FRITZ IAN E.

FLORESCA, RN, MAN

Adult Health Nursing 1
THEORY
ORIENTATION
FRITZ IAN E. FLORESCA, RN, MAN
Requirements

1. Attendance
2. Notebook/Notes
3. Homework/Assignments
4. Quizzes
5. Major Exams

FRITZ IAN E. FLORESCA, RN, MAN
Policies

1. Do not be Late/Absent
2. Wear Uniform
3. Advance Reading
Everyday
4. No Sleeping in class
5. Keep Mobile Phone In
Silent Mode
6. No Cheating




After the discussion, the students
will be able to:

1. Differentiate between acute pain, chronic pain, and
cancer pain.
2. Describe the Harmful effects of pain.
3. Describe the Pathophysiology of pain.
4. Describe factors that can alter the perception of pain.
5. Demonstrate appropriate use of pain assessment tools.
6. Identify appropriate non-pharmacologic and
pharmacologic pain management.
7. Use the nursing process as a framework for the care of
patients with pain.

DEFINITION:
Fifth Vital Sign
Is an unpleasant sensory and
emotional experience associated with
actual and potential tissue damage, or
described in terms of such
damage.(American Pain Society[APS],2003)
PAIN

Three Categories of pain

CATEGORIES OF PAIN
1. ACUTE PAIN

Short period of
time


Minutes, Hours,
Days, Weeks up to
6 months





2. CHRONIC PAIN


Related to
Emotional or
Disease

More than 6 months
to years


Non-Malignant

3. CANCER PAIN


Cause by nerve
Compression due to
Tumor cells

Pain is present
together with
cancer

Malignant

Classification of pain

Classification of Pain
according to LOCATION
----Based on the Body
Part affected
Example:
1. Chest Pain
2. Shoulder Pain
3. Pelvic Pain
4. Knee Pain
5. Joint Pain
BACK
Classification of Pain
according to ETIOLOGY
----Based on the ORIGIN or CAUSE of
pain
1. VISCERAL PAIN-origin of the pain is
from VITAL ORGANS (eg. heart, intestines,
stomach, pancreas)




2. SOMATIC PAIN-originating from the
SKIN, MUSCLE,& BONES
Visceral or Somatic?
Somatic Pain
Visceral Pain
BACK
Classification of Pain
according to DURATION
----Based on the length of pain
experienced/feel by the patient
Example:
1. Acute Pain less than 6 months
2. Chronic Pain more than 6 months
Acute or Chronic?
Experienced for 1 day?
Pain experienced for 5 months?
Pain experienced for 1 year?
Pain experience only after surgery?
Pain experience for 7 months?
Pain experience yesterday?
BACK
Classification of Pain
according to INTENSITY
-----Based on the severity or intensity of pain
using a standard PAIN RATING SCALE.
0- No pain
10- Worst possible pain
Example:
1. Mild Pain 1-3 pain rating scale
2. Moderate Pain 4 to 7 pain rating scale
3. Severe Pain 8 to 10 pain rating scale
Mild, Moderate, Severe?
BACK
Harmful effects of pain

1. NOXIOUS PAIN STIMULUS (eg. Chemical, Mechanical, Electrical trauma)
2. NOCICEPTORS are activated, converts stimulus ()
3. Transmission of impulses to neuronal tracts to SUBSTANTIA GELATINOSA
4. Opening the GATES in the spinal cord
5. Transmit impulses to the brain
6. Interpret by the CEREBRAL CORTEX of the brain.
7. Patient manifest GUARDING BEHAVIOR or FACIAL GRIMACE or AVOIDS the source of pain.

Pathophysiology of pain
Factors affecting pain

Pain Assessment TOOL for ADULT
Pain Assessment TOOL for CHILDREN
QUESTION
1. Which of the following pain rating
scale is used for CHILDREN or pediatric
patients?

a. Digital Rectal Examination
b. Wong Baker Facial Grimace
c. Health History
d. Numeric Pain Rating Scale


QUESTION
2. Which of the following pain scale is
used for older ADULT PATIENT?

a. Wong Baker Facial Grimace
b. Health History
c. Numeric Pain Rating Scale
d. Digital Rectal Examination





NURSING MANAGEMENT
ASSESSMENT


P
Q
R
S
T


1. Acute Pain related to physical injury or
tissue damage from process of SURGERY.
2. Chronic Pain related to the malignancy.
3. Anxiety related to pain that is
experiencing.
4. Ineffective individual coping related to
chronic pain.
5. Impaired physical mobility related to
musculoskeletal pain.
6. Risk for injury related to lack of
perception of pain.
NON PHARMACOLOGIC
MANAGEMENT
1. Cutaneous Stimulation and
Massage
2. Ice and Heat Pack Therapies
3. Transcutaneous Electrical Nerve
Stimulation
4. Guided Imagery
5. Distraction
6. Hypnosis
7. Relaxation Techniques







NON PHARMACOLOGIC
MANAGEMENT
1. Cutaneous Stimulation and
Massage







NON PHARMACOLOGIC
MANAGEMENT
Ice Pack






Heat Pack






NON PHARMACOLOGIC
MANAGEMENT
Transcutaneous Electrical Nerve
Stimulation






NON PHARMACOLOGIC
MANAGEMENT
Guided Imagery






NON PHARMACOLOGIC
MANAGEMENT
Distraction






NON PHARMACOLOGIC
MANAGEMENT
Hypnosis Therapy -form of psychotherapy used to create
subconscious change in a patient in the form of new
responses, thoughts, attitudes, behaviors or feelings





NON PHARMACOLOGIC
MANAGEMENT
Relaxation Techniques Through rest and deep
breathing exercise








A
Non-Opioids
(NSAIDs)
B
Opioids
(MORPHINE)
C
Adjuvants
(COMBINATION)

1. Rhizotomy -A lesion is made in the
dorsal root to destroy neuronal
dysfunction and reduce
nociceptive input.

2. Cordotomy -division of certain
tracts of the spinal cord.

1. Rhizotomy
2. Cordotomy

GLOSSARY
Allodynia: --non-painful stimuli produce pain
Analgesia: --Absence of pain in response to stimulation which
would normally be painful (e.g. using drugs)
Dysesthesia: --unpleasant abnormal sensation
Hyperalgesia / Hyperpathia-- used interchangeably to denote
heightened response to a painful stimuli.
Nociceptor:-- A sensory receptor of the peripheral
(somatosensory nervous system) that transmits
noxious stimuli to CNS.
Neuropathic pain:-- Pain caused by a lesion or disease of
the nervous system.
Noxious stimulus: --A stimulus that is damaging or
threatens damage to normal tissues (chemical,
mechanical, thermal)
Pain threshold: --The minimum intensity of a stimulus that is
perceived as painful.