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PAIN & COMFORT
NURSING
Lecturer: Pn. Umiazieante Bt Suchi
By:
Teoh Jiu Yang 204064
Muhammad Azreen Bin Mohd Jamal 198529
Nurazimah Bt Bohani 201936
Nur Fadlin Izzah Bt Rozuki 200844
WHAT IS PAIN?
Feeling of discomfort strong enough to be intrupsive and to affect or interfere with normal activities
INTRO
Pain is considered as the FIFTH VITAL SIGN
THEORY OF PAIN
pain is defines as a feeling of discomfort or distress or suffering caused by the stimulation of the nerve ending
THEORY OF PAIN
Pain is transmitted to the brain through the nervous system
Transmission
Gate Control Theory
GATE CONTROL THEORY
Theory 1
- Gate open when there is activity in small diameter nerve fibres
- Gate close when there is activity in large diameter of nerve fibre due to massage or vibration
Theory 2
- Gate open when less sensory input by brain stem impulses
- Gate close when high sensory input by brain stem impulses
Theory 3
- Gate open when increase in anxiety originating from cerebral cortex and thalamus input
- Gate close when when decrease in anxienty
ENDORPHINS
ENDOGENOUS
MORPHINES
Endorphins
Endorphins attach to the nerve endings in opioid receptor and block pain transmission
Types of Pain
TYPES OF PAIN
Verbal Signs
- Patient's description about the pains.
Nonverbal Signs
- Guarding a particular body part or reluctance to move.
How to identify the pain?
Acute pain is usually associated with an injury, medical condition or surgical procedure.
Acute Pain
The duration?
It is of short duration that lasting from a few hours to a few days.
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INJURIES that causing acute pain :
- Burns
- Bone Fractures
- Muscle Strains
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the symptoms :
- Patients agitated or restless
- Increase in heart rate
- Increase blood pressure
- Increase respiratory rate
Acute pain may worsen in the presence of anxiety or fear.
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how to control the acute pain?
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- Analgesics (pain medications)
- Surgery
Once the cause is removed, acute pain will be relieved.
Chronic pain is associated with ongoing conditions, such as arthritis and back problems.
Chronic Pain
The Duration :
- Long duration, continue for months or possibly years.
- The limitations imposed by chronic pain can cause long-lasting psychosocial effects for the patient, due to necessary changes in lifestyle.
1.
What we can describe the chronic pain?
2.
- Dull
- Constant
- Shooting
- Tingling
- Burning
How to alleviate the chronic pain :
3.
The combination of pharmacologic and nonpharmacalogic treatments.
This would include combining medication with treatments such as guided imagery, application of heat and cold, and massage.
- Nociceptive pain involves injury to tissue in which receptors called nociceptors are located
- It may be found in skin, joints or organ viscera.
- injuries that triggered nociceptive pain may be caused by trauma, burns or surgery
Nociceptive Pain
Transduction
- First phase
- Begins when tissue damage causes the release of substances that stimulate the nociceptors and start the sensation of pain
Transmission
- Second phase
- Involves movment of the pain sensation to the spinal cord.
Perception
- Third phase
- Occurs when pain impulses reach the brain and pain is recognized.
Modulation
- Fourth phase
- Occurs when neurons in the brain send signals back down the spinal cord by release neurotransmitters.
It is usually associated with a dysfunction of the nervous system, specifically an abnormality n the processing of sensation.
2.
4.
Neuropathic Pain
Examples :
- Diabetes
- Guillain-Barre syndrome
- Cancer
- HIV
- Nutritional deficiencies
- Pain receptors in the body become sensitive to stimuli and send pain signals more easily.
- Nerve endings grow additional branches that send stronger pain signals to the brain.
- As the branches grow, they influence touch and warmth receptors and these receptos begin to send pain signals.
How to managed?
- Use common analgesics sych as those in the NSAID family.
- Also increase with adjuvant medications such as tricyclic antidepressants, anticonvulsants and corticosteroids.
1.
3.
How it occurs?
How to control?
Phantom Pain
- It occurs after the loss of a body part from amputation.
- Patient may "feel" pain in the amputated part for years after the amputation has occured.
- If this is not controlled with conventional methods, pain may be controlled by the use of continuous electrical stimulation from electrodes surgically implanted in the thalamus.
NURSING PROCESS
"Pain is whatever the experiencing person says it is, existing whenever he says it does" (McCaffery and Pasero, 1989
Assessment (Data Collection)
Assessment
- only the patients know what hurts and how much it is
- intervention must be based on the patient's own assessment of the degree of pain and the need for pain relief
Cultural Background
Teach that expression of pain must be avoided
Perception of Pain
- men must denying pain to show strenght and bravery
- elderly may not express pain because don't want to be bother or culturally trained not to complain about pain
Assessment Method
How to assess?
IRRITABILITY
MOANING
CRYING
GRIMACING
FROWNING
INABILITY TO SLEEP
Observeable indicator
RESTLESSNESS
RIGID POSTURE IN BED
PAIN SCALE
assist patients in communicating their pain level
Pain Scale
NUMBER SCALE
rate the level of pain
Number Scale
PICTURE PAIN SCALE
Showing faces in varying degrees of pain
Picture Scale
For children and some adult
FLACC
Face, Legs, Activity, Cry, Consolability
FLACC
for preverbal or non communicative chlidren
CRIES
Crying, Required Oxygen to maintain saturation, Increased Vital sign, Expression, Sleeplessness.
CRIES
For Infant
Readiness for enhanced comfort
NURSING DIAGNOSIS
Fear
Acute pain
- pain is an individual experience
- the reported pain may vary from patient to patient even though they share same medical diagnosis
Nursing Diagnosis
Chronic pain
Anxiety
Fatigue
Sleep deprivation
Deficient knowledge
Self -care deficit
PLANNING
Planning
- plan care must include pain assessment and management
- should include realistic goals
IMPLEMENTATION
- pain is an individual experience
- medication or treatment that prove effective for one patient may not relieve symptoms as well for another patient
- different method may need to be tried
Implementation
Pain Management
Nonmedicinal Methods of Pain Control
- Reduce the amount of medication needed greatly
- Patient should not be denied medication to control the pain
Nonmedicinal Methods
Transcutaneous Electrical Nerve Stimulation (TENS)
Transcutaneous Electrical Nerve Stimulation (TENS)
- small electrical stimulator attached to electrodes
- placed on the skin around the pain area
- low-level current running between electrodes acts to block pain sensation
- control intensity and interval of current with the dials on the stimulator
- High-frequency stimulation (Acute pain)
- Low-frequency stimulation (Chronic pain)
https://www.youtube.com/watch?v=NursaamvpFU
https://www.youtube.com/watch?v=kpbNCVcXFJc
Percutaneous Electrical Nerve Stimulation (PENS)
Percutaneous Electrical Nerve Stimulation (PENS)
- Electric current is sent through thin needle probes positioned in the soft tissues and muscles of the back
- relief of lower back pain, some severe headaches
Binders
Binders
- clothes wrapped around a limb or body part
- support the surface and internal tissues during movement, coughing, and other activities
- effective in relieving pain associated with strains, sprains, and surgical incisions
Application of Heat and Cold
Application of Heat
- relieve pain from muscular strain or overwork
- reducing pain associated with healing tissues
*check temperature to avoid burning patient
- young/old pt - more sensitive to heat damage
- pt with low level of consciousness, impaired movement and feeling, poor circulation
Eg: warm water compresses, warm blankets, Aquathermia K-Pads, tub and whirlpool baths, chemical self-heating packs
Application of Cold
- reducing swelling
- calming muscles spasms and reducing pain in joints and muscles
- Some pt may have poor tolerance for cold treatment
- Ice packs should not be applied directly on the skin
- Optimum time for cold treatment: 15-20 min
Eg: ice, chemical ice pack
Relaxation
Relaxation
- physical technique - involves conscious relaxation of muscle groups
- comfortable - quiet environment
- darkened environment helps them relax
relaxation is done progressively
Biofeedback
Biofeedback
- specialised relaxation technique using a machine that measures the degree of muscular tension with skin electrodes
- coloured lights changes (red > yellow > green)
- tone (higher pitch > lower pitch)
Degree of relaxation is measured and immediate feedback is given to pt
Distraction
Distraction
- assists pt to focus on something other than pain
- merely diverts the attention elsewhere for a time.
- Be aware that it is not a sign that pt is not in pain at all!
Eg: television, playing game, talking with friends, reading
Guided Imagery and Meditation
Guided Imagery (verbally guiding pt to imagine something)
- pt are assisted to form mental images of pleasant environment - comfortable and happy
Some might need verbal direction to hear / feel pleasant sensations, hard to imagine by themselves
Meditation (focusing on an image or thought)
- use of a focus point rather than mental creation of an alternate environment
- Focus on a visual point/sound/repeated phrase/etc
- This focuses attention away from the pain & induces profound physical relaxation and reduction in blood pressure and respratory rate
Meditation
- relieve pain from muscular strain or overwork
- reducing pain associated with healing tissues
*check temperature to avoid burning patient
- young/old pt - more sensitive to heat damage
- pt with low level of consciousness, impaired movement and feeling, poor circulation
Eg: warm water compresses, warm blankets, Aquathermia K-Pads, tub and whirlpool baths, chemical self-heating packs
Music
Music
- distraction of pain
- effective in conjuction with other methods
- together with meditation and relaxation techniques
- Headphones - allow pt to enjoy their own preferences in music
Eg: Nature sounds, sounds of wind and birds in trees
https://www.youtube.com/watch?v=Ercl6NiqyPA
Hypnosis
Hypnosis
- inducing trance-like state using focusing and relaxation techniques
- give suggestions to pt that may be helpful after hypnosis
- SHOULD BE DONE BY SOMEONE TRAINED IN THIS
Only effective and applicable to those who cooperate with this technique
Massage
Massage
- induce relaxation and bring relief from muscle and structural pain
- demonstrates caring relationship - good nursing care
- lotion - use to warm between hands and apply to pt's back refreshes the skin and relieves dryness and itching
Massage distal or proximal to the point of pain may relieve pain while avoiding direct stimulation to an injured site
What is Medical Methods ?
MEDICAL
METHOD
wheather prescription or nonprescription medicine that ordered by physician for the patients
FOUR CATEGORIES OF ANALGESIC MEDICATIONS
Four Basic Categories of Analgesic Medications
Non-narcotic analgesics, inc NSAIDs
1
> Block pain at the peripheral nervous system level
For example : Over-the-counter ~ Aspirin, acetaminophen
COX-2 Inhibitors
2
> Block the COX-2 enzyme , which plays role in arthritis pain
For example : Anti-Inflammatories ~ Celecoxib ( celebrex)
Narcotics or opioids
3.
> Block pain at the central nervous system level
For example : Nargotic agonists ~morphine, oxycodone
Adjuvant analgesics
4.
Various methods of action
For example :
Anticonvulsants ~ Phenytoin
Antidepressants ~ Imiprane
Stimulants ~ Caffeine
ORAL MEDICATIONS
The example product : Time-released Oral Morphine
-Helpful for patients with chronic severe pain, such as cancer.
-Can have a near-normal life for long periods of time despite serious illness.
Oral Medications
Topical Medications
Topical Medications
- Various topical creams such as capsaicin cream
-Medications patches, such as Fentanyl patches
Injected Medications
Injected Medications
- Intramuscular or subcutaneous injection used for severe pain and olny for a relatively short time
-Lost lasting for several hours, but painful for patients
QUESTION
QUESTION & ANSWER
WHAT IS THE BEST WAYS TO IMPLEMENT ON THIS PATIENT?