2. Pain The 5 th Vital Sign

3. Pain Whatever the person says it is, whenever he says he has it! Unpleasant sensation Emotional component

4. Subjective Nature Only pt can describe Can observe crying, screaming, grimacing have to explore why

5. Causes of Pain Vary Sometimes unable to determine Direct treatment at relieving pain

6. Normal Pain Transmission Called Nociception (4 phases) –Transduction –Transmission –Perception –Modulation

7. Activation of Pain Response Trauma, Injury Surgical Incision Tumor Growth Poor Nutrition Temperature extremes

8. Activation of Pain Response Muscle Spasm Fatigue Anxiety Fear of Unknown Lack of Knowledge

9. Types of Pain 1. Acute (Nociceptive Pain) less than 6 months abruptly appears from disease/injury short-lived, gets better

10. Types of Pain 2. Chronic (Neuropathic Pain) greater than 6 months Nervous system abnormally processes sensory input

11. Types of Pain 3. Intractable Chronic, severe Constant, unrelenting Resists therapeutic interventions

12. Types of Pain 4. Referred pain felt in different location from actual origin

13. Types of Pain 5. Phantom pain feel pain in area that has been amputated tx: move missing limb pain meds

14. 6. Angina pain connected with cardiac pathology comes and goes at intervals

15. Types of pain 7. Neuralgia intense burning sensation that follows peripheral nerve

16. Perception of Pain Individualized Pain threshold Pain tolerance Endorphins

17. Responses to pain Voluntary Involuntary Emotional

18. Influence on perception Culture Age History of pain Anxiety Body / Self-image

19. Time of day Suggestion Distraction Brain functioning

20. Nursing Assessment Subjective – patient Objective - nurse - vital signs - outward behavior - physical movements

21. Pain Description Location (look at it) Intensity/Quantity Duration/Pattern Quality Assoc. Characteristics

22. Pain Management Pharmacologic Surgical Intervention Physical Measures Cognitive/Behavioral Measures

23. Pharmacologic Analgesics –Range from Non-Opioid to Opioid Analgesic ladder Oral, topical, SQ, IM, IV, epidural

24. Nursing Interventions Medicate as needed Anticipate pain Explain to pt causes of pain and reasons behind measures

25. Surgical Intervention May be necessary to alleviate pain

26. Physical Measures Physical stimulation Acupuncture Heat and cold Exercise Comfort measures

27. Cognitive/Behavioral Techniques Distraction / Diversion Talking, Support Groups Deep relaxation Imagery / Hypnosis Stress Management

28. Pain Patient is the ultimate expert Family members are very reliable Goal is cure/sx. relief