SI.NO
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SPECIFIC
OBJECTIVE
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TIME
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CONTENT
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TEACHING AND LEARNING
ACTIVITY
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AV
AIDS
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EVALUATION
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1.
2.
3.
4.
5.
6.
7.
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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.
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2min
2min
2min
2min
2min
5min
2min
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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.
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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
