MedicalSurgical Nursing An Integrated Approach 2 E Chapter

Medical-Surgical Nursing: An Integrated Approach, 2 E Chapter 14 PAIN MANAGEMENT

Pain An unpleasant sensory and emotional experience associated with actual or potential tissue damage. n Whatever the client says it is, existing whenever the client says it does. n

Nature of Pain A major function of pain is to signal ongoing or potential tissue damage. n Pain can also be a protective mechanism against further injury. n

Types of Pain n Pain Categorized by Origin. n Pain Characterized by Nature.

Pain Characterized by Origin n Cutaneous Pain (caused by stimulation of the cutaneous nerve endings in the skin). n Somatic Pain (nonlocalized and originates in support structures such as tendons, ligaments, and nerves). n Visceral Pain (discomfort in the internal organs). n Referred Pain (originating from the abdominal organs).

Pain Characterized by Nature n Acute Pain: Sudden onset, relatively short duration; mild to severe intensity; steady decrease in intensity over days to weeks. n Chronic Pain: Long-term (lasting six months or longer), persistent, nearly constant, or recurrent pain that produces significant negative changes in the client’s life.

Physiology of Pain n The body cannot sustain the extreme stress response of pain for more than short periods of time. n The body will conserve its resources by adapting even in the face of continuing pain of the same intensity.

The Gate Control Theory of Pain n Theorizes that person experiences pain with combination of these processes: n Sensory. n Motivational-Affective. n Cognitive.

Conduction of Pain Impulses Transduction (stimulus triggered). n Transmission (impulse travels to spinal cord). n Perception (neural message converted into subjective experience). n Modulation (pain transmitters selectively inhibited). n

Factors Affecting Pain Experience Age. n Previous Experience with Pain. n Cultural Norms. n

Assessment: Subjective Data Location of pain. n Onset and duration. n Quality. n Intensity (on a scale of 1 to 10). n Aggravating and relieving factors. n How pain affects the activities of daily living. n

Assessment: Objective Data Physiologic (Acute pain involves elevated respiratory rate and blood pressure; pallor; dilated pupils, etc. Chronic pain shows adaption). n Behavioral (Acute pain behaviors include crying, moaning, clenched fists, etc. Chronic pain behaviors include depression, listlessness, loss of libido and weight). n

Nursing Diagnoses n Two primary diagnoses used to describe pain are acute and chronic.

General Principles of Pain Relief Individualize the approach. n Use a preventive approach. n Use a multidisciplinary approach. n

Nursing Interventions Pharmacological. n Noninvasive. n Invasive. n

Nurse’s Role in Administering Analgesics Determine whether or not to give the analgesic. n Assess the client’s response to the analgesic. n Report to the physician when a change is needed. n Teach the client and family regarding the use of analgesics. n

Principles of Administering Analgesics n Preventive approach. n Titrate to effect.

Preventive Approach Pain is much easier to control if treated when it is anticipated or at a mild intensity. n Two methods of preventive approach are ATC (around the clock) and PRN (“as required”). n

Titrate to Effect n The analgesic regimen needs to be titrated until the desired effect is achieved. n This involves adjusting the following: n n Dosage. Interval. Route. Choice of drug.

Three Classes of Analgesics Nonopioid. n Opioid. n Analgesic adjuvants. n

Cognitive-Behavioral Interventions n Trusting Nurse- Client Relationship. n Relaxation. n Reframing. n Distraction. n Guided Imagery. n Humor. n Biofeedback.

Reframing n Teaching clients to monitor their negative thoughts and replace them with ones that are more positive.

Guided Imagery n Using one’s imagination to provide a pleasant substitute for the pain.

Biofeedback n A process through which individuals learn to influence their physiological responses to stimuli.

Cutaneous Stimulation The technique of stimulating the skin to control pain. n Includes: n Heat and cold application. n Cryotherapy (cold applications) n Acupressure and massage. n Mentholated rubs. n Electrical Nerve Stimulation. n

Transcutaneous Electrical Nerve Stimulation n The process of applying a low-voltage electrical current to the skin through cutaneous electrodes.

Other Noninvasive Pain Interventions Psychotherapy (including hypnosis). n Exercise. n Positioning and Body Alignment. n

Invasive Pain Interventions Used when noninvasive and pharmacological measures do not provide adequate relief. n Include: n n n Nerve block. Neurosurgery. Radiation therapy Acupuncture.