Funda Lec - Finals Lesson 1

• Pain


  An unpleasant sensory and emotional experience associated with or resembling that associated with actual or potential tissue damage
• Pain is a subjective response to both physical and psychological stressors. Although it is typically experienced as uncomfortable and unwelcome, it also serves as a powerful protective role, warning of potentially health-threatening conditions. It is a personal, private sensation of hurt that signals current or impending tissue damage and serves to protect one from harm
• Types of Pain


  • According to Location
  • According to Duration
  • According to Intensity
  • According to Etiology
• Referred pain


  • Pain that is perceived in an area distant from the site of the stimuli. It commonly occurs with visceral pain as visceral fibers synapse at the level of the spinal cord, close to fibers innervating other subcutaneous tissue organs of the body
• Visceral pain


  • Pain arising from organs or hollow viscera, often presents this way, being perceived in an area remote from the organ causing the pain
• Types of Pain by Duration


  • Acute pain
  • Chronic pain
• Pain Intensity

  • Mild pain – rating of 1 – 3
  • Moderate pain - rating of 4 – 6
  • Severe pain - rating of 7 – 10
• Types of Pain by Etiology


  • Physiological pain
  • Neuropathic pain
• Physiological pain


  • Experienced when an intact, properly functioning nervous system sends signals that tissues are damaged, requiring attention and proper care
• Types of Physiological Pain

  • Somatic pain
  • Visceral pain
• Somatic pain


  • Originates in the skin, muscles, bones, or connective tissues
• Visceral pain


  • Results from activation of pain receptors in the organs and/or hollow viscera. It tends to be poorly located and may have a cramping. Throbbing, pressing or aching quality. It is often associated with feeling sick (sweating, nausea, vomiting)
• Types of Neuropathic Pain

  • Peripheral neuropathic pain
  • Central neuropathic pain
  • Sympathetically maintained pain
• Peripheral neuropathic pain


  • Follows damage and/or sensitization of peripheral nerves
• Central neuropathic pain


  • Results from malfunctioning nerves in the central nervous system
• Sympathetically maintained pain


  • Occurs occasionally when abnormal connections between fibers and the sympathetic nervous system perpetuate problems with both the pain and sympathetically controlled functions
• Pain Threshold


  The least amount of stimuli necessary for a person to label a sensation as pain. It may vary from person to person, and may be related to age, gender, or race but it changes little in the same individual over time
• Pain Tolerance


  The most pain an individual is willing or able to tolerate before taking evasive actions
• Hyperalgesia and Hyperpathia


  Terms that may be used interchangeably to denote a heightened response to a painful stimuli
• Allodynia


  Non-painful stimuli (contact with water, linen or wind) produce pain
• Dysesthesia


  An unpleasant abnormal sensation. It mimics or imitates the pathology of a central neuropathic pain disorder
• Factors Affecting the Pain Experience

  • Ethnic and cultural background
  • Developmental stage
  • Environment and support people
  • Previous pain experiences
  • Meaning of pain
• Commonly Used Pain Descriptors

  • Dull
  • Achy
  • Sharp
  • Stabbing
  • Pressure
• Assessing Pain


  1. Accurate pain assessment is essential for effective pain management

  2. Assessment Interview

  3. Pain History

  4. Location

  5. Intensity

  6. Quality

  7. Pattern

  8. Time of onset

  9. Duration

  10. Constancy

  11. Precipitating factors

  12. Alleviating factors

  13. Associated symptoms

  14. Effects of ADLs

  15. Past pain experiences

  16. Meaning of pain

  17. Coping resources

  18. Affective response
• COLDERRA


  • Characteristics
  • Onset
  • Location
  • Duration
  • Exacerbation
  • Radiation
  • Relief
  • Associated s/s
• NANDA Nursing Diagnoses Related to Pain

  • Acute pain
  • Chronic pain
• Because the presence of pain can affect so many facets of a person's functioning, pain may be etiology of other nursing diagnoses
• Examples of Nursing Diagnoses Related to Pain

  • Ineffective Airway Clearance
  • Hopelessness
  • Anxiety
  • Ineffective Coping
  • Ineffective Health Maintenance
  • Self-Care Deficit
  • Deficient Knowledge
  • Impaired Physical Mobility
  • Disturb Sleep Patterns
• Planning Pain Management


  1. Choose pain relief measures appropriate to the client, based on the assessment data and input from the client or support persons

  2. Nursing interventions may include a variety of pharmacologic and non-pharmacologic interventions
• Implementing Pain Management


  1. Acknowledging and accepting the client's pain

  2. Assisting support persons

  3. Reducing misconceptions about pain

  4. Reducing fear and anxiety

  5. Preventing pain
• Non-pharmacological Pain Management

  • Physical Interventions
  • Cutaneous Stimulation
  • Immobilization
  • Transcutaneous Electrical Nerve Stimulation
  • Cognitive – Behavioral Interventions
• Massage


  • A comfort measure that can aid relaxation, decrease muscle tension, and may ease anxiety because the physical contact communicates caring. It can also decrease the pain intensity by increasing superficial circulation to the area
• Contralateral stimulation


  • Stimulating the skin in an area opposite to the painful area (e.g. stimulating the left knee if the pain is in the right knee). The contralateral area may be scratch from itching, massaged from cramps, or treated with cold packs or analgesic ointments
• Transcutaneous Electrical Nerve Stimulation (TENS)


  • A method of applying low-voltage electrical stimulation directly over identified areas, at an acupressure point, along peripheral nerve areas that innervate the pain area, or along the spinal column
• Cognitive – Behavioral Interventions


  • Distraction
  • Eliciting the relaxation responses
  • Repattening unhelpful thinking
  • Facilitating coping
  • Selected spiritual interventions
• Evaluating Pain Management


  1. Is adequate analgesic being given?

  2. Were the client's beliefs and values about pain therapy considered?

  3. Did the client understate the pain experience for some reason?

  4. Were appropriate instructions provided to allay misconceptions about pain management?

  5. Did the client and support people understand the instructions about pain management techniques?

  6. Is the client receiving adequate support significant others?

  7. Has the client's physical condition changed, necessitating modifications in interventions?

  8. Should related intervention strategies be reevaluated?
• Sleep


  The altered level of consciousness in which the individual's perception of and reaction to environment are decreased
• What regulates sleep and wakefulness?

  • The cyclic nature of sleep is thought to be controlled by centers located in the lower part of the brain. Neurons within the Reticular formation, located in the brain stem, integrate sensory information from the peripheral nervous system and relay the information to the cerebral cortex, The upper part of the reticular formation consists of a ascending fibers called the RAS (reticular activating system) which is involved with the sleep-wake cycle. An intact cerebral cortex and reticular formation are necessary for the regulation of sleep and waking states

  
• Types of Sleep


  • NREM (Non-Rapid Eye Movement Sleep)
  • REM (Rapid eye Movement)

  
• NREM Sleep


  • When the RAS is inhibited
  • BODY RESTORATION
  • About 75% to 80% of sleep