Client with Pain I. Introduction A. Definitions of pain 1. "Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage" International Association for the Study of Pain (IASP) (1979); this definition clarifies the multiple dimensions of pain; pain is more than a change in the nervous system; it is also reflective of the client's past pain experiences and the meaning of the pain 2. "Pain is whatever the person says it is, experienced whenever they say they are experiencing it" (McCaffery & Pasero, 1999); this definition describes the subjectivity of pain; nurses cannot know when another is experiencing pain unless it is communicated; self-report is the only valid measure of pain B. Joint Commission for Accreditation of Healthcare Organizations (JCAHO) Standards 1. Clients have the right to pain assessment a. The facility must provide pain assessment tools b. If a facility cannot treat a client for pain, such as providing a PCA pump, the client must be referred to a facility that can 2. Clients must be treated for pain and involved in their own pain management 3. Discharge planning and teaching will include pain management strategies C. At the end of life, many clients cannot communicate pain because of delirium, dementia, aphasia, motor weakness, language barriers, and other factors; if the client has any potential physical reason for discomfort, the nurse should consider the individual to have pain until proven otherwise II. Neurophysiologic Mechanisms of Pain A. Stimuli 1. The type of nerve receptor responsible for pain sensation is called a nociceptor ; these receptors are located at the ends of small afferent neurons and are woven throughout all body tissues except the brain; they are especially numerous in the skin and muscle; a non-nociceptor is a nerve fiber that does not usually transmit pain 2. Pain occurs when nociceptors are stimulated by a variety of factors (see Table 8-1) Causative Factor Example Microorganisms (e.g., virus, bacteria) Inflammation Impaired blood flow Invasive tumor Radiation Heat Electricity Obstruction Spasm Pneumonia Arthritis Angina Adenocarcinoma Treatment for cancer Sunburn Electrical burn Gallstone
Compression Decreased movement Stretching/straining Fractures Swelling Chemical Muscle cramp Carpal tunnel syndrome Skeletal traction Sprained ligament Any bone Cellulitis Skin rash 3. The intensity and duration of stimuli determine the sensation; long-lasting, intense stimulation results in greater pain than brief, mild stimulation 4. Nociceptors are stimulated either by direct damage to the cell or local release of biochemical secondary to cell injury 5. Biochemical sources a. Bradykinin : an amino acid, appears to be the most potent pain-producing chemical b. Prostaglandins : chemical substances that increase the sensitivity of pain receptors by enhancing the pain-provoking effect of bradykinin c. Histamine d. Hydrogen ions e. Potassium ions B. Pain pathway (see Figure 8-1) 1. Pain is perceived by the nociceptors in the periphery of the body (e.g. skin); transmitted though small
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- Fall '17
- Adrian Hailey