N200 Pain Management

  1. Pain
    • an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
    • **it is whatever the experiencing person says it is, existing when he says it does
  2. Pain occurs when .....
    nociceptors are stimulated by direct damage to the cell or local release of biochemicals following cell injury
  3. What are the four physiological processess
    • *Transduction
    • *Transmission
    • *Perception
    • *Modulation
  4. Transduction
    • conversion of thermal chemical or mechanical stimulus to electrical energy
    • ****Transduction begins in the periphery when a pain-producing stimulus sends an impulse across a sensory peripheral pain nerve fiber (nociceptor), initiating an action potential
  5. Transmission
    Transport of nerve impulse from the site of injury to the brain via the spinal cord
  6. Perception
    The point at which a person is aware of pain
  7. Modulation
    release of inhibitory neurotransmitters (ex-endorphins) to hinder transmission of pain
  8. Causative factory :
    • Example:
    • Pneumonia
  9. Causative Factor:
  10. Causative factor:
    Impaired blood flow
    • Example:
    • Angina
  11. Causative factor:
    • Example:
    • Sprained ligament
  12. Causative factor:
    • Example
    • Any bone
  13. Causative Factor:
  14. Causative factor:
    Skin Rash
  15. Physiological Responses
    • *Sympathetic stimulation (tachycardia, increased BP, sweating, pallor etc)
    • Most persons reach a period of adaptation where vitals return back to normal
  16. Behavioral responses
    • Crying, moaning
    • *untreated pain reduced QOL
  17. Types of Pain
    • *Acute/Transient
    • *Chronic/Persistent
    • *Chronic/ Episodic
    • *Cancer pain
    • *Idiopathic pain
    • *Nociceptive vs Neuropathic
  18. Acute Pain
    • Identifiable cause
    • *Rapid onset, varies in intensity, and lasts briefly
    • *Warns people of impending injury or disease
    • *Complication
    • -can prolong hospitalization, delay rehabitalization
    • *Can progress to chronic pain
  19. Chronic Pain
    • *Prolonged, varies in intensity, and usually lasts longer than is typically expected or predicted
    • *Intractrable pain
    • *Often no identifiable cause
    • *Ongoing and often does not respond to treatment
    • *Endorphins either cease to function or are reduced
  20. Nociceptive Pain
    • *Nociceptors
    • *Somatic
    • *Visceral
    • *Responds well to opioids and/ or non-opiods
  21. Nociceptors
    • Nerves that sense and responds to parts of the body which suffer damage.
    • *Signal tissue irritation, impending injury, or actual injury
  22. Somatic
    • Sprains, bone fractures, burns, bumps, bruises, inflammation
    • *Aching or throbbing and well localized
  23. Visceral
    Arises from visceral organs
  24. Neuropathic Pain
    • *Results from damage to nerves caused by infection or disease
    • *Central
    • *Peripheral
    • *Often chronic
    • *May not respond well to opioids and may respond better to anti-seizure and antidepressant medications
  25. Central (Neuropathic Pain)
    From brain or spinal cord (ex. phantom limb pain)
  26. Peripheral (Neuropathic pain)
    • *From peripheral nervous system
    • *Described as burning, tingling, pins and needles
  27. Factors that influence Pain
    • *Physiological Factors (age, fatigue, genes,)
    • *Social (Attention, previous experience, family/social support)
    • *Spiritual
    • *Psychological (Anxiety, coping style)
    • *Cultural (meaning or pain, ethnicity)
  28. Barriers to pain relief
    • *Healthcare professionals
    • *Healthcare system
    • *Patients
  29. Healthcare professionals (Barriers to pain relief)
    inadequate/inaccurate information about pain management
  30. Healthcare system (Barriers to pain relief)
    • *Low priority given to pain treatment
    • *Restrictive regulation of controlled substances
  31. Patients (Barriers to pain relief)
    • *Reluctance to report pain or take meds- fear of becoming dependent
    • *Fear that pain means disease process is progressing
  32. Assessment of Pain
    • *Patients' pain needs to be assessed on a regular bases (6th vital sign)
    • *Patients expression of pain
    • - most reliable indicator of existence and intensity
    • *ABCDE
    • *COLDSPA
    • *PQRST
  33. Methods of pain assessment
    • *Pain history
    • -tolerance, influence on ADLs
    • *Pain characteristics
    • - Onset, duration, quality, intensity, pattern, non-verbal/behavioral effects
    • *Client expectations
  34. Dilation of bronchial tubes and increased respiratory rate
    • Sympathetic Stimulation
    • ***Provides increased oxygen intake
  35. Increased heart rate
    • Sympathetic Stimulation
    • ***Provides increased oxygen transport
  36. Peripheral vasoconstriction (pallor, elevation in blood pressure)
    • Sympathetic Stimulation
    • ****Elevates blood pressure with shift of blood supply from periphery and viscera to skeletal muscles and brain
  37. Increased blood glucose level
    • Sympathetic Stimulaton
    • ***Provides additional energy
  38. Diaphoresis
    • Sympathetic Stimulation
    • ****Controls body temperature during stress
  39. Increased muscle tension
    • Sympathetic Stimulation
    • ***Prepares muscles for action
  40. Dilation of pupils
    • Sympathetic Stimulation
    • ****Affords better vision
  41. Decreased gastrointestinal motility
    • Sympathetic Stimulation
    • ***Frees energy for more immediate activity
  42. Pallor
    • Parasympathetic Stimulation
    • ***Causes blood supply to shift away from periphery
  43. Muscle tension
    • Parasympathetic Stimulation
    • ***Results from fatigue
  44. Decreased heart rate and blood pressure
    • Parasympathetic Stimulation
    • ***Results from vagal stimulation
  45. Rapid, irregular breathing
    • Parasympathetic Stimulation
    • ***Causes body defenses to fail under prolonged stress of pain
  46. Parasympathetic Stimulation
    Severe or deep pain.
  47. Sympathetic Stimulation
    Pain of low to moderate intensity and superficial pain.
Card Set
N200 Pain Management
from the ppts