220-comfort Flashcards
PAIN IS….
SUBJECTIVE
barriers to prevent healthcare
poor assessment of pain
Inadequate knowledge of pain management
biases and judgement regarding pain
the pain process
transduction- touches hot pan
transmission-signal to the brain
perception- ouch that is hot
modulaation- removes hand
gate control of pain
using another stimulus to divert the perception of pain.
categories of pain
duration
acute
chronic
responses to pain
physical
behavioral
affective
factors affecting pain experience
family, gender, age
environment and support from people
anxiety and other stressors
past pain experience
pain assessment is
asking and believing the patient
non verbal pain indicators
moaning
crying
grimacing
guard position
increased vs but not always especially with chronic pain
reduced social interactions
irritability
difficulty concentrating
changes in eating or sleeping
when should pain be assessed?
at regular intervals
with each new report of pain
after pharmacological and non pharmacological intervention (access pain and sedation)
pain scales used during assessment
FLACC IN EPIC
1-10 IN EPIC
Baker Wong Faces
Checklist of Non Verbal Indicators
PAINAD IN EPIP
Payen Behavior Pain Scale
quality of pain based on source
somatic
visceral
neuropathic
cutaneous
somatic
aching, deep, dull, gnawing, throbbing, sharp, stabbing
examples: muscle, tendon, bone injury
visceral
cramping, squeezing, pressure (referred to distant sites)
examples: gallstones, kidney stones, pancreatitis
cutaneous
superficial, skin or sub Q tissue cuts with sharp and burning sensation
neuropathic
burning, numbness, radiating, shooting, tingling, touch sensitive
examples- herpes zoster, peripheral neuropathy
pain assessment is not
relying on changes in VS
deciding what a patients pain is
deciding they do not have pain while sleeping
assuming they will tell you about pain
what is the WHO 3 step analgesic ladder?
one: pain is increasing or persisting (treat with non opioid/adjuvant drugs)
two: pain is increasing or persisting (treat with opioid/ adjuvant for mild pain)
three: pain is increasing or persisting (treat with opioid/adjuvant for moderate to severe pain
freedom from pain
morphine
considered the gold standard (nausea/vomiting common side effect)
adjuvant drugs
anticonvulsants
tricyclic-antidepressants
steroids
anti-anxiety
Patient controlled anesthesia (PCA)
must be alert to work the pump
patient is in control of pain
IV administration
max dose and locked out setting
can be used for continuous infusion
morphine, fentanyl, hydromorphone
typical PCA order
5 mg (150mg in 30 ML)
each dose 1-3 mg
lockout every 8-15 mins
hour hour limit 30-70mg
break through pain
flare up of moderate to severe pain that occurs even when the patient is taking around the clock ATC medication
physical dependance
the body physiologically adapts to the presence of an opioid and suffers withdrawal if the opioid id suddenly withdrawn
psychological dependence
a pattern of compulsive drug use characterized by continued craving for an opioid and the need to use the opioid for effect other then pain relief
tolerance
common physiological result of chronic opioid use, a larger dose of opioid is required to maintain the same level of analgesia
placebo
considered unethical, the use of a water pils to give the patients to trick their mind into thinking they got medication.
F or M: pain is a natural component of aging process
myth
F or M: pain is often unreported and leads to a higher risk for patient experiencing pain
Fact
F or M: adverse effects of pain medication are more dramatic in elderly due to decreased liver and renal function (drugs metabolize and excreted slower)
fact
