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BASIC INTRODUCTION OF PAIN

Gezy Giwangkancana
Tim Nyeri Akut- Departemen Anestesi dan Terapi Intensif
FK UNOAD/RSUP DR.HASAN SADIKIN Bandung
Quiz 1

Bagaimana
Anda
Mendefinisikan
Nyeri ?
Pendahuluan

Nyeri adalah suatu pengalaman sensorik


dan emosional yang tidak menyenangkan
yang sering berhubungan dengan kerusakan
jaringan

International Association for the Study of Pain (IASP)


Pendahuluan

Nyeri merupakan terjemahan secara


sadar dari suatu rangsangan nyeri
(noxious stimuli) yang dihantarkan
melalui saraf tepi sampai saraf pusat
untuk memulai respons awal
perlindungan dari trauma
International Association for the Study of Pain (IASP)
Take Home Note 1

Hanya pasien yang


dapat mendefinisikan
nyeri personal

Analisa tanda bahaya


sebelum memulai
terapi nyeri
Faktor Analisa Perilaku Nyeri

Jenis Kelamin

Pendidikan

Usia

Faktor lingkungan

Latar belakang kebudayaan

Jenis tindakan trauma

Penyakit yang pernah diderita

Ketakutan, kecemasan serta depresi.
Patofisiologi Nyeri

 Sumber stimuli nyeri sampai dirasakan sebagai


 
persepsi nyeri rangkaian elektrofisiologi
nosisepsi ; terdiri atas :

Transduksi.

Transmisi.

Modulasi.

Persepsi.
Quiz 2

Mengapa Anak Kecil Bila Jatuh Luka Ditepuk –

Tepuk atau Ditiup oleh Ibunya maka nyerinya

hilang ?
Quiz 3

Pernah terluka oleh kertas namun tidak

menyadarinya?

Mengapa setelah dilihat terasa nyeri ?


Patofisiologi Nyeri
Respon tubuh Terhadap Nyeri
TYPES OF PAIN
Tipe Nyeri
Tipe Nyeri
Quiz 5

Tolong Tanyakan Pada Orang Di

Sebelah Anda Apa Nyeri Paling

Berat yang Bisa Dibayangkan ?


ASSESMEN NYERI
ASESMEN NYERI

Dilakukan untuk mengetahui derajat nyeri yang


dirasakan oleh pasien tatalaksana nyeri
sesuai derajat nyerinya
Take Home Message 2

NYERI
ADALAH
TANDA VITAL KELIMA
Remember

Everyone experiences pain differently

One person’s report of severe pain may seem like almost
nothing compared to another

Patients can report pain differently

Caregiver’s challenge is to assess all relevant
factors without imposing personal biases.

Patient’s self-report of pain is the single most
reliable indicator of pain.
Anxiety

Increase Family
hospitalization
and costs worries
If pain is inadequately
controlled, what are the
consequences?

Medication Depressio
worries n

Impaired
Sleep
ambulation
disturbances
Henny SM
Behavioral Indicators of Pain

Restlessness and agitated or hyper-alert state

Short attention span

Irritability

Facial grimacing, posturing, guarding

Anorexia

Lethargy

Sleep disturbance

Aggression
Assessing Pain

The single most reliable indicator of the existence


and intensity of pain is the patients self-report of
pain. The patients' report of pain should be the
primary source of information, since it is more
accurate than the observations or others.
Take Home Message 3

You can Ask or See


Pain but the best is
always to Ask
SOCRATES

Site - Where is the pain?

Onset - When did the pain start, was it
sudden or gradual?

Character - What is the pain like?

Radiation - Does the pain radiate
anywhere?

Associations - Any other signs or symptoms associated
with the pain?

Time course - Does the pain follow any pattern?

Exacerbating/Relieving factors - Does anything
change the pain?

Severity - How bad is the pain?
Visual Analog Scale
Verbal Descriptive Scale
Numerical Rating Pain Scale

The numerical rating scale offers the individual in pain to
rate their pain score

It is designed to be used by those over the age of 9.

In the numerical scale, the user has the option to
verbally rate their scale from 0 to 10 or to place a mark
on a line indicating their level of pain.
 0 indicates the absence of pain, while 10 represents the
most intense pain possible.
Numerical Rating
Pain Scale
Assessing Pain in Children

Children’s
 Behavioral Responses Understanding of Pain
and Verbal
Descriptions of Pain by by Developmental
Children of Different Stages

Developmental Stages Refer to Table 18-3
 Refer to Table 18-4

Henny SM
Pain Assessment Tools

Newborn/ Infant:

CRIES

Developed for use in preterm and ft infants in ICU

Measures crying, O2 sat, HR, BP, expression and sleeplessness

Neonatal Infant Pain Scale (NIPS)

Evaluates facial expression, cry, breathing, arms, legs and state of
arousal

Premature Infant Pain Profile (PIPP)

Gestational age, behavioral state, HR, O2 sat, brow bulge, eye
squeeze, and nasolabial furrow; often used for procedural and post-
op pain

Henny SM
CRIES neonatal
postoperative Pain Scale

Refer to table 18-5

Henny SM
Neonatal Infant Pain
Scale (NIPS)

The Neonatal Infant Pain Scale (NIPS) is a
behavioral scale and can be utilized with both
full-term and pre-term infants.

From birth to one year of age

The tool was adapted from the CHEOPS
scale and uses the behaviors that nurses have
described as being indicative of infant pain or
distress.
Neonatal Infant Pain Scale
(NIPS)
Neonatal Infant Pain Scale
(NIPS)
NIPS Scale

Refer to table 18-6

Recommended for children
under 1 year old.

A score of 3 or more= pain

Henny SM
Neonatal Infant Pain Scale
(NIPS)

Henny SM
FLACC
0 1 2
FACE No particular Occasional grimace Frequent to constant
expression or smile or frown, quivering chin,
withdrawn, clenched jaw
disinterested
LEGS Normal position or Uneasy, restless, Kicking or legs drawn
relaxed tense up
ACTIVITY Lying quietly, Squirming, shifting Arched, rigid, or jerking
normal position, back and forth,
moves easily tense
CRY No cry Moans or Crying steadily, screams
whimpers, or sobs
occasional
complaints
CONSOLABILITY Content, relaxed Reassured by Difficult to console or
touching, hugging, comfort
voice, distraction
Henny SM
Children between 3-8 years

Usually have a word for pain

Can articulate more detail about the
presence and location of pain; less able
to comment on quality or intensity

Examples:

Color scales

Faces scales

Henny SM
Wong Baker Faces Pain Scale


The Wong Baker Faces Pain Scale combines
pictures and numbers to allow pain to be rated by
the user.

It can be used in children over the age of 3, and in
adults.

The faces range from a smiling face to a sad, crying
face.

A numerical rating is assigned to each face, of which
there are 6 total.
Wong Baker Faces
Pain Scale

0 2 4 6 8 10
THANK YOU

TIM WS Nyeri Departmen Anestesi dan Terapi Intensif FK UNPAD/RSUP DR Hasan


Sadikin Bandung Dr dr Tinni Maskoen SpAn KIC KMN MKES
Dr dr Suwarman SpAn KIC KMN MKES
dr Andy Prihartono SpAn KAR KMN-FIPP Mkes
dr Gezy Weita Giwangkancana SpAn
Dr Henny M S.Kep M.Kep
Ani M S.Kep M.Kep