N109: Foundations in Nursing Practice

N109: Foundations in Nursing Practice Study Guide They theorized that pain intensity (in the sensory-discriminative dimension) and unpleasantness (in the affective-motivational dimension) are not simply determined by the magnitude of the painful stimulus. Higher cognitive activities can also influence perceived intensity and unpleasantness. For example, in the excitement of a football game, both dimensions of pain may be blocked. Suggestion and placebos may modulate the affective-motivational dimension and leave the sensory- discriminative dimension relatively undisturbed. For all patients with pain, what is understood about the meaning of pain, disease, and/or disability will play a part in the presentation of the problem and the effectiveness of treatment. For patients with chronic pain, these beliefs form part of the psychosocial context, known to be the largest influence in predicting the extent of pain - associated disability. The clinician interested in improving assessment and treatment must understand the role of psychological factors in the presentation of a pain problem. 2.4 Myths about Pain The nurse must understand that there are certain myths and misconceptions about pain that should be recognized and avoided: • Myth #1: A clinician can get a good sense of the pain a patient is experiencing. Reality: Pain is whatever the patient says it is. Pain is a very personal experience and varies greatly between people. The nurse must consider past and present experiences of pain in order to understand the patient’s perception. • Myth #2: Medications are always the best way to relieve pain. Reality: Although medications are very useful for pain relief, there are several other options that should be used in combination with medications, including behavioral (psychosocial) and mechanical (physical) methods. • Myth #3: The clinician should always begin treating pain with the lowest level onthe analgesic ladder (acetaminophen/nonsteroidal anti-inflammatory drugs), then slowly work up to opioids. Reality: The initial choice of agents for the management of pain is based on the characteristics of the pain, the pain intensity, and the individual patient. The World Health Organization (WHO) first published the analgesic ladder in 1990 (see table below). This ladder is still the basis for pain management today. The pain rating is divided into three steps: mild, moderate, and severe, and the choiceof treatment should be based on the severity. • Myth #4: Use of a strong opioid should relieve a patient’s pain. Reality: Appropriate prescribing and dispensing of pain medication does not eliminate pain completely and permanently. The objective of pain management is to achieve the goals and appropriate endpoints, which will vary from patient to patient. • Myth #5 : The use of opioids should be limited to avoid the risk of addiction. Reality: Studies have shown that the fears of patients becoming addicted are exaggerated and do not justify failure to relieve pain. Patients in pain who are being medically managed and receiving treatment for a specific reason, do not become addicted.

©2017

Achieve Test Prep

Page 34

of 154