Ch 44. Pain Management

Unpleasant, subjective sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage
Goals of effective pain management
– Improve quality of life
– Reduce physical discomfort
– Promotes earlier mobilization and return to previous baseline function
– Results in fewer hospital and clinic visits
– Decreases length of stay, resulting in lower health care costs
Physiological processes of normal pain
– Transduction
– Transmission
– Perception
– Modulation
Gate control pain theory
– Pain has emotional and cognitive components in addition to physical sensations. Gating mechanisms located along the CNS regulate or block pain impulses. Impulses pass when a gate is open, blocked when a gate is closed
Dilation of bronchial tubes & increased heart rate
Provides increased oxygen intake
Peripheral vasocinstriction
Elevated blood pressure with shift away from periphery
Increase blood glucose level
Increased energy
Increased cortisol level
Heightened memory functions, a burst of increased immunity
Controls body temperature during stress
Decreased gastrointestinal motility
Frees energy for more immediate activity
Causes blood supply to shift away from periphery
Vagus nerve sends impulses to chemoreceptor trigger zone in the brain
Rapid, irregular breathing
Causes body defenses to fail under prolonged stress of pain
Chronic episodic pain
Occurs sporadically over an extended duration of time
Idiopathic pain
Pain that is chronic in the absence of an identifiable physical or psychological cause
common biases and misconceptions
– Health care personnel are the best authorities on the nature of a patient pain
– Psychogenic pain is not real
– Chronic pain is psychological
– Patients who are hospitalized will experience pain
– Administering analgesics regularly leads to drug addiction
– The amount of tissue damage in a ninjury accurately indicates pain intensity
– Patients with minor illnesses have less pain that those with severe physical alteration
– Patients who abuse substances overreact to discomforts
Physiological factors that influence pain
– Age
– Fatigue
– Genes
– Neurologic function
Social factors that influence pain
– Attention
– Previous experience
– Family and social support
– Spiritual factors
Psychological factors that influence pain
– Anxiety
– Coping styles
Cultural background factors affect coping with pain
– Individuals learn what is expected and accepted by their culture. Different meanings and attitudes are associated with pain across various cultural groups
ABCDE pain assessment and management
– Ask about pain regularly, assess
– Believe the patient
– Choose appropriate pain-control options
– Deliver interventions in a timely, logical, manor
– Empower patients and their families. Enable them to control their course
Common characteristics of pain that the nurse would assess
– Time, duration, and pattern
– Location
– Severity
– Quality
– Aggravating and precipitating factors
– Relief measures
– Contributing symptoms
Potential or actual nursing diagnoses related to a patient in pain
– Activity intolerance
– Anxiety
– Bathing self-care deficit
– Ineffective coping
– Fatigue
– Impaired physical mobility
– Insomnia
– Impaired social interaction
What are some patient outcomes appropriate for a patient experiencing pain
– Patient reports that pain is a 3 or less on a scale of 1-10
– Avoids factors that intensify pain
– Uses pain relief measures safely
– Level of discomfort does not interfere with dressing self
Nonpharmacologic interventions
– Cognitive behavioral approaches: Change patients perception of pain, and provide patient with a greater sense of control
– Physical approaches: Aim to provide pain relief, correct physical dysfunction
Guidelines for nonpharmacologic therapies
– Tailor to individual
– Cognitive behavioral strategies may not be appropriate for the cognitively impaired
– Physical pain relief strategies focus on promoting comfort and altering physiologic responses to pain
Nonpharmacologic interventions
– Relaxation
– Distraction
– Music
– Cutaneous stimulation (massage, bath, tens)
– Herbals (ginseng, ginko, echinacea, etc, )
– Reducing pain perception and reception
Common side effects of opioids
page 1036 – chart
Nursing principles for administering analgesics
– Know patients previous response to analgesics
– Select proper medications when more more than one is ordered
– Know accurate dosage
– Assess right time and interval for administration
Multimodal analgesia
Different agents allows for lower than usual doses of each medication, therefore lowering the risk of side effects
Goals of PCA
– Patients self administer opioids with minimal risk of overdose
Purpose of perineural local anesthetic infusion
Manage pain from a variety of surgical procedures with a pump that is set as a demand or continuous mode and left in place for 48 hours
Local anesthesia
_ Intended for local infiltration of an anesthetic medication to induce loss of sensation in a specific body part
Regional anesthesia
Injection of a local anesthetic to block a group of sensory nerve fibers
Epidural anesthesia
– Permits control or reduction of severe pain and reduces patient’s overall opioid requirement – short or long term
Goals for the care of patient with epidural infusion
– Pg. 1040
Incident pain
– Predictable and elicited by specific behaviors such as physical therapy or wound dressing
End of dose failure pain
– Pain that occurs toward the end of the usual dosing interval of a regularly scheduled analgesic
Spontaneous pain
– Unpredictable and not associated with any
Barriers to effective pain management
– Inadequate pain assessment, fear of legal repercussion’s, no visible cause of pain, fear of giving a dose that will kill the patient
– Medication or procedure that produces positive or negative effects in patients that are not related to the placebos specific physical or chemical properties
Palliative care
– Care provided where the goal is to live life fully with an incurable condition
– Care provided at the end of life, quality of life or quantity
Principles to evaluate pain management
– new approaches if no relief, evaluate patients perception of pain