Continuing assessment

• Pain is an unpleasant sensory and emotional experience which we associate with tissue damage
• Pain


  The 5th vital sign
• Nociceptive system


  • The system involved in the transmission and perception of pain
• Nociceptor


  Peripheral nerve endings which transmit the sensations to the CNS
• Nociception


  Term used to describe how noxious stimuli are typically perceived as pain; pain perception
• Physiologic process of nociception


  1. Transduction

  2. Transmission

  3. Perception

  4. Modulation
• Physiologic response to pain is noticeable upon the onset of acute pain and may differ from patient to patient
• Physiologic response to pain is best used when patient is unconscious and must not be used to validate verbal report of pain
• Physiologic response to pain


  • Sympathetic (fight or flight)
  • Parasympathetic (rest and digest)
• Behavioral response to pain


  • Verbal statements
  • Vocal behaviors
  • Facial expression
  • Body movements
  • Altered response environment
• Sources of pain


  • Injury or inflammation
  • Stimulation of nociceptors of the PNS
  • Nociceptors communicate injury information to the brain
  • Sensation of pain
• Classification of pain


  • Nociceptive
  • Neuropathic
  • Inflammatory
• Acute pain


  Sudden and recent onset, associated with a specific injury, varies in intensity, lasts for a brief period, can be treated easily, heals spontaneously, protective mechanism
• Chronic pain


  Constant/intermittent pain that persists over a period of time, cause is not clear, difficult to treat, can stem from prolonged disease or dysfunction, can be associated with a mental disorder, typically generalized, strongly influenced by emotions & environment
• Seven dimensions of pain


  • Physical
  • Sensory
  • Behavioral
  • Sociocultural
  • Cognitive
  • Affective
  • Spiritual
• Age and pain


  • Infant
  • Toddler & pre-schooler
  • School age
  • Adolescent
  • Adult
  • Elderly
• Pain is a universal human experience but how people respond varies with the meaning placed on pain and the response to pain that is affected in the culture in which the person is raised
• How to be a culturally competent nurse


  • Be aware of your own cultural and family values
  • Be aware of your personal biases and assumptions about people with different values than yours
  • Be aware and accept cultural differences between yourself and individual patients
  • Be capable of understanding the dynamics of the difference
  • Be able to adapt to diversity
• Nursing management of pain


  1. Maintain a quiet, comfortable and calm environment

  2. Maintain privacy and ensure confidentiality

  3. Ask questions in an open-ended format

  4. Listen carefully to the client's verbal descriptions and document the exact words/phrase used

  5. Note for the client's facial expressions and grimaces during the interview

  6. Do not put words in the client's mouth (apply therapeutic communication)

  7. Explore client's past experiences with pain

  8. Believe the client's expression of pain
• Characteristics of pain


  • Onset of pain
  • Location of pain
  • Duration of pain
  • Characteristics of pain
  • Aggravating factors
  • Relieving factors
  • Treatments used
• Localized pain


  Felt only at its origin
• Projected pain


  Travels along the nerve pathways
• Radiating pain


  Extends in several directions from the point of origin
• Referred pain


  Occurs in places remote from the site of origin
• Visual analogue scales are used to assess pain perception
• Pain assessment of children reflects the balance between the heat produced and the heat lost from the body (heat balance)
• Body temperature


  • Measured in heat unit called "degrees"
  • Core temp. (deep tissues, body cavity, relatively constant)
  • Surface temp. (superficial organs, skin, subcut)
• Pain


  Dull, stabbing, burning sharp, tingling
• Region & Radiation


  What area of the body is the pain occurring? Is it radiating to anywhere else? Is it spreading to another area? foot to the leg? from shoulders to the back?
• Pain Scale


  On a scale of 1-10, with 10 being the worst pain imaginable, where is your pain level right now?
• Time and History


  What were you doing when the pain started? Has it happened before? Is there anything different from the time it started?
• Body Temperature


  Reflects the balance between the heat produced and the heat lost from the body (heat balance)
• Degrees


  Measured in heat unit called "degrees"
• Core Temperature


  Deep tissues, body cavity, relatively constant
• Surface Temperature


  Superficial organs, skin, subcutaneous tissue, fat, changes in response to environment
• Radiation


  Heat loss from a warm object such as the body to the cooler air surrounding the warm object (person loses heat in a cold room)
• Conduction


  Loss of heat from a warm body to a cooler object in contact to the warm body (person becomes cold when sitting in a block of ice)
• Convection


  Loss of heat by air currents moving over the surface of the skin (an electric fan constantly removing layers of heated air next to the body)
• Evaporation


  When liquid becomes gas (during exercise, sweat on the surface of the skin evaporates and cools the body)
• 80% of heat loss occurs through the skin