Chapter 16 — Pain Management, Comfort, Rest, and Sleep

Noxious
Injurious to physical health.
Pain
An unpleasant sensory and emotional experience associated with actual or potentially tissue damage, or described in terms of such damage. It is subjective, and serves as a warning sign.
Intractable
Constant.
Referred pain
Felt at a site other than the injured or diseased organ.
Acute pain
Intense and of short duration. Usually less than 6 months. It creates an autonomic response within the sympathetic nervous system. It makes the body produce epinephrine (fight or flight response).
Chronic pain
Lasts longer than 6 months. Signals that tissue damage has occurred. Can be continuous or intermittent.
Synergistic
Two or more substances or organs working together to achieve something none could do alone.
Depression
Is common in people with chronic pain.
Gate control theory
Melzack suggests that pain impulses are regulated and even blocked by a gating mechanism located along the CNS in the dorsal horn of the spinal cord. If other stimuli (such as back rub, heat, or cold) are being transmitted through this gate, the gate is temporarily blocked, and pain can’t be transmitted.
Endorphins
Morphine like substances produced by the pituitary glands and other areas of the CNS. It is activated by stress and pain. Inhibits transmission of pain impulses when they attach to opioid receptor sites in the brain and prevent the release of neurotransmitters.
Unrelieved pain
Can increase oxygen demand, respiratory dysfunction, confusion, depress immunity, anxiety, depression, and irritability.
HILDA
A pain assessment guide. It stands for How does your pain feel, Intensity, Location, Duration, and Aggravating or alleviating factors.
Assessing pain
Ask the patient about their pain, accept and respect what they, intervene to relieve their pain, and then reassess.
Non-invasive pain relief
They are low-risk and have few side effects, and often don’t require a doctor’s order.
Transcutaneous electric nerve stimulation (TENS)
A pain relief system that uses a small battery operated device that provides a small electric current to the skin.
Signs of pain
Tachycardia, tachypnea, elevated blood pressure, diaphoresis, dilated pupils, clenching teeth, crying or moaning.
Non-opioids
The most widely available and used pain killer. Acetaminophen. These are NSAIDs. Act on the peripheral receptor level, and are available OTC. They block pain impulses to the CNS and reduce inflammation.
Opioids
Formally known as narcotics. Decrease the perception of pain by binding pain receptors in the CNS. For example, morphine and Vicodin. Have the potential to cause depression of vital nervous system functions, respiratory depression being the most severe. Do not use with patients with decreased renal function. Tolerance and physical dependence are expected with long-term tx. This is not addiction. Constipation is the most common side effect.
Meperidine (Demerol)
Most widely used for pain management. Has a rapid onset of action and peak effect, and short duration of action. Avoid for pts with decreased renal function or long term opioid TX. Can cause delirium.
Nurse’s responsibility
Do everything possible to alleviate patient’s pain.
Visual analog scale
A pain scale where the patient marks a spot on a horizontal line to indicate the intensity.
Sleep
Reduced consciousness, providing time for repair and recovery of the body systems for the next period of wakefulness. Restores a person’s energy and feeling of well-being. Involves two phases: REM and NREM.
Diurnal (circadian rhythm)
The 24 hour day-night cycle.
NREM
Has four stages, 1 being lightest, and 4 being deepest. At the end of the 4th stage you come out of a deep sleep and back into stage 2. A typical night consists of four to six cycles. It is necessary for body tissue restoration, and healthy cardiac function.
REM
Important for brain and cognitive restoration. The dream in this phase is believed to functionally important, more vivid and elaborate, allowing a person to clarify emotions, and prepare the mind for events of the next day.