Chapter 4 Care of Client With Pain

8/6/2019 Chapter 4 Care of Client With Pain

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Care of Client

with:I.Pain (Back Pain) - 12/2/2010II.Congenital Musculoskeletal

Conditions - 12/9/2010


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Specific Objectives (Back Pain)

AFTER THE DISCUSSION / ACTIVITIES,STUDENTS WILL BE ABLE TO:

1)Use the nursing process as a

framework for care of the patientwith LBP

2)Describe the rehabilitation and healtheducation needs of the patient with

low back pain3)Integrate acquired knowledge in caring

for a client with LBP


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OVERVIEW OFCONCEPTS

PainClassification of Pain


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pain

unpleasant sensory andemotional experience

associated with actual orpotential tissue damage, ordescribed in terms of suchdamage (IASP)

withdrawal from a potentiallydamaging situation


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DURATIONACUTE

Less than 30 days

3 months from the onset

SUB-ACUTE Pain that lasts from 1-6 months

CHRONIC

More than 6 months 6 months from the onset

pain that extends beyond the expected periodof healing


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LOCATIONLocation in the body (head,

back, pelvic)

Body system involved(rheumatic pain,

myofascial pain,neuropathic pain)


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ETIOLOGYSomatogenic

Perturbation of the bodyNociceptive

Neuropathic

PsychogenicPerturbation of the mind


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Nociceptive

Nociceptive pain is initiated by

stimulation of peripheral nervefibers that respond only to

stimuli approaching or

exceeding harmful intensity(nociceptor)


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Types of nociceptive pain

1. Cause 2. Origin

Thermal Visceral referred pain

Chemical Deep somatic poorlylocalized pain

Mechanical Superficial somatic sharp,

well-defined pain


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neuropathic

Neuropathic pain is caused bydamage to or malfunction of the

nervous system

Peripheral Central

Burning, tingling, stabbing, electrical, pins and needles


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PHANTOM PAIN

pain from a part of the body

that has been lost or fromwhich the brain no longerreceives physical signals


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PSYCHOGENIC PAINPsychalgia

Somatoform pain

caused, increased, or prolongedby mental, emotional, or

behavioral factors


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MOVING ON TO DEEP

SOMATIC PAIN

===BACK PAIN===


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BACK PAIN


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Dealing with Clients Pain?

BiologicallyPsychologicallySocially


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Take into Consideration thefollowing factors


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Cauda Equina Syndrome


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ASSESSMENT:Obtain Physical

History /Physical Exam

NeurologictestingMuscle strengthMuscle atrophyStraight leg

raising

Pain ControlPatients LifestylePatients Posture,

ADLsPsyche towards

Pain


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SIGNS AND SYMPTOMS


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Weight loss, fever,night sweats

History of

malignancyAcute onset in theelderly

NeurologicaldisturbanceBilateral oralternatingsymptoms

Sphincterdisturbance

Immunosuppressi

on Infection

(current/recent)Claudication or

signs ofperipheralischaemia

Nocturnal pain


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Factors prolonging back pain


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Diagnostic Procedures

XRAYBONE SCAN and Blood

StudiesCT ScanMRIEMGDiscography


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INTERVE

NTIONS

-MEDICAL

INTERVENTIONS NURSING


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INTERVENTIONS NURSING

)1 HELP RELIEVE PAIN)2 POSITIONING PROPERLY)3 //APPLYING HEAT COLD)4 /ROM ADLS)5 PROPER BODY MECHANICS)6 DIVERSIONARY ACTIVITIES)7 RELAXATION TECHNIQUES


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CLINICAL CASE

You are working in a primary health


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You are working in a primary healthcare facility as the clinic nurse of an

Orthopedic. Mrs. Rosario, a 35 year oldschool teacher tells you that she is

experiencing pain in the lumbo-sacralarea 3 weeks PTC, where pain is

intense upon waking up. Her gait is notaffected, however, her self-esteem andwork performance is already affecteddue to her consistent absences from

work. No discrepancy noted during thestraight-leg test and no shortening of

the le len th.


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1)Enumerate the possible risk factorsthat triggered the back pain onMrs. Rosario, given her age and

job.2)Describe how should a nurse

perform a straight leg raising

test.3)Formulate a plan of care for Mrs.

Rosario.

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Chapter 4 Care of Client With Pain