Lesson Plan-01 : Pain Management

SI.NO	SPECIFIC OBJECTIVE	TIME	CONTENT	TEACHING AND LEARNING ACTIVITY	AV  AIDS	EVALUATION
1. 2. 3. 4. 5. 6. 7.	Introduce the topic to the students The student will be able to define pain. The student will be able to classify the Pain. The student will be able to listout the factors influencing pain response. The student will be able to enlist the characteristics of  pain response. The student will be able to  enumerate the management  of Pain.                   The student will be able to narrate the role of a nurse in pain management.	2min 2min 2min 2min 2min 5min 2min	INTRODUCTION Pain management (also called pain medicine or algiatry) is a branch of medicine employing an interdisciplinary approach for easing the suffering and improving the quality of life of those living with pain. American Pain society (2003)  consider pain as fifth vital sign. DEFINITION Pain has been defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage.                                                                                                                                  Brunner and Sudhartha Pain is a complex, multidimensional experience. Lewis CLASSIFICATION OF PAIN Pain can be categorised in several ways. NOCICEPTIVE PAIN It is caused by damaged somatic or visceral tissue.  -SOMATIC PAIN, categorised as deep, aching, or throbbing that is well localised arise from born, join, muscle, skin, or connective tissue. -VICERAL PAIN, Which may result from stimuli such as tumour involvement or obstruction, arises from internal organs such as the intestine and bladder. NEUROPATHIC PAIN It is caused by damaged to peripheral nerves or central nervous system. Common causes of neuropathic pain include trauma, inflammation. ACUTE PAIN Can be described as lasting from seconds to 6 months. CHRONIC PAIN Can be described as More than 6 months the pain persistent. FACTORS INFLUENCING OF PAIN RESPONSE ·        Past experience Once the person experiences severe pain, he or she know how severe it is, In other ways a person who has never had severe pain may have no fear of such pain. ·        Anxiety Eg: Postoperative anxiety ·        Culture The cultural expectations and belief about pain differ from one cultural to other. ·        Gender Both men and women have pain, but women report significantly greater pain compare to main. ·        Genetics Africans and Americans reported greater levels of pain. CHARECTERISTICS OF PAIN Factors to consider in a complete pain assessment are                 ·        Intensity The intensity of pain differs from none to mild discomfort to worst pain. Various scales and surveys are helpful to patient to describe the pain Example of pain scale. ·        Timing The nurse inquires about onset, duration, relationship between time and intensity, and changes in rhythmic patterns. ·        Location Determined by having the patient point to the area of the body involved. ·        Quality The nurse asks to the patient to describe the pain in his or her words without offering any clues. If the patient cannot describe the quality of pain, nurse can suggest the words such as burning, aching, and stabbing.  ·        Personal meaning of pain Pain means things to different people, as a result patient experience pain differently. PAIN MANAGEMENT Pain management mainly divided into pharmacological and non pharmacological management ·        Pharmacological  Pain management ·        Non Pharmacological  Pain management        I  Pharmacological  Pain management a)     Nonopioids analgesics include acetaminophen, apirin and other salicylates, and NSAIDS. These agents characterise  by the following: 1)    That is increasing the dose beyond an upper limits provides no greater analgesia. 2)    They do not produce tolerance of physical dependence. 3)    Many are available without a prescription. Eg: of non steroidal anti inflammatory drugs IBUPROFEN -200MG INDOMETHACIN -25 MG KETOROLAC -30 MG DICLOFENAC -50 MG b)    Opioids analgesics produced their effects by binding to receptors in central nervous system. this resulting in:- 1) Inhibition of the transmission of nociceptive input from the periphery to the spinal cord. 2)Altered in limbic system activity Eg: of  Opioids analgesics  drugs Morphine -per oral, rectal, iv, subcutaneous, epidural, intrathecal, sublingual. Hydromorphone - per oral, iv subcutaneous, epidural, intrathecal, im. c)     Adjuvant analgesic therapy These medications, sometimes referred to as co analgesics are drugs used in conjunction with opioids and nonopioids analgesics.Generally coma, these agents were developed originally for other purposes (Antiseizure , anti  depressants and found later to be effective for pain). Drugs 1.      corticosteroids Prednisolone Methyl prednisolone 2.     Antidepressents Amitriptaline Nortryptyline 3.     Anti seizure druds Carbamazepine Gabepentine 4.     Muscle ralaxcant Baclofen 5.     Anaesthetics – local Lidocaine 2.5% +prilocaine2.5% II Non-pharmacological therapy for pain Ø Massage It is a common therapy for pain, many different massage technique exist. Eg; include moving the hands or fingers over the skin slowly or briskly with long strokes or in circles or applying same pressure to the skin to maintain contact while massaging the underling tissue. Ø Excercise It is a critical part of the treatment plan for patient with chronic pain, particularly those with musculoskeletal pain. Research supports the effectiveness of many type of exercise for a variety of painful conditions. Many patients become physically reconditioned as a result of their pain which in turn leads to more pain. Excercise acts via many mechanisms to relieve pain. Ø Transcutaneous electrical nerve stimulation It involves the delivery of electric current through electrodes applied to the skin surface over the painful region, at trigger point, or over a peripheral nerve. A Transcutaneous electrical nerve stimulation system consist of two or more electrodes connected by lead wires to a small, battery- hyphen operator stimulator. Usually a physical therapist is responsible for administering transcutaneous electrical nerve stimulation therapy although nurses can be trained in the technique. Trancutaneous electrical nerve stimulation may be used in acute pain, including post operative pain and associated with physical trauma. The effects of transcutaneous electrical nerve stimulation on chronic pain are less clear but may be effective for some chronic pain patients. Ø Accupuncture It is a technique of traditional Chinese medicine in which very thin needles are inserted in to the body at designated points. Acupuncture is applied to varied pain problems, including musculoskeletal condition. Repetitive strain disorder, myofacial pain syndrome, post surgical pain. Ø Heat therapy It is a application of either moist or dry heat to the skin. Heat therapy can be either superficial or deep. Superficial heat can be applied using an electric heating part a hot pack, hot moist compresses, warm wax, or a hot water bottle. Ø Cold therapy It involves the application of either moist or dry cold to the skin. Dry cold can be applied by means of an ice bag, moist cold bad means of towel socked in ice water, immersion in a bath. Cold therapy is believed to be more effective than heat for a variety of pain full conditions, acute pain from trauma or surgery. Ø Hypnosis It is a structured technique that enables a patients to achieve a stage of Heighten awareness and focused concentration that can be used to alter the patient pain perception. Hypnosis should be administered and monitored only by specially trained clinicians. Ø Relaxation strategies It are varied but their goal is to reach the state that is free from anxiety and muscle tension relaxation reduce the stress, acute anxiety, distracts from pain, alleviate muscle tension combat fatigue. Facilitates sleep and enhance the effectiveness of other pain relief measures. it include relaxation breathing music , imaginary, meditation and progressive muscle relaxation. NURSING ROLE IN  MANAGEMENT OF PAIN Nurse is an important member of the multidisciplinary pain management team. Nurse acts as planner, educator, patient advocator, interpreter and supporter of patient in pain and patient family. Because pain can be present in any patient in a wide variety of care settings, the nurse must be knowledgeable about the current therapies and flexible in try new approaches to pain management. Many nursing role have been described earlier, including conducting pain assessment, administering therapies, monitoring for effects, and teaching patients and families. 1.     provides non-invasive pain management interventions 2.     performs nursing and/or pain assessments of people with pain 3.     identifies and documents previously used pain management interventions and the results of the interventions 4.     identifies the physiological and psychological strengths and weaknesses of the person with pain 5.     communicates effectively with team members regarding findings and collaborates with the team on interventions as indicated 6.     participates in determining whether a patient should be admitted to a pain management program 7.     identifies the patient's and the significant other's support systems and includes them in the plan of care 8.     documents a patient's work history and intervenes with the patient's employer if and/or when a need is indicated 9.     serves as a patient advocate with team members to facilitate problem solving 10.                        provides pain management information regarding the program, interventions, and pharmacological treatment to the patient and any significant others 11.                        participates in staff development, providing current information to the pain management team 12.                        incorporates relevant research findings into practice 13.                        Provides information to the community regarding pain management.	Teacher:-Introduced the topic from general to specific Students:- Carefully listening. Teacher:- Defined the pain Student:-Understanding carefully. Teacher:-classify the pain Student:-Understanding carefully Teacher:-List out the factors influencing pain Student:-Understanding carefully Teacher:-enlist List the factors characteristics pain Student:-Understanding carefully Teacher:- enumerate the management of pain Student:-Understanding carefully Teacher:- narrate the management of pain Student:-Understanding carefully	Black board Pham let    Chart Flash card Model     Ppt       Handout	What is the definition of Pain? What all are the classifications of pain? What all are the Factors influencing pain? What all are the Characteristics pain? What all are the  management  of Pain? What is nurse’s role in pain management?

SUMMARY:

            Till now we have discussed regarding the definition, classification, factors influencing, characteristics, and medical and nursing management of pain.

CONCLUSION:

            By the end of the class all the students will be able to attain adequate knowledge on managing a case of pain with appropriate nursing care.

                                    STUDENT profile

STUDENT NAME                                                        :                                     .

SUBJECT                                                                    : NURSING EDUCATION

TOPIC                                                                          : Pain management

GROUP                                                                        : 

TEACHING AND LEARNING METHODS                  : LECTURE CUM DISCUSSION METHOD

TIME                                                                           : 20 minutes

DATE                                                                          :

Venue                                                                        :  

OBJECTIVES

GENERAL OBJECTIVES:                         

            The student will be able to improve knowledge, and able to manage a client with pain.

SPECIFIC OBJECTIVES:

            By the end of the class, the students will be able

·         to define pain .

·         to classify the pain.

·        to list out the factors influencing pain response

·        to enlist the characteristics of  pain response.

·        to enumerate the management  of pain.

·        to narrate the role of a nurse in pain management