Chapter 42 Comfort Mosby items and derived items

Chapter 42 Comfort Mosby items and derived items © 2005 by Mosby, Inc.

Nature of Pain • • Physical Emotional Cognitive Subjective Mosby items and derived items © 2005 by Mosby, Inc.

Physiology of Pain • • Transduction Transmission Perception Modulation Mosby items and derived items © 2005 by Mosby, Inc.

Neurotransmitters • Substance P • Serotonin • Prostaglandins Mosby items and derived items © 2005 by Mosby, Inc.

Neuromodulators • Endorphins and dynorphins • Bradykinin Mosby items and derived items © 2005 by Mosby, Inc.

Gate-Control Theory of Pain • Gating mechanisms along the CNS • Pain relief measures to close the gate • Pain threshold Mosby items and derived items © 2005 by Mosby, Inc.

Client Responses • Physiological responses • Behavioral responses Mosby items and derived items © 2005 by Mosby, Inc.

Types of Pain • • • Acute pain Chronic pain Cancer pain Pain by inferred pathology Idiopathic pain Mosby items and derived items © 2005 by Mosby, Inc.

Knowledge, Attitudes, and Beliefs • Subjective nature of pain • Nurse’s response to client’s report of pain • Prejudices and misconceptions Mosby items and derived items © 2005 by Mosby, Inc.

Factors Influencing Pain • Physiological – Age – Fatigue – Genes – Neurological function Mosby items and derived items © 2005 by Mosby, Inc.

Factors Influencing Pain (cont'd) • Social – Attention – Previous experience – Family and social support • Spiritual Mosby items and derived items © 2005 by Mosby, Inc.

Factors Influencing Pain (cont'd) • Psychological – Anxiety – Coping style • Cultural – Meaning of pain – Ethnicity Mosby items and derived items © 2005 by Mosby, Inc.

Assessment of Comfort Level • Client’s expression of pain • Characteristics of pain – Onset and duration – Location – Intensity – Quality – Pattern Mosby items and derived items © 2005 by Mosby, Inc.

Assessment of Comfort Level (cont'd) • Characteristics of pain (cont'd) – Relief measures – Contributing symptoms – Behavioral effects on the client – Influences on ADLs • Client expectations Mosby items and derived items © 2005 by Mosby, Inc.

Nursing Diagnoses • • Anxiety Ineffective coping Fatigue Acute pain Chronic pain Ineffective role performance Disturbed sleep pattern Mosby items and derived items © 2005 by Mosby, Inc.

Planning • Goals and outcomes – Client is using pain relief measures safely • Setting priorities • Continuity of care Mosby items and derived items © 2005 by Mosby, Inc.

Implementation: Health Promotion • Client education • Holistic care Mosby items and derived items © 2005 by Mosby, Inc.

Nonpharmacological Pain Relief • • Relaxation and guided imagery Distraction Biofeedback Cutaneous stimulation—massage, application of hot/cold, TENS • Herbals • Reducing painful stimuli and perception Mosby items and derived items © 2005 by Mosby, Inc.

Controlling Painful Stimuli • Managing the client’s environment— bed, linens, temperature • Positioning • Changing wet clothes and dressings • Monitoring equipment, bandages, hot and cold applications • Preventing urinary retention and constipation Mosby items and derived items © 2005 by Mosby, Inc.

Implementation of Comfort Measures • Pharmacological pain relief – Analgesics: NSAIDs and nonopioids, adjuvants – Patient-controlled analgesia (PCA) – Local analgesic infusion pump – Topical analgesics and anesthetics – Local and regional anesthetics Mosby items and derived items © 2005 by Mosby, Inc.

Implementation of Comfort Measures (cont'd) • Surgical interventions • Procedural pain management • Chronic and cancer pain management Mosby items and derived items © 2005 by Mosby, Inc.

Implementation of Comfort Measures (cont'd) • Barriers to effective pain management • Nursing implications for safe and effective implementation of comfort measures Mosby items and derived items © 2005 by Mosby, Inc.

Implementation: Restorative Care • Pain clinics • Palliative care • Hospices Mosby items and derived items © 2005 by Mosby, Inc.

Evaluation • Client care • Client expectations Mosby items and derived items © 2005 by Mosby, Inc.