疼痛pain(英文版).ppt
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? Pain is a subjective feeling and difficult to measure.
?Serves as one of the bodies defense mechanisms, resulting from stimulation of pain receptors.
TOTAL PAIN
Visible Pain
Hidden Pain
Significance of Pain
* Pain is adaptive
* Alerts us to danger
* Motivates escape and avoidance learning
* Motivates recuperation
* Congenital insensitivity to pain
* Pain is partly subjective
* Influenced by expectations and emotions
Impact of Pain on the Dimensions of Quality of Life
Pain is defined by the International Association for the Study of Pain (IASP) as
? "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage"
(Mersky 1979)
? "the inability to communicate verbally does not negate that the individual is experiencing pain and is in need of appropriate pain relieving treatment"
(unconscious, pre-verbal, intellectually disabled, non-English, impaired communication etc)
Types of Pain
Types of Pain
Types of Pain
Types of Pain
Mediators to the Pain Response
Pain pathways
? Specialized receptors = free nerve endings
? Stimulation
- Mechanical damage
- Extreme temperature
- Chemical irritation
? Two types of neurons
- A-delta: first pain, sharp
- C: second pain, dull
? Four distinct processes
- Transduction, transmission, modulation, perception
The Process of Pain Perception: Structures
The Process of Pain Perception: Structures
The Process of Pain Perception: Structures
Nerve Transmission
Nerve Transmission
Second Order Afferents
Ascending Spinal Pathways
Other Structures
Transmitter Substances
Key Point
Key Point
Higher Centers in the Nociceptive System
Higher Centers in the Nociceptive System
? Specificity theory
? Pattern theory
? Gate control theory
? Castel's Model of Pain Control: Level 1
? Castel's Model of Pain Control: Level 2
? Castel's Model of Pain Control: Level 3
Gate Control Theory
Ronald MelzackPatrick Wall
Gate-Control Theory
Pain Assessment
? Accurate pain assessment is essential for effective pain management. Pain is subjective and experienced uniquely by every individual, nurses need to assess all factors affecting the pain experience.
Assessing Pain
Assessment of Pain Intensity
Assessing Pain
Brief Pain Inventory: Cleeland
? Please rate your pain by circling the one number that best describes your pain
? ____________________________________________________________
01 23 45678910
No Pain Pain as bad as you can imagine
What is your Pain at it's
Best / Worst/ Present/ Average
In the past 24 hours, how much RELIEF have pain treatments or medications provided? Please circle the one percentage that most shows how much. _____________________________________________________________
0%10%20% 30%40%50%60%70% 80%90%100%
Pain Rating Scales
? The Visual Analogue Scale may be easier for some patients to use.Show them the scale and ask them to rate their pain.
? The Face Scale may be used for some adults who are unable to use the number scales.Ask the patient to pick a face that matches how they feel and record that # as their pain level.
Pain Rating Scales
? The FLACC scale should be used with patients who are nonverbal or noncommunicative
Pain Documentation
? Be sure to document a complete pain assessment with each nursing assessment on the Assessment tool.
? Record a pain rating on the Clinical Data Flowsheet and include interventions if made and the reassessment after an intervention.
Adverse Effects of Pain
? Cardiovascular
? Pulmonary
? Gastrointestinal
? Renal
? Extremities
? Endocrine
? CNS
? Immunologic
Adverse Effects of Pain
Cardiovascular:Tachycardia, hypertension, increased SVR, increased cardiac work, increased myocardial O2 demand.
Pulmonary:Hypoxia, hypercarbia, atelectasis, decreased cough, decreased vital capacity and function residual capacity, V/Q mismatch.
Gastrointestinal:Nausea, vomiting, ileus, intolerance for oral intake.
Renal:Oliguria, urinary retention.
Adverse Effects ofPain
Extremities:Skeletal muscle spasm, limited mobility, thromboembolism.
Endocrine:Excessive adrenergic activity, vagal inhibition, catabolic metabolism, increased O2 consumption.
CNS:Sedation, fatigue, anxiety, and fear cause central sympathetic stimulation.
Immunologic:Inhibited cellular immunity, increased risk of infection, ?? impaired wound healing ??
Treatment of Chronic Pain
? Surgical procedures to block the transmission of pain from the peripheral nervous system to the brain.
? Synovectomy - Removing membranes that become inflamed in arthritic joints.
? Spinal fusion - joins two or more adjacent vertebrae to treat chronic back pain.
TYPES OF ANALGESICS
? Selection of analgesic therapy
? PCA-Patient control analgesia
? continuous infusions of analgesics
? Epidural and intrathecal analgesia
? Pain scales and using the nursing process
? Opiate analgesia
? Non-opiate analgesia
- Tylenol
- NSAIDS
Pharmacologic Control of Pain
? About half of hospitalized patients who have pain are under-medicated.
? Children are at particular risk of poor pain control methods.
? Medications are given as:
- PRN - "as needed"
- As a prescribed schedule
Types of Pain Medications
? Peripherally active analgesics - work at the periphery (e.g., aspirin, Tylenol).......（后略) ......
? Pain is a subjective feeling and difficult to measure.
?Serves as one of the bodies defense mechanisms, resulting from stimulation of pain receptors.
TOTAL PAIN
Visible Pain
Hidden Pain
Significance of Pain
* Pain is adaptive
* Alerts us to danger
* Motivates escape and avoidance learning
* Motivates recuperation
* Congenital insensitivity to pain
* Pain is partly subjective
* Influenced by expectations and emotions
Impact of Pain on the Dimensions of Quality of Life
Pain is defined by the International Association for the Study of Pain (IASP) as
? "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage"
(Mersky 1979)
? "the inability to communicate verbally does not negate that the individual is experiencing pain and is in need of appropriate pain relieving treatment"
(unconscious, pre-verbal, intellectually disabled, non-English, impaired communication etc)
Types of Pain
Types of Pain
Types of Pain
Types of Pain
Mediators to the Pain Response
Pain pathways
? Specialized receptors = free nerve endings
? Stimulation
- Mechanical damage
- Extreme temperature
- Chemical irritation
? Two types of neurons
- A-delta: first pain, sharp
- C: second pain, dull
? Four distinct processes
- Transduction, transmission, modulation, perception
The Process of Pain Perception: Structures
The Process of Pain Perception: Structures
The Process of Pain Perception: Structures
Nerve Transmission
Nerve Transmission
Second Order Afferents
Ascending Spinal Pathways
Other Structures
Transmitter Substances
Key Point
Key Point
Higher Centers in the Nociceptive System
Higher Centers in the Nociceptive System
? Specificity theory
? Pattern theory
? Gate control theory
? Castel's Model of Pain Control: Level 1
? Castel's Model of Pain Control: Level 2
? Castel's Model of Pain Control: Level 3
Gate Control Theory
Ronald MelzackPatrick Wall
Gate-Control Theory
Pain Assessment
? Accurate pain assessment is essential for effective pain management. Pain is subjective and experienced uniquely by every individual, nurses need to assess all factors affecting the pain experience.
Assessing Pain
Assessment of Pain Intensity
Assessing Pain
Brief Pain Inventory: Cleeland
? Please rate your pain by circling the one number that best describes your pain
? ____________________________________________________________
01 23 45678910
No Pain Pain as bad as you can imagine
What is your Pain at it's
Best / Worst/ Present/ Average
In the past 24 hours, how much RELIEF have pain treatments or medications provided? Please circle the one percentage that most shows how much. _____________________________________________________________
0%10%20% 30%40%50%60%70% 80%90%100%
Pain Rating Scales
? The Visual Analogue Scale may be easier for some patients to use.Show them the scale and ask them to rate their pain.
? The Face Scale may be used for some adults who are unable to use the number scales.Ask the patient to pick a face that matches how they feel and record that # as their pain level.
Pain Rating Scales
? The FLACC scale should be used with patients who are nonverbal or noncommunicative
Pain Documentation
? Be sure to document a complete pain assessment with each nursing assessment on the Assessment tool.
? Record a pain rating on the Clinical Data Flowsheet and include interventions if made and the reassessment after an intervention.
Adverse Effects of Pain
? Cardiovascular
? Pulmonary
? Gastrointestinal
? Renal
? Extremities
? Endocrine
? CNS
? Immunologic
Adverse Effects of Pain
Cardiovascular:Tachycardia, hypertension, increased SVR, increased cardiac work, increased myocardial O2 demand.
Pulmonary:Hypoxia, hypercarbia, atelectasis, decreased cough, decreased vital capacity and function residual capacity, V/Q mismatch.
Gastrointestinal:Nausea, vomiting, ileus, intolerance for oral intake.
Renal:Oliguria, urinary retention.
Adverse Effects ofPain
Extremities:Skeletal muscle spasm, limited mobility, thromboembolism.
Endocrine:Excessive adrenergic activity, vagal inhibition, catabolic metabolism, increased O2 consumption.
CNS:Sedation, fatigue, anxiety, and fear cause central sympathetic stimulation.
Immunologic:Inhibited cellular immunity, increased risk of infection, ?? impaired wound healing ??
Treatment of Chronic Pain
? Surgical procedures to block the transmission of pain from the peripheral nervous system to the brain.
? Synovectomy - Removing membranes that become inflamed in arthritic joints.
? Spinal fusion - joins two or more adjacent vertebrae to treat chronic back pain.
TYPES OF ANALGESICS
? Selection of analgesic therapy
? PCA-Patient control analgesia
? continuous infusions of analgesics
? Epidural and intrathecal analgesia
? Pain scales and using the nursing process
? Opiate analgesia
? Non-opiate analgesia
- Tylenol
- NSAIDS
Pharmacologic Control of Pain
? About half of hospitalized patients who have pain are under-medicated.
? Children are at particular risk of poor pain control methods.
? Medications are given as:
- PRN - "as needed"
- As a prescribed schedule
Types of Pain Medications
? Peripherally active analgesics - work at the periphery (e.g., aspirin, Tylenol).......（后略) ......
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