Category 1
This pain has a short duration and rapid onset.
Acute Pain
What is the best indicator for pain?
Patients self report
This pain, known as "persistent pain" can last up to 3 to 6 months, or longer. It interferes with ADLS and can be related to long-term illness.
Chronic Pain
What are some factors that can influence pain? Give an example of each.
- Emotions (fear, anxiety/depression, confusion)
Fear: They fear that pain or injury can be life threatening.
Anxiety: The anticipation of pain can trigger anxiety.
Confusion: Depending on situation patient may feel angry or guilty.
- Previous Pain Experience
If the patient has already experienced pain, they may be sensitive to it or be more anxious.
- Life Stage
Infants and small children typically respond to pain with crying.
Older Adults may be unable to report pain due to cognitive development.
Be aware of nonverbal cues.
- Communication/Cognitive Impairments
Cognitive Impaired patients may not remember their pain. They may fail to interpret these sensations as pain.
Patients who have communication issues may not be able to verbally tell you how they are feeling.
- Sociocultural Factors
Some patients may express pain differently in their culture or may not be comfortable expressing their pain to you.
Do not assume that patients of the same ethnic group will react the same. Each patient is unique.
What are some nonverbal indicators of pain?
- Facial expressions (grimacing, excessive blinking, dialated pupils)
- Body language
- Crying
- Decreased activity
- Physiological cues (elevated BP, respirations, pulse)
- Irritability
- Moaning
The nurse is assessing a 4 year old child during a sickle cell crisis. What pain scale should she use when asking the child how they feel?
The Wong Baker Faces Pain Rating Scale
Pain that arises in the skin or subcutaneous tissue.
ex: burn or abrasion
Cutaneous or Superficial Pain
This med is classified into 3 groups, nonopioids, opioids, and adjuvants. (pain relievers)
Analgesics
Pain that occurs in an area that is distant from original site.
ex : heart attack pain may be experienced in left arm
Referred Pain
What is pain quality, pain periodicity, and pain intensity?
Pain quality : can be described as sharp or dull, aching, throbbing, stabbing, burning, ripping, searing, or tingling.
Pain periodicity : May be referred to as episodic, intermittent, or constant
Pain intensity : described as mild, distracting, moderate, severe, or intolerable
Pain that is caused by the stimulation of deep internal pain receptors. Can be described as tight pressure or "crampy" pain.
ex : menstrual cramps, labor pain, bowel disorders
Visceral Pain
What is the Visual Analog Scale?
Line where "no pain" is written on the left, "worst pain imaginable" on the right. Patients point to the location on line.
What is the Numerical Rating Scale
The numerical rating scale is a numbered line from 0 to 10. Zero indicates no pain at all, where as ten means the worst possible pain.
What should you include in your assessment for pain?
- Pain location and quality
- Pain intensity
- Aggravating and alleviating factors
- Timing and duration
- Mobility
- Psychological/social factors (depression, abuse)
- Performance of ADLS
- Pain relief and expectations
Pain that originates in the ligaments, tendons, nerves, blood vessels, and bones. Can b described as "achy" or "tender."
ex : fracture, arthritis, bone cancer
Deep Somatic Pain
When applying temperature therapy to a patient you should..
- Only give it if it's order by MD
- Avoid direct contact with skin
- Apply heat or cold intermittently for no more than 15 minutes at a time
- Check skin for extreme redness, blistering, cyanosis, or blanching
What are some cutaneous stimulations for pain?
- Massage
- Temperature Therapy
- Acupressure/Acupuncture
- Transcutaneous electrical nerve stimulator
- Percutaneous electrical stimulation
What are some cognitive behavioral interventions for pain?
- Distraction (visual, tactile, intellectual, auditory)
- Relaxation Techniques
- Guided Imagery
- Diaphragmatic Breathing
- Animal Assisted Therapy
- Therapeutic touch
What are some pain management tasks you can delegate to a UAP?
- Repositioning
- Back rub/Massage
- Providing darkness or quietness for sleep
- Straightening sheets
- Mouth care
- Tv/Music
How does unrelieved pain effect the cardiovascular system?
It can lead to hypercoagulation and an increase in heart rate, BP, cardiac workload, and oxygen demand.
- this may lead to severe chest pain, thrombosis, and a heart attack.
The nurse is assessing a client i pain. Which word might the nurse use when documenting the pattern of a clients pain?
a) Tenderness
b) Episodic
c) Moderate
d) Phantom
- Episodic refers to an incident, occurence, or time period.
What are Opioids?
What are side effect of opioids?
- Natural and synthetic compounds that relieve pain. They work by binding with pain receptor sites to block the pain impulse.
Side Effects :
- Nausea, vomiting, constipation, and drowsiness
- Large doses lead to respiratory distress and hypotension
Which client statement indicates that the client is experiencing neuropathic pain?
a) "My lower back has been hurting for months after the accident."
b) "I stubbed my toe yesterday and it hurts really bad."
c) "I have bad migraines and I can't get relief."
d) "I have burning and tingling in my feet."
D) "I have burning and tingling in my feet."
- Numbness, burning, and tingling are all signs of neuropathic pain.
To administer NSAIDS safely you should know that..?
- NAIDS should be used with caution in patients who are taking anticoagulants or who have impaired blood clotting, renal disease, GI bleeding or ulcers.
- Aspirin is a unique NAID. In addition to reducing inflammation, fever and pain, it can also inhibit platelet aggregation, the first step in clot formation.
- Regular use of aspirin prolongs clotting time. Educate patients if they take aspirin that they will bruise easily and will bleed more if cut.
- Long term use can lead to renal failure, high BP and heart failure.
A client requests pain medication for severe pain. What should the nurse do FIRST when responding to the clients response?
Assess the various aspects of the clients pain
(intensity, quality, duration, etc)