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Pain perception
Pain perception
Factors contribute to wound healing
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Patients suffering with a chronic wound experience pain from an individualized perspective. Each persons’ pain tolerance varies greatly depending on their current lifestyle, stressors, comorbidities, past experiences, and own DNA factors. (9-10) When meeting a patient either for the first time or at follow-up, the clinician should perform a comprehensive pain assessment. Remember, wound care is not just treating the hole in the patient, rather it is treating the patient as a whole, including - but limited to - their pain.
A comprehensive assessment includes physiologic, sensory, affective, cognitive, behavioural and sociocultural dimensions as stated by Ahles and McGuire. (11) When assessing the patient, remember that the above dimensions
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For example, non-verbal patients cannot vocalize that their pain is an 8 out of 10 on a numerical pain scale. This population requires use of the checklist of nonverbal pain indicators (CNPI) where the patients movements or facial grimaces may indicate pain. Dementia patients also may not be able to vocalize correctly and could benefit better pain management with the Abbey Pain Scale Assessment of Discomfort in Dementia (ADD) protocol. (10) Once an assessment tool has been chosen, the same tool should be used at each follow-up for accurate reassessments. Knowing your clients and their individualized needs ensures pain is properly assessed and therefore properly …show more content…
(9-10) Anticipatory pain has been linked to higher levels of anxiety and is noted to create more pain for the patient through a nocebo hyperalgesia effect. (10) Stress can be as simple as fear of the pain felt from removing a bandage, to stress over how the patient will pay for treatments when they can barely pay for food. Although some stressors cannot be relieved by the clinician, fears and anxiety can be relieved by explaining the procedure, allowing the patient to take analgesics before treatment, selecting atraumatic dressings, and encircling the patient in the wound care process. (9-10) Addressing the holistic side with therapeutic touch or meditation can alleviate aspects of pain not relieved by medication. Educating the patient in their pain management addresses any apprehensions or misconceptions they may have while integrating the patient into the care team.
Institute of Medicine Report from the Committee on Advancing Pain Research, Care and Education. (2011). Relieving Pain in America A Blueprint for Transforming Prevention, Care, Education and Research. Retrieved from http://books.nap.edu/openbook.php?records_13172
Assessing and managing pain is an inevitable part of nursing and the care of patients. Incomplete relief of pain remains prevalent despite years of research due to barriers such as lack of kn...
To provide the best care for their elderly patients, nurses must incorporate pain assessment into their daily care of patients. Pain assessment is a key aspect of the nurse’s role. There are many factors to consider when assessing patients’ pain such as if they are verbal or non-verbal, what language they speak, their age and their cultural background. There are many tools that a nurse can use to assess a patient’s pain but one of the most common tools is the 0-10 scale. This tool can be asked verbally by asking what their pain level is on a scale of 0 to 10 with 0 being no pain and 10 being the worst pain they have ever had. You may also use this tool in a visual manner with faces that correlate to the numbers. 0 being a happy face and 10 being a very sad face. Elderly patients from diverse cultural backgrounds are increasing in long term care facilities so it is important to have a 0 – 10 pain scale written in their native language. Some patients are stoic and do not express their pain as much as other people so it is important to understand that a 0 – 10 pain scale might not always be sufficient and could be combined with observing any physical signs that the patient might be in pain such as facial expressions and guarding. Nurses must have a good base of knowledge and attitude towards pain and always take what the patient reports their pain scale to be as truth. If the patient does report pain it would be important to treat the pain or if it is a new occurrence to follow this assessment up with another val...
According to Horgas & Miller (2008), older adults with cognitive or physical limitations, have difficulty expressing details about their pain. These include pain location, duration, onset, type, precipitating factors, and relieving factors of pain. Pain is a subjective experience without valid and reliable objective tests to measure it. The existence and intensity of pain are measured by patient self-report. Unfortunately, older populations with cognitive disability may have difficulty expressing pain via verbal or body language. In some cases, it is astounding to know that pain in older population with dementia is very often undertreated. Therefore, variation in patient's ability to communicate verbally can add another layer to effectively manage pain. When pain issue is not resolved, it decreases overall ability to perform daily activities, and it causes serious impacts in most life (Horgas & Miller, 2008). Likewise, older population with cognitive impairment is even more limited to communicate pain symptoms. Therefore, extra care should be provided to observe even the slightest reactions- body movement, changes in activity routines, changes in interpersonal interactions, facial expression, mental status changes, verbalizations, and vocalizations (Bruckenthal, Reid & Reisner, 2009). Additionally, certain patients may have limited movement that makes difficult for practitioners to assess them. When pain is not controlled in patients with cognitive limitation, they express their pain by being violent, angry, or refusing their routine care. There are patients who come more quiet and...
“The Pain Tree” written by Olive Senior tells the story of a woman who comes back home after many years and begins to think about her childhood in a new light, which changes much of what she thought she knew of her family and childhood. The story shows the main character, Lorraine, revisiting the memories of her family and the woman who had taken care of her as a child, Larissa. Children mainly focus on the happy memories which may be tied to more important topics that they do not understand until they are older. Most children do not pick up on many of the complicated things happening around them. Lorraine can now see the bigger picture of her relationship with Larissa and how large the divides were between Lorraine’s family and Larissa’s
Conclusions. An adequate and clear understanding of the concept of pain and implementing interventions of pain treatment and management is essential in the clinical settings. Understanding the concept of pain is necessary for its relationships with other concepts that are related and similar to the pain experience for theory building. The in the end, understanding the concept of pain will ultimately benefit the patient and lead to better and approp...
Pain is universal and personal to those who are experiencing it. It is subjectively measured on a scale of 0-10 with zero being no pain and 10 being the worst pain ever. This can be problematic for patients and doctors because this score can be understated or overstated. Doctors will make quick decisions based on this score. Patients might feel not believed because only they can feel the pain. However, untreated pain symptoms may be associated with impaired activities of daily life and decreased quality of life. Pain is defined in our textbook, “as an unpleasant sensory and emotional experience associated with actual or potential tissue damage” (Ignatavicius & Workman, 2016, p 25). Actual pain is understood by most because there is an
The provider will ask the patient to assign a number for the severity of their pain. This is useful for patients with mild or moderate dementia. Zero indicates no pain and ten indicates worst imaginable pain. They will often give patients a chart to look at if they don’t fully understand. The ranges are one to three being mild pain; four to six is moderate pain and seven to ten is severe pain (Chatterjee, 2012). Observation scales, such as the Abbey Pain scale, or PAINAD, is useful for scoring pain when patients are unable to (Chatterjee, 2012). While observing, the patients score questions one to six, for example, vocalization (e.g. groaning), facial expression (e.g. Frowning), and changes in body movements (e.g. resistance to care) (Sherder Ej,
Measuring Pain 1. 1. Sensory - intensity, duration, threshold, tolerance, location, etc 2. 2. Neurophysiological - brainwave activity, heart rate, etc 3. 3. Emotional and motivational - anxiety, anger, depression, resentment, etc 4.
Pain and suffering is something that we all would like to never experience in life, but is something that is inevitable. “Why is there pain and suffering in the world?” is a question that haunts humanity. Mother Teresa once said that, “Suffering is a gift of God.” Nevertheless, we would all like to go without it. In the clinical setting, pain and suffering are two words that are used in conjunction. “The Wound Dresser,” by Walt Whitman and “The Nature of Suffering and Goals of Medicine,” by Eric J Cassel addresses the issue of pain and suffering in the individual, and how caregivers should care for those suffering.
A meaningful event from my clinical experience was during week four when my RA and I along with the nurse helped a client who had an unwitnessed fall. I came back to the unit after my break, and then it was my colleague’s turn to go for her break. We had to monitor each others clients during break time. Before she left, she told me that her client is in his room having breakfast and let her know about the client’s foods and drinks intake. He needs one-person assistance and he uses walker. She also told to assist the client to take off his pajamas and change into day clothes if he allows. I went along with another colleague to the client’s room, he was just sitting on the couch and he ate 25% of the foods and drank half cup of juice.
Background: Chronic pain results when there is delayed healing. Grumbine claims that chronic pain ‘produces a fear in the patient and a panicked feeling that the pain will
Marion Good, PhD, RN, has focused her study, “A Middle-Range Theory of Acute pain Management: Use in Research,” on complementary medicine for pain and stress, acute pain, and stress immunity. The purpose of this theory is to put into practice guidelines for pain management. Good, 1998, noted the need for a balance between medication usage and side effects of pain medications. The theory also promoted patient education related to pain management following surgery and encouraged plan development for acceptable levels of pain management. This theory was developed through deductive reasoning. Chinn & Kramer, 2008, defined deductive reasoning as going from a general concept to a more specific concept. Good, 1998, related that there was a balance between analgesia and side effects in which two outcomes can be deduced: (1) a decrease in pain, and (2) a decrease in side effects. These outcomes can be studied further or more detailed concepts can be deduced from them.
The CPCI is a sixty-four item measures usually self-report, however there is a shorter version with forty-two measures (CPCI-42) that can be used if needed (Jensen et al., 1995; Romano, Jensen, Turner, 2003). I did have some confusion as to the seventy items listed in for the CPCI by the two reviewers from the MMYB (2010), until I looked at the test myself. There are sixty-four items and the sixty-fifth is related to medication with five places to respond medication with one additional one for no medications taken (Jensen et al., 1995). There are nine scales in the CPCI. The CPCI scales takes approximately ten to fifteen minutes to complete (PAR, n.d.), fifteen minutes according to the MMYB (2010). Authors of the CPCI are: Mark P. Jensen, Judith A. Turner, Joan M. Romano, and Warren R. Nielson (2008). The first three authors of the CPCI and foundational study are well published: Mark Jensen with over four hundred articles, Judith Turner with over five hundred articles, Joan Romano with over sixty articles (Jensen et al., 1995, Jensen et al., 2008; NCBI,
It is important to get a list of medications, locate pain, and get a description of the pain. Performing an ongoing assessment is essential to determine the status of pain. When working with older adults with cognitive impairments, such as dementia and alzheimer's disease, it is sometimes challenging to perform the assessment. These patients may have a difficult time interpreting their symptoms of pain. Once the nurse finds a unique response to pain, it is important to note it in their chart for future references. It is also important to review the patient’s cultural beliefs. The textbook states, “In some cultures, people may be socialized to tolerate pain without expression.” (Elioupous, 2017). It is important for the nurse to thorough in the assessment so they do not misread situations like this. Many factors can be associated with