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Comfort Ch 41.

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Presentation on theme: "Comfort Ch 41."— Presentation transcript:

1 Comfort Ch 41

2 Pain Considered the 5th Vital Sign Is what the patient says it is

3 Pain Basics Source Area to which it is referred Duration
Nociceptive – sensory Neuropathic – from nerves Psychogenic – mental Area to which it is referred Duration Acute Chronic

4 Sources of Pain Nociceptive Cutaneous Somatic Visceral Neuropathic

5 Types of Pain Physical cause — cause of pain can be identified
Psychogenic — cause of pain cannot be identified Referred — pain is perceived in an area distant from its point of origin

6 Duration of Pain Acute Chronic
Rapid in onset, varies in intensity and duration Protective in nature Chronic May be limited, intermittent, or persistent Lasts for 6 months or longer Periods of remission or exacerbation are common

7 Pain Process Transduction — activation of pain receptors
Transmission — conduction along pathways (A-delta and C-delta fibers) Modulation — initiation of the protective reflex response Perception of pain — awareness of the characteristics of pain

8 Chemicals of Pain Bradykinin Prostaglandins – send stimuli to CNS
Powerful vasodilator Constricts smooth muscle Involved in pain awareness Prostaglandins – send stimuli to CNS Substance P Sensitizes nerve receptors Increases rate of firing

9 Gate Control Theory Relationship between pain and emotions
Small and large diameter nerve fibers conduct and inhibit pain stimuli Gating mechanisms determine impulses that reach the brain

10 Pain Perceptions Pain threshold – lowest intensity at which pain is perceived Adaptation Modulation of pain – regulation or modified by: Neuromodulators- natural, resemble morphine Endorphins – pain blockers, prolonged effect Dynorphins – most potent Enkephalins – less potent, inhibit release of sub.P

11 Pain Responses Physiologic – automatic (involuntary) responses
Behavioral – change in behavior Affective – emotional response Box 41-1, p 1203

12 Factors in Pain Culture Ethnic variables
Family, gender, and age variables Religious beliefs Environment and support people Anxiety and other stressors Past pain experience

13 Assessing Pain Psychological Emotional Sociologic Physiologic

14 Assessing Pain, cont’d Patient’s verbalization and description of pain
Duration of pain Location of pain Quantity and intensity of pain Quality of pain Chronology of pain

15 Assessing Pain, cont’d Patient’s verbalization and description of pain
Duration of pain Location of pain Quantity and intensity of pain Quality of pain Chronology of pain

16 More Assessing Aggravating and alleviating factors
Physiologic indicators of pain Behavioral responses Effect of pain on activities and lifestyle

17 Assessment Tools McGill-Melzack pain questionnaire Pain scale
Faces McCaggery method WILDA pain measurement scale

18 WILDA Scale Words that describe the pain Intensity of pain
Location of pain Duration of pain Aggravating or alleviating factors

19 Diagnosing Pain Type of pain Etiologic factors
Behavioral, physiological, affective response Other factors affecting pain process

20 Nursing Interventions
Establishing trusting nurse-patient relationship Initiating non-pharmacologic pain relief measures Considering ethical and legal responsibility to relieve pain Teaching patient about pain

21 Nursing Plan Remove or alter cause of pain
Alter factors affecting pain tolerance Initiate non-pharmacologic relief measures

22 Non-Drug Comfort Measures
Distraction Humor Music Imagery Relaxation Cutaneous stimulation Acupuncture Hypnosis Biofeedback Therapeutic touch

23 Drug-Related Treatments
Analgesic administration Non-opioid analgesics Opioids or narcotic analgesics Adjuvant drugs

24 Administering Analgesics
Patient controlled analgesia Epidural analgesia Local anesthesia

25 Sedation Scale 1 — awake and alert, no action necessary
2 — occasionally drowsy, but easy to arouse, no action necessary 3 — frequently drowsy, drifts off to sleep during conversation, reduce dosage 4 — somnolent with minimal or no response to stimuli, discontinue opiod, consider use of naloxone (Narcan)

26 Managing Chronic Pain Give medications orally if possible.
Administer medications ATC (around-the-clock) rather than prn. Adjust the dose to achieve maximum benefit with minimum side effects. Allow patients as much control as possible over the regimen.


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