Professional Documents
Culture Documents
1. Physiologic Response
- this may vary according to whether the
pain is acute or chronic.
- Acute pain stimulates the sympathetic
nervous system, resulting in increased
BP, PR, RR, pallor, diaphoresis, and pupil
dilation.
Cont…..
Chronic pain or visceral pain – parasympathetic
stimulation may be observed: lowered BP,
decreased PR, pupil constriction & warm dry skin.
2. Affective Responses
Vary according to the situation, degree & duration of
pain.
The nurse needs to explore the clients
feeling( anxiety, fear, exhaustion, depression)
People with chronic pain become depressed & tends
to be suicidal.
Cont…
3. Behavior Responses –The very young, aphasic
and confused or disoriented persons often
communicate their experience of pain only non-
verbally.
- Facial expression is often the first indication of
pain.
(clenched teeth, tightly shut eye, open somber
eyes, lip biting & other facial grimaces)
Cont…
Immobilization of the body part, muscle
guarding.
Rhythmic body movement – rubbing of
affected body part.
Speech & vocal pitch –Rapid speech &
elevated pitch often reflect anxiety;slow
speech & monotonous tone can signal
intense pain.
IV. Pain Management
It is the alleviation of pain or reduction in
pain to a level of comfort that is
acceptable to the client.
It includes two types of NURSING
interventions: Pharmacologic & Non
Pharmacologic.
1.Pharmacologic Pain Mgt.
It involves the use of Opioids(narcotics), non-
opiods/NSAID, adjuvants, or co-analgesic
drugs.
a. Opiods Analgesics – include opium
derivatives, such as morphine and codeine.
b. Non-opoid – include NSAID such as aspirin ,
acetaminophen, and ibuprofen.
(decrease or inhibit prostaglandin release)
Cont…..
c. Adjuvant analgesics –are medication that
developed for uses other than analgesia
but have found to reduce certain types of
chronic pain.
e.g. mild sedatives or tranquilizers,
diazepam; Antidepressant(Elavil),
Anticonvulsant(tegretol) for neuropathies
in Herpes zosters.
2. Nonpharmacologic pain Mgt.
Goal of Physical intervention :
- Provide comfort
- Correct physical dysfunction
- Alter physiologic responses
- Reduce fears associated with pain-
related immobility or activity restrictions.
Cont…..
a. Cutaneous stimulation – can provide effective
temporary pain relief. It distracts the client &
focuses attention on the tactile stimuli, away
from the painful sensations, thus, reducing
pain perception.
- Create the release of endorphins that block
the pain stimuli.
- Stimulate large diameter A-beta sensory
nerve fibers thus decreasing the transmission
of pain impulses through the smaller A-delta
& C fibers
Cont….
b. Immobilization – Immobilizing painful
body parts.
c. Tanscutaneous Electric Nerve
Stimulation
(TENS) – same function as cutaneous
stimulation.
Cont….
Goals of Cognitive-Behavioral Interventions:
1. Alter pain perception
2. Alter pain behavior
3. Provide clients with greater sense of control
over pain.
d. Distraction - it draws the client’s attention
away from the pain & lessen the perception of
pain.
- e.g. slow rhythmic breathing, masssage &
slow-rhythmic breathing, Active listening,
Guided imagery.
Cont. …
Hypnosis – is an altered state of
consciousness in which an individual’s
concentration is focused and distraction
is minimized.
Cont….
Example of Cutaneous stimulation:
1. Massage
(Effleurage,Tapotement,Petrissage)
2. Application of heat & colds
3. Acupressure – based on the ancient
chinese healing of acupuncture.
4. Contralateral stimulation – stimulating
the skin in an area opposite to the
painful area.
II. Rest & Sleep
A. Rest – implies calmness, relaxation
without emotional stress, and freedom
from anxiety.
- it restores a person’s energy, allowing
the individual to resume optimal
functioning.
- people deprived of rest are often
irritable, depressed, tired and have a
poor control of their emotion,
Cont….
B. Sleep – a state of consciousness which
the individual’s perception and reaction to
the environment are decreased.
- it is characterized by minimal physical
activity , variable levels of consciousness,
decreased responsiveness to stimuli.
C. Physiology of Sleep
1. Circadian rhythm – came from the latin,
circa dies, “about a day”.
- biological clock, controlled from within
the body and synchronized with
environmental factors, such as light and
darkness, gravity and electromagnetic
stimuli.
D. Stages of sleep
a. NREM
- slow wave sleep
- sleep during night, deep, restful sleep &
brings a decrease in physiologic
functions.
E. REM Sleep
Constitutes 25 % of the young adult
Usually recurs about every 90 minutes &
lasts 5-30 min.
It is not as restful as NREM sleep
Most dreams takes place and retained in
the memory.
During this stage the brain is more active
and brain metabolism increases.
F. Stages & Characteristics of NREM
Stage Characteristics
NREM REM
Stage1 Sleep
NREM NREM
Stage 3 Stage 3
NREM
Stage 4
G. Sleep Cycle
People pass through the 4 stages of NREM
sleep, usually lasting about 1 hr.
Sleeper passes from stage I NREM through
stages III to IV in about 20 to 30 min.
Stage IV last for 30 min.
Followed by III & II; then 1st REM stage occurs for
10 min. (1st sleep cycle)
Usual sleeper exp 4-6 cycles in 7-8 hrs of sleep.
H. Function of Sleep
It exerts physiologic effect on the nervous
system & other body structures.
It increases muscle tone
Necessary for protein synthesis, thus, allow
the muscles to repair.
I. Factors affecting sleep
Quality of sleep- ability of an individual to
stay asleep & to get appropriate REM &
NREM.
Quantity of sleep – total time the individuals
sleeps.
Cont…..
Age – sleep pattern variation occurs with
age.
e.g. NB –14 to 18 h; Inf – 12to 14h; Tod –10-
12; PS –11h; Sch age – 10; Adol –8
Environment – can promote or hinder sleep.
Fatigue – it is thought that a person who is
moderately fatigued usually has a restful
sleep.
Cont…
Lifestyle- exercise, work shift
Psychologic stress – Anxiety &
depression disturb sleep.
Alcohol & stimulants – excessive alcohol
disrupts REM sleep. Often experience
nightmares when effect of the alcohol has
worn off.
Diet – dairy products (contains
tryptophan)
Cont ….
Smoking – has a stimulating effect in the
body.
Motivation – the desire of an individual to
stay awake.
Illness – people who are more ill require
more sleep.
Medications – affect the quality of sleep
J. Common Sleep Disorder