N 326 Quiz 2 Study Guide Pain – the #1 reason people seek care, defined as whatever the person experiencing the pain says it is, existing whenever the person says it does, it is very subjective, it can cause depression, stress, and anxiety Untreated pain can result in unnecessary suffering (can create mistrust of hospitals), physical and psychosocial dysfunction, impaired recovery from acute illness and surgery (can lengthen hospital stay), immunosuppression, and sleep disturbances (can heighten the perception of pain)- Inadequate knowledge & skills to assess - Unwillingness to believe patient’s report of pain - Lack of time, expertise, perceived importance - Inaccurate & inadequate information regarding dependence, addiction, and tolerance Pain – complex, multidimensional experience, occurs in all clinical settings & among many different groups of patients, unrelieved & inadequately managed pain costs an estimated $100 billion each year- Longer hospital stays, rehabilitation, visits to outpatient clinics - Leads to disability & economic losses- Loss of productive work time costs US economy >$61 billion each year Nursing’s Role - Assessing pain & communicating information to other HCPs - Ensuring initiation & coordination of adequate pain relief measures - Evaluating the effectiveness of these interventions - Advocating for people with pain Universal Pain Assessment Tool – Wong-Baker Facial Grimace Scale – Patients rate pain on a scale of 0-10, zero meaning no pain and ten being the worst possible pain, this tool is good for the cognitively impaired (VS are good indicators of acute pain, but will not necessarily be abnormal with chronic pain) Physiology of Pain – pain causes: thermal, chemical, mechanical stimuli, there are four (4) processes of nociceptive (normal) pain, nociceptive pain originates when the tissue is injured:1. Transduction – stimuli converted to electrical energy, occurs when there is release of chemical mediators2. Transmission – action potential pain impulse, involves the conduct of the action potential from the periphery (injury site) to the spinal cord and then to the brainstem, thalamus, and cerebral cortex3. Perception – point at which person is aware of pain, conscious awareness of pain4. Modulation – inhibition of pain impulse, involves signals from the brain going back down the spinal cord to modify incoming impulsesGate Control Theory of Pain- No specific pain center in nervous system - Wall & Malzack’s (1999) gate control theory – first to suggest that pain has physical AND emotional & cognitive components - Pain impulses pass through when a gate is open & are blocked when gate is closed (try to close the gate so the pain is not perceived) – pain relief intervention basis - Pain threshold & tolerance influence Types of Pain - Acute pain – protective, an identifiable cause, short duration (<6 months), limited tissue damage & emotional response - Chronic pain – lasts longer than expected, may not have an identifiable cause, and leads to great personal suffering, may be noncancerous (arthritis, low back pain, headache) or cancerous - Idiopathic pain – chronic pain in the absence of an identifiable physical or psychological cause - Referred pain – (ex. gallbladder presents in the shoulder) - Breakthrough pain – pain that extends beyond treated steady chronic pain Factors that Influence Pain – age (some people expect it with age but it is not a normal part of the aging process), fatigue, genes, neurological function, attention, previous experience, family & social support, spiritual factors, anxiety, coping style, cultural & ethnicity factors (also women have a higher tolerance for pain, women are more likely to report pain, and women are more likely to have chronic pain)Nursing Process & Pain (Assessment) ABCDE- Ask about pain regularly & assess pain symmetrically - Believe the client & family in their report of pain & what relieves it- Choose pain control options appropriate for the client, family, and setting - Deliver interventions in a timely, logical, and coordinated fashion - Empower clients & their families. Enable them to control their course to the greatest extent possible (if they need it encourage them to demand a pain specialist) Characteristics of Pain – onset & duration, location, intensity, quality, pain pattern, relief measures, contributing symptoms (depression, anxiety, fatigue, sedation, anorexia), effects of pain on the client (influence on ADLs & IADLs) Basic Measures of Pain - Obtain the client’s self-report of pain - Consider underlying painful or potentially painful pathology or condition - Observe behaviors in patients who are unable to report pain - Attempt an analgesic trial with low-dose non-opioid or opioid analgesic (constipation & lethargy)in patients who are unable to report painNon-pharmacological Pain Relief Interventions – relaxation & guided imagery, distraction (music), biofeedback, cutaneous stimulation (massages, cold & heat application, acupressure, TENS –transcutaneous electrical nerve stimulation), herbals, reducing pain perception, do not massage arms and legs, use cold for acute pain Acute Pain Management - Analgesics o Non-steroidal anti-inflammatory drugs (NSAIDs) and non-opioidso Opioids (narcotics) o Adjuvants – corticosteroids, anti-seizure meds, anti-depressants (neuropathic pain – damageto nerves)- NSAIDs provide relief for mild to moderate acute, intermittent pain (ibuprofen), good for headache and postop pain - Opioids prescribed for moderate to severe acute pain, act on CNS, good for postop, chronic non-cancer pain, and cancer pain (elderly and children may have a reverse effect from morphine ) - PCA – drug delivery system; safe for postop and cancer pain management, patient controlled – there are limits on how much and how often, these patients must be assessed frequentlyAspirin – anti-inflammatory, anti-pain (mild to moderate), anti-pyretic, anti-platelet aggregation, watch out for tinnitus, stomach pain, GI bleeding, thrombocytopenia NSAIDs – analgesic, anti-inflammatory, anti-pyretic, watch out for GI distress, dizziness, rash, heartburn, and occult blood loss (ex. Ibuprofen, Aleve) Epidural Anesthesia – used for the treatment of acute postop pain, L&D pain, & chronic pain of cancer, permits control without serious sedative effects of parenteral or oral narcotics