Chapter 21Pain Management, Comfort, Rest and Sleep
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Chapter 21Pain Management, Comfort, Rest and Sleep - Marcador
Chapter 21Pain Management, Comfort, Rest and Sleep - Detalles
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| McCaffery and Pesero's pain description | Pain is whatever the experiencing person says it is, existing whenever he/she says it does |
| Acute Pain | Intense and Short Duration(Usually less than 6 months). Generally provides warning of potential tissue damage |
| Chronic Pain | Continuous or intermittent pain that lasts longer than 6 months. Generally signals that tissue damage has already occured |
| Endorphins | Potent Polypeptides composed of many amino acids, found in the pituitary gland and other areas of the CNS, that help to suppress pain |
| Gate Control Theory | Pain impulses may be regulated and even blocked by gating mechanisms located along the CNS(in the dorsal horn of the spinal cord) |
| NREM Sleep | Divided into four stages, responsible for maintenance of the body. Attributed with wound healing, immune functions, hormone release and muscle restoration |
| REM Sleep | Stage of sleep responsible for mental restoration. It is believed that dreams in this stage are functionally important and serve to clarify emotions and prepare the mind for the next day |
| Injurious to Physical Health | Noxious |
| PCA | Patient Controlled Analgesia-allows patient to self administer analgesics whenever needed |
| Referred Pain | Pain felt at a site other than the injured or diseased organ/body part |
| Synergistic | Actions of two or more substances/organs achieve an effect that cannot be achieved by an individual substance/organ |
| TENS | Transcutaneous Electric Nerve Stimulation- Uses pocket-sized battery-operated device that provides a continuous, mild electric current to the skin via electrodes attached to a stimulator by flexible wires. The current stimulates large nerve fibers closing the pain gate |
| Three types of pain scales | Visual Analog, Numeric and Verbal Descriptive |
| NREM Stage I | Lightest level of Sleep Lasts a few minutes Decreased physiologic activity Person is easily aroused from sleep Reduction in autonomic activities |
| NREM Stage II | Period of Sound Sleep Lasts 10-20 mins Relaxation progresses Arousal is still easy Body functions still slowing |
| NREM Stage III | Initial stage of deep sleep Last 15-30 mins Arousal is difficult and movement is rare Vital signs decline but still regular Hormonal response includes secretion of growth hormone |
| NREM Stage IV | Deepest Stage of Sleep Lasts 15-30 mins Arousal is very difficult If sleep loss has occurred the majority of the sleep cycle will be in this stage Restores and rests the body Vital signs are significantly lower than during waking hours Hormonal response continues Sleepwalking and enuresis(bed-wetting) are possible |
| Physiological Signs and Symptoms of Sleep Deprivation(6) | Trembling Hands, Decreased Reflexes, Slowed Response Time, Reduction in Word Memory, Decreased Reasoning and Judgement and Cardiac Dysrhythmias |
| Psychological Signs and Symptoms of Sleep Deprivation(7) | Mood Swings, Disorientation, Irritability, Decreased Motivation, Fatigue, Sleepiness, Hyperexcitability |
| Primary Goal of Pain Management | To Provide Pain Relief and Enable the Patient to Carry on ADL's |
| Physiologic Signs of Pain(9) | Increased Pulse, Increased Respiratory Depth and Rate, Increased Systolic and Diastolic Blood Pressure, As homeostasis is reached vital signs will usually return to normal, Diaphoresis, Pallor, Dilated Pupils, Muscle Tension, Nausea and Vomiting |
| Behavioral Signs of Pain(8) | Rigid Body Position, Restlessness, Frowning, Grimacing, Clenched Teeth, Crying, Moaning |
| Name 4 opioid analgesics | Morphine, Fentanyl(Actiq, Duragesic), Hydromorphone(Dilaudid) and Meperidine(Demerol) |
| How do opioids relieve pain? | They modify perception and reaction to pain by binding at pain receptor sites in the CNS and blocking pain |
| How do NSAIDS relieve pain? | Relieve pain by blocking prostaglandins which may serve as mediators of pain and fever |
| 24-hour day-night cycle | Diurnal or Circadian Rhythm |
| HILDA | How the Pain Feels Intensity(1-10) Location Duration Alleviating/Aggravating Factors |
| Endorphine | Attaches to opioid receptors in the brain to produce analgesia |
| Behavioral Signs of Pain | Self Protective(Guards Area) Reduced Attention Span/Narrowed Focus Withdrawn from Social Contact Impaired Thought Process Demonstrates Distracted Behavior(Moaning, Rocking, Crying, Pacing, Restlessness or Seeking out other activities/people) Presents facial mask of pain(eyes appear dull/lusterless, fixed or rapidly changing facial movements, grimacing, teeth clenching, lip biting or jaw tightening) Experiences muscle tone alteration Exhibits diaphoresis, changes in B/P, pulse rate, pupillary dilation, and increased respiration depth/rate Sometimes presents without symptoms of pain |
| IV, IM, Oral | Routes of analgesia administration |
| This route of analgesia has wide fluctuation in absorption, is often painful, and has potential to develop abscesses | IM(Intramuscular) |
| This route of analgesia is best for administration following surgery | IV(Intra-veinous) |
| NSAIDS mechanism of action | Inhibits prostaglandin that may serve as mediators of pain and fever primarily in CNS but also may block pain impulses peripherally |
| Opioids mechanism of action | Bind with pain receptors in the CNS and spinal cord, blocking pain relief |
| Examples of nonopioid analgesics | Acetaminophen, Aspirin, Ibuprofen, Naproxen, Ketorolac Tromethamine, Celecoxib |
| Examples of opioid analgesics | Morphine, Meperidine, Hydromorphone, Fentanyl |
| Naloxone(Narcan) | Opioid antagonist example |
| Most important patient problem to be alert for in opioid use | Respiratory Depression |
| Common CNS analgesic for pain, caution should be used in presence of compromised renal function | Morphine |
| Ultimate goal of pain management | To relieve pain and enable a patient to perform ADLS in as comfortable a manor as possible |
| PCA candidate requirements | Must be alert and oriented and able to follow direction |
| When should a patient receiving PCA be educated on its use? | Before the surgery |
| Benefits of PCA | Gives patient control of pain, able to keep ahead of pain curve |
| Factors that contribute to a patients lack of comfort | Anxiety, Constipation, Constricting Edema, Depression, Diaphoresis, Diarrhea, Distention, Dry Mouth, Dyspnea, Fatigue, Fear, Flatus, Grief, Headache, Hopelessness, Hyperthermia, Hypothermia, Hypoxia, Incontinence, Muscle Cramps, Nausea, Pain, Powerlessness, Pruritus, Sadness, Singultus, Thirst, Urinary Retention, Vomiting |
| Definition of pain adopted by the International Association for the Study of Pain | The unpleasant sensory and emotional experience associated with actual or potential tissue damage or described is terms of such damage |
| Onset, Duration, Location, Intensity, Quality, Pattern and Degree | Pain Assessment Factors(7) |
| Have the capacity to influence whether pain impulses reach a persons conciousness | Cerebral Cortex and the thalamus |
| Creates guidelines for health care providers involving pain management | The Joint Commission |
| It makes the presence of pain known and treatment more likely and ensures regular monitoring | Why is pain the 5th vital sign? |
| It promotes quicker recovery, shorter hospital stays, fewer admissions and improved quality of life | Why is pain management so important? |
| Hot and Cold, Massage, TENS, Relaxation, Distraction, Guided Imagery, Meditation, Hypnosis, Biofeedback | Non Invasive Pain Relief Techniques |
| Nerve Blocks, Epidural, Acupuncture, Neurosurgical Procedures | Invasive Pain Relief Techniques |