Nursing management of pain

Pain- Definitions, types, physiology, factors influencing, assessment and nursing management

1. NURSING MANAGEMENT OF PAIN PRESENTED BY JANNET REENA PURANI

2. DEFINITION OF P AIN “Pain is complex multifactorial phenomenon which includes an emotional experience associated with actual as potential” -MERSKEY & BUGDULK, 1994 The International Association for the Study of Pain (IASP) defines pain as a "sensory and emotional experience associated with tissue damage or described in terms of such damage."

3. TYPES OF PAIN ACUTE PAIN: Acute pain  is a type of  pain  that typically lasts less than 3 to 6 months, or  pain  that is directly related to soft tissue damage such as a sprained ankle or a paper cut.  Acute pain  is of short duration but it gradually resolves as the injured tissues heal. CHRONIC PAIN: Is  pain  that is ongoing and usually lasts longer than six months. This type of  pain  can continue even after the injury or illness that caused it has healed or gone away. NOCICEPTIVE PAIN: Pain  from physical damage or potential damage to the body. SOMATIC PAIN: Pain  that includes skin  pain , tissue  pain , or muscle  pain . VISCERAL PAIN: Pain  that arises from internal organ. Visceral pain often is diffuse or vaguely localized. NEUROPATHIC PAIN: Pain that originates in peripheral nerves or the central nervous system rather than in other damaged organs or tissues

4. PHYSIOLOGY OF PAIN There are four major processes: transduction, transmission, modulation, and perception. Transduction refers to the processes by which tissue-damaging stimuli activate nerve endings. Transmission refers to the relay functions by which the message is carried from the site of tissue injury to the brain regions underlying perception. Modulation is a recently discovered neural process that acts specifically to reduce activity in the transmission system. Perception is the subjective awareness produced by sensory signals; it involves the integration of many sensory messages into a coherent and meaningful whole. Perception is a complex function of several processes, including attention, expectation, and interpretation.

5. FACTORS AFFECTING PAIN PHYSIOLOGICAL AGE FATIGUE GENETIC MAKEUP MEMORY STRESS RESPONSE PSYCHOLOGICAL FEAR AND ANXIETY COPING CULTURAL Race and ethnic differences culture values or disvalues, the display of emotions, postural mobility or verbal expression in response to pain or injury. Some cultural groups expect an extravagant display of emotion in the presence of pain, but others value stoicism, restraint and playing down the pain.

6. ASSESSMENT OF PAIN The  pain assessment  involves an overall appraisal of the factors that may influence a patients experience and expression of  pain Assessment includes SUBJECTIVE DATA OBJECTIVE DATA

7. A. SUBJECTIVE ASSESSMENT 1. PAIN HISTORY While taking pain history, nurse must provide an opportunity for clients to express in their own words, how they view it and their situation This will help the nurse to understand means of pain to client and how the client is coping with it.

8. 2. ONSET AND DURATION OF OCCURRENCE: When did pain begin? How long has it lasted? Does it occur at same time each day? How often does it occurs?

9. 3. LOCATION In which area it is felt? Do the area differ under different circumstances? If several parts of body are painful, do pain occur simultaneously? Is pain unilateral / bilateral? Ask the individual to point site of discomfort

10. 4. INTENSITY Use of pain intensity scale is an easy and reliable method of determining the clients pain intensity Most scales are either 0 to 5 or to 10 Currently used scales are: Numerical scale Descriptive scale Visual analog scale

11. PAIN ASSESSMENT SCALE 1. NUMERICAL RATING SCALE A numerical rating scale with the range of to 10 is another type of pain scale that is used The word “no pain” appear by “0” and “worst pain possible” is found by “10” Patient are asked to choose a number from to 10 that best reflects his/her level of pain

12. 2. VERBAL RATING SCALES Verbal pain scales as name suggests, use words to describe pain. Word such as no pain, mild pain, moderate pain & severe pain are used to describe pain levels.

13. 3. VISUAL ANALOGUE SCALES: VSA use a vertical or horizontal line with words that convey “no pain” at one end and “worst pain” at opposite end Patient is asked to place a mark along line that indicates his/her level of pain.

14. WONG-BAKER FACES PAIN RATING SCALE With the wong-baker pain scale, six faces are used that are numbered to 5 underneath Face 0 is a happy face Face 2 is still smiling Face 4 is not smiling or frowning Face 6 is starting to frown Face 8 is definitely frowning Face 10 is crying

15. B. OBJECTIVE ASSESSMENT 1. BEHAVIORAL EFFECTS: Assess verbalization, vocal response, facial and body movements & social interaction Facial expression is often 1 st indication of pain & may be only one manifestation Vocalization like moaning, groaning, crying, grunting, screaming are associated with pain.

16. 2. PHYSIOLOGICAL RESPONSES: It vary with the origin and duration of pain Early in onset of acute pain, the symapthetic nervous system is stimulated Results in increased blood pressure, pulse rate, respiration, pallor, diaphoresis and pupil dilation

17. P-Q-R-S-T FORMAT PROVOCATION: how the injury occurred & what activities increase or decrease the pain QUALITY: characteristics of pain REFERRAL/ RADIATION Referred: site distant to damaged tissue that does not follow course of peripheral nerve Radiating: follows peripheral nerve, diffuse pain

18. QUESTION TO ASK ABOUT PAIN PATTERN: onset & duration AREA: location INTENSITY: level NATURE: description

19. WHO 3-STEP LADDER

20. PHARMACOLOGICAL MANAGEMENT OF PAIN Types of analgesic medications Analgesic drugs can be divided into two groups: Non-opioid also referred to as non- narcotic, peripheral, mild & antipyretic agents Opioids also called narcotic, central or strong agents

21. NON PHARMACOLOGICAL MANAGEMENT OF PAIN Heat Cold application Massage therapy Physical therapy Transcutaneous electrical nerve stimulation (TEN S ) Spinal cord stimulation (SCS) Aromatherapy Guided imagery Laughter Music Biofeedback Self h y pnosis Acupuncture

22. SURGICAL INTERVENTIONS OF PAIN CORDOTOMY: division of certain tracts of the spinal cord . Cordotomy is performed to interrupt the transmission of pain. RHIZOTOMY : Sensory nerve roots are destroyed where they enter the spinal cord.

23. NURSES ROLE IN PAIN MANAGEMENT PLANNING Goals and outcomes Ex: goal- “the client will achieve a satisfactory level of pain relief within 24 hours”; possible outcomes-“ reporting that the pain is a 3 or less on scale, using pain relief measures safely” Setting priorities: Ex: pain related to incisional pain can be reduced by analgesics but pain related to early labor contractions will only reduced by relaxation excercises . Continuity of care: A comprehensive plan includes a variety of resources for pain control which include nurse specialists, doctors of pharmacolology , physical therapist, occupational therapist.

24. NURSING DIAGNOSIS Ineffective airway clearance r/t chest pain Anxiety r/t past experience of poor control of pain Altered health maintenance r/t chronic pain Impaired physical mobility r/t asthmatic pain perception Knowledge deficit r/t pain Self-care deficit r/t pain or disease condition Ineffective coping Disturbed sleep pattern Impaired social interaction Ineffective role performance

25. NURSING INTERVENTION Use pain assessment scale to identify intensity of pain Assess and record pain & its characteristics, condition, quality, frequency & duration Administer analgesics as prescribed to promote optimal pain Document severity of patient pain on chart

26. Identify & encourage patient to use strategies that have been successful with previous pain Consider cultural influence on response Eliminate the factors that increase the pain experienced Teach the use of non pharmacological therapy techniques