Pathophysiology of Pain, Nurses' Knowledge and Barriers Regarding Pain Management in Intensive Care Units - Literature review Example

By Your Name Unit/Subject Name and Code Instructor’s Name Institution’s Name Introduction Pain is the physical suffering, unpleasant sensory and discomfort that is caused by either injury or illness since it’s classified as a discomfort nobody likes it. Pain remains the most effective way that the body communicates. Pain is mainly brought by stimulus of a given specialized never endings, pain passes a message that the body tissues injured and then induces the discomfort the message is interpreted by the brain making the person to pull out from the injury causing source (Cranwell-& Bruce 2009). The patient under the case study is named H.S was selected as she has had a history of experiencing pain in her life. Mrs. H.S is a 57 year old female who has a past of chronic kidney and hypertension disease. She was diagnosed with a stage iii B clear cell carcinoma of the ovary where she had a surgery in April. Later the patient has had another surgery to remove the intra peritoneal port. The rationale of this paper is to make clear in details the different type of pain that are experienced and how to carry out clinical care on them (Blay et al. 2007). The case study shall be presented though description of pain in relation to the patient understudy (Gordon 2005). Literature review Acute pain According to the conditions displayed by patient H.S, acute pain is noted due to its sudden beginning, it tends to temper after an expected period of time. It is characterized use of words such sharp, stabbing, biting and dull. Acute pain is a physical pain. Acute pain tends to last within a small time which is estimated to be less than thirty days Medics describe acute pain as a ordinary physiological and habitually time-based reaction to given undesirable mechanical or thermal stimulus that is linked with trauma, acute disease, surgery and it is historically receptive to opioid therapy. Mrs. H.S main problem has been malnutrition since she is unable to feed well as the pain in the body is over whelming (Murnion 2010). Chronic pain This is the pain that may last for a period of more than six months, it is definite as pain that persists more time than the chronological course of ordinary healing connected with a known specify type of injury of disease course. It is said to be the continuing pain that tend to extend past the anticipated standard healing period. Persistent pain is also linked with increased fear, anger depression and anxiety. Medics consider chronic pain as a disease in its own. It mainly originates from difficult to treat diseases like cancer (Blay et al. 2007). Often, information may be absent to the family indicating the worrying cause of the prognosis, treatment and consequences on work family life and earning ability hence psychological factors play a better part in presentation (Cranwell-Bruce 2009). In acute type of pain, pain is merely physical that can be easily be treated by painkillers. However, chronic pain is not only a physical experience but also a psychological one where people with chronic pain will have adverse chronic factors as compared to those with acute pain (Macintyre & Schug 2007). Among these psychological factors is manifested by patients with chronic pain to as they are noted to worry more about their pain making them more vulnerable to anxiety and depression. According to studies conducted by medics and psychologist, it was found out that patients suffering from chronic pain can greatly influence the way the pain is felt therefore interfering with the way pain is felt thereby interfering with brains fundamental-inhibiting mechanisms (Gordon 2005). Cancer pain This is the pain that originates from a malignancy compressing or sensitive tissue in the body from treatments and other diagnostic measures from nerve, skin, and other changes that might be caused by immune response or imbalances in the hormones. Patients with sophisticated tumor endure pain that affects their sleep, social relations, mood and daily normal activities. However, the presence and intensity of pain depends with the site of the malignancy and stage of the disease. Pain associated with cancer can be fashioned by chemical or mechanical inspiration of particular pain-signaling nerve endings (Kurtz et al. 2008). The pathophysiological aspects and biophychosocial impact of pain. Mrs H.S displayed different pathophysiogical aspects and biophychosocial impacts caused by the pain they are suffering from. Chronic fatigue syndrome (CFS) that is brought by complex illness that is noted by extended exhaustion and numerous non-specific symptoms among them which include fever, muscle and joint pain, throats and neurocognitive complaints (Blay et al. 2007). According to clinical observation and therapeutic responses medical experts have adopted a classification that divides pain syndromes into idiopathic, psychogenic, neuropathic and mixed. The nociceptive if it is incidental that the pain is owing to ongoing foundation of the nociceptive scheme by tissue injury. Tissue injury activates primary afferent neurons called nociceptors (Macintyre & Schug 2007). Nurses should ensure that they use Mrs. H.S history giving the example of drugs and substance use then the medics should ask the patients about current and past smoking Marijuana, hard drugs and use of alcohol. The understanding the patient’s activities that they involve themselves in such as sleep patterns, impact of the pain on work and personal relationships (Watkins 2008). Present level of physical activity can help the clinician focus on the psychological and physical rehabilitation process. Some of these psychological processes that exacerbate persistent pain like mood disorder and stress. Physical assessment should be carried out in the initial pain assessment and then repeated over time as required by the clinical situation (Pasero & McCaffery 2011). Pain may also cause depolarization of the primary transmission of information proceeds along the axon on the spinal cord then to the higher center. Substances those are responsible for the production, inflammatory cells, tissues and the neuron itself influence transduction. Connectively, the neuropathic pain is the label that is applied to pain syndromes that are inferred to result from injury to the peripheral or central nervous system. Injury sustained to a peripheral nerve axon can result in abnormal nerve morphology. Patients suffering from constant pain appear to encourage disturbances in a feeling that is reactive despair or anxiety with impaired coping that may turn to be worse when they are pain related. Such strife also supply to the pain familiarity and driven pain-linked suffering (Schaible & Richter 2004). A person may be unconscious of pain during the time of a given acute injury sustained in the body this may be when one is having an emotional crisis the nervous system may fail to coordinate with the brain making the pain not to be detected. Alternatively, in cases of exaggerated pain in FM and whiplash there can be decrease in the threshold of nociceptive afferent receptors that are caused by a limited vary in the compassion of sensory fibers that may cause tissue harm (Wang & Tsai 2010). The physiological responses to pain and reaction are less identifiable and more complex with different persons. People respond to pain differently, they are those who will become isolated from the rest of the society making their social activities to reduce (Watkins 2008). Reduction in body weight due to loss of appetite may also be identified with pain this makes one to be vulnerable to other diseases. Patients with chronic pain also tend to turn to drugs and alcohol with the aim of seeking comfort since after having such drugs they will have a temporally ease from the pain they suffer (Macintyre & Schug 2007). Connectively, one is also unable to work and offer his duties at work place owing to their attention being withdrawn as they are distracted by painful stimuli that can affect the painful intensity (Harris 2006). Distraction technique is used to diminish the pain that one is feeling; his is done by shielding the sensory by involving them with other entertaining activities. However, the techniques depend on the person’s likes, pain intensity, duration, age and gender. Moreover specific relaxation methods that relieve physical and metal tension and stress may reduce pain; patients should learn the most effective in reducing surfing and discomfort. In military operation pain is controlled by either using something cold or hot. Other techniques that are used include massage, rubbing (Cranwell-Bruce 2009). Need for regular and accurate pain assessment in pain management. Medics need to take regular records on pain on their patients; however they need to listen to what the patients say about how they are feeling. If a patient says they are feeling pain that can be said to be subjective then the medic should understand it that way (Blay et al. 2007). People who report regarding their personal discomfort or pain remains to be the mainly consistent basis of data about the location, quality, intensity and onset that worsen claims made by a patient about their pain however, such information are used to confirm whether the patient if faking pain. Some of this signs comprise shallow, rapid, low or protected respiratory actions, elevated blood pressure, pallor, diaphoresis, dilated pupils, increased pulse rate, and uneasiness of skeletal muscles. Severe pain that is located deep in the body cavities may serve as a catalyst to parasympathetic neurons supported by a fall in blood pressure, weakness, nausea, vomiting and pallor (Kurtz et al. 2008) Behavioral sign on a person suffering from pain include moaning, tossing in the bed, pacing the floor crying, moving the knees upward towards the abdomen and rubbing the painful site among others (Watkins 2008). Such patients may also have difficulty in sleeping concentration and remembering due to being preoccupied with the pain. Alternatively the psychological character of lenience for ache and responses to the pain felt are less easily identifiable as compared to the physiologic reactions. An individual’s response with pain is believed to be of cultural and psychological influences (Watkins 2008). Among those include the previous experiences with pain, military training in regard to responses to pain and distress, condition of health and the existence of exhaustion and other physical limitations. The intensity of pain can also be influenced by diversion from painful stimuli as they involve one’s awareness of the pain concentration (Costigan 2009). Pain management These are the measures that are adopted to give aid from pain on a patient who is experiencing pain. The usage of analgesic drugs is believed and recognized as the most often way that is misunderstood and abused. Using an analgesic drug where clients ought to be familiar that the drug is in fact on hand when required hence known immediately when asked for. On the other hand, if a patient is required to remain intact awaiting somebody else to make a decision on when the analgesic is required the patient may turn into being resentful, irritated, and nervous therefore reducing and opposing the preferred effect of the drug (Blay et al 2007). Research and studies indicate that incase analgesics beside the bedside or incurably ill then tumor patients should be full at caution, connectively less doses are prescribed to be in use than when they depend on a different person to supply the drugs. Patient controlled analgesia is used effectively and safely by prescribing the drug to the patient and ensuring it is used effectively (Baumann 2009). The distraction technique is used to provide a sensory defensive to make the person less conscious of uneasiness this included the minor surgical procedures under the influence of applied anesthesia or venipuncture. Medics may also perform gentle pressure and massage to trigger the thick-fiber impulses and then create a predominance of tangible signal that will compete with pain signals. Performance of message and gentle strain trigger the thick-fiber impulses and fabricate a prevalence of tactile signals to battle with pain signals (Blay et al. 2007). However this method may differ due to difference in social, cultural, ethical spiritual and ethical pain management where the nurses are required to uphold confidentiality. (Watkins 2008). Pain management in clinical environment In the clinic environment the medics perform procedures on the patients to ensure that the effectively manage the pain qualified by the patients. Firsts they carry out investigation on the intensity of the pain while making records for the same. By demonstration will involve the inclusions of the patients and others as appropriate in the education and shared decision making process for the pain care. Secondly, the medics recognize pain treatment options that are accessed in a complete pain management plan (Blay et al. 2007). Training patients or self pain management plans through the treatment plan as per the payback and the risks that are presented. Connectively, the medics also monitors effects of pain management approaches to adjust the preparation of concern as required. Every case should be taken as a unique one therefore carry out exceptional pain evaluation and management requirements of the special populations. Clinicians should also assist the patients to meet treatment goals. Neglecting of patients by healthy care personnel should be discouraged alternatively it is advisable to always listen to the patient as a way of assessing their level of pain so as to be able to effectively manage it their pain. References Baumann, S 2009, A nursing approach to pain in older adults, Medsurg Nursing, 18(2), pp. 77-82. Blay, S., Andreoli, S., Gastal, F 2007, Chronic painful physical conditions, disturbed sleep and psychiatric morbidity: results from an elderly survey, Ann Clin Psychiatry, 19 pp.169-174. Costigan, M., Scholz, J., Woolf, C., 2009, Neuropathic pain: a maladaptive response of the nervous system to damage, Annu Rev Neurosci, 32 pp.1-32. Cranwell-Bruce, L., 2009, PCA delivery systems, Medsurg Nursing, 18(2), pp. 127-33. Fear, C., 2010, Neuropathic pain: Clinical features, assessment and treatment, Nursing Standard’, 25(6), pp. 35-40. Gordon, B., Dahl, L., Miaskowski, C., McCarberg, B., Todd, H., Paice, A., Lipman, G., Bookbinder, M., Sanders, H., Turk, C. & Carr, B 2005, American pain society recommendations for improving the quality of acute and cancer pain management, Archives of Internal Medicine, 165, pp.1574-80. Harris, D 2006, Cancer treatment-induced mucositis pain: Strategies for assessment and management, Therapeutics and Clinical Risk Management, 2(3), pp. 251-258. 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