1. Linda S. Williams / Paula D. Hopper Copyright © 2011. F.A. Davis Company Understanding Medical Surgical Nursing, 4th Edition Chapter 10 Nursing Care of Patients in Pain

2. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Pain Pain is whatever the experiencing person says it is, existing whenever the experiencing person says it does. (Margo McCaffery, 1999)

3. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Pain (cont’d) Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. (IASP, 2009)

4. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Suffering Suffering represents a threat to one’s self- image or life. Suffering is not synonymous with pain but is closely associated with it. Physical pain is closely related to psychological, social, and spiritual distress. Pain that persists without meaning becomes suffering. ( Ferrell and Coyle, 2008)

5. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Terms to Know  Opioid  Physical Dependence  Psychological Dependence  Tolerance  Ceiling Effect

6. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Pain Transmission  Transduction  Transmission  Perception  Modulation

7. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Mechanisms of Pain Transmission  Nociceptive Pain  Tissue Damage  Neuropathic Pain  Nerve Damage

8. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Neurotransmitters  Prostaglandins  Bradykinin  Serotonin  Substance P  Endorphins  Enkephalins

9. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Types of Pain  Acute  Cancer  Chronic Nonmalignant

10. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Referred Pain

11. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Pain Treatment  Analgesics  Opioids  Nonopioids  Adjuvants  Opioid Antagonists  Other Treatments

12. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition WHO Ladder

13. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Placebos  Administered Inactive Substitutes for Analgesics  Not Justified in the Treatment of Pain

14. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Analgesic Routes  Oral  Rectal  Inhalation  Transdermal  Intramuscular

15. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Analgesic Routes (cont’d)  Intravenous  PCA  Subcutaneous  Intraspinal

16. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nondrug Therapies  Cognitive-behavioral  Education  Relaxation  Imagery  Distraction  Biofeedback

17. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nondrug Therapies (cont’d)  Physical Agents  Heat  Cold  Massage  Exercise  Immobilization  TENS

18. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Pain Assessment: WHAT’S UP?  Where is the Pain?  How Does it Feel?  Aggravating and Alleviating Factors?  Timing  Severity on 0–10 Scale  Useful Other Data  Patient’s Perception

19. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Pain Scales

20. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Patient Education  Drug Effects  Adverse Effects  Dose Frequency and Duration  Interactions  Special Considerations