PAIN & Discomfort pain and comfact management .pptx

Pain and comfact management

1. PAIN & DISCOMFORT Mrs. Shyla Nikhil Lecturer Care college of nursing

2. definition “Pain” is defined as an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described bin terms of such damage. -Mersskey&bogduk,1994 Pain is highly unpleasant physical sensation caused by illness or injury. Pain is a basic bodily sensation that is induced by a noxious stimulus associated with actual or potential tissue damage and characterized by physical discomfort.

3. PHYSIOLOGY/ pathway of pain

4. CAUSES PHYSICAL CAUSES : injury, cuts, burns, tumors, abscess, fractures, infection, cramps, sprains, inflammation NEUROPATHIC CAUSES : peripheral nerve damage, cranial nerve abnormalities PSYCHOGENIC CAUSES: pain resulting from mental event PHANTOM PAIN: amputation

5. Factors effecting pain PHYSIOLOGICAL FACTORS: Age Sex Fatigue Genes Neurological Function

6. PSYCHOLOGICAL FACTORS: C oping styles T olerance levels SOCIAL & ENVIRONMENTAL FACTORS: Family / friends Attention Past experience

7. RELIGIOUS FACTORS: Spirituality Cultural & lifestyle factors: C ultural practices C ultural beliefs

8. ASSESSMENT OF PAIN Characteristic of pain Onset Duration Location Pattern AggrAvating factors Relieving factors Behavioral effects Physiological changes

9. PAIN ASSESSMENT TOOLS 1. NUMERICAL RATING SCALE:

10. 2. VERBAL PAIN RATING SCALE:

11. 3. WONG-BAKER’S FACES PAIN SCALE:

12. PAIN MANAGEMENT

13. ADMINISTRATION OF ANALGESICS GENERAL PRINCIPLES: A ssess pain characteristics Pain scoring Discuss with patient alternative pain relieving methods Post-administration assessment Documentation Observe for adverse effects

14. PHARMACOLOGICAL MANAGEMENT i . non-opioid non-narcotic medications: Acetaminophen(Tylenol): Action: Analgesic Max Dose: 4g For 24hrs Side Effects: Hepatotoxicity, Renal Damage, Hepatic Failure Antidote: Acetylcystine

15. NON STEROIDAL ANTI-INFLAMATORY DRUGS (NSAIDS): Eg : ASPRIN, BRUFEN, NAPROXEN, INDOMETHACIN, SALICYLIC ACID, MEFENAMIC ACID Inidications : Mild Headache, muscle strains, spasms, fever A ction: inhibits release of prostaglandins thereby subsiding inflammatory process Side effects: headache, heart burn, occult blood stools, anorexia

16. ii. OPIOID ANAGLGESICS: administered in severe cases in combination to NSAIDs Action: produce pain killer action by combining with opioid receptors in brain

17. Eg :  morphine, heroin, codeine, oxycodone, hydrocodone, fentanyl, TRAMADOL, PETHIDINE, PENTAZOCINE Side Effects: Drowsiness/ Sedation, Dizziness, Constipation, Euphoria, Nausea, Vomiting And Slowed Breathing. Adverse Effects: Cardiac Arrest, Depression, Hepatic Failure, Circulatory Failure

18. iii. Adjuvants Anti-depressants: Sertraline, Imipramine, Isocarboxazid , Flouxatine Anti- convulsants : Phenetoin Sodium, Sodium Valproate , Carbamazapine Muscle relaxants: Vecuronium , Rocuronium , Atracurium , Sccnylcholine Sedatives: Phenobarbital, Diazepam, Midazolam, Propofol , Thiopentone Anti-anxiety drugs: Phenobarbital , Diazepam, Alprazolam,

19. iv. Local anesthesia local anaesthesia  involves numbing an area of the body using a type of medicine called a local anaesthetic . these medicines can be used to treat painful conditions, prevent pain during a procedure or operation, or relieve pain after surgery. Eg : lidocaine, bupivacaine, ropivacaine

20. Patient controlled analgesia (PCA) Pca is a method of pain control that gives patients to control their pain by being able to control the unit.

21. Invasive techniques of pain management 1. INJECTIONS: nerve blocks epidurals

22. 2. prolotherapy :

23. 3. Radiofrequency radio ablation :

24. 4. Electrotherapy implants: Eg : Spinal Cord Stimulators, Peripheral Nerve Stimulators

25. 5. Neuro-ablative procedures: Eg : Cordotomy , Rhizotomy

26. 6. kyphoplasty :   a minimally invasive procedure used to treat vertebral compression fractures by inflating a balloon to restore bone height then injecting bone cement into the vertebral body.

27. Non-pharmacological pain management Massage Positioning Hot & cold applications Acupuncture Trans-cutaneous electric nerve stimulation (tens)

28. 6. Progressive muscle relaxation ( pmr ) 7. bio-feedback 8. Guided imagery

29. 9. Aroma therapy 10. Oil-therapy 11. Music therapy 12. Hypnotherapy 13. Therapeutic touch 14. Reiki therapy

30. Complimentary and alternative modalities (cam) Complementary and Alternative Medicine is treatment that falls outside of mainstream healthcare. DEFINITION: T hese modalities are a group of diverse medical health care systems, practices, products and procedures along with or without conventional medical treatment. -The National Centre for Complementary and Alternative Medicine ( NCCAM)

31. 1. Ayurveda Believes in the use of plant-based medicines and treatments. hundreds of plant-based medicines are employed, including cardamom and cinnamon. S ome animal products may also be used, for example, milk, bones, and gallstones. in addition, fats are used both for consumption and for external use. Minerals including sulfur, arsenic, lead, copper sulfate and gold are also consumed as prescribed. “This practice of adding minerals to herbal medicine is known as R asa Shastra ”

32. 2. Unani Unani medicine is based on the Greek philosophy. A ccording to basic principles of unani , the body is made up of the four basic elements, i.e. earth, air, water, fire which have different temperaments, i.e. cold, hot, wet, dry. Patient diagnosis depends on observation of these elements and their balance. The treatment ( Ilaj-Bil-Tadbeer ) consists of Dalak (massage), cupping, aroma therapy, bloodletting, bathing, exercise, diet ( Ilaj-bil-ghiza ), Climatic Therapy ( Ilaj-bil-hawa ) unani medicines and surgery.

33. 3. Homeopathy I t is a form of alternative medicine in which practitioners treat patients using highly diluted preparations that are believed to cause healthy people to exhibit symptoms that are similar to those exhibited by the patient. The basic principle of homeopathy, known as the "law of similars ", is "let like be cured by like"

34. 4. Siddha It is a form of medical treatment of diseases using substances of all possible origins in a way that balances the possible harmful effect of each substance. this form of medicine was professed and practiced by “Siddhas” who wrote their recipes on palm-leaves for the use of future generations. S iddha medicine was developed by outstanding dravidians (ancient tamils ), locally called cittars . preparations are made mainly out of the parts of the plants and trees such as leaves, bark, stem, root, etc., but include also mineral and some animal substances

35. 5. Naturopathy it is a system of man building in harmony with the constructive principles of nature on physical, mental, moral and spiritual planes of living without use of drugs. “Naturopathy is a system of treatment which recognises the existence of self healing force within the body." therefore, it advocates aiding human system to remove the cause of disease, i.e. toxins by expelling the unwanted and unused matters from human body for curing diseases, diet, exercise, herbs, osteopathy and simple massage

36. 6. YOGA T he word ‘Yoga' is derived from the sanskrit root ‘ Yuj ', meaning 'to join' or 'to yoke' or 'to unite'. A s per yogic scriptures the practice of yoga leads to the union of individual consciousness with that of the universal consciousness, indicating a perfect harmony between the mind and body, man & nature. Y oga as exercise is a physical activity consisting mainly of postures, often connected by flowing sequences, sometimes accompanied by breathing exercises, and frequently ending with relaxation lying down or meditation.

37. 7. TAI-CHI T ai chi is a practice that involves a series of slow gentle movements and physical postures, a meditative state of mind, and controlled breathing. T ai chi originated as an ancient martial art in china. over the years, it has become more focused on health promotion and rehabilitation.

38. THANK YOU..!