31 Pain, comfort, and sleep Flashcards

1
Q

Gate control theory

A

Pain transmission is viewed as being controlled by a gate mechanism in the CNS. Opening the gate allows the transmission of pain sensation, and closing the gate blocks the transmission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Endorphins

A

endogenous, naturally occurring, opiate-like peptides that reduce or block the perception of pain; comes from the words morphine and endogenous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Nociceptive pain; found where; examples

A

involves injury to the tissue where nociceptors are located; found in skin, joints, or organ viscera; trauma, burns, surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Nociceptive pain involves four phases

A

transduction, transmission, perception, modulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Transduction phase

A

begins when tissue damage causes the release of substances that stimulate the nociceptors and start the sensation of pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Transmission phase

A

involves movement of the pain sensation to the spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Perception phase

A

occurs when pain impulses reach the brain and the pain is recognized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Modulation phase

A

occurs when the neurons in the brain send signals back down the spinal cord by release of neurotransmitters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Neuropathic pain

A

usually associated with a dysfunction of the nervous system- specifically, an abnormality in processing sensations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Examples of neuropathic pain

A

pain receptors in the body become sensitive to stimuli and send pain signals more easily. Nerve endings grow additional branches that send stronger pain signals to the brain. As branches grow they influence touch and warmth receptors, these receptors began to send pain signals. In some cases (DM, Guillanin- Barre syndrome, MS, cancer, HIV, and nutritional deficiencies) the pain signal that normally moves from the periphery toward the brain reverses and is sent in the opposite direction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Type of pain pt is experiencing will help determine what

A

best method to relieve pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Standards relative to direct pt care state:

A

-pt has right to appropriate assessment and management of pain
-pain is assessed in all pt’s
-pt’s are educated about pain and managing pain as part of treatment, as appropriate
-discharge process provides for containing pain care based on the pt’s assessed needs at the time of discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How treatment differs per type of pain (acute and chronic)

A

-acute pain is usually well controlled with analgesics or surgery
-chronic pain is usually treated with pharmacologic and nonpharmacologic treatments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

cause of acute pain is often easily _____

A

determined

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

acute pain may be accompanied by an increase in what

A

increased: heart rate, bp, rr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

acute pain relieved by

A

rest of affected part, medications for infections and inflammations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What’s the issue with taking pain medications before seeing the dr

A

can mask symptoms that the dr needs to observe to establish a diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Acute pain is often a warning of this; what does it allow

A

potential or true tissue damage; allows pt to withdraw from the source or to seek help in relieving symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How is pain transmitted

A

to the brain through the nervous system- afferent (sensory) neurons leading to the spinal nerves and then to the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Gate theory: how do the small and large diameter nerve fibers differ

A

-gate may be opened by activity in the small-diameter from things like tissue damage.
-large-diameter nerve fibers such as massage or vibration seem to close the gate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What’s a possible reason people who are bored and lonely seem to have more intense pain than when they are occupied or distracted by visitors or an interesting program or activity

A

brainstem impulses caused by a high sensory input seem to close the gate, where a lack of this input allows the gate to open

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Chronic pain maybe expresses as this type of pain ___; and be treated with _____ and _____ interventions

A

-dull, constant, shooting, tingling, or burning
-both pharmacologic and nonpharmacologic interventions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

5 types of pain

A

acute
nociceptive
chronic
phantom
neuropathic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Treatment of nociceptive pain may be directed towards-

A

one or all four phases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

NSAIDs work by

A

blocking the production of the substances that trigger the nociceptors in the transduction phase

26
Q

Drugs that interfere with the transmission phase

A

opioids

27
Q

Phase where nonpharmacologic treatments may be effective- such as guided imagery

A

perception phase

28
Q

Drugs that block the neurotransmitter uptake work in this stage

A

modulation

29
Q

Phantom pain may be controlled by (when conventional methods do not work)

A

continuous electrical stimulation from electrodes surgically implanted in the thalamus

30
Q

Why an older person might not express pain; what they may say instead

A

-they may believe it’s a logical consequence of aging
-they do not want to be a bother
-because they have been culturally trained not to complain
–aching, soreness, discomfort, stiffness rather than pain

31
Q

Neuropathic pain treated with (4)

A

NSAIDs, tricyclic antidepressants, anticonvulsants, or corticosteroids

32
Q

An illness that usually occurs after a mild viral infection such as a sore throat, or flu, or after vaccination or surgical procedure

A

Guillain-Barre syndrome

33
Q

How can fear and apprehension affect pain; what nonpharmacological treatment might relieve pain

A

may accelerate pain; relaxation

34
Q

Focused assessment: What to ask; Hx of pain

A

-events of factors that precipitate the pain
-location
-radiation
-intensity
-quality (what the pain feels like)
-aggravating factors
-relieving measures
-past: episodes, successful treatments, surgeries

35
Q

Focused assessment: What to ask; Medications

A

past and present treatment - Rx’s, otc’s, herbal, alcohol or drug use

36
Q

Focused assessment: verbal indicators

A

the severity of pain (pain scale), words used to describe pain, moaning, crying, as well as timing of when the pain began and whether it has changed

37
Q

Focused assessment: What to observe; nonverbal indicators

A

grimacing, guarding, splinting, evident muscle tension, pacing, rocking, fetal positioning, wincing, inability to sleep, restless movements, and withdrawal from others

38
Q

Focused assessment: What to ask; social or psychological factors

A

fear or anxiety, extreme stress, worry, or depression

39
Q

Focused assessment: What to ask; treatments used

A

medications, heat/cold, massage, vibration, acupuncture, chiropractic adjustment, brace or splint

40
Q

Focused assessment: What to ask; contributing factors

A

constipation, sleep deprivation, fatigue, constant cough, rash, GI upset, or reflux

41
Q

For confused pt- watch for these nonverbal cues

A

restlessness, rocking, pacing, rigidity, guarding, wincing, crying, grimacing with movement, new inability to sleep, hypersensitivity to touch, withdrawal from usual contact with others, moaning, or grunting

42
Q

TENS; brief description

A

transcutaneous electrical nerve stimulation; small electrical stimulator attached to electrodes to block pain

43
Q

TENS is more effective in treatment of chronic or acute pain

A

chronic

44
Q

PENS; brief description

A

percutaneous electrical nerve stimulation; electric current sent through thin needle probes positioned in the soft tissues and muscles of the back, series of intermittent treatments using the electric current are given

45
Q

Biofeedback is a specialized relaxation technique using a machine that measures this

A

the degree of muscular tension with electrodes

46
Q

Medical methods of pain control (4)

A

analgesic medications, patient-controlled analgesia, epidural analgesia, implantable pumps

47
Q

analgesic medication options; routes; examples

A

-oral- mild to moderate to severe (time-released morphine)
-topical- various preparations; gel, cream, patch (Lidoderm patch for neuropathic pain, Fentanyl for severe chronic pain)
-injected; IM or Subcut, usually for severe pain (usually for a relatively short period of time), lasts several hours, painful for pt, prolonged use detrimental to the tissues
-IV- given as a bolus (concentrated dose given rapidly), a slow push (over a few min), as an intermittent infusion, or by continuous infusion

48
Q

Patient-controlled pump (PCA); what benefit does this provide to the pt

A

-the most common method used for injectable opioids in acute care
-PCA reduces pt anxiety about the pain by putting pt in control, pt’s typically use less medication

49
Q

Epidural analgesia; where inserted; benefit of this type of analgesia

A

-thin catheter in epidural space near the base of the spine connects the catheter to a small battery-operated programmable pump
-this method is effective in controlling pain while allowing pt to remain alert

50
Q

Implantable pump; what type of pain; how it is implanted and when it’s refilled

A

-pt’s with chronic severe pain
-small pump implanted and attached to an intraspinal catheter providing long-term pain relief
-pump is placed in the subcutaneous tissue of the abdomen, the attached catheter is threaded intrathecally
-pump refilled every 30-90 days (depending on flow rate/ reservoir size)

51
Q

Categories of analgesic medications (4); mode of action; examples

A

-nonopioid analgesics, including NSAIDs; Block pain at the peripheral nervous system level; otc’s like aspirin, naproxen, ibuprofen, acetaminophen & Rx ibuprofen, naproxen, indomethacin
-COX-2 inhibitors; Block the COX-2 enzyme, which plays a role in arthritis pain; anti-inflammatories- celecoxib is currently the only FDA-approved COX-2 inhibitor
-narcotics or opioids; Block pain at the CNS level; Narcotic agonists- morphine, oxycodone, hydrocodone, hydromorphone, codeine, levorphanol, oxymorphone, and meperidine (used less frequent due to side effects)
-adjuvant analgesics; various methods of action; Anticonvulsants: phenytoin, carbamazepine
Antidepressants: amitriptyline, imipramine, SSRIs
Muscle relaxants: baclofen
Stimulants: caffeine, dextroamphetamine

52
Q

NIPS; PIPP

A

Neonatal Infant Pain Scale; Premature Infant Pain Profile scale

53
Q

Benefits of adequate rest in regards to analgesia

A

Increases pain tolerance and allows improved response to analgesia

54
Q

Stage of sleep when hr, bp, respirations are similar to that when awake

A

REM

55
Q

During the night person will go through how many sleep states in 90-min cycles; repeats how often

A

two; 5-6x a night

56
Q

four stages of NREM; activity; lasts

A

-transition stage; light sleep, relaxed muscles; few min
-stage 2; deeper sleep, larger brain wave activity w/ bursts of electrical activity; 10-20 min
-stage 3; delta sleep or slow-wave sleep, rr and hr slow, body becomes immobile, dreaming; 20-40 min
-stage 4; deepest stage, difficult to arouse the sleeping person; 30 min

57
Q

Sleep needs: Newborn, age 1, preschool, school-age, adolescents, adults

A

16hrs; 12-14hrs; 11-13 hrs; 10-11 hrs; 9-10 hrs; 8 hrs

58
Q

transient insomnia

A

caused by stress, excitement, or change in sleeping arrangements

59
Q

chronic insomnia root

A

may be underlying medical, behavioral, or psychiatric problem (like depression)

60
Q

Adults with sleep apnea have an increased risk of; infants with sleep apnea have an increased risk of

A

heart attack; SIDS