RNSG 1523 Nursing Care of the Client with Pain_ Latest
Objectives: Discuss the characteristics, concepts, and processes related to the individual
... [Show More] experiencing pain.
1. Define pain.
“Pain is whatever the experiencing person says it is, existing whenever he says it does” – Pasero and McCaffery
“An unpleasant, subjective sensory and emotional experience associated with actual or potential tissue damage” – international Association for the study of pain (IASP)
NOTE: PAIN IS PURELY SUBJECTIVE UNTIL MEASURED, IT BECOMES OBJECTIVE. RATED ON A PAIN SCALE 1-10.
2. Differentiate among the different types of pain.
▪ Acute = sudden and usually subsides when treated. One example of acute pain is postoperative pain. Protective, usually has an identifiable cause, related to infection.
▪ Chronic = persistent or recurring, lasting 3 to 6 months. Not protective and thus serves no purpose.
Lasts past the expected recovery time. Does not always have an identifiable cause and leads to great
personal suffering. Ex. Arthritis, fibromyalgia
▪ Chronic episodic = Pain that occurs sporadically over an extended period of time is episodic pain. Pain episodes last for hours, days, or weeks. Examples are migraine headaches and pain related to
sickle cell disease.
▪ Cancer-related = can be acute or chronic or both. It most often results from pressure of the tumor mass against nerves, organs, or tissues. Also related to pathological processes, invasive procedures,
toxicities of treatment, infection, and physical limitations
▪ Idiopathic = chronic pain in the absence of an identifiable physical or psychological cause or pain perceived as excessive for the extent of an organic pathological condition. Ex fibromyalgia
▪ Neuropathic = Abnormal processing of sensory input by the peripheral or central nervous system.
Damage to the nerves. Found in diabetics (diabetic neuropathy). Tends to be a burning and tingling
feeling.
▪ Referred = pain perceived at a location other than the site of the painful stimulus/ origin. A patient senses pain at the actual site of the tumor or distant to the site
3. Describe the physiology of pain.
▪ Transduction = Thermal, chemical, or mechanical stimuli usually cause pain. Transduction converts energy produced by these stimuli into electrical energy
▪ Transmission = The pain impulse moves from the spinal cord to the brain. Neurotransmitters (pain- sensitizing substances) spreads the pain message and causes an inflammatory response.
▪ Perception = Once a pain stimulus reaches the cerebral cortex, the brain interprets the quality of the
pain and processes information from past experience, knowledge, and cultural associations in the
perception of the pain. Perception is the point at which a person is aware of pain. It gives meaning to pain, resulting in a reaction
▪ Modulation = release of inhibitory neurotransmitters such as endogenous opioids, serotonin,
norepinephrine, and gamma aminobutyric acid (GABA), which work to hinder the transmission of
pain and help produce an analgesic effect
4. Identify components of the pain experience.
▪ Physiological
• Age
a) Developmental differences found between these age-groups influence how children
and older adults react to pain.
b) Young children have trouble understanding pain, its meaning, and the procedures that cause it.
c) If they have not developed full vocabularies, they have difficulty verbally describing and expressing pain to parents or caregivers.
d) Toddlers and preschoolers are unable to recall explanations about pain or associate it with experiences that occur in various situations.
e) With these developmental considerations in mind, you need to adapt approaches for assessing a child’s pain, including what to ask and the behaviors to observe, and how to prepare a child for a painful medical procedure.
f) Older adults have a greater likelihood of developing pathological conditions, which are accompanied by pain. Serious impairment of functional status often accompanies pain in older patients.
g) Pain potentially reduces mobility, activities of daily living (ADLs), social activities, and activity tolerance. The presence of pain in an older adult requires aggressive assessment, diagnosis, and management.
h) When older adults experience cognitive impairment and confusion, they have difficulty recalling pain experiences and providing detailed explanations of their pain. You need to address misconceptions about pain management in the very young and in older adults before intervening for a patient
• Fatigue
a) Fatigue heightens the perception of pain and decreases coping abilities. Pain is often
experienced less after a restful sleep than at the end of a long day.
• Genes
a) genetic information passed on by parents possibly increases or decreases the
person’s sensitivity to pain and determines pain threshold or pain tolerance.
• Neurological function
a) Any factor that interrupts or influences normal pain reception or perception (e.g.,
spinal cord injury, peripheral neuropathy, or neurological disease) affects the patient’s awareness of and response to pain.
b) Some pharmacological agents (analgesics, sedatives, and anesthetics) influence pain perception and response and thus require close monitoring.
▪ Social
• Attention
a) The degree to which a patient focuses attention on pain influences pain perception.
b) Increased attention is associated with increased pain, whereas distraction is associated with a diminished pain response.
c) This concept is one that nurses apply in various pain-relief interventions such as relaxation, guided imagery, and massage.
d) By focusing patients’ attention and concentration on other stimuli, their perception of pain decline
• Previous experience
a) Each person learns from painful experiences.
b) Previous frequent episodes of pain without relief or bouts of severe pain cause anxiety or fear.
c) In contrast, if a person repeatedly experiences the same type of pain that was relieved successfully in the past, the patient finds it easier to interpret the pain sensation.
d) As a result, the patient is better prepared to take necessary actions to relieve the pain.
e) When a patient has no experience with a painful condition, the first perception of it often impairs the ability to cope
f) In the anticipatory phase of the pain experience, you need to prepare a patient with a clear explanation of the type of pain to expect and methods to reduce it.
g) This usually results in a reduced perception of pain.
• Family/ social support
a) People in pain often depend on family members or close friends for support,
assistance, or protection.
b) The presence of parents is especially important for children experiencing pain.
• Spiritual factors
a) Spirituality stretches beyond religion and includes an active searching for meaning to
situations in which one finds oneself.
b) Spiritual questions include “Why has this happened to me?” “Why am I suffering?” “Why has God done this to me?” “Is this suffering teaching me something?”
c) Other spiritual concerns include loss of independence and becoming a burden to family.
d) Consider making a referral to pastoral care for patients in pain.
e) Recall that pain is an experience that has physical and emotional components. Thus providing interventions designed to treat both aspects is essential for the best possible pain management.
▪ Psychosocial
• Anxiety
a) A person perceives pain differently if it suggests a threat, loss, punishment, or
challenge.
b) For example, a woman in labor perceives pain differently than a woman with a history of cancer who is experiencing a new pain and fearing recurrence.
c) Anxiety often increases the perception of pain, and pain causes feelings of anxiety. It is difficult to separate the two sensations.
d) Critically ill or injured patients who perceive a lack of control over their environment and care have high anxiety levels.
e) This anxiety leads to serious pain-management problems. Pharmacological and nonpharmacological approaches to the management of anxiety are appropriate; however, anxiolytic medications are not a substitute for analgesia
• Coping style
a) Coping style influences the ability to deal with pain.
b) Persons with internal loci of control perceive themselves as having control over events in their life and the outcomes such as pain.
c) In contrast, persons with external loci of control perceive that other factors in their life such as nurses are responsible for the outcome of events.
▪ Cultural
d) Patients who self-administer small doses of intravenous (IV) pain medication using PCA during an acute episode successfully achieve pain control more quickly than those who rely on nurses to administer intermittent doses of pain medications.
• Cultural beliefs and values affect how individuals cope with pain. Individuals learn what is
expected and accepted by their culture, including how to react to pain
• An understanding of the cultural meaning of pain helps you design culturally sensitive care for people with pain
• Culture affects pain expression. Some cultures believe that it is natural to be demonstrative
about pain. Others tend to be more introverted.
• Find a culturally appropriate assessment tool and communicate use of that tool to other health care providers.
5. Assess a patient experiencing pain across the lifespan.
▪ Young to Older Infant
• Loud cry
• Rigid body or thrashing
• Local reflex withdrawal from pain stimulus
• Eyes tightly closed, mouth open in a squeamish shape, eyebrows lowered and drawn together
• Lack of association between stimulus and pain
• Facial expressions
▪ Toddler
• Loud cry or screaming
• Verbal expressions of pain
• Thrashing of extremities
• Attempt to push away or avoid stimulus
• Uncooperative
• Clinging to significant person
▪ School age child
• Stalling behavior
• Muscular rigidity
• Any behavior of the toddler, but less intense in the anticipatory phase and more intense with
painful stimuli
▪ Adolescent
• More verbal expressions of pain with less protest
• Muscle tension with body control
6. Discuss cultural & psychosocial aspects of the pain experience across the lifespan.
▪ Psychosocial
• Anxiety
a) A person perceives pain differently if it suggests a threat, loss, punishment, or
challenge.
b) For example, a woman in labor perceives pain differently than a woman with a history of cancer who is experiencing a new pain and fearing recurrence.
c) Anxiety often increases the perception of pain, and pain causes feelings of anxiety. It is difficult to separate the two sensations.
d) Critically ill or injured patients who perceive a lack of control over their environment and care have high anxiety levels.
e) This anxiety leads to serious pain-management problems. Pharmacological and nonpharmacological approaches to the management of anxiety are appropriate; however, anxiolytic medications are not a substitute for analgesia
• Coping style
a) Coping style influences the ability to deal with pain.
b) Persons with internal loci of control perceive themselves as having control over events in their life and the outcomes such as pain.
c) In contrast, persons with external loci of control perceive that other factors in their life such as nurses are responsible for the outcome of events.
d) Patients who self-administer small doses of intravenous (IV) pain medication using PCA during an acute episode successfully achieve pain control more quickly than those who rely on nurses to administer intermittent doses of pain medications.
▪ Cultural
• Cultural beliefs and values affect how individuals cope with pain. Individuals learn what is
expected and accepted by their culture, including how to react to pain
• An understanding of the cultural meaning of pain helps you design culturally sensitive care for people with pain
• Culture affects pain expression. Some cultures believe that it is natural to be demonstrative
about pain. Others tend to be more introverted.
• Find a culturally appropriate assessment tool and communicate use of that tool to other health care providers.
7. Identify barriers to effective pain management.
▪ Fear of addiction
▪ Worry about side effects
▪ Takes too many pills already
▪ Fear of injections
▪ May need more tests
▪ Needs to suffer to be cured
▪ Pain necessary for past indiscretions
▪ Inadequate education
▪ Reluctance to discuss pain
▪ Not believing patient’s report of pain
8. Describe nursing measures to care for a client in pain across the lifespan.
▪ Adults
• Reduce factors that enhance pain
• Use noninvasive techniques
• Medications: opioid, non-opioid, placebo
• Realize that a pain level of zero is not always a realistic goal
▪ Children
• Reassess children’s pain frequently.
• Use non-pharmacological, pharmacological, or both approaches to manage pain.
• Ask parent or caregiver to reassess the child’s pain.
• Atraumatic measures:
• Avoid procedures in safe places such as a playroom or the child’s bed = they might associate the safe place with pain
• Use a treatment room
• Offer child choices = allow them to pick color or type of band aid
• Allow parents to stay with child during painful procedures
• Use play therapy
• Use least traumatic route for medication administration
9. Describe nonpharmacological methods of pain relief, such as cutaneous stimulation, relaxation, distraction, TENS, and acupressure.
A number of nonpharmacological interventions lessen pain; however, they are to be used with, and not in place of, pharmacological measures. It is for patients who cannot tolerate pain medications, those who wish to reduce multiple medications, and those who are seeking alternative methods of relieving chronic pain.
▪ Relaxation and guided imagery
• Relaxation and guided imagery allow patients to alter affective-motivational and
cognitive pain perception.
• Relaxation is mental and physical freedom from tension or stress that provides individuals a sense of self-control.
• Physiological and behavioral changes associated with relaxation include the following: decreased pulse, blood pressure, and respirations; heightened awareness; decreased
oxygen consumption; a sense of peace; and decreased muscle tension and metabolic rate.
• Relaxation techniques include meditation, yoga, Zen, guided imagery, and progressive relaxation exercises.
• For effective relaxation, teach techniques only when a patient is not distracted by acute discomfort
▪ Distraction
• With sufficient sensory stimuli, a person ignores or becomes unaware of pain.
• Persons who are bored or in isolation have only their pain to think about and thus
perceive it more acutely.
• Distraction directs a patient’s attention to something other than pain and thus reduces awareness of it.
• One disadvantage of distraction is that, if it works, health care providers or family members question the existence or severity of the pain.
• Distraction works best for short, intense pain lasting a few minutes such as during an invasive procedure or while waiting for an analgesic to work.
• Use activities enjoyed by the patient as distractions (e.g., singing, praying, listening to music, humor or laughter therapy, playing games).
▪ Cutaneous stimulation
• Stimulation of the skin helps relieve pain.
• A massage, warm bath, ice bag, and transcutaneous electrical nerve stimulation (TENS) stimulate the skin to reduce pain perception.
• Cutaneous stimulation gives patients and families some control over pain symptoms and treatment in the home.
• Using it properly helps to reduce muscle tension, resulting in less pain.
• When using cutaneous stimulation, eliminate sources of environmental noise, help the
patient to assume a comfortable position, and explain the purpose of the therapy.
• Do not use it directly on sensitive skin areas (e.g., burns, bruises, skin rashes, inflammation, and underlying bone fractures).
• Massage is effective for producing physical and mental relaxation, reducing pain, and enhancing the effectiveness of pain medication.
• Massaging the back, shoulders, hands, and/or feet for 3 to 5 minutes relaxes muscles and promotes sleep and comfort. Massages communicate caring and are easy for family
members or other health care personnel to learn
• Cold and heat applications relieve pain and promote healing.
• Cold is effective for tooth or mouth pain when you place the ice on the web of the hand
between the thumb and index finger. This point on the hand is an acupressure point that
influences nerve pathways to the face and head
• Another form of cutaneous stimulation is transcutaneous electrical nerve stimulation (TENS), involving stimulation of the skin with a mild electrical current passed through
external electrodes. The therapy requires an order from a health care provider.
• The TENS unit consists of a battery-powered transmitter, lead wires, and electrodes.
• Place the electrodes directly over or near the site of pain. Remove any hair or skin
preparations before attaching the electrodes.
• The patient turns the transmitter on when feeling pain. This creates a buzzing or tingling sensation. The patient adjusts the intensity and quality of skin stimulation and applies the
tingling sensation until pain relief occurs.
• TENS is effective for postsurgical and procedural pain control.
10. Describe the action, uses, adverse effects and nursing implications of opioid analgesics and non-opioid analgesics.
▪ Opioid analgesics = pain relievers that either contain opium, are derived from the poppy, or are chemically related to opium. Very strong pain relievers
• Action
✓ Agonist = binds to the opioid pain receptor
✓ Partial agonist = partially binds to the opioid pain receptor, causing a weaker
neurologic response. Ex Butorphanol tartrate (Stadol)
✓ Antagonist = reverses the effects of narcotics
• Uses
✓ generally prescribed for moderate-to-severe pain.
• Morphine (MS Contin)
• Meperidine (Demerol)
• Hydromorphone (Dilaudid)
• Fentanyl (Sublimaze)
• Oxycodone (OxyContin) = Can be combined with acetaminophen (Percocet); ASA (Percodan); ibuprofen (Combunox)
• Codeine
• Hydrocodone = Can be combined with acetaminophen (Lortab, Vicodin); ASA (Azdone), ibuprofen (Vicoprofen)
✓ Cough center suppression
✓ Treatment of diarrhea
• Indications
✓ Adjuvant (useful) analgesic drugs assist the primary drugs with pain relief:
• NSAIDs
• Antidepressants
• Anticonvulsants
• Corticosteroids = can decrease inflammation
• Contraindications
✓ drug allergy
✓ severe asthma
• Adverse effects
✓ Respiratory depression
✓ Sedation
✓ Nausea & vomiting
✓ Constipation
✓ Altered mental processes
✓ Dependence
✓ Antidote: Naloxone hydrochloride (Narcan) + binds to the pain receptors but does not produce pain reducing effects
• Nursing implications
▪ NSAIDs = Nonsteroidal anti-inflammatory drugs
Large and chemically diverse group of drugs with the following properties
• Analgesic
• Anti-inflammatory
• Antipyretic = reduces fever
• Anti-rheumatic =reduces rheumatic arthritis
Ex. Ketorolac (Toradol), indomethacin (Indocin SR), celecoxib (Celebrex)
• Ibuprofen (motrin, advil, etc) = nonsteroidal, anti-inflammatory, don’t give with aspirin (ASA), GI irritation and ulceration, give with food.
❖ Salicylates (aspirin) – indications
✓ Analgesic
✓ Antipyretic
✓ Anti-inflammatory
✓ Anti-platelet effect: used in the prevention of Myocardial Infarction and other
thromboembolic disorders
• Uses
✓ provide relief for mild-to-moderate acute intermittent pain such as the pain
associated with a headache or skeletal muscle strain, inflammation, fever, prevention of MI.
• Adverse effects
✓ GI- bleeding, Nausea/ Vomiting
✓ Blood- Bleeding times increase
✓ Nervous- Stimulates CNS, tinnitus &/or hearing loss (toxic
✓ levels)
✓ Reye’s Syndrome in children who take aspirin while they have a fever/viral infection
• Contraindications
✓ Ulcers
✓ Pregnancy
✓ Anemia
✓ Child with fever/ virus
• Nursing interventions
✓ Force fluids
✓ Give with food if nausea and vomiting is absent (or give buffered, antacid)
✓ Be mindful of herbal interactions
▪ Non-opioid analgesics = Acetaminophen (Tylenol) good for kids
• Uses = mild to moderate pain and fever
✓ Little effect on CNS
✓ Analgesic and antipyretic effects
✓ Little to no anti-inflammatory effects
✓ Available OTC and in combo with opioids
✓ Alternatives for those who cannot take NSAIDs
✓ Contraindications to acetaminophen use include known drug allergy, severe liver
disease
• Toxicity and managing overdose
✓ Over the counter – lethal when overdosed
✓ Overdose – hepatotoxicity: hepatic necrosis
✓ Long-term ingestion also causes nephropathy
✓ Recommended antidote: acetylcysteine
11. Evaluate a patient’s response to pain interventions.
▪ Reassess signs and symptoms of the patient’s pain response; the severity and characteristics of pain and the patient’s self-report
▪ Evaluate the family and friends’ observation of the patient’s response to therapies
▪ Evaluate impact of pain on physical and social functioning
12. Evaluate the influence of your own knowledge, beliefs, and attitudes about pain assessment and management.
▪ The traditional medical model of illness generates attitudes about pain.
▪ This model suggests that physical problems result from physical causes.
▪ Thus, pain is a physical response to organic dysfunction. When there is no obvious source of pain (e.g., the patient with chronic low back pain or neuropathies), health care providers sometimes stereotype pain sufferers as malingerers, complainers, or difficult patients.
▪ Studies of nurses’ attitudes regarding pain management show that a nurse’s personal opinion about a patient’s report of pain affects pain assessment and titration of opioid doses.
▪ The amount of analgesia administered varies based on whether a patient is grimacing or smiling during the nurse’s assessment
▪ Nurses with more than 6 years of work experience, higher job motivation, and perceived higher levels of pain care skills in themselves often use more patient advocacy skills in providing pain management for patients.
▪ Nurses’ assumptions about patients in pain seriously limit their ability to offer pain relief. Biases based on culture, education, and experience influence everyone.
▪ Too often nurses allow misconceptions about pain to affect their willingness to intervene. Some nurses avoid acknowledging a patient’s pain because of their own fear and denial.
▪ They do not believe a patient’s report of pain if he or she does not look in pain.
▪ You are entitled to your personal beliefs; however, you must accept a patient’s report of pain and act according to professional guidelines, standards, position statements, policies and procedures, and evidence-based research findings.
▪ To help a patient gain pain relief, view the experience through the patient’s eyes.
Notes
▪ Importance of pain
• Improves quality of life
• Reduces physical discomfort
• Promotes a return to baseline functioning
• Decrease hospitalizations and length of stay
▪ Nursing role in pain management
• Assess pain and communicate with other health care providers
• Ensures initiation of adequate pain relief measures
• Evaluate effectiveness of interventions
• Advocate for those in pain
▪ Behaviors aid the assessment of pain
▪ Nursing assessment
• Through the patient’s eyes
a. Many people view pain as a part of life. Asking patients about their tolerable pain
level is the first step in helping them regain control.
b. Assessing previous pain experiences and effective home interventions provides a foundation on which you can build.
c. Patients expect nurses to accept their reports of pain and be prompt in meeting their pain needs.
d. When assessing pain, be sensitive to the level of discomfort and determine what level will allow your patient to function.
e. During an episode of acute pain, you primarily assess its location, severity, and quality. Collect a more detailed acute pain assessment when the patient is more comfortable.
f. For patients with chronic pain, a thorough pain assessment includes affective, cognitive, behavioral, spiritual, and social dimensions.
g. Monitor pain on a regular basis along with other, vital sign. Relying solely on a number is unsafe
h. Although pain assessment is a nursing function, nursing assistive personnel (NAP) also screen for pain. NAP have the responsibility to inform the nurse immediately when a patient is having pain, so the nurse is able to confirm the assessment and begin appropriate treatment.
i. The goal is to identify how much pain exists without interfering with patient function, not to identify how much pain the patient tolerates.
j. Failure of clinicians to assess a patient’s pain, accept the findings, and treat the report of pain is a common cause of unrelieved pain and suffering
• Patient’s expression of pain
a. A patient’s self-report of pain is the single most reliable indicator of its existence and
intensity. Pain is individualistic
b. Children, people who are developmentally delayed, patients who are psychotic, the critically ill, patients with dementia, and patients who do not speak English all require different approaches.
• Characteristics of pain = COLDSPA
a. Timing (onset, duration, and pattern) = Ask questions to determine the onset,
duration, and sequence of pain. When did it begin? How long has it lasted? Does it occur at the same time each day? How often does it recur?
b. Location = To assess pain location, ask the patient to describe or point to all areas of discomfort. Do not assume that your patient’s pain always occurs in the same location.
c. Severity = Nurses use a variety of pain scales to help patients communicate their pain intensity.
✓ Examples of pain intensity scales include the verbal descriptor scale (VDS), the
numerical rating scale (NRS), and the visual analogue scale (VAS).
✓ When using the NRS, a report of 0 to 3 indicates mild pain; 4 to 6, moderate pain; and 7 to 10, severe pain, considered a pain emergency.
✓ These scales work best when assessing pain intensity before and after therapeutic interventions.
✓ Assessing pain intensity in children requires special techniques. Children’s verbal statements are most important
✓ Assessment requires you to use words such as owie, boo-boo, or hurt. Some unique tools are available to measure pain intensity in children.
✓ The “Oucher” = uses photographs of the face of a child (in increasing levels of discomfort) to cue children into understanding pain and its severity. A child points to a face on the tool, thus simplifying the task of describing the pain. Used for preschool age (3-5) and up
✓ The Wong-Baker FACES scale assesses pain in verbal children. The scale consists of six cartoon faces ranging from a smiling face (“no hurt”) to increasingly less happy faces; to a final sad, tearful face (“hurts worst”). Children as young as 3 years of age use the scale. Widely used.
✓ FLACC scale = Face, Legs, Activity, Cry, Consolability. the scale is scored in a range of 0-10. used with infants
✓ The older adult, especially those with cognitive impairment, may need more time to respond to the assessment tool and may also require large-print versions of written tools.
✓ Nurses use a variety of other tools to assess pain in neonates, infants, nonverbal toddlers, and children with cognitive impairments.
d. Quality = use hurt and ache to describe their pain, reserving the word pain for severe discomfort. Always use words other than pain to obtain an accurate report. For example, you say, “Tell me what your discomfort feels like.”
e. Aggravating and precipitating factors (pattern) = Ask the patient to describe activities that cause pain such as physical movement or food. Also ask him or her to demonstrate actions that cause a painful response such as coughing or turning a certain way. Asking the patient if there is a particular time of day that the pain is worse or if the pain is intermittent, constant, or a combination helps you plan interventions to prevent it from occurring or worsening.
• Relief measure
a. It is useful to know whether a patient has an effective way of relieving pain such as
changing position, using ritualistic behavior (pacing, rocking, or rubbing), eating, meditating, praying, or applying heat or cold to the painful site.
b. The patient’s methods are ones you can use for treatment. Patients gain trust when they know you are willing to try their relief measures.
c. They also gain a sense of control over the pain instead of the pain controlling them.
d. Assessment of relieving factors includes identification of all the patient’s health care providers (e.g., internist, orthopedist, acupuncturist, chiropractor, or dentist).
• Effects of pain on the patient = When a patient is in pain, you need to conduct a focused
physical and neurological examination and observe for nonverbal responses to pain (e.g.,
“grimacing, rigid body posture, limping, frowning, or crying”)
a. Behavioral effects
✓ When a patient has pain, assess verbalization, vocal response, facial and body movements, and social interaction.
✓ A verbal report of pain is a vital part of assessment. You need to be willing to listen and understand.
✓ Many patients are unable to communicate their pain. An infant or a patient who is unconscious, disoriented or confused, aphasic or who speaks a foreign language is unable to explain the pain experience.
✓ The nonverbal expression of pain either supports or contradicts other information about it.
b. Influence on activities of daily living
✓ Patients who live with daily pain are less able to participate in routine activities, which results in physical deconditioning.
✓ Assessment of these changes reveals the extent of the patient’s disability and adjustments necessary to help patients participate in self-care.
✓ Your primary goal as a nurse is to improve patient function.
✓ Depending on the location of the pain, some patients have difficulty independently performing ADLs.
✓ For example, some pain restricts mobility to the point at which the patient is no longer able to bathe in a bathtub.
✓ Assess the patient’s need for assistance with self-care activities and collaborate with members of the health care team (e.g., physical and occupational therapy)
✓ Assess the work that patients do and their abilities to function in their jobs. Assess the daily chores of homemakers in the same manner as the duties involved in jobs outside the home. Also assess whether it is necessary for patients to stop activity occasionally because of pain, and then help them select ways to minimize or control it so they are able to remain productive.
• Concomitant symptoms = including nausea, headache, dizziness occur with pain severity
• Daily pain diary
▪ Nursing diagnoses for pain
• Activity intolerance
• Anxiety
• Ineffective coping
• Fatigue
• Fear
• Hopelessness
• Impaired physical mobility
• Imbalanced nutrition: less than body requirements
• Insomnia
• Powerlessness
• Chronic low self-esteem
• Impaired social interaction
• Spiritual distress
▪ Why is pain undertreated?
• Inadequate skills to assess and treat pain
• Unwillingness to believe patient reports
• Lack of time, expertise, and perceived importance of pain assessments
• False concepts of addiction and tolerance
▪ Be mindful that the geriatric population metabolizes drugs differently than the adult population. They
may need a reduced dosage because the body metabolizes more slowly.
▪ Consequences of untreated pain
• Unnecessary suffering
• Physical and psychosocial dysfunction
• Impaired recovery from acute illness and surgery
• Immunosuppression
• Sleep disturbances
▪ Untreated pain in children
• Children are almost always under-medicated.
• Pain assessment needs to be a priority.
• Consider developmental stage of the child.
• Consider painful and invasive procedures. [Show Less]