CARE OF PATIENT

HAVING ALTERATIVES
IN COMFORT (PAIN) .

NAME-SUNIA MARNDI
BSC NURSING 4TH YEAR
ROLLL NO-1186021
INTRODUCTION
Pain is a vital function of the nervous system in
providing the body with a warning of potential or
actual injury. It is both a sensory and emotional
experience, affected by psychological factors such
as past experiences, beliefs about pain, fear or
anxiety.
 DEFINITION OF PAIN
“Pain is an unpleasant sensory
and emotional experience
associated with actual or potential
tissue damage.”
Pain is considered the 5th vital sign.
 TYPES OF PAIN
It of 2 types:-
A. Acute pain.
B. Chronic pain.
CLASSIFICATION OF PAIN
 NOCICEPTIVE PAIN
Nociceptive pain arises from the stimulation
of specific pain receptors. These receptors can
respond to heat, cold, vibration, stretch and
chemical stimuli released from damaged cells.
NON CICEPTIVE PAIN

Non ciceptive pain arises from within the

peripheral and central nervous system. Specific
receptors do not exist here, with pain being
generated by nerve cell dysfunction. 
 NOCICEPTIVE PAIN
A. Somatic Pain:-
SOURCES:-tissues such as skin, muscle, joints,
bones, and ligaments - often known as musculo-
skeletal pain.

Receptors activated :- specific

receptors (nociceptors) for heat, cold, vibration, stretch
(muscles), inflammation (e.g. cuts and sprains which
cause tissue disruption), and oxygen starvation (ischaemic
muscle cramps).
 CONT….
Characteristics :- often sharp and well
localised, and can often be reproduced by
touching or moving the area or tissue involved.
Useful Medications:- may respond to
combinations of Paracetamol, Weak Opioids or
Strong Opioids, and NSAIDs.
 CONT….
B. Visceral Pain
Source:- internal organs of the main body
cavities. There are three main cavities -
thorax (heart and lungs), abdomen (liver,
kidneys, spleen and bowels), pelvis (bladder,
womb, and ovaries).

Receptors activated - specific receptors

(nociceptors) for stretch, inflammation, and
oxygen starvation (ischaemia).
 CONT….
Characteristics:- often poorly localised,
and  may feel like a vague deep ache,
sometimes being cramping or colicky in
nature. It frequently produces referred
pain to the back, with pelvic pain
referring pain to the lower back,
abdominal pain referring pain to the
mid-back, and thoracic pain referring
pain to the upper back.
 CONT….
Useful medications :- usually very
responsive to Weak Opioids and 
Strong Opioids. 
NON NOCICEPTIVE PAIN
A. Nerve Pain
Source:- from within the nervous system itself
- also known as pinched nerve, trapped nerve.
 The pain may originate from the peripheral
nervous system (the nerves between the tissues
and the spinal cord),or from the central nervous
system (the nerves between the spinal cord and
the brain).
 CONT…
Causes:- may be due to any one of the
following processes
Nerve Degeneration - multiple sclerosis,
stroke, brain haemorrhage, oxygen starvation
Nerve Pressure - trapped nerve
Nerve Inflammation - torn or slipped disc
Nerve Infection - shingles and other viral
infections
 CONT…
Characteristics:- These signals are then
interpreted by the brain as pain, and can be
associated with signs of nerve malfunction
such as hypersensitivity (touch, vibration, hot
and cold), tingling, numbness, and weakness.
There is often referred pain to an area where
that nerve would normally supply.
 CONT…
Useful medication:- only partially sensitive to
paracetamol, NSAIDs, Opioids. More sensitive
to Anti-depressants, Anti-convulsants, Anti-
arrhythmics, and  Antagonists.
Topical Capsaicin,  may be helpful.
 B. Sympathetic Pain
Source:- due to possible over-activity sympathetic
nervous system, and central nervous system
mechanisms. The sympathetic nervous system controls
blood flow to tissues such as skin and muscle, sweating
by the skin, and responsiveness of the peripheral
nervous system.
Causes - occurs more commonly after fractures and
soft tissue injuries of the arms and legs, and these
injuries may lead to Complex Regional Pain Syndrome
(CRPS).
 CONT…
Characteristics :- presents as extreme
hypersensitivity in the skin around the
injury and also peripherally in the limb,
and is associated with abnormalities of
sweating and temperature control in the
area.
 CONT….
Useful medications:- many of the features
of sympathetic pain are similar to and therefore
nerve pain medications may be useful (
Anti-depressants, Anti-convulsants, and Anti-
arrhythmics).
 SCALE OF PAIN
SINGLE -DIMENTION:-3 single dimention
1) Visual Analog scale
2) Numerical Pain Scale
3) Face scale
 MAXIMUM
NO PAIN PAIN
NUMERICAL PAIN INTENSITY SCALE
FACE SCALE
 CONT…..
MULTIDIMENTIONAL SCALE:
• Assesses the patient as well as the emotional
and behavioral effects of the pain.
 FACTORS OF THE PAIN
 PAST EXPERIENCE:-
 It is tempting to expect that people who have
had multiple or prolonged experiences with
pain will be less anxious and more tolerant of
pain than those who have had little
experience with pain.
 Cont……
ANXIETY AND DEPRESSION:-
 Although it is commonly believed that anxiety increases
pain, this is not necessarily true.
 Anxiety that is relevant or related to the pain may increase
the patient’s perception of pain.
 CONT….
CULTURE:-
Beliefs about pain and how to response to it
differ from one culture to the next.
Early in childhood, people learn from those
around them what responses to pain are
acceptable or unacceptable.
 CONT….
GERONTOLOGIC CONSIDERATIONS:-
 Aging seems to influence the functional features of the
nervous system as evidenced by a loss of myelinated and
unmyelinated fibers in the peripheral nervous system.
 The decrease in myelinated fibers is partly responsible for
causing a decrease in expression of the major myelin
protein.
 NATURE OF PAIN
Location: Where is your pain? Ask client to
point to the area of pain.
Intensity: On a scale of 0 to 10, with 0
representing no pain, how much pain would
you say you are experiencing? If your pain
were a temperature, how hot would it be
(warm, hot, blistering)? If your pain were a
sound, how loud would it be (silent, quiet,
strident, booming).
 CONT…
Quality: In your own words, tell me what
your pain feels like (worms under the skin,
shooting, needle pricking, tingling,
stabbing, etc.).
Chronology/pattern: When did the pain
start question the patient Does your pain
come and go & How often & How long does
it last.
PHARMACOLOGICAL TREATEMENT
ANALGESIC AGENTS FOR MILD PAIN:-
1) NSAIDs
2) Acetaminophen
3) Opioids
4) Alfentanil, Sufentalin
 ANALGESIC AGENTS FOR MODERATE & SEVER
PAIN :-
1) Morphine
2) Codeine
 CONT….
3) Oxycodone
4) Meperidine
5) Propoxyphene
6) Hydrocodone
7) Tramadol
 NONPHARMACOLOGIC TRATEMENT
1) DISTRACTION:-
Distraction helps relieve both acute and chronic
pain.
Distraction, which involves focusing the patient’s
attention on something other than the pain, may
be the mechanism responsible for other effective
cognitive techniques.
 CONT….
2) RELAXATION TECHNIQUES:-
Skeletal muscle relaxation is believed to
reduce pain by relaxing tense muscles that
contribute to the pain.
Research findings support the use of
relaxation in relieving postoperative pain.
 CONT…
3)HYPNOSIS:-
The mechanism by which Hypnosis acts is
unclear.
Its effectiveness depends on the hypnotic
susceptibility of the individual.
4)MUSIC THERAPY:-
Music therapy is an inexpensive & effective
therapy for the reduction of pain and anxiety.
WHO ORGANIZATION PAIN
MANAGEMENT
(WHO) recommends a three-step pain relief
ladder based on the intensity of pain:-
Mild pain (intensity 1–3 on the 0–10 standard):
Use nonsteroidal anti-inflammatory drugs and
adjuvants. If pain persists, then…
Mild to moderate pain (intensity 4–6): Use
combination medications such as oxycodone and
acetaminophen and adjuvants. If pain persists,
then …
 CONT….
Moderate to severe pain (intensity 7–10):
Use potent opioids such as morphine,
fentanyl, methadone, and adjuvants.
NURSING RESPOSIBILITY OF PAIN
1. Acknowledging and accepting the patient’s
pain.
2. Identifying the most likely source of the
patient.
3.Reporting the patient’s level of pain.
4.Developing the patient’s plan of care that
includes an interdisciplinary plan for effective
pain management involving the patient, family
and significants pain.
 CONT….
5. Evaluating the effectiveness of the
strategies and the nursing interventions.
6. Documenting and reporting the
interventions, patient’s response, outcomes;
and Advocating for the patient and family
for effective pain management.
SUM MA RY
 BIBLIOGRAPHY
1) Perry Potter, Fundamentals Of Nursing, 7th edition;2011,
Published By Elsevier, New Delhi, Page No-1052-1070.
2) Clement I, Textbook Of Nursing Fundamentals, 1st
edition;2011,Jaypee Brothers Medical Publishers, New
Delhi, Page No-112-115.
3) Lemone Lynn Taylor Lillis, Fundamentals Of Nursing, 7th
edition; Published by Wolters Kluwer, Page No-1116-1138.