pain management

Pain

·         One major reason why people seek health care

·         Nurses have a central role in assessment & management of pain

Nursing Roles

·         Assess pain, document & communicate with other health care providers

·         Ensure initiation of adequate pain relief measures

·         Evaluate effectiveness of interventions

·         Monitor ongoing effectiveness of pain relief strategies

Definition of Pain

·         Whatever & whenever the person experiencing pain says it is

·         Unpleasant sensory & emotional experience associated with actual or potential tissue damage.

·         Multidimensional experience

-          Physiological

-          Sensory

-          Affective

-          Behavioral

-          Cognitive

 

 

·         Subjective: client’s experience & self-report is essential

-          can be problematic when dealing with or clients who are non-verbal or cognitively unable to rate pain

-          nonverbal information such as behaviors aids the assessment of pain

Pain

Pain may be acute, persistent, or chronic in nature.

Pain assessment: Sensory component

·         Intensity of pain

-          Reliable measure to determine treatment

-          Rated using scales, adjusted to client age & cognitive ability

®      Numerical (0-10)

®      Verbal descriptors

®      Visual analogue

®      Smiling/crying faces

 

 

Pain Rating Scales

·         Wong-baker faces scale

 

·         Oucher scale

 

 

 

Indicators of Pain

·         Infants

-          Body posture

-          Restlessness, etc

·         Children

-          Changes in behavior, activity level

-          Changes in vital signs

·         Cognitively impaired

-          Absence indicators – e.g. decreased interaction etc.

-          Active indicators – e.g. rocking, irritability etc.

 

Pain & Discomfort in post operative client

·         Etiology (clinical unit)

-          Trauma to skin & underlying tissues by incision & retraction during surgery

-          Reflex muscle spasms around the incision

-          Tension & muscle spasm to due anxiety/fear

-          Deep breathing, coughing, changing position

-          Pressure in the internal viscera.

 

Pain – Nursing Management

·         Nursing assessment (clinical unit)

-          Indications of pain & question about the degree & characteristics of pain

-          Identify location

-          Measure before & after treatment is administered.

 

Priority Nursing Problems associated with pain

·         Acute pain

·         Anxiety

·         Fear

·         Altered mobility

·         Impaired tissue integrity

·         Risk for infection

·         Altered respiratory function

 

Nursing interventions

·         Nursing implementation (Clinical Unit)

-          Postoperative pain relief:

®      A nursing responsibility

®      First 48+ hrs, narcotic analgesics (e.g. morphine)

®      Afterward, non-narcotic analgesics, may be sufficient as pain decreases.

?          Narcotic: a drug or other substances affecting mood or behavior & sold for nonmedical purposes, especially an illegal one.

-          Effective pain management:

®      Promotes optimal healing

®      Prevents complications

®      Allows clients to participate in necessary activities.

§  Should be timed to ensure it is in effect during painful activities (e.g. ambulating)

-          Before administering analgesic, nurse should assess nature of client’s pain (location, quality, and intensity):

®      Incisional pain = analgesic administration is appropriate

®      Chest or leg pain may indicate a complication that must be reported & documented, & that medication might mask

®      Gas pain could be aggravated by narcotics.

?          Aggravate: make (a problem, injury, of offense) worse or more serious.

-          Notify physician & request a change in the order if the analgesic

®      Fails to relieve pain

®      Makes client excessively lethargic or somnolent

-          Patient-controlled analgesia (PCA):

®      Provides immediate analgesia

®      Maintains constant, blood level of analgesic agent

®      Involves self-administration of predetermined doses of analgesia by client.

-          Epidural analgesia: infusion of pain-relieving medications through a catheter placed into epidural space surroundings spinal cord

®      Delivery of medication directly to opiate receptors in the spinal cord

®      Administration may be intermittent or constant & is monitored by nurse.

 

Nonpharmacological Therapy

·         Distraction & imagery

·         Relaxation techniques

·         Music

·         Massage

·         Application of heat/cold

·         TENS

-          Transcutaneous electrical nerve stimulation is considered type of cutaneous stimulation in which electrodes attached to a battery-operated unit stimulate the skin & underlying tissues near area of localized pain.

·         Acupressure

·         Exercise

·         Humor, etc.

 

Clinical Approach

·         A= Ask About pain regularly

·         B= Believe the client & family

·         C= Choose appropriate pain control options

·         D= Deliver interventions timely

·         E= Empower clients & their families.