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Nursing Care of Clients Experiencing Pain

Nursing Care of Clients Experiencing Pain. Pain Pathway . A-delta fibers: transmit pain quickly, associated with acute pain C-fibers: transmit pain more slowly, diffuse burning pain and chronic pain

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Nursing Care of Clients Experiencing Pain

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  1. Nursing Care of Clients Experiencing Pain

  2. Pain Pathway • A-delta fibers: transmit pain quickly, associated with acute pain • C-fibers: transmit pain more slowly, diffuse burning pain and chronic pain • Inhibitory mechanisms: the analgesia system stimulates a pain inhibitory center in the dorsal horns of the spinal cord (the exact mechanism is unknown) • Endorphins: naturally occurring opioid peptides present in the neurons in the brain

  3. Pain Pathway

  4. Pain Pathway

  5. Pain Pathway

  6. Acute, Chronic, Central, Phantom, and Psychogenic Pain • Acute Pain • Somatic Pain • May be sharp or diffused • May be accompanied by nausea and vomiting • Visceral Pain • Arises from the body organs • Usually dull and poorly localized • May be referred or may radiate • Referred Pain • Perceived in an area distant from the site of the stimuli

  7. Acute, Chronic, Central, Phantom, and Psychogenic Pain

  8. Acute, Chronic, Central, Phantom, and Psychogenic Pain • Chronic Pain • Recurrent Acute Pain • Well-defined episodes of pain • Migraine headaches, sickle cell crisis • Ongoing Time-limited Pain • Persists for a definite time period • Ends with control of the disease, rehabilitation, or death

  9. Acute, Chronic, Central, Phantom, and Psychogenic Pain • Chronic Pain • Chronic Nonmalignant Pain • Not life-threatening but persists past expected time for healing • Chronic Intractable Nonmalignant Pain Syndrome • Client unable to cope well with the pain • Pain may be mild to severe • The pain itself becomes the pathologic process

  10. Acute, Chronic, Central, Phantom, and Psychogenic Pain • Central Pain • May be caused by a vascular lesion, tumor, or inflammation • Phantom Pain • Thought to be due to stimulation of severed nerves at the amputation site • Psychogenic Pain • Involves a long history of severe pain • The pain is real and can lead to physiologic changes

  11. Factors Affecting Pain Response • Age • Sociocultural influences • Emotional status • Past experiences with pain • Meaning associated with the pain • Lack of knowledge

  12. Myths and Misconceptions Concerning Pain • Pain is a result, not a cause • Chronic pain is really a masked form of depression • Narcotic medication is too risky to be used for chronic pain • It is best to wait until a client has pain before giving medication • Many client’s lie about the existence or severity of pain • Pain relief interferes with diagnosis

  13. Collaborative Care for Pain • Medications • NSAIDs: analgesic, antipyretic, and anti-inflammatory action • Narcotics: opioids • Antidepressants: act on the retention of serotonin, thus inhibiting the pain sensation • Anticonvulsants: used for headache and neuropathic pain • Local anesthetics: blocks the transmission of nerve impulses, therefore blocking pain

  14. Collaborative Care for Pain

  15. Collaborative Care for Pain • Surgery • Cordotomy: an incision into the anterolateral tracts of the spinal cord to interrupt the transmission of pain • Neurectomy: removal of part of the nerve • Sympathectomy: destruction of the ganglia by incision or injection • Rhizotomy: surgical severing of the dorsal spinal roots • Transcutaneous electrical nerve stimulation (TENS): electrodes stimulate the A-beta touch fibers to close the “pain” gate

  16. Collaborative Care for Pain

  17. Collaborative Care for Pain • Complementary Therapies • Acupuncture • Biofeedback • Hypnotism • Relaxation • Distraction • Cutaneous stimulation

  18. Nursing Process for Clients with Pain • Assess the client’s pain level • Establish a nursing diagnosis • Plan and implement a care plan • Educate the client • Evaluate the patient’s response to the care plan

  19. Nursing Process for Clients with Pain

  20. Resources • Evidence Report/Technology AssessmentPain assessment and management of cancer pain. • American Cancer SocietyPrinciples of pain management in the treatment of acute and chronic pain. • Department of Veterans AffairsPain as the 5th vital sign.

  21. Resources • The Joint CommissionType in “pain management standards” in the search box. Be sure to use quotation marks. • American Society for Pain Management NursingProvides information for nurses on pain management through education, standards, advocacy, and research.

  22. Resources • American Pain FoundationHandles the undertreatment of pain. • American Pain SocietyA wide range of resources on pain at this professional site, including bulletins, journals, advocacy/policy, events and guidelines. • American Academy of Pain ManagementServes professionals and clients in pain, including an online forum, local resources, programs, and a pain management databank.

  23. Resources • American Chronic Pain AssociationOffers support and information for people with chronic pain through support and education. Includes FAQs, links, and resources. • Agency for Healthcare Research and QualityOffers pain management guidelines, resources, and research citations.

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