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Why is comfort important in nursing?
- 1. basic human need
- 2. central to the art of nursing
- 3. nurses need to understand comfort
- 4. nurses provide comfort in many settings
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What is the American Pain Society's definition of pain?
"An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage."
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What are the JCAHO standards?
- "Pain is assessed in all patients."
- "Patients have the right to appropriate assessment and management of pain."
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On the pain scale, greater than 3 interferes with what?
patient's activity
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When the patient has pain greater than 7 on pain scale, what does it intefere with?
Patient's quality of life (ADLs)
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What are two things we must remember about pain?
- 1. Assess for pain, it is the 5th VS
- 2. Always involve pt in care!
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What do the small fibers in gate theory do?
Enhance pain transmission
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What do the large fibers do in the gate control theory?
Inhibit pain transmission
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According to the gate-control theory, how does pain travel?
Pain travels along small-diameter, slow-conducting, afferent nerve fibers to the spinal cord's dorsal horns, and end in the gray matter called substantia gelatinosa.
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Give an example of the gate-control theory.
Closing the gate by rubbing baking soda on a bee sting. The baking soda acts as a non-pain sensation and travels through the large fibers to block pain.
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How is the gate-control theory applied to pregnant women in labor?
Massage is used to reduce pain.
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In the assessment and management of pain, what does "ABCDE" stand for?
- A sk, Assess
- B elieve
- C hoose (how to alleviate pain)
- D eliver
- E mpower, Enable (instruct how to alleviate pain, "keep leg elevated"
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What are the 4 things we look for in pain description?
- 1. Location
- 2. Duration
- 3. Intensity
- 4. Etiology
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What are some things to remember about the perception of pain?
1. "Some ppl think they have to endure pain"
2. "Don't cry, be a man"
3. Others are very verbal about pain.
4. Chronic pts ask for meds earlier than later
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What are the 5 factors that play into perception of pain?
- 1. Ethnic and cultural values
- 2. Developmental stage (how does a child tell us?)
- 3. Environment and support people (how we sleep, anxiety)
- 4. Past pain experiences
- 5. Meaning of pain (spritual, social)
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Pain that arises in a different area of the body. What kind of pain is this?
Referred pain
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Pain arising from organs or hollow viscera (gut, bladder, uterus), perceived in an area remote from the organ causing the pain. What is this pain called?
Visceral pain.
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Mild pain on pain scale scores what?
1-3
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Moderate pain is scored what?
4-6
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Severe pain is scored as what?
7-10
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List the 4 strategies used for pain management.
- 1. Acknowledge possibility of pain.
- 2. Listen attentively to what the pt says about the pain.
- 3. Convey that you need to ask about the pain.
- 4. Attend to pt's needs promptly.
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Pain management is defined as...
Alleviation of pain or a reduction in pain to a level of comfort that is acceptable to the pt.
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What are the 2 methods used in pain management?
Pharmacologic and Nonpharmacologic
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What are the 4 different types of pharmacologic pain management?
- 1. Opioids
- 2. Nonopioids
- 3. Nonsteroidal anti-inflammatory drugs
- 4. Coanalgesics
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These are nonnarcotic analgesics used to treat pain that's nociceptive or neuropathic. What are these known as?
Nonopioids
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Acetaminophen(Tylenol), Nonsteroidal anti-inflammatory drugs (Advil), and salicylates (aspirin) are drug types in what category?
Nonopioids
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Narcotics that include derivatives of opium plant and synthetic drugs that imitate natural opioids. What kind of pain management is this?
Opioids
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Nonopioids are particularly effective against...
Joint and muscle pain
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Besides controlling pain, nonopioids also...
reduce inflammation and fever
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Which is good for relieving mild pain?
Nonopioids or nonsteroidal anti-inflammatiory drugs.
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In high doses this can also help relieve severe pain, what are they called?
Nonsteroidal anti-inflammatory drugs
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What is the benefit of combining opioids and nonopioids?
Nonopioids provide additional relief which then allows for a lower dose of opioid, which also lowers adverse effects.
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List 6 cutaneous stimulation measures.
- 1. Massage
- 2. Heat or Cold therapy
- 3. Acupressure
- 4. Contralateral stimulation (rub opposite body part)
- 5. Immobilization/bracing
- 6. TENS (Transcutaneous Electrical Nerve Stimulation) like EKG for low back pain
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A chemical interruption of a nerve pathway by injecting a local anesthetic into the nerve. (Ex. novacaine) What nonpharmacologic invasive therapy is this?
Nerve Block
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An interruption of the pain conduction pathways surgically. What nonpharm invasive therapy is this?
Cordotomy (last resort!)
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A state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and administration of an antagonist. This is known as...
Physical Dependence
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A state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug's effect over time. This is known as...
Tolerance
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The maximum effect a drug can have is called...
"ceiling effect"
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What are the 8 ways opiates can be delivered?
- 1. Oral
- 2. Nasal
- 3. Transdermal
- 4. Rectal
- 5. Subcutaneous
- 6. Intravenous– faster than oral
- 7. Intraspinal– affects respiratory
- 8. Continuous local anesthetics
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What are the 8 side effects of opioids?
- 1. respiratory depression
- 2. sedation
- 3. nausea
- 4. vomiting
- 5. urinary retention
- 6. blurred vision
- 7. sexual dysfunction
- 8. constipation
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Increasing intake of fluids and fiber, exercising helps with what opioid side effect?
Constipation
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A damp washcloth helps what opioid side effect?
Pruritis– itching on face/nose due to IV, PCA pump, or epidural.
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Encouraging BRP or if severe, catherizing aids what side effect of opioids?
Urinary retention
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List some cognitive-behavioral nonpharm pain management therapies.
- 1. Distraction activities
- 2. Relaxation techniques
- 3. Guided Imagery
- 4. Meditation
- 5. biofeedback
- 6. hypnosis
- 7. cognitive reframing
- 8. emotional counseling
- 9. therapeutic touch or Reiki
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What are some possible nursing Dx?
- 1. Anxiety
- 2. Coping, ineffective
- 3. Fatigue
- 4. Hopelessness
- 5. Injury, risk for
- 6. Mobility, impaired
- 7. Nausea
- 8. Pain, acute
- 9. Pain, chronic
- 10. Self-care deficit-bathing, grooming, toileting
- 11. Sexual dysfunction
- 12. Sleep pattern disturbed
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