NURSE-3101 Lecture Notes - Lecture 12: Analgesic, Music Therapy, Infusion Pump

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Published on 20 Oct 2016
School
Department
Professor
COMFORT AND PAIN MANAGEMENT
COMPLEMENTARY AND ALTERNATIVE THERAPIES
DISCUSSION QUESTIONS
1. What is acute pain? What are the features of acute pain?
a. Episode of pain that lasts from seconds to less than 6 months
2. What is chronic pain? What are the features of chronic pain?
a. Episode of pain that lasts for 6 months or longer; may be intermittent or
continuous
3. Describe the following sources of pain:
a. Cutaneous pain.
i. Superficial pain usually involving the skin or subcutaneous tissue
b. Somatic pain.
i. Pain originating in structures in the body’s external wall
c. Visceral pain.
i. Pain originating in the internal organs in the thorax, cranium, or abdomen
4. Describe referred pain. Why does referred pain occur? What are some examples of
referred pain?
a. Pain in an area removed from that in which stimulation has its origin
i. Heart attack
1. Shoulder, upper arms, crushing chest pain, jaw pains, mid back
pains
5. Define and give examples of the following etiologies or causes of pain:
a. Nociceptive pain.
i. Pain from a normal process that results in noxious stimuli being perceived
as painful
1. Opioids
b. Neuropathic pain.
i. Pain that results as a direct consequence of a lesion or disease affecting
abnormal functioning of the peripheral nervous system (PNS) or central
nervous system (CNS)
c. Intractable pain.
i. Severe pain that is extremely resistant to relief measures
d. Phantom pain.
i. Sensation of pain without demonstrable physiologic or pathologic
substance; commonly observed after the amputation of a limb
e. Psychogenic pain.
i. Pain for which no physical cause can be identified
6. What are some common responses to pain?
a. Physiologic (involuntary) responses.
i. Involuntary body responses
1. Moving away from painful stimuli
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2. Grimacing, moaning, and crying
3. Restlessness
4. Protecting the painful area and refusing to move
b. Behavioral (voluntary) responses.
i. Reflect body movements
1. Typical Sympathetic Responses When Pain Is Moderate and
Superficial
a. Increased blood pressure*
b. Increased pulse and respiratory rates*
c. Pupil dilation
d. Muscle tension and rigidity
e. Pallor (peripheral vasoconstriction)
f. Increased adrenalin output
g. Increased blood glucose
2. Typical Parasympathetic Responses When Pain Is Severe and
Deep
a. Nausea and vomiting
b. Fainting or unconsciousness
c. Decreased blood pressure
d. Decreased pulse rate
e. Prostration
f. Rapid and irregular breathing
c. Affective (psychological) responses.
i. Reflect mood and emotions
1. Exaggerated weeping and restlessness
2. Withdrawal
3. Stoicism
4. Anxiety
5. Depression
6. Fear
7. Anger
8. Anorexia
9. Fatigue
10. Hopelessness
11. Powerlessness
7. Identify some cultural differences in the expression of pain.
a. African Americans
i. Often viewed as a sign of illness or disease.
b. Arab Americans
i. Often view pain as unpleasant and something that should be controlled.
c. Chinese Americans
i. Often believe pain is related to the influence of imbalances in the yin and
yang. The whole body’s balance of yin and yang rather than just the area
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where pain is present is vital to one’s wellness. The whole body must be
treated and not just the symptoms.
d. Greek Americans
i. Ponos (pain) is viewed by most as an evil that needs to be eradicated.
e. Mexican Americans
i. Most delay seeking medical help for pain and hope, instead, that it will go
away; consider it a necessary part of life.
f. Navajo Indians
i. Do not usually openly express their pain or request pain medication.
8. What is the influence of the nurse’s personal attitude toward pain?
a. Each person’s interpretation is influenced by background, such as how he or she
has experienced and dealt with pain in the past, and what culture has taught the
person about pain.
9. How does the nurse assess the following characteristics of pain? (p.1162)
a. Location.
i. “Where is your pain? Is it external or internal?” (Asking the patient with
acute pain to point to the painful area with one finger may help to localize
the pain. Patients with chronic pain may have difficulty trying to localize
their pain, however.)
b. Duration.
i. “How long have you been experiencing pain? How long does a pain
episode last? How often does a pain episode occur?”
c. Quantity (intensity).
i. Ask the patient to indicate the degree (amount) of pain currently
experienced on the following scale
d. Quality.
i. “What words would you use to describe your pain?
e. Chronology (pattern).
i. “How does the pain develop and progress?” (If pattern can be identified,
interventions early in a pain sequence will often be far more effective than
those used after the pain is well established.) “Has the pain changed since
it first began? If so, how?”
f. Aggravating factors.
i. “What makes the pain occur or increase in intensity?”
g. Alleviating factors.
i. “What makes the pain go away or lessen? What methods of relief have
you tried in the past? How long were they used? How effective were
they?” (Methods of relief currently in effect for hospitalized patients
should be apparent from the chart. It is important to verify the use of
current orders and their effectiveness with the patient. Outpatients may
need to be asked to record a medication profile, a thorough and accurate
account of all medications they are taking.)
h. Physiologic responses to pain.
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