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Icu triad part1 - Coggle Diagram
Icu triad part1
Components of pain
Sensory component is the perception of many characteristics of pain, such as intensity, location, and quality
Affective component includes negative emotions such as unpleasantness,anxiety, and fear.
Behavioral component includes the strategies used by the person
to express, avoid, or control pain.
Physiologic component refers to the stress response
Cognitive component refers to the interpretation or the meaning of pain
by the person who is experiencing it
Pain
Critically ill patients frequently confront suffering,
and events that threaten the intactness of the person
IASP) (1986), which defines it as:
• “an unpleasant subjective sensory and
emotional experience associated with present or
potential injury
Procedural pain is defined as, the unpleasant sensory
and emotional experience that arises from actual or
potential tissue damage associated with diagnostic or
treatment procedures.
Procedural pain can be both a physiological and a
psychological stressor to these patients.
Agitation
Not so much a diagnosis, but a consequence of
more fundamental etiologies, as pain, anxiety,
and delirium
Is a psychomotor disturbance characterized by a marked increase in both motor and psychological activities, often accompanied by a loss of control of action and a disorganization of thought.
hyperactive patient movements that range in intensity from slight restless hand and body movements, to pulling out lines and tubes, or physical aggression and self-harm
Assess by RASS
Factors contributing to pain in ICU
Physical factors :Symptoms of critical illness (eg, angina, ischemia,
dyspnea),
Psychological : Anxiety and depression, impaired
communication, inability to report and describe
pain, fear of disability, or death, Separation
from family and significant others, sleep
deprivation, delirium, or altered sensorium.
Icu environment : Continuous noise from equipment and staff, continuous or unnatural patterns of light, awakening and physicalmanipulation every 1 to 2 hours for vital signs or
positioning, continuous or frequent invasive & painful
procedures, and competing priorities in care—unstable
vital signs, bleeding, dysrhythmias, poor ventilation may
take precedence over pain management.
Managment of agitation
Historically, benzodiazepines were used to quickly reduce agitation, but they are now avoided because they increase the risk of delirium.
Propofol
A powerful sedative commonly used for mechanically ventilated patients.
Rapid onset: 2–4 minutes.
Short duration/half-life: eliminated in 30–60 minutes.
Ideal for situations requiring quick awakening, such as:
Spontaneous Awakening Trials (SAT)
Spontaneous Breathing Trials (SBT)
Neurological assessments
Benzodiazepines
No longer recommended for sedation in mechanically ventilated critically ill patients.
Associated with:
Increased delirium
Longer duration of mechanical ventilation
Worse overall outcomes
Types of pain
Acute Pain has a short duration, and it usually
corresponds to the healing process (30 days),
but should not exceed 6 months
Chronic pain persists for more than 6 months
after the healing process from the original
injury.
Stress response to pain
• A biologic stress response is activated by pain
• Stress response involves the nervous, endocrine,and immune systems in the hypothalamicpituitary-adrenal axis (HPA)
Pain assessment
Subjective
Brief Pain Inventory
Initial Pain Assessment Tool
McGill Pain Questionnaire–Short Form
Patient’s self-report of pain using the mnemonic PQRSTU
Objective
Behavioral Pain Scale (BPS)
Critical-Care Pain Observation Tool (CPOT)
Non-Verbal Pain Scale (NVPS)
Pain Behavioral Assessment Tool (PBAT)
Pain Assessment and Intervention Notation (PAIN)
Managment of pain
Pharmacological measures
Non opioid
NSAIDs are preferred non-opioid analgesics.
They decrease pain by inhibiting inflammatory mediators (histamine, bradykinin) at the injury site.
Provide effective pain relief without sedation, respiratory depression, or bowel/bladder issues.
Acetaminophen is commonly used in ICUs but may cause liver damage.
Combining NSAIDs with opioids allows lower opioid doses with effective analgesia.
Opioid
Work by binding to pain-related receptors (especially mu receptors) in the CNS and PNS.
Common IV opioids in critical care:
Morphine sulfate
Fentanyl
Hydromorphone
Other opioids used:
Codeine
Oxycodone
Methadone
Non pharmacological measures
a. Physical Techniques
Cold application
Massage / therapeutic touch
b. Cognitive-Behavioral Techniques
Relaxation and distraction
Guided imagery
Music therapy
c. Environmental Modification
Adjusting the patient’s surroundings to reduce stress and discomfort.
Remember
Pain causes catabolic stimulation and hypoxemia → increases delirium risk.
Unrelieved pain may lead to sleep loss, frustration, ↑ work of breathing, and agitation.
Patients in (ICU) often experience pain, agitation,
and delirium (PAD).
Although, pain, agitation and delirium (PAD) not
placed as highly on the list of priorities for a critically ill
patient
Inadequate PAD assessment and management can have
consequences for patient outcomes in the intensive care
unit (ICU) environment.