Test 3

• Pain “the 5th vital sign” = Subjective Data


  Pain is whatever the person experiencing says it is, existing whenever the person says it does. Body’s human defense system.
• Pain Assessment

  done whenever you do assessment, also done upon hourly rounds
• Objective Data for Pain

  crying, moaning, Increased HR, Increased BP
• Gate Control Theory


  Body cannot feel two types of pains at the same time. Ex. if you have headache and break toe, now you don’t have a headache
• Gate Control Theory Interventions

  Tens Machine, nerves gets over stimulated, heat/cold therapy, music therapy, back massage = CUTANEOUS Stimulation
• Acute Pain

  rapid onset, intense, protective in nature [Typically local, easy to describe ] ex: pricked finger, surgery
• Effects of Acute pain

  Increased HR, BP, Respiratory Rate
• Treatment for acute pain

  typically use PRN meds, the patient must ask for the medication
• Chronic Pain

  last beyond the normal healing period, periods of remission, or exacerbation lasts 1-6 months, commonly 3 months. [ Very hard to describe, poorly localized, harder to assess, threat, and describe because of this provider can dismiss pain ] [can lead to depression, angry, frustrated]

  ex. back injury
• remission

  disease is present but the patient does not experience pain
• exacerbation

  the symptoms reappear
• Treatment for chronic pain

  typically around the clock medication additionally, patient may have PRN medication for breakthrough pain
• Cutaneous

  superficial, with tissue
• Examples of Cutaneous

  injection, paper cut
• Somatic

  “deep” tendons, ligaments, bones, nerve, blood vessels
• Example of Somatic

  sprain
• Visceral

  organs, Abdomen * usually poorly localized.
• Referred

  pain originates in on part of the body but perceived somewhere else
• example of Referred

  MI (heart attack) referred to the neck, shoulder, chest, or arms (often left arms) for men, back; for women
• Etiology

  The cause
• Nociceptor

  peripheral tissue damage, usually lower extremity
• Neuropathic

  pain: has to do with nerves, “Pins and needles”
• Intractable

  resistant, usually chronic pain that built tolerance to meds, hard to identify
• Phantom pain

  missing limbs, usually amputation more common with legs
• Psychogenic

  emotional pain that feels like it was physical even though nothing physical happened
• Behavioral (Voluntary)

  yelling, moaning, rubbing the area, restless
• Physiologic (Involuntary)

  Increased HR, BP, RR, muscles will tense
• Affective (Attitude)

  withdraw, anxiety, depression [more typical with chronic pain]
• Older Men

  tolerate pain better
• Pediatric

  tolerate pain well, which means sometimes become under-treated
• Why is it important to treat pain

  because it promotes healing, if not treated it won’t heal effectively

  Want to educate patient on medication

  If they refuse to take medication, find out why, educate on why it is important to take, ask if something

  else that can help

  Always asses pain level first

  Attempt to intervene, start plan prior to pain getting worse
• FLACC (face legs activity cry and consolability)


  used with nonverbal, comatose patient, infant from 2 months to 7 years old.
• Behavioral

  critically ill patients who are intubated
• CRIES

  neonates (ages 0-6 months)
• Numerical Pain Scale

  adults- children 9+ years old, who are able to use numbers to rate intensity of pain
• Wong-Baker

  pediatrics (Adults and children 3+ in all patient care settings)
• Assess for Why is it important to treat pain

  what is acceptable pain for patient.Try and use nonpharmocologic treatment first such as humor, listening to music, using imagery
• Cold Therapy

  decrease pain, decrease muscle spasm, CONSTRICT blood vessels, decrease bleeding, decrease inflammation/ swelling (edema) promote comfort
• use Cold therapy for Treatment

  dental pain, muscle spasms after sprains
• Assess with cold therapy

  pallor, cyanosis, numbness, pain