15
Lesson Plans for
Pain Management
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 15.1:
2. Explain the physiologic basis for pain.
4. Identify differences in the duration of pain and patient responses to acute and chronic pain.
6. Explain the special needs of the older adult patient with pain.
Lesson 15.2:
8. Describe interventions used in the management of pain.
10. List the factors that should be considered when pain is not relieved with analgesic medications.
CHAPTER TEACHING FOCUS
• In this chapter, the student will be introduced to topics related to pain management.
• The student will become acquainted with the physiology of pain, factors influencing response to pain,
responses to pain, and pain assessment.
• Nonpharmacologic and pharmacologic interventions will also be discussed.
CONCEPTS
The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2013).
THEME: Protection and Movement
• Concept: Pain
• Exemplar: Cancer Pain, p. 216
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Introduction to Medical-Surgical Nursing, 6th ed.
CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) Medications that are used to treat pain are called __________.
a) anxiolytics
b) thrombolytics
c) analgesics
d) antiemetics
2) Endorphins and enkephalins are the body’s natural opioid-like substances that __________.
a) block the transmission of painful impulses to the brain
b) interfere with RNA and DNA synthesis in nerve cells
c) selectively block beta-adrenergic receptors
d) inhibit calcium movement across the nerve cell membrane
3) Afferent nerve pathways are activated by __________.
a) nociceptors
b) analgesics
c) endorphins
d) the brain
4) Pain tolerance is defined as __________.
a) the amount of pain a person has
b) the intensity of pain a person will endure
c) the point at which analgesic is ineffective
d) a pain rating of 5
5) The sympathetic nervous system’s responses to pain include which of the following?
a) Decreased blood pressure, pulse rate, and respiratory rate
b) Increased blood pressure, pulse rate, and respiratory rate
c) Decreased blood pressure, increased pulse rate, increased respiratory rate
d) Increased blood pressure, decreased pulse rate, decreased respiratory rate
6) Most chronic pain is called neuropathic pain because it __________.
a) is isolated to a specific nerve pathway
b) is most likely psychological in nature
c) is debilitating in most instances
d) follows an abnormal pathway
7) Nursing assessment of the patient in pain should be done __________.
a) 1 day after admission and then on a regular basis
b) when the family arrives
c) on admission and then on a regular basis
d) only when the patient complains of pain
8) The application of heat to relieve pain is an example of which nursing intervention?
a) Physical comfort measure
b) Environmental control
c) Stimulation technique
d) Distraction
9) Which of the following is an example of an opioid agonist-antagonist?
a) Hydromorphone (Dilaudid)
b) Methadone (Dolophine)
c) Buprenorphine (Buprenex)
d) Meperidine (Demerol)
10) Opioid addiction is best described as __________.
a) the physiologic changes that occur from repeated doses of opioids
b) the psychological dependence characterized by a continual craving for opioid aside from pain relief
c) a condition in which higher doses are required to achieve pain relief
d) a common occurrence in postoperative patients
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Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: What is the difference between a patient’s pain threshold and his or her pain tolerance?
Question: What are three criteria used to describe pain in a pain assessment? Provide an example of
each.
Answer: Criteria used to describe pain are location, quality, intensity, and aggravating and alleviating
4 Chapter 15 Pain Management ______________________________________________________________
LESSON 15.1
Instructor Preparation
Textbook Objectives Covered
1. Define pain.
3. Explain the relationships between past pain experiences, anticipation, culture, anxiety, or
activity and a patient’s response to pain.
5. Identify situations in which patients are likely to experience pain.
6. Explain the special needs of the older adult patient with pain.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Guest speakers: a nurse who works with postoperative patients
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying pain management, including:
• Nociceptors and pain physiology
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• acute pain (p. 215)
• addiction (p. 227)
• pain threshold (p. 213)
• pain tolerance (p. 214)
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 15.1
Student Preparation
Assignments 2 hours
1
READ – Textbook (pp. 212-213)
REVIEW
• Figure 15-1: The gate-control theory of pain (p. 214)
ANSWER – Text
• Review Questions for the NCLEX Examination: 1 (p. 232)
ANSWER – Study Guide
• Part IA: 1, 2 (p. 81)
2
READ – Textbook (pp. 213-215)
REVIEW
ANSWER – Text
• Review Questions for the NCLEX Examination: 2 (p. 233)
ANSWER – Study Guide
3
READ – Textbook (p. 215)
ANSWER – Text
• Review Questions for the NCLEX Examination: 3, 4 (p. 233)
ANSWER – Study Guide
4
READ – Textbook (pp. 215-217)
REVIEW
• Table 15-1: Differences in Acute and Chronic Pain (p. 216)
• Table 15-2: Classification of Pain (p. 216)
5
READ – Textbook (pp. 215-217)
ANSWER – Study Guide
• Part IIE: 5 (p. 82)
6 Chapter 15 Pain Management ______________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 15.1
6
READ – Textbook (pp. 220–221)
REVIEW
• Box 15-3: Evaluating Pain in Cognitively Impaired Older Adults and Observing Pain
ANSWER – Study Guide
• Part IIE: 4 (p. 82)
• Part IIIF: 5, 7 (p. 85)
50-Minute Lesson Plan
Lecture Outline 20 minutes
Slide 1
Chapter 15
Pain Management
1
Slide 2
Definition of Pain
• International Association for the Study of Pain defines it as “an unpleasant sensory and
emotional experience associated with actual or potential tissue damage”
2
Slide 3
Physiology of Pain
• Sensory experiences: time/space, emotions, cognition
• Afferent pathways
TALKING POINTS:
• Why are some parts of the body more sensitive to pain than other parts?
Slide 4
Physiology of Pain (cont.)
• Pain receptors are sensitive to chemical changes, temperature, mechanical stimuli, and
tissue damage
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 15.1
Slide 5
the spinal cord.
Physiology of Pain (cont.)
• Impulses then travel up the spinal cord to the brain
• In the brain, the cortex interprets the impulses as pain and identifies the location and
TALKING POINTS:
• Once pain is transmitted to the spinal cord and brain, the descending pathway is activated
Slide 6
Gate-Control Theory
• Pain reflects physical and psychosocial factors
• Painful impulses are transmitted to the spinal cord through small-diameter nerve fibers in
the afferent pathway
TALKING POINTS:
• Many theories have been proposed to explain pain, but none fully describe the pain
experience.
• Who are Melzack and Wall?
Gate-Control Theory (cont.)
• Factors that cause the gate to open include tissue damage, a monotonous environment,
and fear of pain
TALKING POINTS:
• Large-diameter nerve fibers are stimulated by cutaneous (skin) stimulation through
massage, position change, and heat or cold applications.
• What types of sensory input may close the gate?
3
Factors Influencing Response to Pain
• Although people may have the same injury or insult, they may respond differently because
8 Chapter 15 Pain Management ______________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 15.1
Slide 9
Physical Factors
• Pain threshold
• Point at which stimulus causes sensation of pain
• Pain tolerance
• Intensity of pain that a person will endure
• Age
TALKING POINTS:
• Anger, fatigue, anxiety, insomnia, depression, and uncontrolled pain all lower the pain
threshold.
• Increasing or prolonged pain may lower the pain tolerance because the patient fears the
pain will not be relieved.
Slide 10
Psychological Factors
• Culture and ethnicity
• Different ways of expressing/responding to pain
• Religious beliefs
TALKING POINTS:
• It is critical to avoid making judgments based on how you think a person should react or
behave.
• What reactions may patients have to pain?
Slide 11
Psychological Factors (cont.)
• Past experiences and anxiety
• May have developed positive coping strategies to deal with previous painful
experiences
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 15.1
Autonomic Nervous System
• Activates the fight–or-flight response; certain physiologic responses initiated
TALKING POINTS:
• The pain signal is interpreted by the brain as a stressor.
• What behaviors may the patient exhibit in response to pain?
4
Slide 13
Acute Pain
• Follows the normal pathway for pain from nociceptor activation to the brain and may be
called nociceptive pain
4
&
Chronic Pain
• Persists/recurs for >6 months; may last a lifetime
• Most chronic pain is neuropathic pain because it follows an abnormal pathway for pain
• See Table 15-2, p. 216
TALKING POINTS:
• Treatment may or may not be helpful in relieving the pain.
Comparison of Acute and Chronic Pain
• Chronic pain serves no useful purpose; acute warns of tissue damage and trauma
TALKING POINTS:
• Chronic pain can lead to depression, marital difficulties, loss of self-esteem, immobility,
and isolation.
10 Chapter 15 Pain Management ______________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 15.1
6
Slide 16
Nursing Care of the Patient in Pain
• Assessment
• Accept patient’s report of pain
• Determine status of the pain
Slide 17
Question 1
• Factors that increase endorphin levels include all of the following except _________.
A. morphine
B. sexual activity
C. exercise
D. laughter
TALKING POINTS:
• Correct answer: A
• Rationale: Research suggests that prolonged stress and pain, as well as the prolonged
use of morphine and alcohol, decrease endorphin levels. Factors that increase endorphin
Slide 18
Question 2
• Which of the following is a true statement about pain?
A. Anger, fatigue, anxiety, insomnia, depression, and uncontrolled pain all raise the pain
threshold.
B. With a higher threshold, the person experiences pain more readily with less stimuli.
TALKING POINTS:
• Correct answer: C
• Rationale: During hospitalization or illness, a patient may experience anxiety, fatigue, or
______________________________________________________________ Chapter 15 Pain Management 11
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 15.1
Activities
Classroom Choose from below to make 30 minutes
Online
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
DISCUSS
• Discuss and compare the International
Association for the Study of Pain definition
with McCaffrey’s definition for nurses.
• Have each student write a short description
of how he or she defines pain. Ask for
volunteers to share their definitions with the
class to build a consensus definition.
• Refer to the key terms on p. 212. Write each
ASSESS BASELINE
• Post the Pretest and the Background
Assessment online and have your class
complete them. Use the results to guide how
you teach the class.
2
DISCUSS
• Discuss the roles of the afferent pathways,
the central nervous system, and the efferent
pathways in the physiology of pain.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe the
gate-control theory of pain, including factors
12 Chapter 15 Pain Management ______________________________________________________________
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LESSON 15.1
3
DISCUSS
• Discuss how psychological factors can
interact with physical factors to influence the
pain experience as well as the patient’s
response to pain.
• Invite a nurse who works with postoperative
patients to speak to the class about various
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe
anxiety related to pain anticipation.
• Post the following discussion topic online
and have students comment. What are
some common physiologic factors that can
4
DISCUSS
• Present the following scenarios to the class
and ask the students to identify whether the
patient portrayed is experiencing acute or
chronic pain. Have the students explain their
reasoning for classifying the pain as acute or
chronic.
• A recent amputee continues to
experience phantom pain, burning, and
itching in his missing limb.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Compare and
contrast chronic and acute pain; patients’
verbal, behavioral, and physiologic
responses; and possible interventions.
5
DISCUSS
• Discuss various situations in which patients
may experience either chronic or acute pain.
• Lead a class discussion in which students
POST AND COMMENT
• Post the following discussion topic online
and have students comment. What are
some challenges that nurses face in
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 15.1
6
DISCUSS
• Facilitate a class discussion about pain in
older adults. Have students identify factors
that influence pain in older adults and the
special needs that they have related to pain.
nursing care and interventions.
• Present the following reasons why older
patients often do not report their pain. Then
as a class, discuss nursing interventions for
each with a care goal of lessening or
alleviating the patient’s pain.
• A patient who does not report pain
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe how
older patients might respond differently to
pain, as well as the nurse’s role in helping
Critical Thinking Question
Two patients who have had the same surgical procedure have been assigned to a nurse.
One patient complains of severe pain, requests pain medication frequently, and expresses
her pain by crying and moaning. The other patient appears relatively comfortable, has
requested minimal amounts of pain medication, and appears very relaxed. What are some
factors that might be influencing these patients’ responses to pain?
Discussion Guidelines: There are many factors that can influence a patient’s response to pain.
Instructor Notes/Student Feedback