...Pain Assessment and Management G u i d e l i n e f o r Marlene Walden, PhD RNC NNP CCNS Sharyn Gibbins, PhD RN NNP P r a c t i c e , 2 n d E d i t i o n Pain Assessment and Management Guideline for Practice, 2nd Edition This guideline is an outline of the pain assessment and management practices that currently are accepted and documented by experts in the field of neonatal care. In addition, it summarizes and recommends pain assessment and management practices based on the best evidence for the nursing care of infants. This guideline does not preclude the use of manufacturers’ recommendations or other acceptable methods of assessing and managing pain in infants. The use of other practices known to improve the quality of neonatal care is encouraged and not restricted by this document. The National Association of Neonatal Nurses (NANN) developed this guideline in response to members’ requests. Broad in scope, it can provide a foundation for specific nursing protocols, policies, and procedures developed by individual institutions. Authors Marlene Walden, PhD RNC NNP CCNS Sharyn Gibbins, PhD RN NNP Reviewers Daniel Batton, MD, American Academy of Pediatrics Sandra Sundquist Beauman, MSN RNC Jim Couto, MA, American Academy of Pediatrics Mary Ann Gibbons, BSN RN Melinda Porter, RNC CNS NNP Ann Stark, MD FAAP, Chair of AAP Committee on Fetus and Newborn Carol Wallman, RNC NNP MS, NANN/AWHONN Liaison to AAP Committee on Fetus and...
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...Quotes about pain from QuotationsBook.com Who, except the gods, can live time through forever without any pain? - Aeschylus The injuries we do and the injuries we suffer are seldom weighed on the same scales. - Aesop The greatest evil is physical pain. - Augustine, St. The moment an ill can be patiently handled, it is disarmed of its poison, though not of its pain. - Beecher, Henry Ward And God shall wipe away all tears from their eyes; and there shall be nor more death, neither sorrow nor crying, neither shall there be any more pain. [Revelation] - Bible To banish cares, scare away sorrow and soothe pain is the business of the poet and singer. - Bodenstedt 1 There has never been a great athlete who died not knowing what pain is. - Bradley, Bill Pain dies quickly, and lets her weary prisoners go; the fiercest agonies have shortest reign. - Bryant, William C. The great art of life is sensation, to feel that we exist, even in pain. - Byron, Lord It is easier to find men who will volunteer to die, than to find those who are willing to endure pain with patience. - Caesar, Julius All pain is either severe or slight, if slight, it is easily endured; if severe, it will without doubt be brief. - Cicero, Marcus T. The injuries that befall us unexpectedly are less severe than those which are deliberately anticipated. - Cicero, Marcus T. 2 After great pain, a formal feeling comes. The Nerves sit ceremonious, like tombs. ...
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...Introduction Chronic pain is one of the most frequent diagnosis and the most common problem for which elderly patients in the clinical setting seek help. Chronic pain refers to an unpleasant, distressful and uncomfortable feeling. Studies have shown that chronic pain is often undertreated even when the prevalence rates and syndromes are well understood. The means of relief are within practitioners’ capabilities to provide care. With careful assessment and a comprehensive plan of care that addresses the various aspects of the patients needs; chronic pain can be controlled in the vast majority of cases. Thus, awareness and provision of basic and specialized interventions can ensure comfort and improve quality of life. However, chronic pain left untreated or undertreated may cause suffering. This will also cause disease-mediated symptoms such as pain, dyspnea, fatigue, and loss of mobility. Needless to say, there are accompanying emotional states such as depression, anxiety, and a sense of uselessness. This paper will explore the under treatment of chronic pain among the elderly, its defining attributes, the use of an analysis model and its relationship to the concept. Identify a nursing theoretical framework used to analyze and resolve the problem. Also, an attempt will be made to identify an evidence based practice and research to support strategies for the resolution of the problem. Problem Under treatment of Chronic Pain in the Elderly However, most often than...
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...Pain and Aggression in Nursing Home Residents With Dementia Ahn, Hyochol; Garvan, Cynthia; Lyon, Debra. July/August 2015. Pain and Aggression in Nursing Home Residents With Dementia. Nursing Research. 64(4):256-263. Primarily, pain may impact the combative behavior of residents with dementia in nursing homes. Conversely, nurses trained to diagnose the symptoms and pain cues can avert or lessen the pain with dementia residents who cannot communicate. Accordingly, nurses who identify pain can intervene with proper pain management, and reduction. Nevertheless, aggressiveness is an indicator of pain in dementia patients; this study discusses the correlation between pain and aggression, and the circumstances to which they emerge (Ahn, Garvan &...
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...individuals perceive pain to a lesser degree or that sensitivity is diminished. Although pain is a common experience among individuals 65 years of age and older, it is not a normal process of aging. Pain indicates pathology or injury. Pain should never be considered something to tolerate or accept in one's later years. Unfortunately, many clinicians and older adults wrongfully assume that pain should be expected in aging, which leads to less aggressive treatment. Older adults have additional fears about becoming dependent, undergoing invasive procedures, taking pain medications, and having a financial burden. The most common pain-producing conditions for aging adults include pathologies such as arthritis, osteoarthritis, osteoporosis, peripheral vascular disease, cancer, peripheral neuropathies, angina, and chronic constipation. People with dementia do feel pain. The somatosensory cortex is generally unaffected by dementia of the Alzheimer type. Sensory discrimination is preserved in cognitively intact and impaired adults.1 Because the limbic system is affected by Alzheimer disease, current research focuses on how the person interprets and reports these pain messages.24 See further discussion on pain assessment with dementia on p. 170. Gender Differences Gender differences are influenced by societal expectations, hormones, and genetic makeup. Traditionally, men have been raised to be more stoic about pain and more affective or emotional displays of pain are accepted for women...
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...Task 2 The International Association for the study of pain (1979) define pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. This suggests that only the person can tell you what the pain is like and it cannot be confirmed or denied by reference to tissue damage or pathophysiology. Consequently, the perceptual experience of pain is not merely a sensational experience, but also an emotional experience. It is important to distinguish between acute and chronic pain. Acute pain is biologically useful; it serves as the body’s alarm of an underlying medical condition, whereas chronic pain loses this function. The medical model beliefs that there is a major difference in acute and chronic pain. According to it, someone with an acute pain will be obvious tissue damage. The pain they experience will be directly to do with that. However, with the chronic pain, there is no obvious tissue damage. Consequently, they are psychological disorder. From psychological point of view, the reason why there are enormous variation in how patients experience and manage their pain is that pain is a physiological experience and maybe the variety they need, perceptions are due to their personal extremely anxious. Reason why there are enormous differences most be a psychological reason, such as anxiety of the belief that the pain will take over their life and or maybe they are sick or got mental health problems...
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...Vol. 14 No. 3 September 1997 Journal of Pain and Symptom Management 175 Special Article Nurses' Knowledge of Pain Assessment and Management: How Much Progress Have We Made? M a r g o McCaffery, MS, RN, FAAN, a n d Betty R. Ferrell, PhD, FAAN Nursing Consultant (M.M.), Los Angeles, California and Nursing Research (B.t~E ), City of Hope National Medical Center, Duarte, California, USA Abstract Uadertreatment of pain and lack of knowledge about pain management have been evident for approximately two decades. Because nurses are often the cornerstone of pain management, nurses' knowledge in this area is especially important. This paper explores indications of progress in the level of nursing knowledge about basic aspects of pain management. The literature is reviewed and findings from recent (1995) surveys of nurses' knowledge are compared with results of similar surveys conducted beginning in 1988. Improvements in nurses' knowledge of pain assessment, opioid dosing, and likelihood of addiction seem to have occurred. However, knowledge deficits continue. Fewer than one-half of the nurses surveyed understand that the patient's self report of pain is the single most reliable indicator of pain and that the nurse should increase a previously safe but ineffective dose of opioid. Findings from surveys on addiction reveal that the longer the patient receives opioids the more concerned nurses become about causing addiction. Nevertheless, results of current knowledge surveys...
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...Growing Pains Cheaque Gay PSY202: Adult Development 7/18/2013 A person’s childhood is usually the most important time in a person’s life. During this time they experience innocence, develop personality, they build character and they develop maturity. Many people look as their childhood as a time where everything was perfect, no worries or anything. In reality your childhood has a lot to do with our character, personality, and why we are the way we are today. Many children that come from a broken home tend to have more struggles and problems in their adult life, versus children that grew up in a stable home. Although we are all destined to go through something or deal with hard times no matter what background you come from, we all struggle in our own way. My paper will discuss the innocence of my childhood and the not so innocent. You will also see how my childhood and a big impact or the decisions and choices I made in my adult life; it all will represent the pain of growing. Although it was painful growing up, it was because of my growing pains, that I’m a better person today. As a child growing up, I can remember always being out with my parents. We did so much I almost forgot how our house looked. If we weren’t at the amusement parks, beach, my grandmother’s house, we were at another relative’s home. No matter where we were, we were always together. The unstoppable four: my mom, my pops, my sister and I. We lived in a nice single family home on the Westside of Baltimore...
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...Pain is subjective as such, and numerous factors may affect individual's pain experience. Huether and McCance (2012) stated, “interpretation of pain is influenced by many factors, including cultural preferences, male and female roles, and life experiences, including past painful experience and current expectation” (p.326). Therefore, sources of pain are physical, emotional, psychological, spiritual and cultural wounds, and the severity of pain depends on the individuals so is the effectiveness of the treatment; no one approach to pain is useful for all kinds of different pain experiences. While Physical pains could be easily treated with pharmaceutical approaches, emotional, psychological, spiritual and cultural pain are treatable solely with a...
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...Chronic Pain What are the risk factors for low back injury? Physical and family risk factors • Being middle-aged or older • Being male • Having a family history of back pain • Having had a back injury before • Being pregnant. A woman's back is significantly stressed by carrying a baby. • Having had compression fractures of the spine • Having had back surgery before • Having spine problems since birth Risk factors you can change with lifestyle changes • Not getting regular exercise • Doing a job or other activity that requires long periods of sitting, heavy lifting, bending or twisting, repetitive motions, or constant vibration, such as using a jackhammer or driving certain types of heavy equipment • Smoking. People who smoke are more likely than people who don't smoke to have low back pain. • Being overweight. Excess body weight, especially around the waist, may put strain on your back, although this has not been proved. But being overweight often also means being in poor physical condition, with weaker muscles and less flexibility. These can lead to low back pain. • Having poor posture. Slumping or slouching on its own may not cause low back pain. But after the back has been strained or injured, bad posture can make pain worse. "Good posture" generally means your ears, shoulders, and hips are in a straight line. If this posture causes pain, you may have another condition such as a problem with a disc or bones in your back. • Being under stress. Stress and other...
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...NOTES: PAIN: STRUCTURE AND FUNCTION: • Neuroanatomical pathway: o Originates from either or both CNS and PNS o Nociceptors = from PNS to CNS Located in skin, connective tissue, muscle, thoracic, abdominal, pelvic viscera. Stimulated by either trauma or chemicals released from damaged tissue PNS to CNS: • A-delta fibres: myelinated, large diameter => rapid transmission. Localised, short-term, sharp. • C fibres: unmyleinated, small diameter. Diffuse, burning, aching, constant pain. Perisist after the initial injury. o Nociception: How noxious stimuli are typically perceived as pain. 4 phases: • Transduction: from PNS to spinal cord: injury => chemical release: substance P, histamine, prostaglandins, serotonin, bradykinin = NTs that propagate message; second set of NTs: S.P., glutamate, ATP. • Transmission: from spinal cord to brain • Perception: conscious awareness of a painful sensation. • Modulation: pain message inhibited. Descending pathways from brain => 3rd set of NTs => slow down pain impulse => analgesic effect. o Sources of pain: Visceral pain: • Large interior organs • Stretching, trauma. • Eg. Ureteral colic, appendicitis, cholecystitis, ulcer pain • Transmitted by ascending nerve fibres + ANS fibres => presentation of autonomic responses: o Vomiting, nausea, pallor, diaphoresis. Deep somatic pain: • Result of pressure, trauma, ischaemia to BVs, joints, tendons, muscle, bone. Cutaneous somatic pain: • Skin surface or subcutaneous...
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...fibromyalgia Fybromyalgia simply means pain (algia) coming from muscles (my) and fibrous tissues (fibro) such as tendons and ligaments. It is usually accompanied by other symptoms in addition to the pains and is sometimes called fibromyalgia syndrome. It is a chronic persistant condition. “ The cause of fibromyalgia is not known....research has shown that people with fybromyalgaia have certain subtle changes in some chemicals in the brain and nervous system.....there seems to be a minor change in the level of neurotransmitters, the chemicals responsible for transmitting messages between nerves and brain cells. Research studies have shown that there is also an increased amount of a chemical substance called substance P in the cerebrospinal fluid and that this may be involved in the way pain messages are transmitted.” ( www.patient.co.uk/health/fybromyalgia) As the cause of fibromyalgia is thought to be from the processes in the brain and spinal cord there is little evidence that the disease is due to a problem with the peripheral muscles, tendons and ligaments although the pain is often felt there. Fybromyalgia affects one in fifty people, it usually develops between the ages of twenty five to fifty five and is more common in women. Common symptoms of fibromyalgia are pain, particularly in the neck and back, sensitivity to touch, joint sorenesss, tiredness, and problems sleeping. “ People diagnosed with fibromyalgia often experience chronic pain that can be very debilitating to their...
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...Pain and Suffering The argument that is being disputed deals whether pain and suffering is truly evil or a necessary discomfort in order to achieve a greater relationship with our creator. There are three misconceptions that are used to argue that there cannot be a loving God. The first is that the very definition of loving is automatically related to making people happy and comfortable. This is argued through the very fact that the greatest act of love, Jesus’ crucifixion, brought immense anguish to Jesus, but he welcomed the pain as he knew that eternity along his father and saving us from sin would be worth it. This leads to the second false assumption that states that the events that occur in this lifetime will be greater than our eternal life. This premise dictates that all of our suffering will be worthless if we do not truly believe that there is a God since our eternal life will be lost. The third and final false assumption is that we are able to understand the world through God’s perspective. With no doubt this assumption is incredibly flawed as we are simple humans unable to comprehend on the same level as our God. This is exemplified by the fine example of a bear with a leg caught in a bear trap. A bear-lover who tries to free it will, with no doubt, cause it more pain, but the bear-lover means no harm and knows that the only way to free it is to shoot it with tranquilizers. We are the bear: unintelligent, fearful, and curious as to why someone would cause us more...
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...Pain Management: A concept Analysis Laura Miller Sacred Heart University Pain Management: A concept Analysis Millions suffer from acute or chronic pain every year and the effects of pain exact a tremendous cost on our country in health care costs, rehabilitation and lost worker productivity, as well as the emotional and financial burden it places on patients and their families. The costs of unrelieved pain can result in longer hospital stays, increased rates of re-hospitalization, increased outpatient visits, and decreased ability to function fully leading to lost income and insurance coverage (American academy of pain medicine,2006). The most often used definition for pain is: an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (Chandra & Ozturk, 2005, p.34; Loeser & Melzack, 1999, p.1607; McHugh & Thoms, 2001, p.33). The aim is to improve communication, develop tools to evaluate the effectiveness of pain management, and how it can be the solution in decreasing the cost of unrelieved pain, decrease re-hospitalization and also improve function and quality of life. Current use and historical perspective Individuals have a great tendency to treat their pain before seeking any medical assistance. Every culture has some type of home remedy that they rely on to treat any type of element including pain. According to Bonica, Pain is as old as humankind and Humankind has been suffering from...
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...Pain What is pain? Pain can be separated in two subcategories physical pain and emotional pain each with its own definition. Everyone has suffered from one or the other or both. Either way both are very unpleasant feelings. In the dictionary "pain” Is defined as a Physical suffering or distress. Though unpleasant pain is something we need for survival. Both emotional and physical pain are very different. Some people describe emotional pain as being the worst kind of pain there is though not everyone agrees with that statement. In this essay I'll be comparing both types of pain and go more in depth in each subcategory. Physical Pain is inevitable and it is a pain that is vital to our existence. If someone were to leave there had on a stove...
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