tissue ischemia


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The precise mechanism o! paintransmission and perception is un%nown

There are two separate pathways thattransmit pain impulses to the 'rain-

+. Type %/delta fibers are associated withfast, sharp, acute pain and

0. Type fibers are associated with slow,chronic, aching pain


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?ate ontrol Theory by 8elack

and att%ccording to the gate control theory,

peripheral nerve fibers carrying pain to thespinal cord can have their input modified at the

spinal cord level before transmission to thebrain.


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"mall/diameter nerve fibers carry thepain stimuli through the same gate, but

large diameter fibers that carry the non/pain impulses go through the same gateand inhibit the transmission of thosepain impulses/ that is close the gate.

This theory is the basis of many painintervention strategies.


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The gate control theory has led to the

recognition that the pain can 'e reduced ormodulated at !our points-

+. The peripheral site of pain

0. The spinal cord

2. The brainstem

3. The cerebral cortex


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The pain gate situated in the su'stantia

gelatinosa cells in the dorsal horn o! thespinal cord can 'e shut in se#eral ways-

"timulation of touch/fibers by rubbing, stroking, massage,vibration and application of liniments and other ointments.

;elease of endogenous opioids produce in various parts of thecentral nervous system contains neuromodulators that releaseendogenous opioids include enkephalins, endorphins and

dynorphins, which are morphine/like in actions


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$lectrical stimulation of the skins sensory nerve

fibers inhibits pain.

8orphine and other opioids drugs bind to the opioidreceptors in the dorsal horn of the spinal cord and

inhibit or block completely the transmission of thepain signal

!ormal and excessive sensory stimuli may alsorelieve pain by competing with the pain stimuli."uch thing as music, application of heat and cold,imagery and elaborate distractions such as videogames can all be used to close the pain gate


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erebral cortex and thalamic inhibition of painsuch as reducing anxiety and teaching theclient about the pain and helping the client

feel capable of controlling the pain.


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Factors a!!ecting the Pain +xperience

%. $thnicAultural valuesB. %ge

. $nvironment and support persons

:. %nxiety and stress


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;$"P7!"$" T7 P%I!

SYMPATHETICRESPONSES

(IGHT OR LIGHT!

PARASYMPATHETICRESPONSES

(A"APTATION!

Increased pulse rate Decreased pulse rate

Increased systolic bloodpressure

Decreased systolic bloodpressure! syncope

Increased respiratory rate Variable breathing pattern

Diaphoresis -ausea.Vomiting

Increased muscle tension /arm dry skin

Pallor Prostration

Pupil dilatation Pupil constriction

Rapid pitch. elevated pitch Slow% monotonous speech

Increased alertness /ithdrawal


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P%T17P19"I7>7?9 7= P%I!

I PAT"OP"2,IO3O*2 OF PAINTRAN,MI,,ION

PAIN R+C+PTOR, AND ,TIM(3I

.Pain receptors, called nociceptors, are free nerveendings of unmyelinated or lightly myelinatedafferent neurons.

. !ociception is the sensory detection and neural

transmission of unpleasant events.. The !ociceptors are located extensively in the skin

and mucosa and less fre#uently in selected deeperstructures, such as viscera, joints, arterial walls,

and bile ducts.


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!ociceptors respond to harmful or potentiallyharmful stimuli that may be chemical,thermal, or mechanical.

hemical stimuli for pain include histamines,bradykinin, prostaglandins, and acids, some ofwhich are released by damaged tissues.

%noxic tissue also releases chemicals thatlead to pain. Tissue swelling may cause painby creating pressure Cmechanical stimulationDon nociceptors in adjoining tissues.


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%fter tissue injury and in somepathologic conditions, pain receptors do

not adapt to repeated stimulation andmay become more sensitive.

%s a result, pain sensitivity to anormally painful stimulus may beincreased C hyperalgesiaD or a normallynonpainful stimulus, such as touch, maybe painful CallodyniaD.


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PAIN TRAN,MI,,IONPain impulses are transmitted to the spinal cordby two types of fibers< thinl& m&elinatedfaster-conducting A- delta fibers andsloer-conducting unm&elinated C fibers.

The greatest difference lies on the type of painthe pain fibers will transmit. Pain that may bedescribed as 5sharp6 or 5pricking6 and that canbe easily localied results from impulses

transmitted by the %/delta fibers.


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PAIN TRAN,MI,,ION%n example of this type of pain is that felt

by a needle prick.

Pain that may be described as 5burning,6Edull,6 or 5aching6 and that is more diffuseresults from impulses transmitted by the fibers.

Impulses transmitted on the larger diametermyelinated %/beta and %/alpha fibers have aninhibitory effect on those transmitted over %/delta and fibers.


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PAIN TRAN,MI,,IONThe pain impulses cross the spinal cord

over inter/ neurons and connect with

ascending spinal pathways.The most important ascending

pathways for nociceptive impulseslocated in the ventral half of the spinalcord are the spinothalamic tract/,,0 and the spinoreticular tract/R,0.


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PAIN TRAN,MI,,IONThe "TT is a discriminative system and

conveys information about the nature andlocation of the stimulus to the thalamusand then to the cortex for interpretation.

Impulses transmitted over the ";T Cwhichgoes to the brainstem and part of the

thalamusD activate the autonomic andlimbic Cmotivational/affectiveD responses.


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PAIN MOD(3ATION:iscovery of receptors in the brain to

which opiate compounds bind led to thediscovery of two naturally occurringendogenous morphine/likepentapeptidesC4/ amino acidcompoundsD, met and leu-enephalin.

These enkephalins are classified asendorphinsCfrom the termsendogenous and morphineD.


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PAIN MOD(3ATION7ther endorphins, such as beta-endorphin, alsohave been identified.The endorphins are thought to suppress pain by

C+D acting presynaptically to inhibit release of theneurotransmitter substance P or C0D acting post/synaptically to inhibit conduction of painimpulses.

The endorphins are found in high concentrationin the basal ganglia of the brain, thalamus,midbrain, and dorsal horn of the spinal cord.


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PAIN MOD(3ATION:escending spinal pathways from thethalamus through the midbrain and medullato the dorsal horns of the spinal cord, conduct

nociceptive inhibitory impulses.

/erotoninis one neurotransmitter thatsupports these inhibitory impulses.

The endogenous descending pain'suppressive system is more effectivelyactivated by nociceptive stimuli transmittedby %/delta fibers.


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PAIN MOD(3ATION$lectrical stimulation by means of

transcutaneous electrical ner2e

stimulators ,3+/0using lowfre#uency and high intensity activatesopiate analgesia.

Acupunctureis also thought to usethe opiate path ways.


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,PINA3 CORD PAT"4A2, and C+NTRA3 PAT"4A2,

There are numerous pain pathways to the brain.The peripheral nerve fibers enter the dorsalroots of the spinal cord posteriorly, go up two to

three segments and terminate in the nerve cellsof the spinal cord called the substanciagelatinosa.

8ost signals pass through + or 0 more neurons

before reaching long/fibered neurons that crossto the opposite side of the cord.


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,PINA3 CORD PAT"4A2, and

C+NTRA3 PAT"4A2,%scend to the cortex is then completed by

way of the dorsal column system and thespinothalamic system.

The :7;"%> column system functions totransmit impulses that re#uires rapid andaccurate processing, fine gradation of

intensity and discreet localiation.It transmits fine touch.

Pressure, vibration and position sense.


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,PINA3 CORD PAT"4A2, and

C+NTRA3 PAT"4A2,The /I+4,%A5AMIC tractis the pain tract.

It transmits the pain impulses and tenperatureimpulses via the lateral spinothalamic tract to

the brain for pain interpretation.


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T1$7;I$" 7= P%I! T;%!"8I""I7!&arious theories of pain transmission

have been proposed

The affect, specificity, and patterntheories were early theories that led tothe development of the gate controltheory.

!o single theory explains thecomplexity of the pain phenomenon.


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T1$7;I$" 7= P%I! T;%!"8I""I7!%lthough the gate control theory does

not fully explain pain transmission, itserves as a basis for understanding paintransmission.

There are four major theories9 >I&I!?+. Pain generally causes decreased energy,

which affects all aspects of daily living.Patients in pain often find it difficult to

perform basic daily tasks.

0. Pain can make it difficult for the patient

to fall asleep or stay asleep and theresulting lack of sleep can contribute tofatigue


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I8P%T 7= P%I! 7! %TI&ITI$" 7= :%I>9 >I&I!?2. Pain can interfere with the patients

school activities or work. Patients inpain may not be able to concentrate

on work and studies

3. Patients with pain may focus on theirpain and thus be unable to exploreoutside interests and relationships


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T"+ N(R,IN*MANA*+M+NT OF PAIN

NON/P"ARMACO3O*ICA3 APPROAC"+, TO PAINMANA*+M+NT


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%. %ltering Pain Transmission0 +lectrical stimulators.The purpose of electrical stimulators is to

modify the pain stimulus by blocking or

changing the painful stimulus withstimulation perceived as less painful. Thesuccess of this approach is thought to beexplained by the gate control theory of pain

transmission, that is, blockage of painstimulus by stimulation of the large sensoryfibers.


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%. %ltering Pain Transmission1 Neurosurgical procedures

.onstant relentless chronic pain that

cannot be controlled by analgesicsCintractable painD may be reduced oreliminated by one of variousneurosurgical procedures. 7ther forms

of pain control usually are attemptedbefore neurosurgical procedures.


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%. %ltering Pain Transmission.Ner#e 'loc%

.% nerve block involves the injection of substancessuch as local anesthetics or neurolytic agents

Ce.g., alcohol or phenolD close to nerves to blockthe conduction of impulses over the nerves.!erve blocks fre#uently are used for thesymptomatic relief of pain. They are used to treat

chronic pain associated with peripheral vasculardisease, trigeminal neuralgia, causalgia, andcancer.


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%. %ltering Pain Transmission5Acupuncture.%cupuncture is an ancient form of disease

treatment that can be used for pain relief.;ecently, the acupuncture method been used in

estern countries. "mall needles are skillfullyinserted and manipulated at specific body points,depending on the type and location of pain. Thegate control theory provides the best explanation

for the success of acupuncture. The localstimulation of large/diameter fibers by theneedles is thought to 5close the gate6 to pain.


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B. 8odifying Pain ;esponse0&eha#ior modi!ication

.Behavior modification consists of a plannedchange in the way a person behaves by meansof rewarding desired behavior and ignoringundesirable behavior. =orms of behaviormodification are used unconsciously all thetime< a young boy 5throwing a tantrum6 may be

ignored, but as his behavior becomes moreappropriate, his mother may reward him withher time and attention.


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B. 8odifying Pain ;esponseBehavior modification may be useful forpersons with chronic pain. =or example, oneprotocol for patients with chronic low back

pain is to set a limit of +* minutes daily fordiscussion of their pain experiences Cwith theexception of data/gathering interviewsD. Painmedications are given on a regular schedule

to dissociate the feelings of pain withinappropriate use CrewardD of analgesics orother unhealthy behaviors.


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B. 8odifying Pain ;esponse1&io!eed'ac% and autogenic training."ome persons are able to alter their body functionsthrough mental concentration. In biofeedback training amachine that monitors brain wave activityCelectroencephalographD is used. The individual

concentrates on slowing his or her brain wave activity torates at which pain and distress are unlikely to causediscomfort Ci.e., complete relaxationD. It may take manymonths of regular practice to achieve the desired level ofcontrol. The nurse should encourage and praise the

persons efforts.


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B. 8odifying Pain ;esponseIn autogenic training the same type of self/recognition is used to alter various autonomicnervous system functions, such as pulse,

blood pressure, and muscle tension. Practiceduse of transcendental meditation and othermethods of concentration and self/controlmay achieve the same degree of auto

regulation without the use of sophisticatedphysiologic monitoring e#uipment.


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B. 8odifying Pain ;esponse. "ypnosis.1ypnosis may be used in the treatment

of various conditions, particularly whenthese conditions are aggravated bytension and stress. Patients are helped toalter their perception of pain through theacceptance of positive suggestions madeto the subconscious. 8any per sons areable to learn self/hypnosis.


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. 8odifying the Pain "timulus0 Cutaneous stimulation and massage

.The gate control theory of pain

proposes that the stimulation of fibersthat transmit non/painful sensationscan blck or decrease the transmissionof pain impulses. These pain relief

strategies are based on this theory.


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. 8odifying the Pain "timulusutaneous stimulation innervates the large %/beta fibers, closing the gate to impulses fromthe periphery. 8ethods of cutaneous

stimulation include the followingightly rubbing the affected area

0. %pplication of heat or cold to area

2. hirlpool massage of area

3. Back rub or massage can also produce musclerelaxation


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. 8odifying the Pain "timulus1 Reducing additional physical stimuli.%lthough in many instances pain cannot be

prevented, it is often possible to avoid

additional pain when pain is already present.=or example, when moving the body or anextremity, supporting the trunk or extremitywill prevent increasing the pain by unilateral

pulling on muscles, joints, and ligaments.Interventions include the following measures7%TI7!

!urses can ask the individual topoint tot eh site of discomfort. % drawingof the body can assist in identifying the

pain especially among children.:escriptive terms must be used in thedocumentation like proximal, distal,medial, lateral and diffuse.

A t ! li t h i i i


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Assessment o! a client who is experiencingpain includes-

%. omprehensive pain history C8c?ill/8elack Pain LuestionnaireDocation

Intensity Cpain intensity scale, the ongABaker=aces ;ating "caleD

Luality

Pattern

Precipitating factors


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%ssociated symptoms

$ffect on activities of daily living Cscale + to +*D

Past pain experiences

8eaning of pain

oping resources

%ffective ;esponses


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& Daily pain diary

C Physical examination !ocusing onautonomic ner#ous system responses

and 'eha#ioral responses5Because pain is a subjective phenomenon,

pain assessment is complex in process(however, tools are available to assist the nurse

in this matter.6

?uidelines for %ssessment of the Patientith Pain


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0 Assess the characteristics o! the patient;spain

%. "everity of pain

B. Luality, location, duration, and rhythmicity of pain. Tolerance for pain

:. 1armful effects of pain on patients recovery

$. "trategies that patients believe will help relieve pain

=. oncerns the patient has about his pain

?uidelines for %ssessment of the Patient ithPain


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Pain

1 Assess the patient;s 'eha#ioral responsesto the pain experience

%. :etermine if the pain is acute or chronic

B. 7bserve for the following behavioralresponses

+. Physiologic manifestations Cchanges in pulse,blood pressure, respiratory rate, etc.D

0. &erbal statements

2. &ocal responses


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?uidelines for %ssessment of the Patient ith Pain

3. =acial expressions

4. Body movements

). %lteration in response to the environment

J. Physical contact with others

. %daptation of physiologic or behavioral

responses

F. $ffect of pain on ability to communicate andcarry out usual activities of daily living


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?uidelines for %ssessment of the Patient ith Pain

. Assess !actors that in!luence responsesto pain

%. $thnic and cultural factors

B. Previous pain experiences

. 8eaning of the pain experience

:. Patients responses to pain reliefstrategies


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DIA*NO,I,

%lthough nursing diagnosis given toclients suffering pain is pain or chronicpain, the pain itself may be the etiologyof the many other nursing diagnoses.


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Planning-

7verall client goals include preventing,modifying or eliminating pain so thatthe client is able partially or completelyto resume usual daily activities and to

cope more effectively with the painexperience.


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hen planning, nurses need to choosepain relief measures appropriate for theclient. !ursing interventions mayinclude a variety of pharmacological andnon/pharmacological interventions,

selecting several strategies from bothbroad categories is usually mosteffective.


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"cheduling measures to prevent pain isfar more supportive of the client thantrying to deal with pain once the clientperceives it.


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IMP3+M+NTIN*

Pain management includes two basic nursinginterventions< pharmacological and non/pharmacological measures


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Ma>or nursing functions for all clients are-

%.To acknowledge and convey belief inthe clients pain

B.To assist support persons

.To reduce misconceptions about pain

:.To reduce fear and anxiety associatedwith the pain

Pharmacological interventions, ordered by thephysician include the use of opioids


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physician, include the use of opioids,nonopioidsA!"%I:" and adjuvant drugs

The nurse assesses the clients pain needs,administers the ordered analgesics and evaluatesthe clients response to analgesics provided.

%nalgesic medication can be delivered in severalways to meet the specific needs of individuals.8ore recent methods include long acting andli#uid morphine, transdermal preparations,

continuous intravenous infusions and intraspinalinfusion.

Patient controlled analgesia CP%D enables the


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Patient/controlled analgesia CP%D enables theclient to exercise control the minimie feelings ofhelplessness

Physical nonpharmacologic pain interventionsinclude cutaneous stimulation, hot and cold

applications, massage, acupressure, contralateralstimulation, transcutaneous electrical nervestimulations CtensD( and acupuncture.

!urses can also promote hygiene and comfort.

Bed bath, warm or cold shower, Bed rest, cleanbed sheets, fre#uent repositioning and oralAskincare are very important relief measures


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!urses can also teach anticipatory guidance.The nurse can teach the post/operativepatients how to minimie surgical pain likesplinting the incision with pillow, positioningtechni#ues, and pre/medication beforeactivities.

ognitive/behavioral interventions include

distraction techni#ues( relaxation techni#uesguided imagery, biofeedback, therapeutictouch and hypnosis


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+6A3(ATION

$valuation of the clients pain therapyincludes(

%. The response of the client

B. The changes in the pain

. The clients perceptions of the effectiveness ofthe therapy

:. 7ngoing verbal or written feedback from theclient and family is integral to this process


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,(MMAR2


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Painis a subjective experience that iswhatever the patient says it is and occurswhenever the patient says it occurs

%lthough pain is a source of human misery, itminimies injury and warns of disease

%ll pain relief measures are based on athorough ongoing nursing assessment


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$stablishing rapport between the nurse and thepatient enhances the effectiveness of pain reliefmeasures

/edationdoes not always indicate pain relief

Because patients may not always report pain,the nurse must assess them regularly


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Patients of all ages experience pain, but theway they express pain differs with age

The nurse should be able to recogniephysiologic, psychological and non/verbal waysof expressing pain

>ack of pain expressions does not alwaysmean lack of pain


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!on/invasive pain relief measures can increase theeffectiveness of pharmacological or invasive methods

The nurses optimistic attitude about expected painrelief helps produce a positive result

$ducating the patient and family about pain reduces

the anticipatory fear and anxiety, thereby increasingthe patients tolerance


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-sing a preventive approach for pain relief is more

beneficial than waiting until pain becomes severe

Intramuscularand intra2enousroutes are

utilied for severe pain and the intramuscular formoderate pain and oral for mild pain

The nurse must utilie the nursing process inrelieving patient of 5painful experiences6

ms1 comfort and pain

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