Rnsg 1413 Comfort Chapter42 Power Point Fall 2006[1]

Chapter 42 Comfort

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Gate-Control Theory of Pain • Suggest that cutaneous stimulation activates larger, faster-transmitting Abeta sensory nerve fibers. This decreases pain transmission through small-diameter A-delta and C fibers. A back massage is a nursing intervention based on gate-control theory Mosby items and derived items © 2005 by Mosby, Inc.

Client Responses • Physiological responses – Nausea and vomiting are responses to deep severe pain – Tachycardia is commonly seen with of low to moderate intensity – Diaphoresis is commonly seen with pain of low to moderate intensity – Pupil dilation is seen with pain of low to moderate intensity. Mosby items and derived items © 2005 by Mosby, Inc.

Behavioral responses An individuals self-report of pain is the single most reliable indicator of the existence and intensity of pain and any related discomfort. Pain is individualistic. Mosby items and derived items © 2005 by Mosby, Inc.

Types of Pain • • • • •

Acute pain Chronic pain Cancer pain Pain by inferred pathology Idiopathic pain

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Knowledge, Attitudes, and Beliefs • Subjective nature of pain • Nurse’s response to client’s report of pain • Prejudices and misconceptions

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Assessment of Comfort Level • Client’s expression of pain • Characteristics of pain – Onset and duration – Location – Intensity– use a descriptive scale – Quality- sensation experienced- “What does the discomfort feel like?” – Pattern-what precipitates the pain Mosby items and derived items © 2005 by Mosby, Inc.

Pain Descriptions • Deep or visceral pain- diffuse and may radiate in several directions. It may also be described as a burning pain. • Referred pain is felt in a part of the body separate from the source of the pain. • Radiating pain feels as though it travels down or along a body part. • Superficial or cutaneous pain is of short duration and is localized. Mosby items and derived items © 2005 by Mosby, Inc.

Nursing Diagnoses • • • • • • •

Anxiety Ineffective coping Fatigue Acute pain Chronic pain Ineffective role performance Disturbed sleep pattern Mosby items and derived items © 2005 by Mosby, Inc.

Planning • Goals and outcomes – Client is using pain relief measures safely - patients with cancer may have goals that do not include eradication of the pain but that patent will respond to adaptations in pain analgesics.

• Setting priorities • Continuity of care Mosby items and derived items © 2005 by Mosby, Inc.

Nonpharmacological Pain Relief • Anticipatory response– by providing the patient information on a procedure and it potential discomfort it may decrease the pain. • Distraction-directs the clients attention to something else.- this could also be guided imagery focusing on a pleasant experience. • Biofeedback • Cutaneous stimulation—massage ( long firm strokes down the back), application of hot/cold, • Herbals • Reducing painful stimuli and perception Mosby items and derived items © 2005 by Mosby, Inc.

Controlling Painful Stimuli • Managing the client’s environment— bed, linens, temperature • Positioning • Changing wet clothes and dressings • Monitoring equipment, bandages, hot and cold applications • Preventing urinary retention and constipation Mosby items and derived items © 2005 by Mosby, Inc.

Pharmacological Pain Relief – Analgesics: NSAIDs and nonopioids, opioids, adjuvants • Non-opiate analgesics are often used to treat mild musculoskeletal pain effectively.

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Local analgesic infusion pump Topical analgesics and anesthetics Local and regional anesthetics, blocks Transmucosal analgesics – should not be chewed, the unit is placed in the client’s mouth and swabbed over the inside of the cheeks and lower gums, no more than 2 units should be used per breakthrough pain episode, and the unit needs to be allowed to dissolve and absorb over a 15-minute period.

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PCA – Patient-controlled analgesia (PCA)- these patients receiving opioid epidural infusions must be monitored every 15 minutes during the initial dosing phase. • The best patients for this procedure are patients post operative and patients with good cognitive function • It is not recommended for patients with renal failure or patients with psychogenic pain. • -epidural catheters should be secured carefully to the outside of the skin to stop catheter displacement. • Use a transparent dressing and change tubing as per facility policy.

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Implementation of Comfort Measures (cont'd) • Surgical interventions • Procedural pain management • Chronic and cancer pain management • TENS unit is used when pain is percieved. Mosby items and derived items © 2005 by Mosby, Inc.

Implementation: Restorative Care • Pain clinics • Palliative care • Hospices

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