CARING FOR CLIENTS WITH PAIN

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CARING FOR CLIENTS WITH PAIN

• MEDICAL SURGICAL NURSING I
• CHAPTER 16

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TYPE OF PAIN

• CLASSIFIED BY
• ITS SOURCE
• Nociceptive
• Neuropathic
• ITS ONSET, INTENSITY, DURATION
• Acute
• Chronic

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NOCICEPTIVE PAIN-normally transmitted pain fig
16-1

• SOMATIC PAIN affects bones, joints, muscles,
  skin or other structures made up of connective
  tissue
• superficial pain or cutaneous pain
• deeper pain such as a fractured bone

• VISCERAL PAIN arises from internal organs
  caused by ischemia, compression of an organ,
  intestinal distention with gas or spasms
• usually accompanied by n/v, pallor,
  hypotension, sweatin
• Referred pain pain perceived in the general
  area of the body where the organ is located fig
  16-2

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NEUROPATHIC PAIN

• Pain that is processed abnormally by the nervous
  system due to damage to either the pain pathway
  in the peripheral nerve or pain processing center
  in the brain
• Example phantom limb pain in a person that has
  had an amputation
• Cancer pain may be either
• nociceptive when the tumor creates pressure
  in the organ or
• neuropathic when drugs or radiation used to
  treat the cancerous tumor cause nerve damage

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Characteristics of acute chronic pain

• ACUTE PAIN
• Short duration few seconds to lt 6 months
• Associated with trauma or other recent
  identifiable etiology or cause

• CHRONIC PAIN
• lasts longer than 6 months
• people around the pt begin to show negative
  reactions to the chronic pain sufferer such as
• box 16-1

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PAIN TRANSMISSION-fig 16-3

• Transduction the conversion of chemical
  information in cellular environment to electrical
  impulses that move toward the spinal cord
• Transmission phase in which peripheral nerve
  fibers form synapses with neurons in the spinal
  cord

• Perception phase in which the brain experiences
  pain at a conscious level also known as the pain
  threshold
• pain tolerance is different for everyone
  influenced by gender, age culture
• Modulation phase in which the brain interacts
  with the spinal nerves to alter the pain
  experience with pain-inhibiting neurochemicals

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PAIN ASSESSMENT

• Pain is whatever the person says it is, and
  exists whenever the person says it does
• Margot McCaffery, nursing pain expert
• Assessment biases exist among nurses. Many feel
  that a person must look like they are in pain.
• Assessment tools exist to try quantify what a
  pts pain is fig 16-4
• Simple descriptive pain scale
• 0 10 Numeric pain intensity scale
• Visual analog scale
• Wong-Baker FACES scale fig 16-5

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ASSESSMENT STANDARDS

• Established by the Joint Commission on
  Accreditation of Healthcare Organizations or
  JCAHO
• Everyone has the right to assessment and
  management of pain
• Pain is assessed using a tool that is
  appropriate for the persons age, developmental
  level, health condition, and cultural identity
• Pain must be regularly assessed
• Pain is treated or the client referred
  elsewhere
• Health care workers must receive education
  regarding pain assessment management
• Clients their families must also receive
  education
• The clients choices regarding pain management
  are respected

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PAIN MANAGEMENT

• Techniques used to prevent, reduce, or relieve
  pain
• Block the pain perception
• Interrupt pain-transmitting chemicals at the site
  of injury
• Combine analgesics with adjuvant drugs
• Substitute sensory stimuli over shared pain
  neuropathways
• Alter pain transmission at the level of the
  spinal cord

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PAIN MANAGEMENT

• DRUG THERAPY - table 16-1
• Analgesics
• Opiods or Narcotics Demerol, Morphine
• Nonopiods or Nonnarcotics
• asa, NSAIDS

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Methods of Administration

• Oral, rectal, transdermal, parenteral
• Patient Controlled Analgesia or PCA allows pts
  to self-administer their own analgesic by means
  of a IV pump nurse programs dose time
  intervals into the pump to prevent overdose
• Intraspinal Analgesia a narcotic or local
  anesthetic is infused into the subarachnoid or
  epidural space through a catheter inserted by the
  MD

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DRUG THERAPY

• Addiction a repetitive pattern of drug seeking
  drug use to satisfy a craving for a drugs mind
  or mood-altering effects fewer than 1 of pts
  actually become addicted
• Tolerance a condition in which a client needs
  larger doses of a drug to achieve the same effect
  as when they 1st started the drug not an
  indicator of addiction
• Physical dependence means that a person has
  physical discomfort or withdrawal symptoms when a
  drug that is routinely taken is abruptly
  withdrawn. These drugs should be dcd gradually
  over a week or more

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ADJUVANT DRUG THERAPY

• Drugs that are not ordinarily used for pain
  relief
• May achieve better results than pain relieving
  drugs alone
• Antidepressants
• Corticosteroids
• Anticonvulsants
• Psychostimulants

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NONDRUG INTERVENTIONS

• HEAT AND COLD
• TRANSCUTANEOUS ELECTRICAL STIMULATION OR TENS
  UNITS
• ACUPUNCTURE ACUPRESSURE
• PERCUTANEOUS ELECTRICAL NERVE STIMULATION OR PENS
• IMAGERY, BIOFEEDBACK, HUMOR, BREATHING EXERCISES,
  PROGRESSVIE RELAXATION, DISTRACTION, HYPNOSIS

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SPINAL SURGERY TECHNIQUES

• FOR INTRACTABLE PAIN or pain that does not
  respond to any other methods used
• Rhizotomy - a surgical procedure on the spine in
  which the sensory nerve root is severed just
  before it enters the spinal cord permanent loss
  of sensation usually reserved for the
  terminally ill
• Cordotomy same as above except it is severed
  inside the vertebral column

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NURSING MANAGEMENT

• Initial assessment
• Regular reassessments
• Educate the client about available pain
  management
• Monitor for side effects of any medications
  administered
• Client and family teaching box 16-1
• Nursing care plan 16-1

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General Nutritional Considerations

• Perform painful procedures at times when they
  will not interfere with meals
• Pain meds should be administered 30-45 minutes ac
  to help the client be pain free for meals
• Small, frequent meals may be more acceptable to
  clients who experience drug or pain related
  anorexia. Ask them what they would like to eat

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General Pharmalogical Considerations

• Transdermal fentanyl (Duragesic) may be used to
  manage chronic pain in those requiring opioid
  analgesia. It is released into the systemic
  circulation over 72 hours
• Clients should not use OTC analgesic agents such
  as ASA, ibuprofen or acetaminophen consistently
  to treat chronic pain. They should consult their
  MD.

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General Gerontologic Considerations

• Pain perception may be diminished in older
  adults. Some acute conditions may not be
  reported to medical personnel.
• If a confused older adult is unable to report
  pain they may exhibit other signs such as
  agitation, behavior changes or irritability.