Pain: The fifth vital sign

Why is pain the 5th vital sign

it must be assessed regularly, it raises HR, BP and temp

what is the #1 reason people are in the hospital

PAIN

Transduction

Activates nociceptors

Transmission

action potential travels

Perception

recognize & perceive

Modulation

pain signal facilitated or inhibited

Deep somatic pain is

bones, ligaments, tendons, bone cancer, fracture, arthritis

cutaneous pain is

superficial like paper cut

visceral pain is

deep internal, labor, bowel, organ cancer, kidney stones

radiating pain is

pain that moves outward toward other body parts

referred pain is

pain is perceived at other locations

phantom pain is

pain is felt in a limb that is no longer there

psychogenic pain is

patient has pain but there is no identifiable cause

Nociceptive pain is

the most common type, pain receptors respond to stimuli, like trauma, injury or inflammation

neuropathic pain is

chronic pain, injury to one or more nerves results in repeated transmission of pain signals (fibromialgia)

Acute pain is

rapid onset & short duration, as tissues heal it goes away

chronic pain is

more than 3 or 6 months interferes with ADL

intractable pain is

chronic and resistant to relief

nociception involves what 4 processes?

transduction, transmission, perception and modulation

factors affecting the pain experience

emotions, anxiety and other stressors, past pain exp, culture, gender (men-underreported), developmental (premies more susceptible, geriatric less susceptible), environment and support people

Nursing process for pain

assess the nautre of pain, description, health, alcohol (requires higher amt of med), and medication history

A delta fibers are

Fast

C fibers

slower - chronic pain

when to assess pain

on admission, with each check of VS, when the client complains of pain, pror to & after a pain management intervention, before & after a procedure

pain assessment: OLDCART

onset, location, duration, characteristics, aggravating, relieving, treatments

Factors effecting pain to check

lab values (c reactive protein), level of orientation (confused patients, unconscious, oversedated), bowel sounds (constipation common with opiods), urine output (urinary retention common with opiods and acute pain)

sympathetic (acute)

acute pain, higher SBP, HR, RR, dilated pupils

parasympathetic (chronic)

lower SBP, HR, withdrawal, constricted pupils

alternative therapies

accupuncture, accupressure, massage, cold app, heat app, heat&cold app, distraction, guided imagery, therapeutic touch, music, relaxation/deep breathing

to massage you must obtain

pt permission and dr order

cold application

do not apply area being treated with radiation, or open wounds or poor circulation. prevents swelling & bleeding

heat application

promotes circulation to speed healing, not to area bleeding or radiation, or injured within last 21hrs