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Comfort and Pain NC3


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nociceptive pain
1.somatic pain- ligaments, tendons, bones, blood vessels and nerves
2.viseral pain- abdominal cavity, cranium and thorax,
3.referred pain- pain felt in apart of the body that is removed from the tissues causing the pain
neuropathic pain
described as shooting, stabbing and is often severe. Damage from cutting, crushing or compression, viral or chemical exposure
restraining of the nociceptive process inhibiting the pain signal transmission. Endorphins and enkephalins provide biochemical descending inhibition. Massage, heat, and cold application inhibit ascending modulation. Biochemical mediators of pain- serotonin, histamine, potassium, bradykinin and substance P
dorsal horn
location in the spinal cord that prevents or permits pain impulses to reach the brain. Part of the Gate control theory. Opening the gate is caused by A-delta and C-fibers. Closing of the gate is influenced by A-alpha and A-beta fibers
Pain threshold
pain stimulation required before a pt feels it. Uniform throughout a person's lifetime, differs among different people. Pain threshold changes if tissue damage is present. Changes in relation to person's level of consciousness
pain tolerance
most intensity of pain that a person is willing to tolerate. Varies markedly over time in the same person and differs among different people
characteristics of pain
location, intensity, quality, and onset and duration
chronic pain
mild to severe, parasympathetic nervous system response, continues beyond healing
acute pain
mild to severe, sympathetic nervous system response- increased HR, respiratory rate, elevated blood pressure, diaphoresis, dilated pupils
malignant pain
intractable- highly resistant to relief. Relief requires use of multiple methods such as imagery and PCA
procedural pain
short term, experienced during a procedure
dispeling myths about pain
1.newborns do feel pain
2.sleep or lack of complaint does not indicate pain relief
3. pain is not a normal part of aging
4. peopel with chronic pain do not have hypochondriasis nor do they have hysterical personalities
diabetic neuropathy
decreased sensation to pain associated with peripheral nerve disease
What does massage, heat and cold application do for pain
inhibits ascending modulation of pain signals
Heat and cold therapy
contraindicated over broken skin, mucous membranes or rashes. Heat and cold reduce muscle spasm and decrease pain but heat should not be used within 24 hours of injury because it increases blood flow, edema and bleeding at the site
transcutaneous electrical nerve- stimulation is an adjunct to manage acute or chronic pain. TENS produces analgesia by stimulating A-beta fibers to block A-delta and unmyelinated C-fibers to block noxious stimuli from the periphery by stimulating endorphins in the dorsal horn. It should not be used for clients with pacemakers because itmay interfere with or inhibit the output of some demand-type pacemakers.
environmental interventions
room temperature, noise reduction, improving ventilation and use of assistive devices can increase comfort or decrease pain
anitcipatory guidance
using honest explanation of what the client will feel
used best during brief periods of intense pain (during dressing changes)
guided imagery
helping patient focus on a pleasant, relaxed mental image
blocks patient's awareness of pain through suggestions
comfortable position, passive attitude, quiet evnoronment and concentration. It complements other pain-relief techniques
learn voluntary control over autonomic functions, such as heart rate, hand temperature, and muscle tension. Motivation of the client is important because it requires extensive training
nonsteroidal antiinflammatory drug- ibuprofen, naproxen, tolmetin, and indomethacin- aspirin and acetaminophen are all single agent therapies used for mild pain relief
opioid agonist
relief of moderate to severe pain during consciousness- morphine, codeine, hydromorphone, oxycodone, oxymorphone, meperidine, fentanyl and methadone. All analgesia by binding to specific opioid receptors
opioid antagonist
Naloxone- reverse the depressant effects of opiods. Tx for opiod overdose
opiod agonist-antagonists
pentazocine, nalbuphine, butorphanol, dezocine- bind only to certain opioid receptor sites. Can cause acute withdrawl syndrome in persons dependent on opioid agonists
Topical drugs
used for localized pain relief of skin or mucous membranes.
Benefits of PCA
1.uses smaller opioid dosages, 2.decreased delay in receiving pain med,
3.decreases potential for overdosing, 4.decreases dependency on nursing personnel
5. decreases client anxiety and promotes earlier activity with improved pulmonary status
Best used for moderate to severe pain and with patients who cna understand and follow instructions
marked rhythmic waxing and waning of respirations from very deep to very shallow breating and temporary apnea. Pattern is not unusual during sleep in the elderly and should not be exclusive reason to restrict opioid pain relief
adjunvant medications
meds that enhance analgesia of opioids, tx symptoms that exacerbate pain or provide independent analgesia for types of pain. Corticosteriods, antidepressant drugs and hypnotics
3 step analgesic ladder
1-non-opioid analgesics +/- and adjuvant. Moderate pain persist go to...
2. opioid admin +/- non-opioid +/- adjuvant
3. opioid for moderate to severe pain +/- mon-opioid +/- adjuvant. Used in the relief of cancer pain
signs and symptoms of pain
acute pain will manifest in changes in blood pressure, heart rate, respiratory rate and metabolic responses. Rapid, shallow breathing may result in hypoxemia, nausea, vomiting, dizziness,and diarrhea. Chronic pain may result in adaptation and commonly observed responses may be present
Verbal and nonverbal clues of pain
verbal are most dependable indicators of pain.
- Nonverbal pain clues- rubbing painful area, frowns and grimaces and increased muscle tension occurring with guarding and immobilization.
Promoting safety by monitoring sedative level of analgesics
1. respiratory rate is moderaltely affected (8-10 breaths/min) withhold the opioid and reduce subsequent doses
2. respiratory rate is significantly affected (<8 breaths/min) administer Narcan until adequate respiratory rate returns by pain relief remains intact

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