pain perioperative nsg

8/3/2019 Pain Perioperative Nsg

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PAIN/PERI-OPERATIVE

NURSING

ARMIE B. TUAZON RN, MANc


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Basis of Grades per Term

Regular Class (including Quizzes,

recitation, and discussions)

Major Examinations (Prelim & Midterm) Return demonstration( Final)

Quizzes 30%

Recitation 30%

Major Examination 40%

Total 100%


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Basis o Course Gra e or t e

Semester:

Prelim Term Grade 30%

Semi-Final Term Grade 30%

Final Grade Term Grade 40%

-----

Total 100%


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Classroom Policies

Quizzes and ExaminationsStudent should come prepared

and on time.

Special quizzes and exams will

only be given to those with

justifiable reasons and aftersecuring a signed excuse slip

from the Dean.


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Attendance and Uniform

Attendance will be checked atthe start of the class, all those

not making acknowledgement

during the checking of

attendance will be automatically

marked absent.


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Identification cards should be

worn at all times, those without

the following will not beaccepted in class.


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Discipline

Students are expected to act inaccordance to the policies in the

student handbook.

Courtesy should be practiced at all

times.


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Mobile phones must be turned off or

in silent mode while the class is

going on; charging of mobile phonesinside the classroom is also

prohibited.


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COURSE OBJECTIVE

By the end of prelim, the learner willbe able to:

1. Define pain.

2. Describe the theories and concepts

associated with pain.

3. Compare characteristics of acutepain, chronic (persistent) pain, and

cancer pain.


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4. Describe the physiology of pain.

5. Describe factors that can alter the

perception of pain.

6. Use the nursing process as a

framework for the care of patientswith pain.


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PAIN

Merskey & Bogduk- an unpleasant sensory and

emotional experience associated

with actual or potential tissue

damage.


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American Pain Society

-the fifth vital sign

McCaffery

- defines pain as "whatever the

experiencing person says it is,

existing whenever he or she it does".


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Sternbach

defines pain as:(1)a personal, private, sensation of

hurt;

(2) a harmful stimulus which signals

current or impending tissue damage;

(3) a pattern of responses whichoperate to protect the organism

from harm.


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PAIN THEORIES

1.Specificity Theory (Rene Descartes) -

- proposed that the intensity of pain

is directly related to the amount ofassociated tissue injury.


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2. Pattern theory (Goldschneider)

- proposed that there is no separate

system for perceiving pain, and the

receptors for pain are shared with

other senses, such as of touch.


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3. Gate control theory ( Melzack and

Casey)- proposed that there is a specified

system (gate control) that modulates

sensory input before evokingperception and response to the

stimuli.


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Me zac suggests t at severa

factors can open the gate:

Physical factors, such as injury or

activation of the large fibers

Emotional factors, such as anxiety,

worry, tension and depression;

Behavioural factors, such as focusingon the pain or boredom.


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The gate control theory also

suggests that certain factors close

the gate:

Physical factors, such as medication,

stimulation of the small fibers; Emotional factors, such as happiness,

optimism or relaxation;

Behavioural factors, such as

concentration, distraction or

involvement in other activities.


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Which approach, definition, or theory of

pain allows the greatest degree of

individualization with the pain

experience?

A.Specificity theory

B. Goldscheiders theory

C. McCafferys definition

D. Sternbachs definition


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The significance of the gate-control

theory is that it helps explain how: a. Thoughts and emotions may

modify the perception of pain.

b. Spinal cord injury affects pain.

c. Neurotransmitters influence pain

perception. d. Neuromodulators influence pain.


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CONCEPTS ASSOCIATED WITH

PAIN Pain threshold

- The process of recognizing, defining,

and responding to pain.

P

ain tolerance- The most pain an individual is willing or

able to tolerate before taking evasive

action.


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TYPES OF PAIN

According to Duration:

1. Acute pain

- Sudden or immediate onset because

it indicates that damage or injury hasoccurred.

- lasting from seconds to 6 months.- Intensity may vary from mild to

severe.


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2. Chronic Pain

- constant or intermittent pain that

persists beyond the expected healingtime

- lasts for 6 months or longer


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Types:

1 .Chronic non-malignant- from low back pain or rheumatoid

arthritis

2. Chronic intermittent

- from migraine headache

3. Chronic malignant pain (cancer related

pain)

- qualities of both acute & chronic

pain


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All but one of the following is true

about acute pain. Select the untruecharacteristic.

a. Onset may be sudden or slow.

b. It serves no purpose and is

nonprotective.

c. Intensity may vary frommild tosevere.

d. It subsides as healing takes place.


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According to Intensity (using 0-no

pain to 10-worst possible pain)

Mild- 1-3 range

Moderate- 4-6 range

Severe- 7-10 and is associated withthe worst outcomes


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According to Location:

1. Cutaneous (superficial pain)

- skin & subcutaneous

- easily localized

- abrupt(sharp, prickly or gradual

burning)


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2. Deep Somatic Pain

- pain in the muscle and bones

- poorly localized

- pain from deep structure

frequently radiates from primarysite.


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3. Visceral Pain

- comes from body organs, abdominal,

cranium, thorax


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4. Referred pain

- pain felt in the area distant from the

site of the stimulus.


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5. Neurophatic pain

- damage nerve fibers in the peripheryor by damage to the CNS.

- Needles, burning, stabbing pain


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6. Phantom limb pain

- following amputation continue to

experience sensations in the

amputated part.


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7. Intractable pain (very severe)

- Highly resistant to relief

- The focus of treatment turns from

cure to pain reduction, functionalimprovement, and the enhancement

of quality of life.


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Physiology of pain


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The experience of pain involves a

sequence of five biochem

ical andelectrical processes. The one in

which the person becomes aware of

pain is: a. Transduction.

b.Perception.

c. Transmission.

d. Modulation.


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FACTORS AFFECTING PERCEPTION

AND INTERPRETATION OF PAIN

1. Ethical and cultural values

- Beliefs about pain and how to respond

to it differ from one culture to theanother.


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2. developmental stage(age)

- The way older people respond to pain

may differ from the way youngerpeople respond.


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3. environment and support people

- a strange environment can compound

pain.

- Person without a support network may

perceive pain as severe, while personwho have supportive people around

may perceive less pain.


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4. Past pain experiences

Negative experience of pain at

birth/childhood

- greater difficulties of managingpain

Positive experience

viewed positively because the

experience was not bad as the

previous one


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- Some clients may accept pain more

readily than others, depending on thecircumstances and the clients

interpretation of its significance.


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6.anxiety/fear and stress

- anxiety that is relevant or related to the

pain may increase the patient's

perception of pain.- Anxiety that is unrelated to the pain

may distract the patient and may

actually decrease the perception ofpain.


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Men-reported less pain than women


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When caring for people in pain,

nurses should consider all but oneof the following factors. Select the

least important factor.

a. Cultural differences

b.Physiologic issues

c.

Socioeconom

ic status d.Psychological factors


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JOINT COMMISSION ON THE

ACCREDIT

ATION OH HE

ALTH C

AREORGANIZATION (JCAHO)

Incorporated pain assessment &

management into its standards.

State that Pain is assessed in all

patients & patients have rightsto appropriate assessment &

management of pain


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American Pain Foundation

developed the Pain Care Bill of

Rights, which addresses the

importance of pain management


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NURSING MANAGEMENT

PAIN ASSESSMENT

Comprehensive pain history


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1.LOCATION

Done by means of pointing out the site

of discomfort or pain perceived in thedifferent areas in the body.

QUESTION

1. where is your discomfort?

2. In what part or area did you perceived

the pain?


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2.PAIN INTENSITY OR RATING SCALES

- Also known as WONG BAKER FACES

RATING SCALE

- Is an easy and reliable method ofdetermining the INTENSITY of clients

pain.

0 = indicating no pain10 = highest # indicating the WORST

POSSIBLE PAIN


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3.Pain Quality

- Using descriptive adjectives that helps to

determine the QUALITY of pain.

- Record it VERBATIM QUESTION:

1. Tell me what your discomfort feels

like?


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4.Patterns of pain

1.TIME OF ONSET: When did or does the

pain start?

2.DURATION: How long have you had it or

how long does it usually last?

3. CONSISTENCY: Do you have pain free

periods? When? & for how long?


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5.Precipitating Factors

- Certain activities that precedes painEx.

Physical exertion that can lead to chest pain

abdominal pain after eatingrheumatoid arthritis due to cold weather

QUESTION:

1. What triggers the pain or makes it worse?


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6.ALLEVIATING FACTORS

- Done by means of describing anything

that they have done to alleviate the pain.

Ex. Home medsherbal teas

medications

rest or divertional activities


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Questions:

1. What measures or methods have you

found helpful in lessening or relieving thepain?

2. What pain medications did you use?


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7.ASSOCIATED SYMPTOMS

- It may result from the presence of the pain

Ex. Nausea

vomitingdizziness

diarrhea

QUESTION:1.Do you have any other symptoms?


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8. Effects on the activities of daily living

QUESTION:

1. How does the pain affect your life?

Ex.(eating, working, sleeping, & social &

recreational activities)


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9.Past pain experience

QUESTION:

1. Tell me about your past painexperience you have had & what was

done to relieve the pain?


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10. COPING RESOURCES

QUESTION:

What do you usually do to help you dealwith pain?


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11.AFFECTIVE RESPONSE

QUESTION:

How does the pain makes you feel?A

nxious?Depressed? Frightened? Tired? Burdensome?


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The primary source of information

about pain is the:

a.Parent or guardian.

b. Nurse or caregiver.

c.Attending physician.

d.Person in pain.


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NURSING DIAGNOSIS(NANDA)

Acute pain

Chronic pain


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Pain maybe the etiology of other

nursing diagnoses:

Ineffective airway clearance

Hopelessness

Anxiety

Ineffective coping


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Ineffective health maintenance

Self-care deficit

Deficient knowledge (pain controlmeasures)

Impaired physical mobility

Insomnia


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The two primary diagnoses for pain

identified by the North American

Nursing Diagnosis Association

(NANDA) are:

a.Adult and pediatric.

b.Acute and chronic.

c.

Short-term

and long-term.

d.Physical and psychological.

PLANNING


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PLANNING

Develop a plan that incorporates a

wide range of strategies is usually

effective It should be documented in the

clients record.


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in home care, a copy needs to be

made available to the client,

support persons, and caregivers.

IMPLEMENTATION


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IMPLEMENTATION

Establishing the NursePatient

Relationship and Teaching

Providing Physical Care

Managing Anxiety Related to Pain Pain Management


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Nurse's Role in Pain

Managementohelps relieve pain by

administering pain-relieving

interventions.

oassessing the effectiveness of

those interventions, monitoringfor adverse effects,


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serving as an advocate for the

patient when the prescribed

intervention is ineffective inrelieving pain


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PAIN MANAGEMENT

Pharmacologic Interventions

Accomplished in collaboration with

the health care team

Primary nursing responsibility:

1. assess/ evaluate effectiveness ofthe drugs

2. evaluate the side effects


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PREMEDICATION ASSESSMENT

1. ask about the allergies tomedications & the nature of

previous allergic response

2. obtain patients medical history

& history of health disorder

3. assess for the pain statusincluding intensity & changes in

pain.

CATEGORIES OF ANALGESICS


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CATEGORIES OF ANALGESICS

OPOIDS/NARCOTICS- a

morphine-like compound that

produces bodily effectsincluding pain relief, sedation,

constipation, and respiratorydepression.

Types:


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Types:

1. full agonists- Examples:

morphine, Oxycodone and

Hydromorphone

2. partial agonists- Examples:

Buprenorphine


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3. mixed agonist-antagonist-

Examples: Dezocine, Pentacozine

hydrochloride, Butorphanoltartrate, Nalbuphine

hydrochloride


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Common Opoid Side Effects

Constipation

Nausea and vomiting

Sedation

Respiratory Depression

Pruritus Urinary retention

- NONOPIODS)/NONSTEROIDAL


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NONOPIODS)/NONSTEROIDAL

ANTI-INFLAMMATORY DRUGS

Acetaminophen has only

analgesic and antipyretic effects

-NSAIDs have anti-inflammatory,analgesic, and antipyretic effects

i id d


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Most nonopioid drugs are potent:

a.A

nti-em

etics.

b.Antibiotics.

c.Anti-inflammatory agents.

d. Sedatives.


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- COANALGESICS/ADJUVANT

are drugs that is not classified as

pain medication


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Example of drugs that relievepain:

1. Antidepressants2. Anticonvulsants

3. local anesthetics


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Example of drugs that relieve

other discomforts:

1. Anxiolytics

2. Sedatives

3. Antispasmodics


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Example of drugs that reduce the

side effects of analgesics

1. stimulants

2. laxatives

3. antiemetics

APPROACHES FOR USING


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APPROACHES FOR USING

ANALGESIC AGENT

1. BALANCED ANALGESIA

3 general categories:

a. opiods

b. NSAIDS

c. local anaesthetics

PRO RE NATA (PRN)


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PRO RE NATA (PRN)

the nurse will wait for the patient

to complain of pain and then

administer analgesia.

PREVENTIVE APPROACH


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PREVENTIVE APPROACH

Administered at set intervals so

that medication acts before the

pain becomes severe

INDIVIDUALIZED DOSAGE


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INDIVIDUALIZED DOSAGE

Dosage & interval between doses

is based on PATIENTS

REQUIREMENTS rather thanroutine


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ANALGESIA

Allows the patients to control the

administration of their own

medication within predeterminedsafety limits


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PCA PUMP


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LOCAL ANESTHETICS

Works by blocking nerve

conduction when applied directly

in the nerve fibers. Applied directly to the site of

injury

TOPICAL ANESTHETIC


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TOPICAL ANESTHETIC

APPLICATION

Target the damaged nerves

responsible for the discharge of

pain impulses

INTRASPINAL ADMINISTRATION


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INTRASPINAL ADMINISTRATION


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Placebo Effect

occurs when a person responds

to the medication or other

treatment because of anexpectation that the treatment

will work rather than because it

actually does so.

A placebo violates the ethical principles of


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A placebo violates the ethical principles of

honesty because it:

a. Strips individuals of the right to make

decisions about themselves.

b. Has been used by hucksters

throughout history.

c. Seeks to deceive the person who

takes the placebo.

d. Is may be used in research to study

the effects of drugs.

WHO Three-step Analgesic


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WHO Three step Analgesic

Ladder

h l


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Nonpharmacologic Interventions

1. Cutaneous Stimulation and Massage

2. Thermal Therapies


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2. Thermal Therapies


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4. Distraction


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4. Distraction

5. Relaxation Techniques


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5. Relaxation Techniques

6. Guided Imagery


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6. Guided Imagery

7. Hypnosis


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7. Hypnosis

8. Music Therapy


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py

9. Alternative Therapies


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p

chelation, therapeutic touch, herbal

therapy, reflexology, magnetic therapy,

electrotherapy, polarity therapy,

acupressure, emu oil, pectin therapy,

aromatherapy, homeopathy, and

macrobiotic dieting


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Neurologic and Neurosurgical

Approaches


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Approaches

1. Stimulation Procedures

2. Interruption of Pain Pathways


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p y

Cordotomy

Rhizotomy


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y

Rhizotomy and cordotomy are:


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Rhizotomy and cordotomy are:

a.

Considered low-risk pain-relievingmeasures.

b. Indicated for specific types of

pain.

c. Both performed in conjunction

with a lam

inectom

y.

d. Surgical procedures that involve

nerve destruction.

Evaluating Pain Management


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Strategies

An important aspect of caring for

patients in pain is reassessing the

pain after the intervention hasbeen implemented.


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These assessments indicate the

effectiveness of the pain relief

measures and provide a basis forcontinuing or modifying the plan

of care.

pain perioperative nsg

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