Lession plan new for msc nursing hha gga gyya ftdtahgv .docx

case notes

1. LESSON PLAN ON
PAIN SCALE MONITORING
PREPARED BY
Manaswini Pradhan

2. Cantral Objectives
At the end of the class the students will acquire in depth knowledge regarding the Pain score monitoring and apply this knowledge in future Patient care
practices with a positive attitude.
Specific Objectives:
defines the topic.
enumerates the signs and symptoms of pain
enlists the types of pain.
describes the physiology of pain.
describes the mechanism of pain
enlists the factors influencing pain
enumerates the types of pain scales
Name of the teacher: Manaswini Pradhan
Subject:
Unit: 4
Topic: Pain Score Monitoring
Group: PCA Students
Method of Teaching:
AV Aids: LCD
Venue: Avittom Class Room
Number of students: 4
Previous Knowledge:
Duration:
Time:
Date:

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2min
5min
Introduces the
topic
Defines the topic
INTRODUCTION
Pain is the subjective experience for the patient and can
be characterized in many different ways: sharp or dull,
burning or tingling, or generalized aching. Unrelieved
pain has been associated with negative outcomes and
physiologic alterations, such as increased pheripheral
vascular resistance and cardiac oxygen consumption,
hypercoagulability, and compromised immune function.
Pain management is an important component of
comprehensive patient care.
DEFINITION
• “Pain is whatever the experiencing person say it
is existing whenever the experiencing person says it does”
(McCaffery,1989)
• “Pain is an unpleasant sensory and emotional
experience, associated with or expressed in terms of actual
or potential tissue damage” (IASAP,1989)
NATURE OF PAIN
Pain is subjective highly individualized. Its stimulus
is physical and / or mental in nature.
Lecturing cum
Discussion
Lecturing cum
Discussion
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LCD
How to explain pain?

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5min
enumerate the
signs and
symptoms of pain
It interferes with personal relationships and influences
the meaning of life. Only the patient knows whether
pain is present and how the experience feels. It may
not be directly proportional to amount of tissue injury.
SIGNS AND SYMPTOMS OF PAIN
Increased respiratory rate
Increased heart rate
Peripheral vasoconstriction
Pallor
Elevated BP
Increased blood glucose levels
Diaphoresis
Dilated pupils
Moaning
Guarding the area
Restlessness, Irritability
Lecturing cum
Discussion
Lecturing cum
Discussion
LCD
LCD
List down the signs
and symptoms of
pain?

5. time Specific
Objective
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5mins
Enlist the types
of pain
TYPES OF PAIN
1.Base on duration
2.Based on location
3.Based on intensity
4.Based on etiology
1.Based on duration
1.1Acute pain
When pain lasts only through the expected
recovery period, it is described as acute pain
It is protective, has an identifiable cause, is short duration and has
limited tissue damage and emotional
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Discussion
Lecturing cum
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LCD
List down the
types if pain?

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Response.
It eventually resolves with or without treatment, after
an injured area heals
Complete pain relief is not always achievable, but
reducing pain to a tolerable level is realistic.
Unrelieved acute pain can progress to chronic pain
1.2Chronic pain
chronic pain is the pain that lasts longer than 6 months
and is constant or recurring with a mild-to-severe
intensity
it does not always have an identifiable cause and leads
to great personal suffering. Eg: arthritic pain, headache
Associated symptoms of chronic pain include fatigue,
insomnia, anorexia, weight loss, hopelessness and
anger
Chronic pain may be
oChronic non cancer pain
oChronic cancer pain
oChronic episodic pain
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2.Based on location
3.Based on Intensity
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3.1.Mild pain:
Pain scale reading from 1 to 3 is considered as mild pain
3.2.Moderate pain:
Pain Scale reading from 4 to 6 is considered as moderate pain
3.3.Severe pain:
Pain scale reading from 7 to 10
4.Based on etiology
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4.1.Nociceptive pain (Somatic and Visceral)
 Nociceptive pain is experienced when an intact properly
functioning nervous system sends signals that tissues are damaged,
requiring attention and proper care.
 For example, the pain experienced following cut or broken
bone alerts the person to avoid further damage until it is properly healed.
 Somatic Pain: that is originating from the skin, muscles, bone,
or connective tissue.
 Visceral Pain: that results from the activation of nociceptors of
the thoracic, pelvic, or abdominal viscera (organs). Characterized by
cramping, throbbing, pressing, or aching qualities. Eg; Labor pain,
angina pectoris or irritable bowel.
4.2.Neuropathic pain
 It is associated with damaged or malfunctioning nerves due to
illness, injury, or undetermined reasons.
 Examples: diabetic peripheral neuropathy, spinal cord injury
pain
Lecturing cum
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10
mins
Describes the
physiology of
pain
PHYSIOLOGY OF PAIN
Pain plays an important in the survival of all animals. It acts as
a signal, alerting us to potential tissue damage, and leads to a
wide range of actions to prevent or limit further damage.
Physiologically, pain occurs when sensory nerve endings called
nociceptors (also referred to as pain receptors) come into
contact with a painful or noxious stimulus.
Lecturing cum
Discussion
LCD Explain the
physiology of
pain

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The resulting nerve impulse travels from the sensory
nerve ending to the spinal cord, where the impulse is
rapidly shunted to the brain via nerve tracts in the spinal
cord and brainstem. The brain processes the pain
sensation and quickly responds with a motor response in
an attempt to cease the action causing the pain.
1.Primary sensory neurons in the peripheral
nervous system, which conduct painful
sensations from the periphery to the dorsal root
of the spinal cord.
2.Secondary sensory neurons in the spinal cord
or brainstem, which transmit the painful
sensation to the thalamus.
3.Tertiary sensory neurons, which transmit the
painful sensation from the thalamus to the
somatosensory areas of the cerebral cortex.
Sensory Nerves Entering the Spinal Cord
A section of a lumbar vertebra showing the sensory
nerves (in yellow, with bulge) entering the dorsal part of
the spinal cord. There are two major classes of nerve
fibers associated with the transmission of pain:
1. Unmyelinated C fibers
2. Myelinated A-delta fibers
Lecture cum
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13. 5mi
n
Describes the
mechanism of
pain
The C fibers are small and conduct impulses slowly. They
respond to thermal, mechanical, and chemical stimuli and
produce the sensation of dull, diffuse, aching, burning,
and delayed pain. A-delta fibers, which are myelinated
and thus conduct impulses rapidly, respond to mechanical
(pressure) stimulus and produce the sensation of sharp.
localized, fast pain.
One of the most important central pain
pathways is the spinothalamic tract, which originates in
the spinal cord and extends to the thalamus. This spinal
tract transmits sensory information related to pain,
temperature, and crude touch.
Another prominent pathway is the spino-
reticular tract, which is involved in nociceptive
processing. The spino-reticular tract is similar to the
spino-thalamic tract in that it is excited by similar sensory
fibers. Rather than ascending to the thalamus however,
spino-reticular neurons terminate within the brainstem
MECHANISMS OF PAIN
Pain can be caused by a mechanical, chemical or
inflammatory, or thermal mechanism.
Lecturing cum
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Lecturing cum
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LCD Explain the
mechanism of
pain?

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5mi
n
Enlist the
factors
influencing
pain
Pain of mechanical origin can be caused by acute
trauma, injury, or overuse. It may be constant,
variable, or intermittent in nature and is affected by
movement and position.
Pain of chemical or inflammatory origin is
associated with arthritis and other inflammatory
disorders. It is often constant but responds to
positioning, therapy, rest, and gentle movement.
Medications are usually a part of the management
regimen for chemical or inflammatory pain.
Pain of thermal origin is the result of excessive
heat or cold. If an acute pain sensation is intense
enough, it can cause system-wide responses: increased
alertness; focused attention; the suppression of
feeding, sleep, and reproduction, and increased
vascular tone, respiration, and blood sugar levels. If
pain persists or becomes chronic it can even change
the circuitry in the central nervous system.
FACTORS INFLUENCING PAIN
1. Developmental factors
2. Physiological factors- fatigue, genes, neurological
functioning
3. Social factors- attention, previous experience,
family
and social support, spiritual factors.
Lecturing cum
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Lecturing cum
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LCD
LCD What are the
factors that
influencing pain?

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4. Psychological factors- anxiety, coping style.
5. Cultural factors
Developmental factors
Age:
Age influences pain, particularly in infants and older adults
Young children have trouble understanding pain and the
procedures that cause it. If they have not developed full
vocabularies, they have difficulty verbally describing and
expressing pain to parents or caregivers. With the
developmental factors in mind assessment should be done
for pain in children. Older adults have a greater likelihood of
developing pathological conditions, which are accompanied
by pain.
Physiological Factors 1
Fatigue.
Fatigue heightens the perception of pain and decreases
coping abilities. . If it occurs along with sleeplessness, the
perception of pain is even greater. . Pain is often experienced
less after a restful sleep than at the end of a long day.
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Genes
Research on healthy human subjects suggests that
genetic information passed on by parents possibly
increases or decreases the person's sensitivity to
pain and determines pain threshold or pain
tolerance.
Neurological Function.
Any factor that interrupts or influences normal pain
reception or perception (e.g., spinal cord injury) affects
the patient's awareness of and response to pain.
Social Factors
Attention.
The degree to which a patient focuses attention on pain
influences pain perception. Increased attention is
associated with increased pain, whereas distraction is
associated with a diminished pain response.
Previous Experience.
If a person repeatedly experiences the same type of pain
that was relieved successfully in the past, the patient
finds it easier to interpret the pain sensation. If a person
is having worst previous experience he may experience
much pain.
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Family and Social Support
The presence of family or friends can often make the
pain experience less stressful. The presence of parents
is especially important for children experiencing pain.
Spiritual Factors
Spiritual questions include "Why has this Spiritual
Factors happened to me?" "Why am I suffering
Spiritual pain goes beyond what we can see. "Why has
God done this to me?" "Is this suffering teaching
oIf the person is experiencing like this feelings it
me makes much painful
Psychological Factors
Anxiety:
Anxiety often increases the perception of pain, and
pain causes feelings of anxiety. Critically ill or injured
patients who perceive a lack high anxiety levels. This
anxiety leads to severe pain.
Coping Style.
Lecturing cum
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18. Persons with better coping levels perceives lessa pain
than the person with lower coping levels.
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19. 10
mins
Explains the
assessment
tools, pain
scales and
narcotic scales
Cultural Factors.
Cultural beliefs and values affect how
individuals cope with pain.
individuals learn what is expected and accepted
by their culture, including how to react to pain.
Culture affects pain expression. Some cultures
believe that it is natural to be demonstrative
about pain. Others tend to be more introverted.
ASSESSMENT- PAIN SCALES AND NARCOTIC
SCALES
Pain assessment: is a multidimensional observational
assessment of a patients' experience of pain.
Pain measurement tools: are instruments designed to
measure pain.
PAIN ASSESSMENT
1.Precipitating/Alleviating Factors: - What
causes the pain? What aggravates it? Has
medication or treatment worked in the past?
2.Quality of Pain: - Ask the patient to describe the
pain using words like "sharp", dull, stabbing,
burning"
Lecturing cum
Discussion
Lecturing cum
Discussion
LCD
LCD
List down the
types of pain
scales?

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3.Radiation-Does pain exist in one location or radiate to
other areas?
4.Severity - Have patient use a descriptive, numeric or
visual scale to rate the severity of pain.
5.Timing-Is the pain constant or intermittent, when did it
begin
PAIN ASSESSMENT TOOLS
Three ways of measuring pain:
Self-report what the child says (the gold standard)
Behavioral -how the child behaves
Physiological - clinical observations
1. FLACC - The acronym FLACC stands for Face, Legs,
Activity, Cry and consolability.
Behavioral
2 months-8 years and also used up to 18 years for
children with cognitive impairment and/or
developmental disability (always elicit support from
parents or carers to help with pain assessment)
It may be difficult to assess children with cognitive
impairment and/or are non-verbal. Ask the parent
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2. WONG-BAKER FACES PAIN SCALE
3-18years Self report Explain to the person that each face is for a
person who feels happy because he has no pain (hurt) or sad because he
has some or a lot of pain. Face 0 is very happy because he doesn't hurt
at all. Face 2 hurts just a little bit. Face 4 hurts a little more. Face 6
hurts even more. Face 8 hurts a whole lot. Face 10 hurts as much as you
can imagine, although you don't have to be crying to feel this bad. Ask
the person to choose the face that best describes how he is feeling
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3.VISUAL ANALOGUE SCALE
8-years and older
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2mi
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Concludes the
topic
AFTER PAIN ASSESSMENT
Inform your physician/ pain management
team when pain score above 5 onwards
Follow orders as per physician order and
drug chart.
Manage the pain with pharmacological
and nonpharmacological measures
Reassess the pain after one hour
Document the pain management measures
in pain assessment form
Don’t forget to document the assessment
and outcome in patient records
CONCLUSION
Pain can be treated through a variety of methods.
The most appropriate method depends upon the
situation. Management of chronic pain can be
difficult and may require the coordinated efforts of
a pain management team, which typically
includes medical practitioners,-clinical
pharmacists, clinical
psychologists, physiotherapists, occupational-
therapists, physician assistants, and nurse
practitioners.
Lecturing cum
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LCD

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RECAPITULIZATION
Time:10min
Mark:15
What is pain?
What are the signs and symptoms of pain
List down the types of pain?
Explain the pathophysiology and
mechanism of pain?
What are the factors that influencing
pain?
Differentiate the types of pain scales?
ASSIGNMENT
Write an assignment on PCA role in pain
scale monitoring
BIBLIOGRAPHY
Raj D Elakkuvana Bhaskara, Textbook
of nursing Foundation – I, EMMESS
publications 2022, Page no:197-203
Potter and Perry, essentials of nursing
foundation, Elsevier publications.
Kath Jyothi, Text book of nursing foundation for
B.Sc Nursing Students, First Edition, Vision
Health Sciences Publication
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