NSG 326 Adult Health IPainSlide 3Nursing’s RoleSlide 5Physiology of PainSlide 7Slide 8Gate-Control Theory of PainTypes of PainReferred PainFactors Influencing PainNursing Process & PainCharacteristics of PainSlide 15Basic Measures of PainNonpharmacological Pain Relief InterventionsAcute Pain ManagementSlide 19Slide 20Epidural AnesthesiaBarriers to Effective Pain ManagementSlide 23Slide 24Slide 25Slide 26Slide 27Slide 28Prepared by Dr. K. A. EnnenNSG 326 Adult Health I Week #3Pain2PainDefined as whatever the person experiencing the pain says it is, existing whenever the person says it does.Untreated pain can result in unnecessary suffering, physical & psychosocial dysfunction, impaired recovery from acute illness & surgery, immunosuppression, & sleep disturbances.•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, & tolerance3PainComplex, multidimensional experienceMost common reason for health care visitsOccurs in all clinical settings & among many different groups of patients.Unrelieved & inadequately managed pain costs an estimated $100 billion each year.•Longer hospital stays, rehospitalizations, visits to outpatient clinics•Leads to disability & economic losses•Loss of productive work time costs US economy > $61 billion each year.4Nursing’s RoleAssessing pain & communicating information to other health care providersEnsuring initiation & coordination of adequate pain relief measuresEvaluating the effectiveness of these interventionsAdvocating for people with pain56Physiology of PainPain causes: thermal, chemical, mechanical stimuliFour (4) processes of nociceptive (normal) pain:•Transduction•Stimuli converted to electrical energy•Transmission•Action potential pain impulse •Perception•Point at which person is aware of pain•Modulation•Inhibition of pain impulse789Gate-Control Theory of PainNo specific pain center in nervous systemWall & Malzack’s (1999) gate-control theory•First to suggest that pain has physical AND emotional & cognitive componentsPain impulses pass through when a gate is open & are blocked when gate is closed•Pain-relief intervention basisPain threshold & tolerance influence10Types of PainAcute 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 cancerousIdiopathic pain•Chronic pain in the absence of an identifiable physical or psychological causeReferred painBreakthrough pain•Pain that extends beyond treated steady chronic pain11Referred Pain12Factors Influencing PainAgeFatigueGenesNeurological FunctionAttentionPrevious experienceFamily & Social supportSpiritual factorsAnxietyCoping styleCultural & Ethnicity factors13Nursing Process & PainAssessment•ABCDE•Ask about pain regularly & assess pain systematically•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.14Characteristics of PainOnset and durationLocationIntensityQualityPain patternRelief measuresContributing symptoms•For example: Depression, anxiety, fatigue, sedation, anorexiaEffects of pain on client•Influence on ADLs & IADLs1516Basic Measures of PainObtain the client’s self-report of painConsider underlying painful or potentially painful pathology or conditionObserve behaviors in patients who are unable to report painAttempt an analgesic trial with low-dose non-opioid or opioid analgesic in patients who are unable to report pain17Nonpharmacological Pain Relief InterventionsRelaxation & Guided ImageryDistraction•MusicBiofeedbackCutaneous stimulation•Massages•Cold & heat applications•Acupressure•TENS (Transcutaneous electrical nerve stimulation)HerbalsReducing pain perception18Acute Pain ManagementAnalgesics•Nonsteroidal antiinflammatory drugs (NSAIDs) and nonopioids•Opioids (narcotics)•AdjuvantsNSAIDs provide relief for mild to moderate acute intermittent pain•Headache, postop painOpioids prescribed for moderate to severe acute pain, act on CNS•Postop, chronic noncancer pain, and cancer painPCA – drug delivery system; safe for postop and cancer pain management21Epidural AnesthesiaUsed for treatment of acute postop pain, L&D pain, & chronic pain of cancer.Permits control w/o serious sedative effects of parenteral or oral narcotics.22Barriers to Effective Pain ManagementComplex involving the client, health care provider, family, & health care system•Addiction fears•Inadequate pain assessment•Dollar amount reimbursed•Reluctance to discuss pain•Belief pain is part of
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