Chapter 19. Pain Management, Rest, and Restorative Sleep. Fundamentals of Nursing Care Concepts, Connections, & Skills, Second Edition

Transcription

1 Chapter 19 Pain Management, Rest, and Restorative Sleep Presented by Farahnaz Danandeh, Nursing GHOC

2 Classifications of Pain Acute: Sudden pain; short duration of less than 6 months Chronic: Pain that lasts longer than 6 months Intractable: Pain that cannot be relieved Referred: Pain felt in an area other than where it was produced Radiating: Pain that begins at a specific site and shoots out to a larger area beyond the origin site

3 Neuropathic Pain vs. Nociceptive Pain Neuropathic Occurs due to injury or destruction of peripheral nerves or CNS Extends beyond local region to broad area Nociceptive Occurs from the stimulation of nerve pain receptors (nociceptors) Generally localized within a specific area

4 Gate Control Theory Explains the transmission and perception of pain and how interventions relieve the pain Purports that the transmission of pain impulse to the CNS is controlled by a gate that responds to sensory input The gate is open for pain to be transmitted to the brain The gate is closed when the nerve impulse for pain is blocked from transmission

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6 Stimulation of Nerve Fibers Broad nerve fibers close the gate Stimulated by exercise, heat, cold, massage, and transcutaneous electrical nerve stimulation (TENS) Smaller, narrower nerve fibers open the gate Stimulated by injury and damage to tissues

7 Patient Pain The pain is always what the patient says it is It does not matter if the patient does not appear to be in pain Falling asleep does not mean the patient does not have pain

8 True/False Question Endorphins are synthetic chemicals administered for pain management that act like morphine does to produce feelings of euphoria and well-being. A. True B. False

9 Answer B. False Rationale: Endorphins are natural body chemicals that act like morphine and are produced by the brain in response to pleasant thoughts or feelings, exercise, laughter, sex, and massage.

10 Types of Nociceptive Pain Cutaneous: Pertains to the skin surface and underlying subcutaneous tissue Visceral: Soft-tissue pain caused by stimulation of deep internal pain receptors Deep somatic (osteogenic): Bone, ligament, tendon, and blood vessel pain

11 Multiple Choice Question Which of the following types of nociceptive pain would be experienced by a patient with liver cancer? A. Cutaneous B. Visceral C. Deep somatic D. Osteogenic

12 Answer B. Visceral Rationale: Cutaneous pain is related to skin tissue; visceral pain is soft-tissue pain; and deep somatic or osteogenic pain originates in bone, ligament, tendon, and blood vessels.

13 Factors Affecting Pain and Pain Perception Ethnic and cultural beliefs Developmental stage Individual values Previous pain experiences Personal support systems Emotions and stress level Fatigue

14 True/False Question Pain perception does not change with age and it is not natural for elderly patients to have more pain simply due to aging. A. True B. False

15 Answer A. True Rationale: Pain perception does not change with age and it is not natural for elderly patients to have more pain simply due to aging. However, some older adults believe they are expected to hurt more when they age and as a consequence may suffer in silence.

16 Body Responses to Pain Physiological Psychological Behavioral

17 Assessment Parameters for Pain Level or extent of pain using a pain scale Site of pain Characteristics of the pain Whether the pain is continuous or intermittent Whether the pain is acute or chronic What elicits the pain Patient s desires in relation to the pain

18 Non Pharmaceutical Pain Hot and cold packs Massage and effleurage Transcutaneous electrical nerve stimulator (TENS) Acupressure and acupuncture Relaxation Guided imagery Distraction Relief Measures

19 Multiple Choice Question A nurse reads a story to a 6-year-old cancer patient undergoing chemotherapy. This is an example of which non pharmaceutical pain relief measure? A. TENS B. Relaxation C. Guided imagery D. Distraction

20 Answer D. Distraction Rationale: TENS is a device that stimulates the nerves; relaxation and guided imagery are techniques that guide the patient into a relaxed state; and distraction decreases the conscious awareness of the pain through the different senses.

21 Types of Distraction and Examples Visual: Reading a book or newspaper; watching a movie Auditory: Listening to music, poetry, chanting, sounds of nature, talking book, sermon Tactile: Receiving a back rub, foot rub, head massage, or hair brushing Intellectual: Having a conversation; studying; working a crossword puzzle or Sudoku; playing Scrabble, Monopoly, dominoes, or card games

22 Pharmaceutical Pain Management NSAIDS: Reduce inflammation Non Opioids: Non-narcotic pain relievers Opioid narcotics: Analgesics that relieve visceral and deep somatic pain Adjuvant drugs: Produce pain relief from another method or increase effects of opiates, opioids, and nonopioid drugs

23 Restorative Sleep vs. Resting Restorative sleep Allows the individual to awaken feeling rested, refreshed, and energized Partial loss of consciousness occurs; more difficult to arouse the person Resting May or may not involve sleep External noises will awaken the individual

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25 Both behavioral levels of consciousness and the correlated patterns of electrical activity are related to the function of a part of the brainstem called the reticular formation. Electrical stimulation of the ascending reticular systems arouses a sleeping cat to alert consciousness and simultaneously activates its brain waves to the waking pattern.

26 Occurrences Without Restorative Sleep Healing is slow and incomplete Immunity and pain tolerance decrease Fragile emotions and impatience affect relationships Cognitive functions are impaired Work performance suffers Accidents increase dramatically

27 Amount of Sleep Need by Age Group Newborns: 16 to 18 hours per day Infants up to 2 years: 12 to 14 hours per day Children 3 to 6 years: 12 hours per day Children 7 to 12 years: 10 hours per night Adolescents: 8.5 to 9.5 hours per night Young adults: 7.5 to 8 hours per night Older adults: Gradual decrease to 5.5 or 6 hours

28 Factors Affecting Sleep Lifestyle Stress and anxiety Environment Illness and health problems Sleep disorders

29 Interventions to Promote Sleep Prepare the environment Promote comfort and relaxation Provide pain relief and sleep medications if needed

30 Common Myths about Pain Management, Rest, and Restorative Sleep Pain control is necessary for quality restorative sleep Just because a patient who requests medication falls asleep before it is administered doesn t mean the patient isn t hurting The nurse should awaken the patient and administer the analgesic

31 Information in the Connection Features Clinical Connection Knowledge Real World Supervision/Delegation Patient Teaching Post Conference

32 Information in the Safety Features Why are the particular safety features so important that they are highlighted as safety issues? What could happen if those safety guidelines are not followed?

33 Information in the Skills Procedure Review the steps of the skills procedure. Make sure you understand why the steps are important. What could happen if each of the steps are not followed or are followed out of order?