Promoting Comfort

1
Promoting Comfort

• Chapter 29
• Potter and Perry
• June Mair, RN, MSN
• Visuals by Anita Kovalsky RN, MNEd

2
Promoting Comfort

• Pain
• Universal human experience
• Protective physiological mechanism can be a
  warning sign of tissue damage!!!
• Subjective and Individualized
• Considered as the fifth vital sign

3
Physiology of Pain

• RECEPTION
• Cellular damage caused by thermal,
  mechanical, chemical or electrical stimuli
• Painful stimuli releases pain-producing
  substances such as histamines, bradykinins
  potassium
• Neurotransmitters and neuromodulators play an
  important role in pain

4
Physiology of Pain (contd)

• PERCEPTION
• Person is aware of pain
• Fatigue and pain therapies can affect
• clients awareness and response to
• pain
• REACTION
• Physiological and behavioral response
• Body is able to adjust or vary pain
  perception
• Response to pain varies in individuals

5
Gate Control Theory of PainA Pain Perception
Theory

• GATE considered to be located in the spinal
  cord?pain impulses pass through the Gate?
  transmitted to thalamus, reticular formation, and
  the limbic system (where Pain is perceived and
  interpreted)
• Pain impulses pass through when Gate is OPEN
• Closing of Gate is the basis for pain-relief
  certain therapies, as these CLOSE the Gate by
  releasing endorphins and decrease clients
  perception of pain

6
Types of Pain

• Three major categories
• Acute
• Chronic non-cancer
• Chronic cancer

7
Acute Pain

• Follows injury, disease or surgical intervention
• Lasts for brief time, less than 6 months
• Resolves with or without treatment after damaged
  area heals
• May prolong hospital stay, delay rehabilitation
  if not controlled
• Complications may include immobility, sleep
  deprivation and exhaustion if control is
  inadequate

8
Chronic Pain

• Lasts longer than 6 months
• Non life-threatening
• May have no identifiable cause
• Major cause of physical and psychological
  disability
• Symptoms are fatigue, insomnia, weight loss,
  depression, anger

9
Cancer Pain

• May be chronic or acute
• Can be at actual site of tumor or distant to site
• Has periods of remission and exacerbation
• Intractable if uncontrolled

10
Factors influencing Pain

• Age
• Gender
• Culture
• Meaning of pain
• Attention
• Anxiety
• Fatigue
• Previous experiences to pain
• Coping
• Family support

11
Standards for Pain Assessment

• Agencies which provide guidelines for Pain
  Management include
• World Health Organization
• American Society of Pain Management Nurses
• Joint Commission on Accreditation of Healthcare
  Organizations
• Agency for Health Care Policy

12
Pain Assessment

• Onset and duration
• Location and intensity
• Characteristics
• Severity and quality
• Pain pattern and relief measures
• Concomitant symptoms and effect on client

13
Pain Scales

• Numerical
• Verbal (Descriptive)
• Visual analog
• Wong-Baker Faces

14
Non-Pharmacologic Pain-Relief Measures

• Massage
• Imagery
• Music
• Biofeedback
• Meditation
• Hypnosis
• Exercise
• Therapeutic touch
• Acupuncture
• Relaxation techniques

15
Pharmacologic Pain-Relief Measures

• Analgesics Acetaminophen (Tylenol)
• Opioid Morphine. Demerol
• Adjuvants Sedatives, steroids, antianxiety
  agents
• Local anesthetics
• Topical local
• Transdermal
• Patient-Controlled Analgesia (PCA)
• Epidural Catheter
• Placebo

16
Restorative Care

• Provide client with long-term pain control
• Programs designed for pain management include
• Pain clinics
• Hospices
• End-of- life care