Pain Management

By Sr. Ignata SSpS

 Tujuan
• Mampu mengkaji nyeri
• Mampu mengimplementasikan strategi
mengurangi nyeri
• Mampu mengevaluasi keefektifan strategi
mengurangi nyeri tersebut
 Definisi nyeri
• “an unpleasant sensory and emotional
experience which we primarily associate
with tissue damage or describe in terms of
such damage, or both.”
• phenomena kombinasi dari aspek sensory,
emosional, dan kognitif dan eksistensi dari
keadaan pathology fisik tidaklah mutlak
muncul pada pasien yang sedang
mengalami nyeri
 Etiologi
• Trauma mekanik menimbulkan nyeri
karena ujung-ujung saraf bebas
mengalami kerusakan akibat benturan,
gesekan ataupun luka.
• Trauma thermal menimbulkan nyeri
karena ujung saraf reseptor mendapat
rangsangan akibat panas atau dingin.
• Trauma kimiawi terjadi karena tersentuh
zat asam atau basa yang kuat.
• Trauma elektrik dapat menimbulkan nyeri
karena pengaruh aliran listrik yang kuat
mengenai reseptor rasa nyeri.
• Neoplasma nyeri karena terjadinya tekanan atau
kerusakan jaringan yang mengandung reseptor
nyeri dan juga karena tarikan, jepitan atau
metastase.
• Nyeri pada peradangan terjadi karena
kerusakan ujung-ujung saraf reseptor akibat
adanya peradangan atau terjepit oleh
pembengkakan.
• Nyeri yang disebabkan oleh factor psikologis
 Types of pain
• Three basic categories of pain:
1. Acute pain
2. Chronic pain (non malignant pain)
3. Cancer related pain
 Gate control theory of pain
• Described by Melzack and Wall in 1965
• First theory to suggest that psychological
factors play role in the perception of pain.
• The theory guided research toward the
cognitive behavioral approach to pain
management.
• Explained how interventions such as
distraction and music therapy provide pain
relief.
 Gate control theory of pain
• This theory proposes that stimulation of the
skin evokes nervous impulses that are
transmitted by three systems located in the
spinal cord. The substansia gelatinosa in
the dorsal horn, the dorsal column fibers,
and the central transmission cells act to
influence nociceptive impulses.
Gate control theory of pain
Gate control theory of pain
Skala pengkajian nyeri
 Nurse’s role in pain management

• Identifying goals for pain management

• Establishing the nurse-patient relationship

and teaching

• Providing physical care

• Managing anxiety related to pain

 Nonpharmacologic Interventions
1. Cutaneous stimulatin and massage
have an impact through the descending
control system and it produces muscle
relaxation.
2. Ice and heat therapies  heat: increases
blood flow to an area. Ice: prevent the
rebound phenomenon.
3. Distraction
 Nonpharmacologic Interventions

4. Relaxation techniques

5. Guided Imagery

6. Hypnosis

7. Music therapy

8. Transcutaneous electrical nerve

stimulation (TENS).
Kelompok 1
Kelompok 2
Kelompok 3
Kelompok 4
 Penugasan: membahas kasus
• Kelp 1 • Massage
• Kelp 2 • Ice &heat therapies
• Kelp 3 • Distraction
• Kelp 4 • Relaxation techniques
• Guided Imagery
• Hypnosis
• Music therapy