Nursing 109

N109: Foundations in Nursing Practice Study Guide

Categorizing Pain There are several ways to categorize pain. Pain is most often classified by the kind of damage that causes it. The two main categories are pain caused by tissue damage, also called nociceptive pain, and pain caused by nerve damage, also called neuropathic pain. A third category is psychogenic pain, which is pain that is affected by psychological factors. • Nociceptive pain: Nociceptive pain comes from tissue damage. The pain stems from an injury to the body’s tissues, such as bone, soft tissue, or organs. The injury to body tissue can come from a disease, such as cancer, or it can come from physical injury, such as a cut or a broken bone. • Neuropathic pain: Nerves function by transmitting signals, including pain signals, to and from the brain. Damage to the nerves can interfere with the way those signals are transmitted and cause pain signals that are abnormal. Nerves can be damaged by diseases, such as diabetes, or they can be damaged by trauma. Certain chemotherapy drugs and other medications may cause nerve damage. Nerves can also be damaged as a result of stroke or an HIV infection. The pain that comes from nerve damage may be the result of damage to the central nervous system (CNS), which includes the brain and spinal cord, or it might result from damage to peripheral nerves that send signals to the CNS. • Psychogenic pain: Psychogenic pain most often has a physical origin, either in tissue damage or nerve damage, but the pain caused by that damage is increased or prolonged by such factors as fear, depression, stress, or anxiety. In some cases, pain originates from a psychological condition. 2.2 Characteristics of Pain It is important for the nurse to assess the characteristics of the patient’s pain. These characteristics can be easily remembered using the LOCATES acronym. • L ocation of the pain and radiation to other parts of body: What specific point is most painful? Does the pain go anywhere else (radiate)? • O ther associated symptoms: Other than the pain sensation, are there other symptoms that accompany the pain (nausea, numbness, tingling, weakness, fever, fatigue, etc.)? • C haracter and intensity of the pain: How does the patient describe the pain? Is it sharp, dull, stabbing, throbbing, burning, or itching? And how does the patient describe the intensity of the pain? Is it mild, moderate, intense, or severe? • A ggravating and alleviating factors: What makes the pain better or worse? Does movement make it better or worse? Eating? Breathing? • T iming of the pain: When did the pain start?What was the individual doing immediately before the pain started? When does the pain occur? Before or after meals? A particular time of the day? How long does it last? Is it constant or intermittent? Or is it a transitory sensation, lasting only until the noxious stimulus is removed? • E nvironment where the pain occurs: What was the patient doing when the pain started, and does the pain seem to get better or worse in certain environments? • S everity of the pain: The nurse should ask the patient to rate the pain on a scale of 0 to10 with 10 being the worst pain ever. For the pediatric patient, a “smiley face” scale can be used to rate pain. The nurse should also use observation skills to aid in determining severity; however, it

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