2.7a Pain and Sleep Flashcards
Negative Effects of Pain
Physiologic responses to pain Interferes with sleep quantity and quality Metabolism and myocardial oxygen demand Breakdown of Body tissue Impaired Immune function
Types of Pain
8 types
Central: neurological disorder caused by damage to the sensory pathways of the central nervous system (epilepsy, Parkinson’s)
Myofascial: chronic condition that causes pain in the musculoskeletal system. This pain is confined to a particular area (overuse/acute muscle injury, plantar fasciitis, a tension HA)
Neuropathic: damage or injury to the nerves that transfer information between the brain and spinal cord from the skin, muscles and other parts of the body (no obvious injury, carpel tunnel, diabetic neuropathy)
Phantom: missing body part, damaged/dysfunctional nerve endings)
Psychogenic: describe a pain disorder attributed to psychological factors (anxiety HA, emotional situation)
Radicular pain: pain that radiates from your back and hip into your legs through the spine
Somatic: pain receptors in tissues (including the skin, muscles, skeleton, joints, and connective tissues) are activated. Typically, stimuli such as force, temperature, vibration, or swelling activate these receptors. This type of pain is often described as: cramping
Visceral: pain receptors in the pelvis, abdomen, chest, or intestines are activated. We experience it when our internal organs and tissues are damaged or injured (gallbladder, kidney stones)
Characteristics of Pain
Acute pain
Acute pain: sudden onset, self limited, localized. Can be identified
Acute Visceral pain receptors in the pelvis, abdomen, chest, or intestines are activated. We experience it when our internal organs and tissues are damaged or injured
Acute Refereed pain
Acute Cutaneous pain
Acute Deep Somatic pain: occurs when pain receptors in tissues (including the skin, muscles, skeleton, joints, and connective tissues) are activated. Typically, stimuli such as force, temperature, vibration, or swelling activate these receptors
Characteristics of Pain
Chronic Pain
Chronic Pain:
Recurrent acute pain well defined episodes of pain and times with no pain (migraine HA)
Chronic malignant pain caused by life threatening disease (cancer)
Chronic nonmalignant pain persists beyond time expected (back pain)
Breakthrough Pain
Breakthrough Pain : can be chronic or persistent Sudden Flare up Temporary Debilitating Unpredictable Inconsistent Distressing
Nociceptive pain
Nociceptive pain is a type of pain caused by damage to body tissue. Nociceptive pain feels sharp, aching, or throbbing. It’s often caused by an external injury, like stubbing your toe, having a sports injury, or a dental procedure
Peripheral or visceral
Chronic or acute
Neuropathic Pain
Neuropathic pain is caused by damage or injury to the nerves that transfer information between the brain and spinal cord from the skin, muscles and other parts of the body. The pain is usually described as a burning sensation and affected areas are often sensitive to the touch
Lesion or disease affecting somatosensory
Factors Affecting Responses to Pain
Age: older adult pain conduction is slower to respond to pain. More acute and chronic pain. Older age decreased tolerance for pain
Gender: women have lower pain threshold but experience higher pain
Sociocultural influenced by family and community.
Psychologic Influences: depression, lack of sleep can cause increased pain sensation
Past experience with pain
Pain threshold
Caring for a patient in pain
Interprofessional care
Collaborative Care
Pain clinics
Hospices
Medication
Nonopioids
Acetaminophen
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Opioid analgesics (narcotic)
**assess gastrointestinal, BP, cardiovascular with long term use, respiratory, vasodilation, cough reflex
Medications
types
Agonist/antagonist
Agonist: binds to receptor which initiates a physiological/biological response when combined with a receptor
Mixed agonist-antagonist: drug which under some conditions behaves as an agonist while under other conditions, behaves as an antagonist (agonist produces actions, antagonist inhibits action)
Partial agonist: drugs that bind to and activate a given receptor, but have only partial efficacy at the receptor relative to a full agonist
Adrenergic Agonist: drug that stimulates a response from the adrenergic receptor
Medications
types
Antidepressant: can also be used to treat pain, can cause orthostatic, urinary retention, impaired memory
Anticonvulsants: shingles, herpes, migraine HA, diabetic neuropathy, also used to reduce pain, improve sleep
Local anesthetics: blocks pain, muscle relaxants
Reversal Agents
Naloxone Opiate antagonist
Naloxone Opiate antagonist Rapid onset > 1 sec (Morphine, Methadone, Nalbuphine) Binds with opiate receptors Blocks effects of opioids
Reversal Agents
Flumazenil Benzodiazepine antagonist
Flumazenil Benzodiazepine antagonist
Rapid onset > 1 min (Monitor for seizure activity, can lower seizure threshold)
Versed (Midazolam) Valium (Diazepam)
Nursing Responsibilities R/T NSAIDs Use
Do not administer aspirin with other NSAIDs
Assess and document if the patient is taking hypoglycemic agent or insulin; the NSAIDs may increase the hypoglycemic effect
Administer with meals, milk or a full glass of water to decrease gastric irritation
Assess patients who are also taking anticoagulants for bleeding; the NSAIDs increase this risk
Nursing Responsibilities R/T Opioid Use
Keep an opioid antagonist
Assess allergies or adverse effects
Assess for respiratory disorders
Assess the characteristics of the pain
Take and record baseline vital signs
Administer the drugs, following established guidelines
Monitor vital signs and respiratory status
Provide for patient safety.
MONITOR SEDATION
Drug Management
Addiction
Drug abuse
Tolerance
Addiction treatable disease characterized by compulsive use of a substance despite negative consequences, such as health threats or legal problems
Drug abuse The use of any chemical substance for other than a medical purpose
Tolerance is a cumulative state in which a dose of the chemical elicits a smaller response than before. With increasedtolerance, the individual needs higherandhigher doses to obtain the desired effect.
Drug Management
Withdrawal
Respiratory Depression
Withdrawal is an uncomfortable state lasting several days, with S/S of tremors, diaphoresis, anxiety, high blood pressure, tachycardia, and possibly convulsions.
Respiratory Depression when an individual’s rate of breathing (respiration) falls to or below a sustained rate of 12 breaths per minute or the individual’s breathing rate fails to fully ventilate or profuse their lungs, the individual is suffering from respiratory
Nursing Interventions R/T Palliative Care
Advocate for adequatepain
Avoid unnecessary procedures, tests,andactivities for dying patients.
Provide time for the patientandfamily to be together.
Turnandreposition the patient only for comfort
Provide temperature comfort
Administer supplemental oxygen,
Obtain medication orders as needed
Treat restlessness and delirium aggressively
Five behavioral indicators ofpain
Five behavioral indicators ofpain
Breathing (normal, labored, hyperventilation),
Vocalization (moaning, calling out, crying),
Facial expression (smiling or without expression, sad, frowning, grimacing),
Body language (relaxed, tense, rigid, or striking out), and
Consolability (distractible, reassured, or unable to console
PAINADscale
see chart
What is intraspinal?
Intrathecal or epidural route
Manage chronic intractable malignant pain and postoperative pain
What is a nerve block?
Local anesthetic
May be combined with steroidal anti-inflammatory
Injected into or near a nerve usually in an area between the nociceptor and dorsal root
What is an implantable pump (intrathecal pump)?
An intrathecal pump is a battery-operated device which delivers medication directly into the spinal canal. Intrathecal pumps may be used to treat chronic pain or spasticity, and is sometimes used to treat cancer-related pain
What is neuroablative techniques
Neuroablation is a technique of selectively destroying nerves to relieve chronic pain. most target of neuroablation are purely or largely sensory nerves that do not server any vital functions
What is neuroaugmentation techniques
Neuroaugmentation is an invasive pain management technique incorporating various methods of electrical stimulation (e.g. of spinal cord and peripheral nerve) methods and implantable drug delivery systems to function. .
