ch 44- pain management Flashcards
1
Q
defines it as “an unpleasant, subjective sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
A
International Association for the Study of Pain (IASP)
2
Q
improves quality of life, reduces physical discomfort, promotes earlier mobilization and return to previous baseline functional activity levels, results in fewer hospital and clinic visits, and decreases hospital lengths of stay, resulting in lower health care costs.
A
Effective pain management
3
Q
transduction, transmission, perception, and modulation
A
four physiological processes of nociception:
4
Q
is the protective physiologic series of events that bring awareness of actual or potential tissue damage.
A
nociceptive pain
5
Q
observable activity in the nervous system in response to an adequate stimulus (third-person perspective)
A
nociceptive pain
6
Q
is the process whereby an activated nociceptor converts energy produced by these stimuli (e.g., exposure to pressure or a hot surface) into an action potential
A
Transduction
7
Q
thermal, chemical, or mechanical stimuli can cause nociceptive pain when the amount of stimuli is strong enough to meet the activation threshold of nociceptors, which are specialized nerve endings distributed throughout the skin, muscles, joints, and viscera
A
Transduction
8
Q
-Generated from the breakdown of phospholipids in cell membranes
• Thought to increase sensitivity to pain
A
Prostaglandins (Neurophysiology of Pain: Neuroregulators)
9
Q
- Released from plasma that leaks from surrounding blood vessels at the site of tissue injury
- Binds to receptors on peripheral nerves, increasing pain stimuli
- Binds to cells that cause the chain reaction producing prostaglandins
A
Bradykinin(Neurophysiology of Pain: Neuroregulators)
10
Q
- Found in pain neurons of dorsal horn (excitatory peptide)
- Needed to transmit pain impulses from periphery to higher brain centers
- Causes vasodilation and edema
A
Substance P(Neurophysiology of Pain: Neuroregulators)
11
Q
• Produced by mast cells, causing capillary dilation and increased capillary permeability
A
Histamine(Neurophysiology of Pain: Neuroregulators)
12
Q
• Released from the brainstem and dorsal horn to inhibit pain transmission
A
Serotonin(Neurophysiology of Pain: Neuroregulators)
13
Q
- Are the natural supply of morphinelike substances in the body
- Activated by stress and pain
- Located within the brain, spinal cord, and gastrointestinal tract
- Cause analgesia(inability to feel pain) when they attach to opiate receptors in the brain
- Present in higher levels in people who have less pain than others with a similar injury
A
Neuromodulators (Inhibitory)/(Neurophysiology of Pain: Neuroregulators)
14
Q
neurons carrying nociceptive input include projection neurons, local interneurons, and propriospinal neurons.
A
Dorsal horn
15
Q
transmit sharp, localized nociceptive information
A
fast-transmitting myelinated A-delta fibers (transmission)
16
Q
relay impulses that are dull, achy, and poorly localized
A
smaller-diameter unmyelinated C fibers (transmission)
17
Q
Once a pain stimulus reaches the cerebral cortex, the brain interprets the quality of the pain and processes information from past experience, knowledge, and cultural associations in the perception of the pain
A
Perception
18
Q
person is aware of nociceptive impulses and perceives pain.
A
Perception
19
Q
identifies the location and intensity of pain
A
somatosensory cortex(Perception)
20
Q
primarily the limbic system, determines how a person feels about it. There is no single pain center.
A
association cortex (Perception)
21
Q
Projection neurons activate endogenous descending inhibitory mediators (see Box 44.1), such as endorphins (endogenous opioids), serotonin, norepinephrine, and gamma-aminobutyric acid (GABA), that aid in producing an analgesic effect
A
Modulation (fourth and last phase of the normal pain process)
22
Q
Projection neurons activate endogenous descending inhibitory mediators , such as endorphins (endogenous opioids), serotonin, norepinephrine, and gamma-aminobutyric acid (GABA), that aid in producing an analgesic effect
A
Modulation (fourth and last phase of the normal pain process)
23
Q
include expansion of the pain beyond the initial location, exaggerated response to noxious(harmful) stimuli known as hyperalgesia(increased sensitivity/ response to pain), and pain in response to normally non-noxious stimuli, also called allodynia.
A
Clinical manifestations of central sensitization//
Modulation (fourth and last phase of the normal pain process)
24
Q
include trauma, drugs, tumor growth, and metabolic disorders.
A
factors that disrupt the pain process
25
Pain of low-to-moderate intensity and superficial pain elicit the
fight-or-flight reaction of the general adaptation syndrome
26
Stimulation of the ? results in physiological responses
sympathetic branch of the ANS
27
Continuous, severe, or deep pain typically involving the visceral organs (e.g., with a myocardial infarction or colic from gallbladder or renal stones) activates the
parasympathetic nervous system
28
was the first to suggest that pain has emotional and cognitive components in addition to 1063 physical sensations. The theory explains how rubbing an injured area can reduce pain
Melzack and Wall’s gate-control theory (1965)
29
effect: Provides increased oxygen intake
Dilation of bronchial tubes and increased respiratory rate (Sympathetic Stimulation response)
30
effect: Provides increased oxygen transport
Increased heart rate(Sympathetic Stimulation response)
31
effect: Elevates blood pressure with shift of blood supply from periphery and viscera to skeletal muscles and brain
Peripheral vasoconstriction (pallor(pale), elevation in blood pressure)(Sympathetic Stimulation response)
32
effect: Provides additional energy
Increased blood glucose level(Sympathetic Stimulation response)
33
effect: Heightened memory functions, a burst of increased immunity, and lower sensitivity to pain
Increased cortisol level (short term)(Sympathetic Stimulation response)
34
effect: Controls body temperature during stress
Diaphoresis (Sympathetic Stimulation response)
35
effect:Prepares muscles for action
Increased muscle tension(Sympathetic Stimulation response)< fight or flight Resp
36
effect: Affords better vision
Dilation of pupils(Sympathetic Stimulation response)
37
effect: Frees energy for more immediate activity
Decreased gastrointestinal motility(Sympathetic Stimulation response)
38
effect: Causes blood supply to shift away from periphery
Pallor(Parasympathetic Stimulation )
39
effect: Vagus nerve sends impulses to chemoreceptor trigger zone in the brain
Nausea and vomiting(Parasympathetic Stimulation )
40
effect: Results from vagal stimulation
Decreased heart rate and blood pressure(Parasympathetic Stimulation )
41
effect: Causes body defenses to fail under prolonged stress of pain
Rapid, irregular breathing(Parasympathetic Stimulation )
42
pain response is complex, influenced by a person’s culture, pain experiences, perception of pain, and ability to manage stress. If left untreated or unrelieved, pain significantly alters quality of life with physical and psychological consequences; this phenomenon is referred
high-impact pain
43
Clenching the teeth, facial grimacing(uncontrolled spasms in face), holding or guarding the painful part, and bent posture are common indications of
acute pain
44
can affect a patient’s activity (eating, sleeping, socialization), thinking (confusion, forgetfulness), emotions (anger, depression, irritability), quality of life, and productivity
Chronic pain
45
acute (transient) and chronic (persistent)
two types of pain
46
identifiable cause, is of short duration, and has limited tissue damage and emotional response. It is common after acute injury, disease, or surgery
acute (transient)
47
threatens a patient’s recovery by hampering his or her ability to become active and involved in self-care. This results in prolonged hospitalization from complications such as physical and emotional exhaustion, immobility, sleep deprivation, and pulmonary complications.
Complete pain relief is not always achievable, but reducing pain to a tolerable level is a realistic goal.
acute (transient)
48
not protective and thus serves no purpose, but it has a dramatic effect on a person’s quality of life
Chronic pain
49
- not protective
| - does not always have an identifiable cause
Chronic pain
50
- include arthritis, low back pain, headache, fibromyalgia, and peripheral neuropathy
-may be viewed as a disease
-significant psychological and cognitive effects and can constitute a serious, separate disease entity itself.
non–life threatening
chronic noncancer pain
51
is a major cause of psychological and physical disability, leading to problems such as job loss, inability to perform simple daily activities, sexual dysfunction, and social isolation. The goal of treating chronic noncancer pain is to improve functional status with a multimodality plan.
Chronic pain noncancer pain
52
Associated symptoms include fatigue, insomnia, anorexia, weight loss, apathy(lack interest), hopelessness, depression, and anger
- does not show obvious symptoms and does not adapt to the pain
- labeled as drug seeker
chronic pain(noncancer pain)
53
specialize in diagnostic testing and in noninvasive and invasive treatments that patients may be able to obtain from their general health care providers
Pain centers
54
Pain that occurs sporadically over an extended period of time is
- last for hours, days, or weeks
ex: migraine headache that occurs up to 14 days per month
episodic pain
55
ain is normal (nociceptive), resulting from stimulus of an undamaged nerve, and/or neuropathic, arising from abnormal or damaged pain nerves
-caused by tumor progression and related pathological processes, invasive procedures, toxicities of chemotherapy, and infection
cancer pain
56
Normal stimulation of special peripheral nerve endings—called nociceptors; usually responsive to nonopioids and/or opioids.
Nociceptive pain (like touch)
57
Comes from bone, joint, muscle, skin, or connective tissue; is usually aching or throbbing in quality and well localized
Somatic pain:(Nociceptive pain)
58
Arises from visceral organs such as the gastrointestinal tract and pancreas; is sometimes subdivided:
1. Tumor involvement of organ capsule that causes aching and fairly well-localized pain.
2. Obstruction of hollow viscus, which causes intermittent cramping and poorly localized pain.
Visceral pain(Nociceptive pain)
59
Pain caused by a lesion or disease of the somatosensory nervous system; treatment usually includes adjuvant analgesics.
Neuropathic pain
60
Injury to either the peripheral or central nervous system.
ex: phantom pain-peripheral NS
burning pain below the level of a spinal cord lesion reflects injury to the central nervous system
Deafferentation pain:(Centrally generated pain)// Neuropathic pain
61
Associated with impaired regulation of the autonomic nervous system.
Examples: Pain is associated with complex regional pain syndrome, type I(no nerve injury), type II. (nerve dysfunction)
Sympathetically maintained pain(Centrally generated pain)// Neuropathic pain
62
Pain felt along the distribution of many peripheral nerves.
Examples: Diabetic neuropathy, alcohol-nutritional neuropathy, and Guillain-Barré syndrome.(immune sys attacks nerve= ascending paralysis)
Painful polyneuropathies (Peripherally generated pain)//Neuropathic pain
63
Usually associated with a known peripheral nerve injury; pain is felt at least partly along the distribution of the damaged nerve.
Examples: Nerve root compression, nerve entrapment, trigeminal neuralgia (affect nerve face to brain)
Painful mononeuropathies(Peripherally generated pain)//Neuropathic pain
64
is chronic pain in the absence of an identifiable physical or psychological cause or pain perceived as excessive for the extent of an organic pathological condition
ex: complex regional pain syndrome (CRPS)
Idiopathic pain
65
including cultural (e.g., gender, age, education), knowledge, and patient diagnosis, contribute to the differences in?
pain ratings
66
is a complex process, involving physiological, social, spiritual, psychological, and cultural influences
Pain
67
is not an inevitable part of aging. Likewise ? perception does not decrease with age.
Pain
68
may be associated with impaired physical function, falls, diminished appetite, dysmobility, impaired sleep, depression, anxiety, agitation and delirium, as well as more subtle decrements in cognitive function
Persistent pain
69
may lead to a less predictable response to analgesics, increased sensitivity to medications, and potentially harmful drug effects
age-related changes and increased frailty (weak)
70
muscle mass decreases, body fat increases, and percentage of body water decreases.= increases the concentration of water-soluble
- frequently eat poorly, resulting in low serum albumin levels. Many analgesics are highly protein bound. In the presence of low serum albumin, more free drug (active form) is available, thus increasing the risk for side effects or toxic effects
- decline of liver and renal function naturally occurs with aging=reduced metabolism and excretion of drug=greater peak effect and longer duration of analgesics
- changes in the skin such as thinning and loss of elasticity (resume its shape)affect the absorption rate of topical analgesics.
Older AdultsFactors Influencing Pain in Older Adults
71
have been identified for pain in musculoskeletal, neuropathic, and vascular conditions, as well as migraine
Numerous genetic risk factors
72
have been shown to play 1067a role in sensitivity, perception, and expression of pain in a variety of conditions
Genetic influences on pain
73
actor that interrupts or influences normal pain reception or perception (e.g., spinal cord injury, peripheral neuropathy, or neurological disease)
Neurological Function
74
relaxation, guided imagery, and massage. By focusing patients’ attention and concentration on other stimuli, their perception of pain declines
Attention//Psychological Factors
75
A: Ask about pain regularly. Assess pain systematically.
B: Believe patient and family in their report of pain and what relieves it.
C: Choose pain control options appropriate for the patient, family, and setting.
D: Deliver interventions in a timely, logical, and coordinated fashion.
E: Empower patients and their families. Enable them to control their course to the greatest extent possible.
ABCDE pain assess/ managment
76
Pain resulting from stimulation of skin
| Pain is of short duration and localized. It usually is a sharp sensation. ex needle stick, cut, laceration
Superficial or Cutaneous ( Classification of Pain By Location)
77
Pain resulting from stimulation of internal organs
Pain is diffuse and radiates in several directions. Duration varies, but it usually lasts longer than superficial pain. Pain is sharp, dull, or unique to organ involved.
ex Crushing sensation (e.g., angina pectoris); burning sensation (e.g., gastric ulcer)
Deep or Visceral (Classification of Pain By Location)
78
Common in visceral pain because many organs themselves have no pain receptors (The entrance of sensory neurons from affected organ into same spinal cord segment as neurons from areas where individual feels pain causes perception of pain in unaffected areas.)
ex Myocardial infarction, which causes referred pain to the jaw, left arm, and left shoulder; kidney stones, which refer pain to groin
Referred (Classification of Pain By Location)
79
Sensation of pain extending from initial site of injury to another body part
Pain feels as though it travels down or along body part. It is intermittent or constant.
ex: Low back pain from ruptured intravertebral disk accompanied by pain radiating down leg from sciatic nerve irritation
Radiating
80
requires patients to rate pain on an 11-point line of 0 to 10, with 0 representing no pain and 10 representing the worst pain the patient can imagine (gd w/disabilities)
numerical rating scale (NRS)
81
consists of a line with two- to six-word descriptors equally spaced along the line
verbal descriptive scale (VDS)
82
consists of a straight line without labeled subdivisions
visual analog scale (VAS)
83
provides a pictorial representation of pain intensity (3 yrs or older)
Wong-Baker Faces Pain Rating Scale (FPS-revised)
84
series of photographic images of faces in varying degrees of distress(2 yr old)/ specific ethnic grps-Asian, Hispanic, and African American
Oucher pain scale (0-10)
85
is often described as crushing or viselike
myocardial infarction
86
described as dull, aching, and throbbing, indicating nociceptive pain
pain of a surgical incision
87
is usually pricking pain, burning, electric-like, or numbness
neuropathic pain
88
assess verbalization, vocal response, facial and body movements, and social interaction
Behavioural Effects of pain
89
Moaning
• Crying
• Gasping
• Grunting
Vocalizations (Behavioral Indicators of Effects of Pain)
90
* Grimace
* Clenched teeth
* Wrinkled forehead
* Tightly closed or widely opened eyes or mouth
* Lip biting
Facial Expressions (Behavioral Indicators of Effects of Pain)
91
* Restlessness
* Immobilization
* Muscle tension
* Increased hand and finger movements
* Pacing activities
* Rhythmic or rubbing motions
* Protective movement of body parts
* Grabbing or holding a body part
Body Movement (Behavioral Indicators of Effects of Pain)
92
* Avoidance of conversation
* Focus only on activities for pain relief
* Avoidance of social contacts
* Reduced attention span
* Reduced interaction with environment
Social Interaction (Behavioral Indicators of Effects of Pain)
93
include meditation, yoga, Zen, guided imagery, and progressive relaxation exercises
Relaxation techniques
94
transcutaneous electrical nerve stimulation (TENS) may reduce pain perception. One suggestion is that it causes release of endorphins, thus blocking the transmission of painful stimuli. The gate-control theory suggests that cutaneous stimulation activates larger, faster-transmitting A-beta sensory nerve fibers. This closes the gate, thus decreasing pain transmission through small-diameter C fibers
Cutaneous Stimulation
95
is contraindicated in cases of muscle, bone, or joint injury; bruised, swollen, or inflamed areas
Massage
96
helps to relieve the pain from a tension headache
| -chronic pain
moist heat
97
applications reduce the acute pain from inflamed joints
- tooth or mouth pain
- effective before vaccine injections.
cold
98
works both peripherally and centrally: centrally it acts by activating sites in the spinal cord and brainstem that use opioid and serotonin receptors; peripherally neuroreceptors at the site of the TENS application produce analgesia
-can be applied at various frequencies (<10 Hz to >50 Hz) and intensity (sensory versus motor)
TENS
99
gd for acute, emergent, and postsurgical and procedural pain control
-Stimulation intensity has been shown to be the critical factor
TENS
100
(1) nonopioids, including acetaminophen and nonsteroidal antiinflammatory drugs (NSAIDs); (
2) opioids (traditionally called narcotics);
(3) adjuvants or co-analgesics, a variety of medications that enhance analgesics or have analgesic properties
three types of analgesics:
101
. Acetaminophen (Tylenol), considered one of the most tolerated and safest analgesics available, is available in a variety of over-the-counter (OTC) oral medications (e.g., cold and flu remedies) or rectal forms and in an intravenous (IV) preparation (Ofirmev)
-direct effect on the central nervous system by selectively inhibiting cyclooxygenase (enzyme)
Nonopioids
102
has analgesic and antipyretic (no fever)
- maximum 24-hour dose is 4 g like aspirin
- combined with opioids (e.g., oxycodone, hydrocodone, tramadol) because it reduces the dose of opioid needed to achieve successful pain control.
- cause hepatotoxicity; treat w/ acetylcysteine
Acetaminophen ((APAP)
| 325 mg/tablet
103
such as aspirin, ibuprofen, and naproxen relieve mild-to-moderate acute intermittent pain such as that from headache or muscle strain.
Nonselective NSAIDs
104
Treatment of mild-to-moderate postoperative pain begins with an NSAID unless contraindicated
- inhibiting cyclooxygenase (COX), the enzyme that synthesizes prostaglandins
- drugs inhibit cellular responses to inflammation
- act on peripheral nerve receptors to reduce transmission of pain stimuli and inflammation
- asthma or an allergy to aspirin are also allergic to NSAIDs
NSAID
105
depress the central nervous system, & interfere with bowel or bladder function
opioids
106
increase gastrointestinal irritation because COX normally synthesizes the prostaglandins that protect gastric mucosa. may reduce renal blood flow since COX causes vasodilation to maintain renal blood flow.
- use in the older patient is not recommended because it is associated with more frequent adverse effects (gastrointestinal bleeding as well as renal insufficiency)
NSAIDs
107
Mild-to-moderate musculoskeletal pain in older adults i
Acetaminophen (APAP)
108
moderate-to-severe pain. In any acute pain situation, opioids are not always necessary, but with severe trauma and immediately postoperatively, short-term use of opioid medications
opioids
109
act on higher centers of the brain and spinal cord by binding with opiate receptors to modify perceptions of pain
- morphine, codeine, hydromorphone, fentanyl, oxycodone, and hydrocodone
- side effects: nausea, vomiting, constipation, and memory and thought changes
opioids
110
* Thought and memory impairment
* Drowsiness, sedation, and sleep disturbance
* Confusion
* Hallucinations, potential for diminished psychomotor performance
* Delirium
* Depression
* Dizziness and seizures
Central Nervous System (CNS) Toxicity// Opioid Side Effects
111
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Ocular
• Pupil constriction
Respiratory
• Bradypnea
• Hypoventilation
Cardiac
• Hypotension
• Bradycardia
• Peripheral edema
Gastrointestinal
• Constipation
• Nausea and vomiting
• Delayed gastric emptying
Genitourinary
• Urinary retention
Endocrine
• Hormonal and sexual dysfunction
• Hypoglycemia—reported with tramadol and methadone
Skin
• Pruritus
Immunological
• Immune system impairment possible with chronic use
Musculoskeletal
• Muscle rigidity and contractions
• Osteoporosis
Pregnancy and Breastfeeding
• When at all possible, avoid opioid use during pregnancy to prevent fetal risks
Tolerance
• Over time, increased doses needed to obtain analgesic effect
Withdrawal Syndrome
• Rapid or sudden cessation or marked dose reduction may cause rhinitis, chills, pupil dilation, diarrhea, “gooseflesh”
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Opioid Side Effects
112
naloxone (0.4 mg diluted with 9 mL saline) I
revere opiod
113
sedation always occur before rr
| -effective for acute pain and cancer pain of moderate or severe intensity
opiod
114
combines drugs with at least two different mechanisms of action to optimize pain control. Medications are combined to target different sites in the peripheral or central pain pathways
Multimodal analgesia
115
can interact adversely with CNS depressants, anticholinergic drugs, hypotensives, and monoamine oxidase inhibitors
morphine-like drugs
116
Dizziness, confusion, and changes in vision are opioid-related side effects that pose increased safety risks for the elderly;
-Do not mix opioids with alcohol, antihistamines, barbiturates, benzodiazepines, other sedatives, or muscle relaxants.
opiod
117
are medication orders in which a dose varies over a prescribed range to provide flexibility 1086in dosing depending on a patient’s condition or situation
-consider the patient’s age, pain intensity, pain tolerance, pharmacogenetic profile, renal and liver function, and co-morbidities and prescribe a maximum dose that ranges to 2 to 3 times the lower or minimum dose
Range orders
118
Co-analgesics or adjuvants are drugs originally developed to treat conditions other than pain but that also have analgesic properties.
-tricyclic antidepressants (e.g., nortriptyline), anticonvulsants (e.g., gabapentin), and infusional lidocaine successfully treat chronic pain, especially neuropathic pain. Corticosteroids
Adjuvants.
119
relieve the pain from inflammation and bone metastasis
Corticosteroids (Adjuvants.)
120
for bone pain
bisphosphonates and calcitonin(Adjuvants.)
121
is a drug delivery system that allows patients to self-administer opioids (usually morphine, hydromorphone, or fentanyl) with minimal risk of overdose.
- not recommended for opioid-naïve patients following surgery because of the possibility for respiratory depression.
patient-controlled analgesia (PCA)
122
include prescription and OTC creams, gels, sprays, liquids, patches, or rubs applied on the skin over painful muscles or joints and for peripheral neuropathy
Commonly used topical agents include NSAID products (ketoprofen patch) and capsaicin and local anesthetics such as lidocaine, prilocaine and diclofenac
-effective in chronic pain management
-placed on pain site
Topical analgesics
123
fentanyl, buprenorphine, and clonidine
| -work when placed away 4m pain site
analgesic transdermal medications
124
is a topical analgesic effective for cutaneous neuropathic pain such as postherpetic neuralgia in adults. Place three patches, cut to size, on and around the pain site using a 12-hour on, 12-hour off schedule
- ELA-Max/LMX and eutectic mixture of local anesthetics (EMLA) are available for children
- ELMA- thick cream to the skin 30 to 60 minutes before minor procedures
Lidoderm patch
125
Do not place topical or transdermal analgesics on wounds, damaged skin, or the face. Pruritus or burning of the skin or a localized rash is common after
topical applications
126
is the local infiltration of an anesthetic medication to induce loss of sensation to a body part. Health care providers often use local anesthesia during brief surgical procedures
Local anesthesia
127
is the injection or infusion of local anesthetics to block a group of sensory nerve fibers
Regional anesthesia
128
Smaller sensory nerve fibers are more sensitive to local anesthetics than are large motor fibers. As a result, the patient loses sensation before losing motor function; conversely, motor activity returns before sensation.
Regional anesthesia
129
is the use of perineural injections and infusions of local anesthetic agents to relieve pain.
regional anesthesia
130
, a form of regional anesthesia
| -acute postoperative pain, rib fracture pain, labor and delivery pain, and chronic cancer pain
epidural analgesia
131
sensory loss along with significant motor weakness
local/regional anesthesia
132
include nausea and vomiting, hypotension, urinary retention, constipation, respiratory depression, and pruritus
- monitor them as often as every 15 minutes
epidural opioid use
133
intrathecal implantable pumps or injections, spinal cord and deep brain stimulation, neuroablative procedures (cordotomy, rhizotomy), trigger point injections, cryoablation, and intraspinal medications (e.g., opioids, steroids, local anesthetics)
chronic pain (Invasive Interventions for Pain Relief)
134
a transitory increase in pain in someone who has relatively stable and an adequately controlled level of baseline pain
breakthrough cancer pain (BTCP)
135
(e. g., morphine sulfate extended release and oxycodone HCl) relieve pain for 8 to 12 hours
- dosed on a scheduled basis, not prn
controlled-release medications
136
100 times more potent than morphine, is available for opioid-tolerant patients with cancer or chronic pain
- up to 72 hrs
- gd if pt can't do orally (transdermal)
- contraindic- weigh less than 100 lb, hypothermia
- never cut patch& do place heating pad over patch
Transdermal fentanyl
137
treats breakthrough pain in opioid-tolerant patients. Patients take the medication by placing an opened transmucosal package in their mouth between the buccal mucosa and gums and actively sucking on the medicine
- dont swallow or drink
- absorb 15 min
transmucosal fentanyl “unit”
138
patient should not use more than 1 unit of oral transmucosal fentanyl citrate at a time and no more than 2 units of oral transmucosal fentanyl citrate of each episode
transmucosal fentanyl “unit”
139
when patients are unable to swallow, have nausea or vomiting, or are near death
-contraindicated diarrhea or cancerous lesions involving the anus or rectum
analgesics rectally
140
include those with severe pain for whom oral and injectable medications provide minimal relief, those with severe nausea and vomiting, and those unable to swallow oral medications.
continuous infusions
141
A state of adaptation that is manifested by a drug class–specific withdrawal syndrome produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.
Common symptoms of opioid withdrawal include shaking, chills, abdominal cramps, excessive yawning, and joint pain
Physical Dependence
142
A primary chronic neurobiological disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. Addictive behaviors include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.
Addiction
143
A state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more effects of the drug over time
Drug Tolerance
144
are pharmacologically inactive preparations or procedures that produce no beneficial or therapeutic effect.
placebos
145
assess for obstructive sleep apnea syndrome before before surgery by anesthesia using the STOP-BANG questionnaire
-risk for respiratory depression
obstructive sleep apnea syndrome (OSAS)
146
be used to monitor for unintended patient sedation
- highest risk for oversedation and respiratory distress (OSRD) during the first 24 hours of PCA administration
- monitor first 1-2 hrs within 24 hrs
- oversedation leads Resp depression
Pasero Opioid Sedation Scale (POSS)
147
should include detailed information regarding vital signs, pulse oximetry and capnography, pain assessment scores, STOP-BANG score for OSAS if done, POSS sedation scores, level of consciousness, anxiety level, and activity level (can include safety priming)
Hand-off report (pain nursing process)
