LESSON PLAN

ON
PAIN AND ITS MANAGEMENT

SUBMITTED TO: SUBMITTED BY:

MRS.B.JAYA LAKSHMI MAM K.BEULAH
H.O.D OF NURSING EDUCATION M.Sc NURSING 1ST YEAR
GOVT COLLEGE OF NURSING GOVT COLLEGE OF NURSING
GUNTUR. GUNTUR
 BASE LINE DATA

NAME OF THE STUDENT : K.Beulah

NAME OF THE COURSE : M.Sc(N) I Year
NAME OF THE SUBJECT : Medical Surgical Nursing-I
NAME OF THE TOPIC : PAIN AND ITS MANAGEMENT
METHOD OF TEACHING : Lecture Cum Discussion
VENUE : B.Sc(N) 2nd year class room.
DATE & TIME : 21/9/22 At 2PM(45 Min)
A.V AIDS :Black board,Charts,Models,flash cards,PPT
NAME OF THE EVALUATOR: Mrs.B.Jaya Lakshmi
H.O.D Of Nursing Education
Govt college of nursing,
Guntur.
 OBJECTIVES

GENERAL OBJECTIVE : By the end of the lesson plan, students will be able to acquire in depth knowledge regarding
Pain and its management.
SPECIFIC OBJECTIVES: At the end of lesson plan,,students will be able to

 Introduce pain
 Define pain
 Explain the nature of the pain
 Enumerate the types of pain
 Explain physiology of pain
 Explain dimensions of the pain
 Explain the theories of pain
 Enlist the factors affecting pain
 Explain about therapies of pain management
 Explain nursing management of pain


SL.NO TIME SPECIFIC CONTENT TEACHING AV AIDS Evaluation
OBJECTIVES AND
LEARNING
ACTIVITY
1 2 Min Introduce pain INTRODUCTION OF PAIN Lecture method Blackboard

Everyone has experienced some types or degree

of pain. it is the most common reason why people
seek health care. Despite Being one of the most
commonly occurring symptoms in the medical
world pain is one of the least understood a person
in pain feels distress or suffering and seek relief
however the nurse cannot see or feel the clients
pain
Pain is subjective now pain is considered to be a
separate disease

2 3Min Define pain DEFINITION OF PAIN Lecture method PPT What is the
Defined as an unpleasant subjective sensory and definition of
emotional experience associated with actual or Pain?
potential issue damage are described in terms of
such damage

The American pain society also stresses the

importance of self report pain is always subjective
the clinician Must accept the patients report of pain
Agency for healthcare research and quality from the
guidelines for cancer pain states health
 professionals should Be the primary source of
assessment

Lecture cum PPT

NATURE OF PAIN
3 2Min Explain nature of discussion What is the
pain nature of pain?
Pain is must more than a physical sensation caused
by a specific stimulus depei experience is complex
involving physical emotional and cognitive
components pain is subjective and highly
individualised pain cannot be objectively measured
only the client knows whether pain is present and
what the experience is like.

TYPES OF PAIN What are the

4 5 min Enumerate the types of pain?
types of pain ? Pain can be described by its origin or cause and by Lecture cum
its nature or description discussion Flashcards
On the basis of origin pain can be classified as:
Cutaneous pain
This is caused by stimulating the cutaneous nerve
endings in the skin and results in a well organised
burning or prickling sensation example tangled hair
that
Somatic or deep pain
This is non localised and originates in supporting
structure such as tendons ligaments and nerves pain
is somatic structures is a complicated phenomenon
the pain is poorly localised map reduce nausea and
is frequently associated with sweating and changes
in body pressure deep somatic pain is generally
diffuses less localizable then cutaneous pain also
pain forms deep structures frequently radiates from
primary sites example pain from lumbar disc is felt
along the sciatic nerve
Visceral or splanchnic pain
Visceral pain is a discomfort In the internal organ is
less localised and more slowly transmitted than
cutaneous pain usually autonomic Manifestation
accompany .
Visceral pain is transmitted through sympathetic
and parasympathetic fibers of ANP With the pain
often referred to the body surface often in site at a
distance On the base of nature pain is divided
into two
Acute pain
Acute pain has a sudden onset relatively short
duration mild to severe intencity with a study
decreased in intensity over a period of days to
weeks once the noxious chemale are solved the
pain usually disappears it is usually associated with
a specific condition injury are tissue damage caused
by disease yeah healing occurs acute pain should
diminish example toothache headache needle sticks
the client will exhibit elevated heart rate respiratory
rate and blood pressure and me because dial freak
and have dilated pupils these signs resembled
anxiety which often occupies anxiety
Recurrent acute pain
It is repeat if painful episodes that recure over a
prolonged period or throat the clients lifetime pay
intervals alternate with painful episodes
Chronic pain
Chronic pain is defined as long term persistent
nearly constant r recurrent pain reducing significant
changes in the clients life chronic pain may last
long after the pathology is resolved
Chronic acute pain
It occurs almost daily over a long period month are
years and may never stop example cancer pain
Chronic malignant pain
It is also called chronic benign pain occurs almost
daily and last for at least 6 months ranging from
mild to severe intensity 3 critical characteristics of
chronic non malignant pain is identified by MC
caffery and pasero
A. Caused by non life threatening causes
B. Not responsive 2 currently available pain
relief method
C. Me continue for the rest of the clients life

Other classifications
Psychogenic pain
Idiopathic pain
 Nociceptive pain
Neuropathic pain
Deafferentiation
pain

5. 3 min PHYSIOLOGY OF PAIN: Lecture cum PPT What is the

Explain
physiology of discussion physiology of
pain ? The opioid system and the non -opioid system are pain?
the two known endogenous analgesia systems in
humans .It is mediated by endorphins .The non -
opioid system is mediated by monoamine
substances such as norepinephrine and serotonin.

6. 5 min DIMENSIONS OF PAIN Lecture cum Chart What are the

Explain As a multi dimensional phenomenon, pain consists discussion dimensions of
dimensions of pain ?
of 5 dimensions
pain 1.Physiologic
2.Behavioural
3.Sensory
4.Cognitive
5.Affective

PHYSIOLOGIC DIMENSIONS OF PAIN

The neural mechanism by which pain is perceived
consists of four major steps:
 It is the conversion of a mechanical thermal
or chemical stimulus into a neuronal action
potentional.
 The noxious stimuli causes cell damage
with release of sensitizing chemicals like
prostaglandins ,bradykinin,
serotonin,histamine etc..,.
 The substances activate nociceptors and
lead to generation of action potential.
TRANSMISSION

 It is the movement of pain impulses from

the site of transduction to the brain.Action
potentials continues
 Site of injury to spinal cord.
It occurs when pain is recognized and responded
by the individual experiencing the pain .It is the
conscious experience of pain .
 It involves the activation of descending
pathways that exert inhibitory or facilitatory
effects on the transmission of pain .
 The neurons originating in the brain stem
descend to the spinal cord and release
substances that inhibit nociceptive impulses
 Modulation of pain signals can occur at the
level of periphery ,spinal cord ,brain stem
and cerebral cortex .
 Descending modulatory fibres release
chemicals such as serotonin
,norepinephrine, gamma, amino butyric
 acids and endogenous opioids that can
inhibit pain transmission
SENSORY AFFECTIVE BHAVIOUR
CONGNETIVE SOCIOECULTURAL
DAIMENSTION OF PAIN
 The sensory component of pain is the
recognition of the sensation as painful
sensory pain elements include pattern area
,intensity and nature.
 The affective responses include anger ,fear
,depression and anxiety .Negative emotions
can impair the patients quality of life
 The behavioural component of pain refers to
the observable actions used to express or
control pain.
 For example ,facial expressions such as
grimacing may reflect pain ,discomfort
,posturing may be used to decrease pain
associated with specific movements .The
cognitive component of pain refers to
beliefs ,attitudes ,memories and meaning
attributed to pain
 The socio cultural dimension of pain
encompasses factors such as demographics
support systems ,social roles and culture.
7. 5 min Enlist the theories Theories of pain Lecture cum Model What are the
of pain ? Specificity theory discussion theories of pain
?
This theory was based on assumptions that painwas
perceived following injury because there was a
single,dedicated,hard wired system of affluent
nerves.
Which carried messages from specific pair
receptors in the periphery to a pain center in the
brain.
The simple idea proposed that specific pair
receptors in the periphery to a pain center in the
pain.
Specific nerve endings in the skin and other tissues
respond exclusively to norepinephrine stimuli.

That affluent nerve carry the information to

specialized parts of the dorsal horn of the spinal
cord and hence via the anterolateral spinothalamic
tract to the thalamus (or )
Pain center in the brain and to the relevant part of
sensory cortex.
PATTERN THEORY
*This relate to the perception of pain to patterns of
impulses in the nervous system rather than to
impulses in dedicated pain pathways.
 *The pattern may be temporal ( or)spatial pattern
theories may explain some chronic (or) recurrent
pains which occur when there are nerve lesions.
THE GATE CONTROL THEORY
.
* In 1965, melzack and wall proped tha gate control
pain theory,which was first one recognizing the
psychological aspects.
*The gate control theory combined cognitive
,sensory and emotional component in addition to
the physiological
aspects,and proposed that they can act on a
aspects,and proposed that they can act on a gate
control system to block the individuals’s perception
pain.
*The theory suggests that nerve fibers that
contribute to pain transmission converge at a side
In the dorsal horn of the spinal cord.
*The image of gate is useful in teaching clients and
their families about pain relief measures.
*If a person is anxious ,the gate can be opened by
signals sent from the roo down to the mechanism in
the dorsal horn of
Spinal cord.
8. 2 min List out factors FACTORS AFFECTING THE PAIN Lecture cum What are the
affecting pain discussion Black board factors
EXPERIENCE
affecting the
pain?
 *age
*previous pain experience
*drug abuse
*cultural norms
*gerintological con Phases of pain experience
*the anticipation (or) fear of pain
*The sensation of pain.
*The aftermath of pain
9. 5 min Explain the MANAGEMENT OF PAIN
management of Lecture cum Palmplets What are the
Drug therapy
pain? discussion drugs used to
Equianalgesic dose reduce the pain
If refers to a dose of one analysis 6 that is ?
equivalent in a pain relieving effect compared with
another analgesic. This equivalence permits
substitution of analysis in the event that a particular
drug is ineffective or causes intolerable side effects
generally equivalent dose are provided for opioids
and are important because there is no upper dosage
limit for many of these drugs
Scheduling analgesics
Appropriate analysis scheduling should focus on
preventive or ongoing control of pen rather than
providing analysis only after the patients pain has
become severe analysis 6 titration is dose
adjustment based on assessment of the adequacy of
analysis affect versus the side effects produced
analysis ladder the WHO Treatment plant cells for
concurrent treatment of the cause of the pain when
possible and use of the 3 ladder approach step one
drug are used for a mild pain and step to for a mild
to moderate paid and Step 3 for a moderate to
severe pain if pain persists or increase drugs from
the next higher step are used to control pain
Drug therapy for mild plan
When plan is mild not opioid analgesics and other
NSAIDs are used these agents are characterised by
the following there is a effect to their analysis
properties that is increasing the dose beyond an upp
er limit provides no greater analgesia
Drug therapy for mild to moderate pain
When pain is moderate in intensity or mild but
persistent non opioid therapy step to drug are
indicated example the drugs usually are prescribed
in combining an opioid with a non opioid analgesic
Adjuvant drugs used for pain management
Kartika steroids antidepressants anti Caesars
muscle relaxants anaesthetics route of Drug
Administration
oral
Sublingual and buccal
intranasal
Rectal
Transdermal
l parental route intraspinal deliver
10. 2 min Explain surgical SURGICAL THERAPY Lecture cum PPT What are the
therapy ? Nerve block discussion surgical
Nero blocks are used to narrow blocks are used to therapies for
pain ?
reduce pain by temporarily or permanently
interrupting transmission of nociceptive input by
application of local anesthetics are neuro lytic
agentsagents
Neuroablative techniques
The techniques destroy nerves thereby interrupting
pain transmission these destroying the sensory
division of a peripheral or spiral now or classified a
neurectomy sympathectomies
Neuro argumentation
It involves electrical stimulation of the brain and
then spinal cord
Neuroaugmentation
It involves electrical Stimulation of the brain and
spinal cord

11. 5 min Non pharmacological therapy for pain Lecture cum Leaflet what are the
Explain non  Massage discussion non pharmaco
pharmacological measurements ?
 Vibration
management ?
 Transcutaneous electrical nerve stimulation
 electrical nerve stimulation
 Acupuncture
 Heat therapy
 Cold therapy
  Exercise
cognitive therapy
 Distraction
 Hypnosis
 Relaxation
12. 5min Explain nursing NURSING MANAGEMENT OF PAIN Lecture cum PPT What are the
management ? nurse role in caring for people in pain discussion nursing
measures for
In relation to the person in pain
pain?
 Assessor
 Preventer
 Strength ladder and validator
 supporter of patients methods of control
 Teacher of coping strategies
 Provide of specific pain therapies
In relationship to other career
 Advocate and evaluator
 Team membe
 team coordinator
in relationship to the environment
Planner provider are controller of ambient
temperature noise etc
Assessment
Subject to data
A client pain threshold and pain tolerance level
should be assisted pain threshold is the intensity
level where a person feels pain it varies with each
individual and with each type
 Objective data
Objective data often present a different picture
depending on the type of pain the client is
experiencing

Recording pain assessment findings

A flow sheet provides one place to document most
of the information used to make a plan management
decisions including plan rating vital signs analysis
administered and the level of arousal

Nursing diagnosis
the 2 primary nursing diagnosis used to describe
paying are acute pain and chronic pain many
diagnosis can be related to the client in pain
depending on the effort of pain
 activity intolerance
 anxiety
 Anxiety constipation
 Constipation deficient knowledge
 Knowledge describe body image
 Describe body image describe sleep pattern
 distributed through process
 Distributed through process
 Fatigue
 Fear
 Hopelessness
  impaired social interaction
 ineffective breathing pattern
 ineffective individual coping
 In effect role performance
 In effect therapeutic management
powerlessness
Planning or outcome identification
When planning care mutual goal settings with
the client experiencing pain is out most
important the nurse and the client worked
together to develop realistic outcome the
general principles of management includes

14. 1 min Conclude the CONCLUSION Lecture cum

topic pain discussion
Nurse are often the first healthcare professional
to encounter the person in pain so the
relationship of patient and analysis can have an
important part in the care of person with pain

15.
BIBLIOGRAPHY
1.Brunner and sudharth ,text book of medical
surgical nursing ,Wolters Kluwer,Vol-2,Pg
No:1116-1118
2.B.T Basavantappa,A text book of medical
surgical nursing, jaypee publishers, Pg no:146-147