New pain pre

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Prepared By: Dr/ Magda BayoumiYour Text HerePain 27//14312Dr/ Magda Byoumi

Pain3Lecturer/ Magda Byoumi

Definition of pain.Causes.Classification of pain. Nursing Diagnosis and pain.Pain pathways.Pain management.Nonpharmacological pain.Pharmacologic pain.Out Lines:Out lines4Lecturer/ Magda Byoumi

Pain can be described as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage".Definition5Lecturer/ Magda ByoumiDefinition:

It may be caused by disease, trauma, or certain therapeutic procedures or have no identifiable cause. Causes: Csuses6DR/ Magda Byoumi

Pain is classified as acute or chronic. Chronic pain may be noncancer or cancer pain. Acute and chronic pain are differentiated according to onset, duration, and cause. Acute pain is protective, has a sudden onset, an identifiable cause, and an anticipated duration. It may progress to chronic pain if not successfully treated.

Classification of pain: Classification of Pain7Dr/ Magda Byoumi

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Impaired Physical Mobility Fatigue Risk for Disuse Syndrome Anxiety, Ineffective Coping, or Powerlessness Social Interaction and Spiritual Distress Acute Pain and Chronic PainNursing Diagnosis and Pain:Nursing Diagnosis and Pain9DR/ Magda Byoumi

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Pain Pathways: Pain Pathways11Dr/ Magda Byoumi


Electrical impulses along nerves to the spinal cord and then upward to the brain.Sometimes the signal evokes a reflex response. When the signal reaches the spinal cord, a signal is immediately sent back along motor nerves to the original site of the pain, triggering the muscles to contract without involving the brain. Pain receptors and their nerve pathways differ in different parts of the body.

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Pain pathways.Previously, pain pathways were seen as having three components:-A first order neurone cell bodyA second-order neurone spinal cordA third-order neurone projects (via the internal capsule). BRAIN


Nonpharmacological pain.Pharmacologic painPain management Pain Management15Dr/ Magda Byoumi

Nonpharmacological strategies are varied physical (progressive muscle relaxation, massage, transculanous electrical nerve stimulation "TENS" heat/cold application), or psychological/cognitive (music, biofeedback, imagery, education) and should be used in conjunction with and not instead of pharmacological interventions Nonpharmacological Pain Management Nonpharmacological Pain Management16DR/ Magda Byoumi


P: Precipitating factors: position, movement, edema, constricting dressings, tubes or drains, invasive procedures, distended bladder. Assessment PQRSTAssessment PQRST18Lecturer/ Magda Byoumi

Qsharp, dull, burning, nagging, stabbing, aching, throbbing, shooting, or crushing. Rationale: Helps determine type of pain (somatic, visceral, ; Quality: neuropathic).

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Quality ( Characteristics)Somatic (myofascial/joints):( Aching, deep, gnawing, throbbing, sharp, stabbing, constant, increases with movement, well localized)Visceral (organ-related, smooth muscle): ( Cramping, squeezing, pressure-like, poorly localized, constant or intermittent, associated with symptoms of visceral discomfort )Neuropathic : (Burning, searing, shooting, electric-like, numbing, radiating, stabbing, tingling, touch sensitive)Characteristics of PainCharacteristics of Pain20Lecturer/ Magda Byoumi

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R: Region: localized, radiating, or generalized. Have client point to area of body affected

S: Severity: have client rate pain both at rest and with activity using an appropriate pain scale Different scales may be used with different clients; however, the same scale must be used consistently with each client


Wong-baker faces: Wong-Baker Faces22Lecturer/ Magda Byoumi

Numerical 0 1 2 3 4 5 6 7 8 9 10Nopain Severe painDescriptive No pain mild pain moderate pain severe pain unbearable painVisual analog No pain unbearable pain


T: Timing/Duration: onset: sudden or gradual; constant or intermittent or both.


Facial expression: grimace, frowning, crying Vocalizations: moaning, groaning Posture: bent, leaning, guarding Gait: favors one side, uneven Activity level: increased, decreased, restless Muscle: tense, guarded Behavior: change in usual activities Emotions: irritable, withdrawn Change in ADLs: eating, sleeping, dressing,Behavioral Indicators of Pain 27//143125Behavioral Indicators of Pain

Analgesics are the most common treatment for pain. Analgesics are classified as nonopioid (e.g., acetaminophen), nonsteroidal antiinflammatory drugs (NSAIDs), opioids (e.g., morphine sulfate, hydromorphone, oxycodone, and fentanyl), and adjuvant analgesics (e.g., anticonvulsants, antidepressants, muscle relaxants, and antiarrhythmics). pharmacological Pain Management 27//143126Lecturer/ Magda Byoumi

Analgesics are the most common treatment for pain. Analgesics are classified as nonopioid (e.g., acetaminophen), nonsteroidal antiinflammatory drugs (NSAIDs), opioids (e.g., morphine sulfate, fentanyl), and adjuvant analgesics (e.g., anticonvulsants, antidepressants, muscle relaxants, and antiarrhythmics).

27//1431Dr/ Magda Byoumi27pharmacological Pain Management(Pain controlled analgesia) PCA

Mrs Hesa at inpatient cardiac department, vital signs taken early morning at 6 am and reported client rates pain 7, substernal sharp chest pain like electrical thrill along to neck, shoulder to left arm increase with activity even moving, immediately the nurse give her nitroglycerin sublingual 3 tables through 15 min and then the pain relived and reported 2 27//1431Dr/ Magda Byoumi28

P: Precipitating factor: pain increase with activity.P: Palliative factor: pain decreased with medication (nitroglycerin).Q: Quality: sharp chest pain. like electrical thrillR: Region & Radiation: chest; radiated to neck, shoulder to left arm.S: Severity: 7 and decrease to 2 after medication. T: Timing: 15 min. 27//1431Dr/ Magda Byoumi29


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New pain pre