Comfort alterations notes

  • Pain: Whatever the person experiencing it says it is

  • Acute pain: Rapid onset and varies in intensity from mild to severe

    After underlying cause is resolved, pain disappears

  • Response to acute pain: Increased HR/BP, diaphoretic (sweating), pupils normal or dilated, restlessness

  • Chronic pain: Pain lasts beyond normal healing period (1-6 months)

    Can be constant, episodic (remission with exacerbation), or recurring

  • Response to chronic pain: Normal vital signs, restlessness with exacerbation, commonly impacts mental well-being (depression, anger, frustration, sleep/appetite disturbance)

  • Nociceptive pain: Caused by damage of body tissues (hitting elbow, falling or scrapping knee, twisting ankle, stubbing toe)

    Described as throbbing, sharp, or achy pain

    Locations can be visceral or somatic pain

  • Neuropathic pain: Caused by damage to the nerves (peripheral & central neuropathic pain, cancer, alcoholism, stroke, limb amputation, chemotherapy drugs, radiation, or diabetes)

    Described as stabbing, burning, shooting, pins and needles, sharp pain

    Generally does not respond to conventional analgesics

  • Intractable pain: Does not respond to therapy or interventions (degenerative spinal disease, CRPS, neuropathy, osteoporosis)

    Focus is reducing discomfort

  • Phantom pain: Caused when limb is removed (no nerve endings are present but patient still feels pain in their limb)

    Described as burning, fiery sensation, crushing, cramping

    VERY REAL and needs to be treated

  • Phantom pain treatments: NSAIDs, pain relievers, antidepressants, beta blockers, antiseizure meds, muscle relaxers, injections, neurostimulators, spinal cord stimulators, TENS units

  • Cutaneous pain: Superficial, involves the skin or subcutaneous tissue (burning)

    Ex: papercut

  • Somatic pain: Diffuse (spread out) or scattered. Originates in tendons, ligaments, bones, blood vessels, and nerves (bone/joint pain)

    Ex: Ankle sprain

  • Visceral pain: Poorly localized. Originated in the thorax, cranium, and abdomen (aching/squeezing)

    Ex: Bladder pain

  • Referred pain: Originates from one part in the body but is perceived in an area distant from its point of origin

    Ex: heart attack- pain felt in the neck, shoulder, chest or arms

  • Malignant/ cancer pain: Results from the direct effects of the disease and its treatments

  • Gate control theory: Distracts your body from feeling pain

    Non-painful input, such as TENS unit, massage, heat, ice, or acupuncture, CLOSES the gate to painful input, preventing the pain sensation from traveling to the central nervous system

  • Gate control theory example: Bang your head on a cupboard door, you rub the injured spot- decreasing the sensation of the pain

  • TENS unit: Delivers small electrical impulses that floods the nervous system with information, reducing its ability to transmit pain signals to the spinal cord and brain while releasing endorphins (bodu’s natural pain relievers or “feel good hormones”

  • Factors that affect pain:

    • Past experience with pain/background (have they had pain before? how have they handled it? do they need more interventions to control their pain?)

    • Cultural/religious considerations (What are their cultural/religious beliefs about pain? are they stoic? do they vocalize? do they believe this is a punishment?)

    • Age (how do children respond to pain vs an adult?)

    • Family (what were they taught about pain? is it acceptable to express pain? is pain a sign of weakness?)

    • Anxiety/stressors (is the pain going to have a positive outcome (baby) or negative (death), anxiety/fear/sleeplessness/muscle tension increases perception of pain) (ex: giving a shot- hurts when they tense up)

  • Communication DO:

    • Open ended questions (tell me more..)

    • Active listening (I see…)

    • Seeking clarification (I’m not sure I understand…)

    • Summarizing (does that sound correct…)

    • Reflecting (what do you think you should do?)

  • Communication DON’T:

    • Ask “why”

    • Use cliches (you’ll be just fine)

    • Stereotype/judge

    • Give advice

    • Use “elderspeak” or baby talk

  • Numeric scale: Scale to rate pain from 0 (no pain) to 10 (worst pain imaginable)

  • When to use numeric scale: Most commonly used scale, best for adults who can self-report pain

  • Wong-Baker FACES: Visual tool for assessing pain with a picture that represents the pain

  • When to use Wong-Baker FACES: Best for children or others who cannot quantify the severity of their pain on a 0-10 scale

  • FLACC: Scale with 5 criteria (face, legs, activity, cry, and consolability) where each is assigned a score from 0-2

  • When to use FLACC: To assess pain for children between 2 months- 7 years. Or individuals who are unable to verbally communicate their pain

  • COMFORT behavioral scale: Behavioral-observation tool for children of all ages who are receiving mechanical ventilation

  • PAINAD scale: Assessing pain in noncommunicative clients with advanced dementia

  • Non-pharmacological interventions:

    • TENS unit

    • Heat/ice

    • Toileting/making comfortable

    • Quite environment/hypnosis

    • Guided imagery

    • Massage/acupunture

    • Exercise or repositioning

    • Distraction (laughter, music, TV)

  • Non-opioid analgesics or NSAIDs: Tylenol or ibuprofen

  • Opioid Analgesics: Mild (tramadol) Strong (hydromorphone/morphine)

  • Adjuvant or Co-analgesics: Medications with a primary purpose other than pain relief (antidepressants, anticonvulsants, steroids)

  • Patient-controlled analgesia (PCA pump): Set to administer schedules and/or on-demand dosing

    Assess patient at minimum every 4 hours (continous pulse-ox due to increased risk for respiratory depression)

  • Pain threshold: Lowest intensity at which pain is experienced

  • Pain tolerance: Point when a patient can no longer endure pain

  • Medication Tolerance: Body becomes accustomed and needs a larger dose for pain relief

  • Breakthrough pain: Pain that occurs in-spite of medical intervention/flare-up

    Often use PRN meds to treat

  • Dependence: Withdrawal symptoms that occur when an opioid is suddenly reduced or stopped because of physiological adaptations

  • Addiction: Sever problems related to compulsive and habitual use of substances

  • Opioid intoxication: Behavioral or psychological changes that occur during or shortly after opioid use

  • Overdose: Biological response of the human body when too much of a substance is ingested

  • Tolerance: Diminished effect with continued use of the same amount of an opioid

    Need for increased amounts of medication to reach desired effect

  • Misuse: Taking prescription pain medications other than as prescribed

  • Substance use disorder: Neurobiological illness caused by repeated misuse of substances

  • PQRST: Standardized set of questions to gather additional data about client’s pain

  • Location: Where is the pain?

    If unable to answer, can you point?

  • Onset: When did the pain start?

  • Provocation: What makes it better or worse?

  • Quality: How would you describe your pain?

  • Radiation: Does the pain go from one place to another?

    Can you point to it?

  • Severity: Can you rate your pain 0-10?

  • Time: How long does the pain last?

  • Comfort: Managing symptoms, relieving pain, enhancing the quality of life

  • Periodicity: Tendency of a phenomenon to recur at regular intervals

  • Exacerbation: Worsening of a disease or increase in the severity of its symptoms

  • Remission: Reduction or disappearance of the signs and symptoms of a disease