Chapter 41 Comfort

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 41 Comfort


Categories of Pain• Source

– Nociceptive– Neuropathic– Psychogenic

• Area to which it is referred• Duration

– Acute– Chronic


Sources of Pain• Nociceptive• Cutaneous• Somatic• Visceral• Neuropathic


Origin of Pain• Physical—cause of pain can be identified• Psychogenic—cause of pain cannot be identified• Referred—pain is perceived in an area distant from its

point of origin


The Pain Process• Transduction—activation of pain receptors• Transmission—conduction along pathways (A-delta and C-

delta fibers)• Modulation—initiation of the protective reflex response• Perception of pain—awareness of the characteristics of

pain


Stimulator of Nociceptors or Pain Receptors• Bradykinin• Prostaglandins• Substance P


Gate Control Theory of Pain• Relationship between pain and emotions• Small and large diameter nerve fibers conduct and inhibit

pain stimuli• Gating mechanism determine impulses that reach the

brain


Perception of Pain• Pain threshold• Adaptation• Modulation of pain

– Neuromodulators– Endorphins, dynorphins, enkephalins


Pain Sensation and Relief


Common Responses to Pain• Physiologic• Behavioral• Affective


Duration of Pain• Acute

– Rapid in onset, varies in intensity and duration– Protective in nature

• Chronic– May be limited, intermittent, or persistent– Lasts for 6 months or longer– Periods of remission or exacerbation are common


Factors Affecting Pain Experience• Culture• Ethnic variables• Family, gender, and age variables• Religious beliefs• Environment and support people• Anxiety and other stressors• Past pain experience


Assessment Parameters for Pain• Psychological• Emotional• Sociologic• Physiologic


General Assessments of Pain• Patient’s verbalization and description of pain• Duration of pain• Location of pain• Quantity and intensity of pain• Quality of pain• Chronology of pain


General Assessments of Pain (cont.)• Aggravating and alleviating factors• Physiologic indicators of pain• Behavioral responses• Effect of pain on activities and lifestyle


Pain Assessment Tools• McGill-Melzack pain questionnaire• Pain scale• McCaggery method• WILDA pain measurement scale


WILDA Scale• Words that describe the pain• Intensity of pain• Location of pain• Duration of pain• Aggravating or alleviating factors


Diagnosing Pain• Type of pain• Etiologic factors• Behavioral, physiologic, affective response• Other factors affecting pain process


Nursing Interventions for Pain• Establishing trusting nurse-patient relationship• Initiating nonpharmacologic pain relief measures• Considering ethical and legal responsibility to relieve pain• Teaching patient about pain


Manipulating Pain Experience Factors• Remove or alter cause of pain• Alter factors affecting pain tolerance• Initiate nonpharmacologic relief measures


Nonpharmacologic Pain Relief Measures• Distraction• Humor• Music• Imagery• Relaxation• Cutaneous stimulation• Acupuncture


Nonpharmacologic Pain Relief Measures (cont.)• Hypnosis• Biofeedback• Therapeutic touch


Pharmacologic Pain Relief Measures• Analgesic administration• Nonopiod analgesics• Opioids or narcotic analgesics• Adjuvant drugs


The WHO 3-Step Analgesic Ladder


Numeric Sedation Scale• 1 — awake and alert; no action necessary• 2 — occasionally drowsy, but easy to arouse; no action

necessary• 3 — frequently drowsy, drifts off to sleep during

conversation; reduce dosage• 4 — somnolent with minimal or no response to stimuli;

discontinue opioid, consider use of naloxone


Pain Management Regimens for Cancer or Chronic Pain• Give medications orally if possible• Administer medications ATC rather than prn• Adjust the dose to achieve maximum benefit with

minimum side effects• Allow patients as much control as possible over the

regimen


Additional Methods for Administering Analgesics• Patient-controlled analgesia• Epidural analgesia• Local anesthesia


Placement of an Epidural Catheter


Question

A patient who has bone cancer is most likely experiencing which of the following types of pain?A. CutaneousB. SomaticC. VisceralD. Referred


Answer

Answer: B. SomaticRationale:Deep somatic pain is diffuse or scattered and originates in tendons, ligaments, bones, blood vessels and nerves.Cutaneous pain usually involves the skin or subcutaneous tissue.Visceral pain is poorly localized and originates in body organs.Referred pain is pain that originates in one part of the body and is perceived in an area distant to that part.


Question

Tell whether the following statement is true or false.The best judge of the existence and severity of a patient’s pain is the physician or nurse caring for the patient.A. TrueB. False


Answer

Answer: B. FalseThe best judge of the existence and severity of a patient’s pain is the patient.


Question

Which of the following modulators of pain is thought to reduce pain sensation by inhibiting the release of substance P from the terminals of afferent neurons?A. EndorphinsB. DynorphinsC. EnkephalinsD. Nociceptors


Answer

Answer: C. EnkephalinsRationale:Enkephalins are thought to reduce pain by inhibiting the release of substance P from the terminals of afferent neurons.Endorphins and dynorphins are released when certain measures are used to relieve pain.Nociceptors are the peripheral nerve fibers that transmit pain.


Question

Which of the following pain assessment tools is recommended for use with children?A. McGill-Melzack pain questionnaireB. McCaggery methodC. WILDA pain measurement scaleD. Wong-Baker FACES


Answer

Answer: D. Wong-Baker FACESRationale: The Wong-Baker FACES pain rating scale asks children to compare their pain to a series of faces ranging from a broad smile to a tearful grimace. This scale is visual and easy to interpret for young children and older adults.


Question

A sedated patient is frequently drowsy and drifts off during his conversation with the nurse. What number on the sedation scale best describes this patient? A. 1B. 2C. 3D. 4


Answer

Answer: D. 3Rationale:3 denotes that the patient is frequently drowsy and hard to awake.1 means the patient is awake and alert.2 denotes the patient is occasionally drowsy, but easy to arouse.

At 4 the patient is somnolent with minimal or no response to stimuli.

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Chapter 41 Comfort

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