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Chapter 35 (Taylor)

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by

Elizabeth E

on 15 October 2013

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Transcript of Chapter 35 (Taylor)

Chapter 35 (Taylor)
Chapter 5 (Iggy)

Comfort/Pain
I. The Pain Experience

-"Pain is whatever the experiencing
person says it is, existing whenever he or she
says it does"
A. Types of Pain
1. Duration of Pain
-
acute pain
: rapid onset, varies in intensity, protective
-
chronic pain
: limited, intermittent, or persistent
>lasts beyond healing period
>periods of remission and exacerbation
>poorly localized
>affects ADLs, leads to depression
2. Source of Pain
-cutaneous pain: skin/subcutaneous tissue
-
somatic pain
: diffuse/scattered and originates is bones,
tendons, ligaments, nerves
-
visceral pain
: body organs, abdomen
3. Mode of Transmission
-referred pain
>heart attack (pain in left arm/neck)

4. Etiology
-neuropathic pain: result from injury to nerves or CNS

-intractable pain: resistant to therapy

-phantom pain: pain from limb that is not there

-psychogenic pain: pain from mental event(heartbreak)

B. The Pain Process
1. Transduction
-activation of pain receptors
-nocireceptors: transmit pain
-substances that stimulate nocireceptors:
>BRADYKININ, Prostaglandins, Substance P

2. Transmission of Pain Stimuli
-pain from site of injury to higher centers via free
nerve endings
-Free nerve ending pain receptors:
>
A-delta-fibers
(fast-conducting) -acute pain
>
C-fibers
(slow-conducting) -visceral pain
3. Perception of Pain
-person's interpretation of pain
-pain threshold: lowest intensity of a stimulus that
causes the subject to recognize pain

4. Modulation of Pain
-pain is inhibited of modified
-modified or regulated by neuromodulators (opioid
compounds)
>have an analgesic effect
>block the release or production of pain-transmitting
substances
>
Endorphins
: have analgesic effects/euphoria
>
Enkephalins: inhibit the release of Substance P

5. The Gate Control Theory of Pain
-A-delta and C-fibers transmit impulses that travel to
the spinal cord where the gating mechanism occurs

-when the gate is open, pain impulses ascend to the
brain and vice versa

-C-fibers inhibit (close the gate)


II. Factors Affecting
The Pain Experience
A. Culture
1. Ethnic variables
2. Family, Gender, and Age Variables
3. Religious Beliefs
B. Environment and Support People
C. Anxiety and Other Stressors
D. Past Pain Experience



III. The Nursing Process
For Comfort

A. Assessing
1. Pain as the Fifth Vital Sign
2. Common Misconceptions
3. Components of a Pain Assessment
P- Precipitating or palliative
Q- Quality or Quantity
R- Does it radiate?
S- Severity scale
T- Timing/Onset/Duration/Frequency

Physiologic responses to pain:
-BP, pulse,RR, skin color, pupil size, anxiety, nausea
Behavioral responses to pain:
-protective of site, facial grimacing, moans, screams

4. Assessment of Special Populations
-CRIES SCALE for infants 0 - 6 months
B. Diagnosing
1. Pain or Chronic Pain as the Problem
2. Pain or Chronic Pain as the Etiology

C. Outcome Identification and Planning

D. Implementing
1. Trusting Nurse-Pt Relationship
2. Manipulating Factors
>less noise, rest
3. CAM
-distraction
-humor
-listening to music
-guided imagery
-employing relaxation
-using cutaneous stimulation
>TENS, massage, heat/cold
-acupuncture
-biofeedback
-TT

4. Managing Pharmocologic Relief Measures
a. administering analgesics
-relieve pain by reducing perception of pain
-nonopioid (acetaminophen/NSAIDs)
-opioid (morphine, codeine, hydropmorphone)
-adjuvant drugs (antidepressants)
-Ativan antidote=
ROMAZICON

b. Opioid Analgesics
-most common side effects: sedation, nausea,
and CONSTIPATION (give stool softner/lax)
-Zofran for nausea
-RESP DEPRESSION (preceded by sedation)
>numeric sedation scale
1=A&O
2=occasionally drowsy but easy to arouse
3=frequently drowsy;drifts off to sleep during
conversation>decrease dosage
4=somnolent with minimal or no response
DISCONTINUE OPIOID (give NARCAN)

-physical dependence, tolerance, addiction
C. Nonopioid analgesics
-drug of choice for MILD to MODERATE pain
-take with food (gastric bleeding)
-NSAIDS interfere with platelet function
-combo of nonopiod and opioid=more analgesia

D. Adjuvant Drugs
-enhance the effect of opioids

E. Assessing Pt before and after opioid administration
-PRN is inadequate for chronic pain/ use ATC
-use PRN for breakthrough pain
-ask pt if pain med is providing adequate relief

G. Cancer/Chronic Pain Management
-ATC
-WHO ladder for chronic pain management

H. Pt-controlled Analgesia (PCA)
-suitable candidate is A&O
-pt in charge of pain
-
ONLY THE PT PRESSES THE BUTTON

-
two
nurses check pt id, dose, concentr-
ation, pump settings, tubing and site

By: Elizabeth Espinoza VVC
Full transcript