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Konsep Nyeri Dan Manajemen Nyeri

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Concepts of Nursing

Concepts Related to the Care of Individuals

PAIN
Pain
 Is a highly unpleasant and very personal
sensation that cant be shared with other.

 It is considered the fifth vital sign.

 It is one of the human body defence


mechanisms that indicates the person is
experiencing problem.
Sources of Pain
 Nociceptive: pain that is usually transmitted
after normal processing of noxious stimuli

 Neuropathic: results from injury or abnormal


functioning of peripheral nerves or CNS

 Psychogenic: unknown physical cause


PHYSIOLOGY OF PAIN

SOURCES
Injury, Inflammation Chemical/Thermal Heat, Cold

PAIN RECEPTORS
(Nociceptors)

DISCHARGE IMPULSES

Electrical Activity to spinal cord and onto the Brain

BRAIN = Electrical activity becomes the


experience of

PAIN
Duration of pain

 Acute pain: generally rapid in onset, varies in


intensity from mild to severe, lasts from brief
period to less than 6 months
Duration of pain
 Chronic pain: may be limited, intermittent or
persistent but lasts for 6 months or longer and
interferes with normal functioning.

 Remission: when the pain present but the patient does


experience symptoms

 Exacerbation: reappearance of symptoms

 Intractable pain: resistant pain to therapy, and persists


despite a variety of interventions
Origin of Pain
 Physical cause — cause of pain can be
identified

 Psychogenic — cause of pain cannot be


identified

 Referred — pain is perceived in an area


distant from its point of origin
Pain threshold

 Is the lowest intensity of stimulus that causes


the subject to recognize pain
Common Responses to Pain

 Physiologic: ↑BP, ↑HR,↑RR, pupil dilation,


muscle tension and tension rigidity, pallor,
↑adrenaline level, ↑blood glucose

 Behavioral: grimacing, moaning, crying,


restlessness
Common Responses to Pain

 Affective: exaggerated weeping,


withdrawal, anxiety, depression, fear,
anger, anorexia, fatigue, hopelessness,
powerlessness.
Factors Affecting Pain Experience

 Culture
 Ethnic variables
 Family, gender, and age variables
 Religious beliefs
 Environment and support people
 Anxiety and other stressors
 Past pain experience
General Assessments of Pain
 Patient’s verbalization and description of pain

 Duration of pain

 Location of pain

 Quantity and intensity of pain

 Quality of pain
General Assessments of Pain

 Chronology of pain

 Aggravating and alleviating factors

 Behavioral responses

 Effect of pain on activities and lifestyle


Pain Assessment Tools
Pain Assessment Tools
Pain assessment tools
WILDA Scale

 Words that describe the pain


 Intensity of pain
 Location of pain
 Duration of pain
 Aggravating or Alleviating factors
Diagnosing Pain

 Type of pain

 Etiologic factors

 Behavioral, physiological, affective response

 Other factors affecting pain process


Nursing Diagnosing

NANDA includes the following diagnostic labels for


clients experiencing pain or discomfort:
 Acute pain
 Chronic pain

 When writing the diagnostic statement, the nurse


should specify the location (e.g, left frontal
headache)
Nursing Diagnosing

 Pain may be the etiology of other nursing


diagnosis. e.g:

-Disturbed sleep pattern related to increased


pain perception at night
Nursing Interventions for Pain
 Establishing trusting nurse-patient relationship

 Initiating nonpharmacologic pain relief measures

 Considering ethical and legal responsibility to relieve


pain

 Teaching patient about pain and home care


Manipulating Pain Experience Factors

 Remove or alter cause of pain

 Alter factors affecting pain tolerance

 Initiate nonpharmacologic relief measures


Nonpharmacologic Pain Relief Measures

 Distraction
 Humor
 Music
 Imagery
 Relaxation
 Acupuncture
 Hypnosis
 Therapeutic touch
Distraction
Imagery
Relaxation
Acupuncture
Hypnosis
Therapeutic touch
Pharmacologic Pain Relief Measures

 Analgesic administration

 Nonopiod analgesics e.g. NSAIDs

 Opioids or narcotic analgesics

 Adjuvant drugs e.g. anticonvulsants,


antidepressants, ..
Why clients may be reluctant to report
pain:
 Fear of injectable route of analgesic administration

 Belief that pain is to be expected as apart of the


recovery process

 Belief that pain is a normal part of aging

 Belief that expression of pain reveal weakness

 Concerns about side effects and risks especially of


opioid drugs
Additional Methods for Administering
Analgesics

 Patient controlled analgesia

 Epidural analgesia

 Local anesthesia
Patient controlled analgesia
Epidural analgesia
Local anesthesia

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