-
McCaffery�s definition of pain
Pain is whatever the person experiencing it says it is and exists whenever he says it does
-
Nociceptors
receptors that activate the afferent pathways; unable to adapt to repeated stimuli so they continue to fire until the stimuli are removed
-
What can inhibit pain?
Endorphins and enkephalins that can have an opioid effect by blocking or diminishing pain perception
-
What can decrease endorphin levels?
Prolonged stress and pain, prolonged use of morphine and alcohol
-
What can increase endorphin levels?
Brief stress and pain, laughing, exercise, sex, acupuncture, TENS, massive trauma
-
Factors that cause the gate to open include
tissue damage, monotonous environment, and fear of pain
-
What can close the gate?
Stimulation of large-diameter fibers through massage, position change, and heat or cold applications; distraction, guided imagery, preparatory information
-
What physical factors affect pain?
Pain threshold, pain tolerance, age, physical activity, surgery and anesthesia
-
Pain threshold
Point at which stimulus causes sensation of pain
-
What lowers pain threshold?
Anger, fatigue, anxiety, insomnia, depression and uncontrolled pain
-
Pain tolerance
Intensity of pain that a person will endure
-
What is the most painful surgery?
Upper Abdomen
-
What psychological factors affect pain?
Culture, religion, past experiences, anxiety, situational factors
-
Because the brain interprets pain as a stressor, it activates the
sympathetic NS
-
What are predictable responses to acute pain?
Increased heart rate, respiratory rate, and BP
-
Cause of acute pain is
known, treatable, and temporary
-
Acute pain
follows the normal pathway for pain from nociceptor activation to the brain
-
Chronic pain
persistent, recurs for > 6 months; neuropathic because it follows an abnormal pathway
-
Unusual sensations of chronic pain
burning, shooting pain and abnormal sensations that occur when there is no pain stimulus present; cause may be unknown
-
What purposes do pain serve?
Chronic-no useful purpose; acute warns of tissue damage and trauma
-
Sympathetic nervous system adapts
so HR, BP and R may be normal; nurse may underestimate severity and undermedicate
-
Most chronic pain is
neurogenic
-
When should pain be assessed?
On admission and on a regular basis
-
Six steps of pain
Accept pt report, determine status of pain, describe pain, examine site of pain, identify coping methods, document findings and evaluate interventions
-
How should pain be described?
Location, quality, intensity, aggravating and alleviating factors
-
Physical interventions
physical comfort measures, environmental control, stimulation techniques
-
Psychological interventions
anxiety reduction, distraction, relaxation and imageryn
-
Nonpharmacological interventions
increase tolerance and threshold
-
Hot and cold
heat< 30 minutes and don�t put on abdominal pain or malignancy; cold<15 minutes and don�t put on people taking vasoconstriction and heart disease
-
Nonopioid analgesics affect
PNS, have ceiling effect on analgesia
-
Opioid analgesics affect
CNS
-
Examples of opioid agonists
codeine, methadone, dilaudid, Demerol, morphine, fentanyl
-
Examples of opioid agonist antagonists
nubain, puprenex, stadol, talwin
-
Side effects of opioids
constipation, sedation, nausea, respiratory depression, confusion, hypotension, dizziness, urinary retention
|
|