Question

Discuss each of the following topics related to the patient experiencing pain: . Interpret the multidimensional nature of pain . Critique the rationale and nursing considerations associated with drug therapy and other collaborative care measures implemented for pain management Appraise barriers to effective pain management Examine pain assessment, pain management, and incorporation of client's individual beliefs and needs related to pain management

Answer 1

MULTIDIMENSIONAL NATURE OF PAIN

The multi dimensional nature of the pain includes physiologic,affective,cognitive,behavioural,and socio cultural influences on pain perception and expression.

The physiologic dimension,includes genetic,anatomic and physical determinants of pain.The affective component is the emotional response to the pain experience.

The behavioural component of pain refers to the obsevable actions used to express or control the pain.

The cognitive component of pain refers to beliefs,attitudes,memories and meaning attributed to pain.

The socio cultural dimension of pain encompasses factors such as demographics,support systems,social roles and culture.

DRUG THERAPY

Pain medications are generally divided into three categories non- opiods,opiods and co-analgesic or adjuvant drugs.

Nursing considerations for adjuvant drugs used for pain management

• Corticosteroids,avoid high dose for long-term use.
• Antidepressants,Monitor for anticholinergic adverse effects and blood levels during chronic therapy.
• Antiseizure drugs,start with low doses ,increase slowly.check liver function,renal function and blood counts .
• Muscle relaxant,monitor for weakness,urinary dysfuntion,avoid abrupt discontinuation because of CNS irritability.
• Anaesthetics,monitor for sideffects,high incidence of nausea,dizziness,perioral numbness,paraesthesias,tremor,can cause seizures,dysrhythmias and myocardial depression at high doses.

Collaborative measures.-Pharmacologic and non pharmacologic interventions should be incorporated into the treatment plan.The patient should be supported through the period of trial and error that maybe necessary to implement an effective therapeutic plan. Some of the non pharmacologic therapies are physical therapies which include Acupuncture,application of heat and cold, excercise, massage,PENS and TENS.Cognitive therapies include distraction,hypnosis,imagery and relaxation strategies.

Barriers are

• Fear of addiction.
• Fear of tolerance
• Concern about sideffects,
• fear of injections.
• desire to be a good patient.
• desire to be stoic.
• forgetting to take analgesic.
• Fear of distracting the health care provider from treating the disease.
• Concern that pain signifies disease progression.
• sense of fatalism.
• ineffective ,medication.

The goals of a nursing pain assessment are to describe the patients multidimensional pain experience for the purpose of identifying and implementing appropriate pain management techniques.,to identify the patients goal for therapy and resources for self management.Basic pain characteristics include the following elements ,onset,duration,and pattern of the pain,location,intensity,quality,associated symptoms and factors that increase or relieve the pain.,Most components of a pain assessment involve direct interview or observation of the patient.Diagnostic studies and phytsical examination findings complete the initial assessment.

Patients beliefs

patient and family beliefs,attitudes,and expectations influences response to pain and pain treatment.YThe nurse asess attitudes and beliefs that may hinder effective treatment ,such as the belief that opiod use will result in addiction.In an acute care setting ,time limitations may dictate an abbreviated assesssment of the affective,behavioural,cognitive and socio cultural dimensions of pain .