Promoting Rest Comfort Chapter 16 Pain and nonverbal
Promoting Rest & Comfort Chapter 16
Pain and non-verbal expression • Pain signals actual or potential damage to the body • Everyone’s pain threshold and tolerance is different & individual • A person’s family, culture, previous experience with pain & current emotional state can influence acknowledgment or denial of pain and their reaction to pain. • Non-verbal expressions of pain include: (pg, 277) • Wincing or grimacing frowning or worried expression decreased appetite • Rubbing body part guarding (protecting) area rocking or pacing • Moaning or crying care restlessness or aggressive behavior resisting
Differences in Pain When a patient says they are in pain we believe and acknowledge their pain and it’s intensity since we can not feel what they do. 1. Acute: occurs suddenly usually sudden injury or illness lasts less than 6 months and 3. Pain threshold: point at which person becomes aware of pain (individualized). gets better over time as healing progresses 2. Chronic: last beyond 6 months may be constant or intermittent ranges in intensity from mild to severe. 4. Pain tolerance: highest level of discomfort that person is willing to experience before seeking to relieve it.
Elderly people are more likely to have chronic pain due to ageing conditions and co-morbities. According to the International Association for the Study of pain, about 50% of older people living in a community and 80% of those living in nursing homes have chronic pain. Pain Medications, Dependence and Addiction Opioids: work on the central nervous system. In most cases people who have pain function better with the use of these medicines. Why? Dependence: the body becomes physically dependent on the medication and higher doses are required to achieve the same effect. Dependence & Addiction are not the same! Addiction: has both a mental and physical component. The person is driven to seek the drug at all costs, and obtaining the drug becomes the focus of their world.
Pain is not a natural process of ageing Conditions causing chronic pain Arthritis Osteoarthritis Peripheral neuropathy Cancer Osteoporosis Amputation GERD—gastroesophageal reflux disease Reasons for refusing pain medication Being fearful of what the pain means (Do I have I? cancer? My father had ALS—do Not wanting to be a bother Taught to be stoic and not complain Not wanting the side effects that come with some pain medications (diarrhea, constipation, nausea) Fear of addiction Not wanting to worry loved ones & family members
Reporting & Documenting Pain Hot & Cold applications require a doctors order!! Should never be put directly on skin. Tempeture should be no higher than 105 F, and removed at least every 20 min. for assessment. • • Location of pain Characteristics of pain Intensity of pain Frequency of pain
Consequences of Untreated Pain Body, Mind & Spirit is focused on the pain. • Decreased mobility == muscle stiffness, lung congestion, decreased motility of digestive system (constipation), increased occurrence of blood clots • Sleep disturbances == decreases healing, increases aggression and mood chances, increases confusion in elderly, reaction time slow, unsteady when walking increases falls. • Emotional effects == increased depression and anxiety • Decreased ability or desire to perform usual functions == personal hygiene, spiritual services, socialization (group activities), family interactions (prefers to be alone),
Relieving Pain and Promoting Rest & Comfort • Ways to Relieve Pain: • Promoting Rest & Comfort • Reposition • Know pg. 281 • Quiet environment (speech travels at nite, call lights, other patients, overhead pages) • Soothing music, or TV with low sound • Shower or sponge bath before bed • Massage • Making sure they have everything at hands reach that they might need during rest (call light, tissues, water, phone) increases security and decreases anxiety. • Toileting • Distraction (mind can only pay attention to so many signals at a time. • Massages • Heat or Cold applications ( MD ordered) • Hot & Cold applications require a doctors order!! Should never be put directly on skin. Temperature should be no higher than 105 F, and removed at least every 20 min. for assessment. Cold applications require 60 min. in-between applications • Quiet, resting environment • BE OBSERVANT & Report to Nurse • Is the pain medication working? You can ask but also be aware of non-verbal expressions. Do they walk better? Do they guard the area less? Can they sleep now (not as restless)? Has their mood improved?
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