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Lesson Plan-01 : Pain Management



SI.NO
  SPECIFIC
OBJECTIVE
TIME
CONTENT
TEACHING AND LEARNING
ACTIVITY
     AV  AIDS
     EVALUATION



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Introduce the topic to the students








The student will be able to define pain.







The student will be able to classify
the Pain.






















The student will be able to listout the factors influencing pain response.








The student will be able to enlist the characteristics of  pain response.
























The student will be able to  enumerate the management  of
Pain.






















                 



























































































































The student will be able to narrate the role of a nurse in pain management.



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2min




INTRODUCTION

Pain management (also called pain medicine or algiatry) is a branch of medicine employing an interdisciplinary approach for easing the suffering and improving the quality of life of those living with pain. American Pain society (2003)  consider pain as fifth vital sign.


DEFINITION

Pain has been defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage.
                                                                        
                                                        Brunner and Sudhartha

Pain is a complex, multidimensional experience.
Lewis


CLASSIFICATION OF PAIN
Pain can be categorised in several ways.

NOCICEPTIVE PAIN
It is caused by damaged somatic or visceral tissue.

 -SOMATIC PAIN, categorised as deep, aching, or throbbing that is well localised arise from born, join, muscle, skin, or connective tissue.

-VICERAL PAIN, Which may result from stimuli such as tumour involvement or obstruction, arises from internal organs such as the intestine and bladder.

NEUROPATHIC PAIN
It is caused by damaged to peripheral nerves or central nervous system. Common causes of neuropathic pain include trauma, inflammation.

ACUTE PAIN
Can be described as lasting from seconds to 6 months.

CHRONIC PAIN
Can be described as More than 6 months the pain persistent.


FACTORS INFLUENCING OF PAIN RESPONSE
·        Past experience
Once the person experiences severe pain, he or she know how severe it is, In other ways a person who has never had severe pain may have no fear of such pain.
·        Anxiety
Eg: Postoperative anxiety
·        Culture
The cultural expectations and belief about pain differ from one cultural to other.
·        Gender
Both men and women have pain, but women report significantly greater pain compare to main.
·        Genetics
Africans and Americans reported greater levels of pain.


CHARECTERISTICS OF PAIN
Factors to consider in a complete pain assessment are
               
·        Intensity
The intensity of pain differs from none to mild discomfort to worst pain. Various scales and surveys are helpful to patient to describe the pain
Example of pain scale.
·        Timing
The nurse inquires about onset, duration, relationship between time and intensity, and changes in rhythmic patterns.
·        Location
Determined by having the patient point to the area of the body involved.
·        Quality
The nurse asks to the patient to describe the pain in his or her words without offering any clues. If the patient cannot describe the quality of pain, nurse can suggest the words such as burning, aching, and stabbing. 
·        Personal meaning of pain
Pain means things to different people, as a result patient experience pain differently.
PAIN MANAGEMENT
Pain management mainly divided into pharmacological and non pharmacological management
·        Pharmacological  Pain management
·        Non Pharmacological  Pain management


       I 








Pharmacological  Pain management
a)     Nonopioids analgesics include acetaminophen, apirin and other salicylates, and NSAIDS. These agents characterise  by the following:
1)    That is increasing the dose beyond an upper limits provides no greater analgesia.
2)    They do not produce tolerance of physical dependence.
3)    Many are available without a prescription.

Eg: of non steroidal anti inflammatory drugs
IBUPROFEN -200MG
INDOMETHACIN -25 MG
KETOROLAC -30 MG
DICLOFENAC -50 MG

b)    Opioids analgesics produced their effects by binding to receptors in central nervous system.
this resulting in:-
1) Inhibition of the transmission of nociceptive input from the periphery to the spinal cord.
2)Altered in limbic system activity
Eg: of  Opioids analgesics  drugs
Morphine -per oral, rectal, iv, subcutaneous, epidural, intrathecal, sublingual.
Hydromorphone - per oral, iv subcutaneous, epidural, intrathecal, im.

c)     Adjuvant analgesic therapy
These medications, sometimes referred to as co analgesics are drugs used in conjunction with opioids and nonopioids analgesics.Generally coma, these agents were developed originally for other purposes (Antiseizure , anti  depressants and found later to be effective for pain).
Drugs
1.      corticosteroids
Prednisolone
Methyl prednisolone
2.     Antidepressents
Amitriptaline
Nortryptyline
3.     Anti seizure druds
Carbamazepine
Gabepentine
4.     Muscle ralaxcant
Baclofen
5.     Anaesthetics – local
Lidocaine 2.5% +prilocaine2.5%


II Non-pharmacological therapy for pain
Ø Massage
It is a common therapy for pain, many different massage technique exist. Eg; include moving the hands or fingers over the skin slowly or briskly with long strokes or in circles or applying same pressure to the skin to maintain contact while massaging the underling tissue.
Ø Excercise
It is a critical part of the treatment plan for patient with chronic pain, particularly those with musculoskeletal pain. Research supports the effectiveness of many type of exercise for a variety of painful conditions. Many patients become physically reconditioned as a result of their pain which in turn leads to more pain. Excercise acts via many mechanisms to relieve pain.

Ø Transcutaneous electrical nerve stimulation
It involves the delivery of electric current through electrodes applied to the skin surface over the painful region, at trigger point, or over a peripheral nerve. A Transcutaneous electrical nerve stimulation system consist of two or more electrodes connected by lead wires to a small, battery- hyphen operator stimulator. Usually a physical therapist is responsible for administering transcutaneous electrical nerve stimulation therapy although nurses can be trained in the technique.
Trancutaneous electrical nerve stimulation may be used in acute pain, including post operative pain and associated with physical trauma. The effects of transcutaneous electrical nerve stimulation on chronic pain are less clear but may be effective for some chronic pain patients.

Ø Accupuncture
It is a technique of traditional Chinese medicine in which very thin needles are inserted in to the body at designated points. Acupuncture is applied to varied pain problems, including musculoskeletal condition. Repetitive strain disorder, myofacial pain syndrome, post surgical pain.

Ø Heat therapy
It is a application of either moist or dry heat to the skin. Heat therapy can be either superficial or deep.
Superficial heat can be applied using an electric heating part a hot pack, hot moist compresses, warm wax, or a hot water bottle.

Ø Cold therapy
It involves the application of either moist or dry cold to the skin. Dry cold can be applied by means of an ice bag, moist cold bad means of towel socked in ice water, immersion in a bath. Cold therapy is believed to be more effective than heat for a variety of pain full conditions, acute pain from trauma or surgery.

Ø Hypnosis
It is a structured technique that enables a patients to achieve a stage of
Heighten awareness and focused concentration that can be used to alter the patient pain perception. Hypnosis should be administered and monitored only by specially trained clinicians.

Ø Relaxation strategies
It are varied but their goal is to reach the state that is free from anxiety and muscle tension relaxation reduce the stress, acute anxiety, distracts from pain, alleviate muscle tension combat fatigue. Facilitates sleep and enhance the effectiveness of other pain relief measures. it include relaxation breathing music , imaginary, meditation and progressive muscle relaxation.





NURSING ROLE IN  MANAGEMENT OF PAIN
Nurse is an important member of the multidisciplinary pain management team. Nurse acts as planner, educator, patient advocator, interpreter and supporter of patient in pain and patient family. Because pain can be present in any patient in a wide variety of care settings, the nurse must be knowledgeable about the current therapies and flexible in try new approaches to pain management. Many nursing role have been described earlier, including conducting pain assessment, administering therapies, monitoring for effects, and teaching patients and families.
1.     provides non-invasive pain management interventions
2.     performs nursing and/or pain assessments of people with pain
3.     identifies and documents previously used pain management interventions and the results of the interventions
4.     identifies the physiological and psychological strengths and weaknesses of the person with pain
5.     communicates effectively with team members regarding findings and collaborates with the team on interventions as indicated
6.     participates in determining whether a patient should be admitted to a pain management program
7.     identifies the patient's and the significant other's support systems and includes them in the plan of care
8.     documents a patient's work history and intervenes with the patient's employer if and/or when a need is indicated
9.     serves as a patient advocate with team members to facilitate problem solving
10.                        provides pain management information regarding the program, interventions, and pharmacological treatment to the patient and any significant others
11.                        participates in staff development, providing current information to the pain management team
12.                        incorporates relevant research findings into practice
13.                        Provides information to the community regarding pain management.


Teacher:-Introduced the topic from general to specific
Students:-
Carefully listening.


Teacher:-
Defined the
pain
Student:-Understanding carefully.






Teacher:-classify the pain
Student:-Understanding carefully
















Teacher:-List out the factors influencing pain
Student:-Understanding carefully






Teacher:-enlist List the factors characteristics pain
Student:-Understanding carefully




























Teacher:- enumerate the management of pain
Student:-Understanding carefully

















































































































































Teacher:- narrate the management of pain
Student:-Understanding carefully










Black board







Pham let





  




Chart
























Flash card



















Model

























   







Ppt























     


































































































































Handout














What is the definition of
Pain?








What all are the classifications of pain?





















What all are the Factors influencing pain?













What all are the Characteristics pain?































What all are the  management  of
Pain?




















































































































































What is nurse’s role in pain management?










SUMMARY:
            Till now we have discussed regarding the definition, classification, factors influencing, characteristics, and medical and nursing management of pain.
CONCLUSION:
            By the end of the class all the students will be able to attain adequate knowledge on managing a case of pain with appropriate nursing care.


                                    STUDENT profile
STUDENT NAME                                                                                            .
SUBJECT                                                                    : NURSING EDUCATION
TOPIC                                                                          : Pain management
GROUP                                                                        
TEACHING AND LEARNING METHODS                  : LECTURE CUM DISCUSSION METHOD
TIME                                                                           : 20 minutes
DATE                                                                          :
Venue                                                                        :  


OBJECTIVES
GENERAL OBJECTIVES:                         
            The student will be able to improve knowledge, and able to manage a client with pain.
SPECIFIC OBJECTIVES:
            By the end of the class, the students will be able
·         to define pain .
·         to classify the pain.
·        to list out the factors influencing pain response
·        to enlist the characteristics of  pain response.
·        to enumerate the management  of pain.
·        to narrate the role of a nurse in pain management























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