NLE Perioperative & Pain Nursing — Pain ManagementConcept Map

Concept

Pain Physiology and Types

Sub Concepts

• Transduction - noxious stimulus activates nociceptors
• Transmission - impulse travels to spinal cord and brain
• Perception - conscious awareness of pain
• Modulation - body dampens/amplifies signal via endogenous opioids
• Acute Pain - recent onset, warning signal, resolves with healing
• Chronic Pain - persists beyond 3-6 months, lacks acute signs
• Nociceptive Pain - from tissue damage (somatic/visceral)
• Neuropathic Pain - from nerve damage/dysfunction

Relationship To Central

Foundation for understanding pain mechanisms and guides assessment and intervention selection

Concept

Pain Assessment

Sub Concepts

• PQRST Framework - Provocation, Quality, Region, Severity, Timing
• Numeric Rating Scale 0-10 - adult standard
• Wong-Baker FACES Scale - children aged 3+ and communication barriers
• FLACC Scale - behavioral tool for infants/nonverbal (Face, Legs, Activity, Cry, Consolability)
• Reassessment timing - 30-60 min post-oral, 15-30 min post-IV
• Functional assessment - effect on sleep, activity, mood
• Cultural considerations in pain expression

Relationship To Central

Essential first step in nursing process; guides treatment selection and monitors effectiveness

Concept

Pharmacologic Management

Sub Concepts

• WHO Analgesic Ladder - Step 1 non-opioids, Step 2 weak opioids, Step 3 strong opioids
• Non-Opioid Analgesics - Acetaminophen (hepatotoxicity risk, max 4g/day), NSAIDs (GI/renal risks)
• Opioid Analgesics - Morphine, Fentanyl, Hydromorphone, Oxycodone (respiratory depression risk)
• Adjuvant Drugs - Antidepressants, Anticonvulsants (gabapentin), Corticosteroids
• Routes of Administration - Oral preferred, IV acute, Transdermal chronic, Epidural, Intrathecal
• Equianalgesic Dosing - prevents under/over-dosing during route changes
• Around-the-clock dosing for continuous pain vs. PRN for breakthrough

Relationship To Central

Primary treatment modality; requires knowledge of drugs, dosing, safety, and monitoring

Concept

Opioid Safety and Critical Nursing Responsibilities

Sub Concepts

• Respiratory depression - most dangerous adverse effect
• Assess respiratory rate BEFORE administration - hold if RR <12
• Monitor level of consciousness and oxygen saturation
• Naloxone - opioid antagonist/antidote for overdose reversal
• Constipation management - proactive bowel regimen required
• Other adverse effects - sedation, nausea, urinary retention, hypotension, miosis
• Special populations - older adults (start low, go slow), opioid-naive patients
• Recognize tolerance, physical dependence vs. addiction distinctions

Relationship To Central

Patient-safety critical; prevents adverse events and overdose complications

Concept

Patient-Controlled Analgesia (PCA)

Sub Concepts

• Mechanism - patient self-administers preset IV opioid dose via button
• Safety feature - lockout interval prevents overdose
• Key rule - ONLY patient presses button, never family (PCA by proxy is unsafe)
• Nursing verification - drug, concentration, dose, lockout limits with second nurse
• Monitoring parameters - RR, sedation, SpO2, pain relief, amounts delivered/attempted
• Equipment readiness - naloxone and resuscitation equipment must be available
• Patient education - press when pain begins, understand lockout intervals

Relationship To Central

Evidence-based technique providing patient autonomy and steady pain control

Concept

Non-Pharmacologic Management

Sub Concepts

• Cutaneous stimulation - heat, cold, massage, TENS (Transcutaneous Electrical Nerve Stimulation)
• Cognitive-behavioral - relaxation, guided imagery, distraction, music, biofeedback
• Positioning, rest, immobilization of painful area
• Acupuncture and acupressure
• Gate control theory rationale - non-painful stimuli close spinal gate, reduce transmission
• Especially valuable for chronic pain and adjunct to reduce opioid needs

Relationship To Central

Complements medications, supports gate control theory, reduces opioid requirements

Concept

Chronic Pain Management

Sub Concepts

• Multimodal approach - combines analgesics, adjuvants, therapy, psychosocial support
• Around-the-clock long-acting opioids with breakthrough doses (cancer pain model)
• Functional goals over pain elimination - improved sleep, activity, quality of life
• Address depression, anxiety, social isolation
• Believe patient's report; avoid undertreating due to addiction fears
• Monitor tolerance (needing more for same effect) - distinct from addiction
• Physical dependence (withdrawal on abrupt stop) - expected, not addiction
• Addiction - compulsive use despite harm
• Palliative care - generous opioid titration for suffering relief

Relationship To Central

Requires distinct multimodal interdisciplinary approach with functional goals

Concept

Legal and Ethical Framework (RA 9173)

Sub Concepts

• RA 9173 Nursing Act - defines Registered Nurse scope of practice
• Nursing diagnosis - NANDA application (e.g., Acute Pain, Chronic Pain)
• Maslow-based prioritization - pain management addresses safety/comfort needs
• NCM levels - independent, dependent, collaborative nursing actions
• Documentation requirements - pain assessment, interventions, outcomes, reassessment
• Philippine healthcare delivery context - access, resource availability, cultural factors
• Interdisciplinary collaboration - coordination with physicians, therapists, specialists

Relationship To Central

Governs nursing practice in pain management; defines scope and accountability

To

Pain Types

From

Pain Physiology

Strength

strong

Relationship

Understanding the four processes (transduction, transmission, perception, modulation) explains how different pain types (acute, chronic, nociceptive, neuropathic) are generated and perceived

To

Pain Assessment

From

Pain Types

Strength

strong

Relationship

Different pain types require different assessment approaches; acute pain shows sympathetic signs while chronic pain may not; neuropathic pain requires specific descriptors like burning or shooting

To

Pharmacologic Management

From

Pain Assessment

Strength

strong

Relationship

Assessment findings (pain severity, type, location) determine which step of WHO ladder to initiate and guide medication selection and dosing

To

Non-Pharmacologic Management

From

Pain Assessment

Strength

moderate

Relationship

Assessment establishes baseline; non-pharmacologic measures complement pharmacologic treatment and are continuously reassessed for effectiveness

To

Opioid Safety

From

Pharmacologic Management

Strength

strong

Relationship

Opioid safety monitoring is essential when using Step 2 and Step 3 medications; respiratory depression is the most critical adverse effect requiring before-administration RR assessment

To

Naloxone Knowledge

From

Opioid Safety

Strength

strong

Relationship

Understanding opioid adverse effects, particularly respiratory depression, necessitates knowledge of naloxone as the reversal antidote and its short-acting properties requiring potential repeat dosing

To

Opioid Safety

From

Patient-Controlled Analgesia

Strength

strong

Relationship

PCA typically delivers opioids; same safety monitoring parameters apply (RR, sedation, SpO2) with additional safety feature of lockout interval and emphasis on patient-only button use

To

Chronic Pain Management

From

WHO Analgesic Ladder

Strength

strong

Relationship

Chronic pain uses WHO ladder principles but with long-acting medications around-the-clock plus breakthrough doses; escalates based on functional goals rather than pain elimination alone

To

Gate Control Theory

From

Non-Pharmacologic Management

Strength

moderate

Relationship

Non-pharmacologic measures (heat, massage, distraction) work by closing the spinal gate to pain transmission, reducing the perception and transmission of pain impulses

To

Tolerance vs Addiction Distinction

From

Chronic Pain Management

Strength

strong

Relationship

In chronic pain, tolerance (needing more drug for same effect) and physical dependence (withdrawal on abrupt stop) are expected and distinct from addiction (compulsive use despite harm)

To

Non-Opioid Analgesics

From

Pharmacologic Management

Strength

strong

Relationship

Non-opioids (acetaminophen, NSAIDs) comprise Step 1 of WHO ladder; understanding their mechanisms, maximum doses, and adverse effects is critical for safe administration and monitoring

To

Modulation Pathway

From

Pain Physiology

Strength

moderate

Relationship

The modulation process involving endogenous opioids (endorphins) and descending pathways explains how both pharmacologic opioids and non-pharmacologic measures reduce pain perception

To

Pain Assessment

From

Legal Framework RA 9173

Strength

moderate

Relationship

RA 9173 defines nursing scope; pain assessment is an independent nursing action and responsibility in all healthcare settings across Philippines NCM levels

To

NANDA Nursing Diagnoses

From

Legal Framework RA 9173

Strength

strong

Relationship

Common pain-related NANDA diagnoses include Acute Pain and Chronic Pain; proper documentation aligns with RA 9173 standards and guides interdisciplinary collaboration

To

Interdisciplinary Collaboration

From

Legal Framework RA 9173

Strength

strong

Relationship

RA 9173 specifies that nurses work collaboratively with physicians and other healthcare providers in pain management; defines scope of independent vs dependent vs collaborative actions

To

Wong-Baker FACES Scale

From

Assessment Tool Selection

Strength

moderate

Relationship

FACES scale is appropriate for children aged 3+ and adults with communication barriers; simple visual tool aligns with pediatric pain assessment standards

To

FLACC Scale

From

Assessment Tool Selection

Strength

moderate

Relationship

FLACC is behavioral tool for infants and nonverbal patients; requires observational skills rather than self-report; useful in NCM context for vulnerable populations