Nursing Care of Patients Experiencing Acute and Chronic Pain – Flashcards

An unpleasant sensory and emotional experience associated with actual or potential tissue damage. (International Association for the Study of Pain) When a person is anxious they perceive pain more, to depression, to increased pain, it's a cycle. With pain the patients aren't able to perform the assessments as effectively, the pin must be addressed first. Purpose of pain is a protective mechanism to warn the patient, that something is being damaged, nurses need to manage pain first. Our role is to prevent the person from having pain, around the clock before the pain occurs if the patient is expected to have pain. Whatever the experiencing person says it is, existing whenever he/she says it does (McCaffrey)

All patients must be assessed for pain and all patients have a right to appropriate assessment and management of pain ALWAYS complete assessment for pain, never leave it blank. 5th vital sign Elderly, children, and cancer patients are notoriously under treated for pain.

Allows pain stimulation to travel up the thalamus, the awareness of pain is thought to take place in the thalamus. The interpretation of pain is in the entire cerebral cortex. The endorphins and enkephalins, if heat is applied or rubbing, then endorphins are competing to block the pain perception. Blocks the thicker fibers and allows the thinner fibers to relay the pain sensation, lessening it.

Ischemic tissue pain, lack of oxygen. Transduction occurs and can trigger release of substances to release the perception of pain

Histamine Bradykinin Acetylcholine Potassium Prostaglandins

Enkephalins Endorphins Serotonin

Duration, etiology, type, location

Acute Chronic non-malignant Chronic intermittent Cancer-related

biologic, chemical, physical ( mechanical)

muscles, nerve pain, appendicitis, visceral any of the category pain that occurs in a certain area and felt in another area, still perceiving pain and still needs to be addressed, pain so severe that it is resistant to all kinds of treatment, nothing is relieving the pain, malignant pain, can be chronic or acute and can be intermittent pain that occurs between medication

Mild to severe Sympathetic nervous system responses (observable) Related to tissue injury Resolves with healing Restless and anxious Reports of pain Pain behavior

Mild to severe Adaptation response Parasympathetic nervous system responses

Progression of cancer Treatment Acute or chronic Need large dose of pain med

Postop complications Slow recovery Poor outcomes Respiratory Cardiovascular Endocrine Immune system

Disability Depression Anger Fatigue

Compulsion characterized by behaviors that include impaired control over drug use, compulsive use, continued use despite harm and craving mostly for its psychic effects

Opioids taken over a long period of time with abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist. Not necessarily an addiction. Physical - drug class specific withdrawal syndrome Psychological - emotional craving for drug effect Prevent occurrence of withdrawal symptoms

Decreased sensitivity to analgesic properties of opioid with need for increasing doses to maintain same level of pain relief Adequate pain relief no longer obtained

Neuronal Psychological Past experience Cultural Gender Age Support

Vital signs may be normal Facial expression may not be changed Shifting away or guarding frequently Reporting pain only if asked directly Sleepiness is increased Physical activity is decreased

Triggers/relief Associated s/s Intensity Location Onset and duration Quality Personal meaning Allergies Threshold Tolerance

P= provoked (what brought about pain) Q= quality R= region/radiation S= severity T= timing

Sympathetic Parasympathetic Verbal Non-verbal Adaptation response

Morphine Codeine

Salicylate Acetaminophen Nonsteroidal Anti-inflammatory Drug (NSAID

Anticonvulsants Antianxiety

Liver damage Auditory problems Decreases serum level of NSAIDS Increase sodium retention GI bleeding and irritation Take with food or milk

Reduce anxiety Prevention PCA Medications Opioids NSAIDS Placebos Adjuvant Anesthetic agents Blocks Non-pharmcological Surgery-Chordotomy, Implantable electrical stimulation Acupuncture Non-invasive

Respiratory Depression Constipation GI upset Cutaneous Effects Orthostatic hypotension Urinary Retention

Massage Contralateral stimulation TENS Acupressure Relaxation Breathing Therapeutic touch Distraction Hypnosis Heat and cold application Diathermy

Pain as etiology of other nursing diagnoses; Ineffective Airway Clearance Hopelessness Ineffective coping Ineffective health maintenance Self Care Deficit Deficient Knowledge Impaired Physical Mobility Disturbed Sleep Pattern