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NU 340 > Ch. 6 > Flashcards

Ch. 6 Flashcards

1
Q

definition of pain

A
  • unpleasant sensory and emotional experience associated with actual or potential tissue damage

*Pain is whatever the experiencing person says it is and exists whenever he or she says it does

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2
Q

attitudes and practices related to pain

A
  • attitudes of health care providers and nurses affect interaction with patients experiencing pain
  • many patients are reluctant to report pain: desire to be a “good” patient, fear of addiction
  • opioid crisis has affected attitudes and practices in pain management
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3
Q

acute pain

A
  • short-lived
  • activation of sympathetic nervous system (fight or flight response)
  • temporary with sudden onset, and easily localized
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4
Q

chronic (persistent) pain

A
  • can last a person’s lifetime
  • lasts or recurs for indefinite period (more than 3 months)
  • gradual onset
  • serves no biological purpose
  • chronic cancer pain
  • chronic non-cancer pain
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5
Q

major distinction between chronic and acute pain is __

A

the effect on biologic responses

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6
Q

acts as a warning sign

A

acute pain

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7
Q

acute pain results from

A

sudden, accidental trauma;
- surgery;
- ischemia;
- acute inflammation

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8
Q

absence of physiologic and behavioral responses does or does not mean absence of pain?

A

does not mean absence of pain

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9
Q

acute pain: sensory perception of pain changes as

A

injured area heals

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10
Q

acute pain responses

A
  • increased HR, BP, RR
  • dilated pupils
  • sweating
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11
Q

chronic pain: character and quality

A
  • often change over time
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12
Q

chronic pain can result in

A
  • emotional, financial, and relationship burdens
  • depression, hopelessness
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13
Q

chronic non-cancer pain

A
  • global health issue for people > 65
  • formerly called chronic nonmalignant pain
  • neck, shoulder, low back
  • misc. chronic disorders: endometriosis, diabetic neuropathy, migraines, fibromyalgia
  • over half of veterans of recent wars have this condition: can cause depression, decreased sense of well-being
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14
Q

procedural pain

A
  • associated with medical procedures or surgical interventions
  • usually acute
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15
Q

categories of pain

A
  • localized
  • projected
  • radiating
  • referred
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16
Q

sources of pain

A
  • nociceptive pain: somatic or visceral
  • neuropathic pain
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17
Q

somatic pain

A

superficial pain
- in the skin

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18
Q

visceral pain

A

deeper internal pain
- abdominal organs (ie appendix)

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19
Q

painful stimuli often originate in

A

extremities

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20
Q

if pain is not transmitted to the brain

A

the person does not feel pain

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21
Q

which two fibers transmit periphery pain

A
  • A delta fibers
  • C fibers
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22
Q

older adults are at a greater risk for

A

under treated pain
- under treatment of cancer pain due to inappropriate beliefs about pain sensitivity, tolerance, and ability to take opioids

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23
Q

assessment of pain

A
  • patients self-report is “gold standard” for assessment
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24
Q

nurse’s role in pain assessment

A
  • serve as advocate
  • act promptly to relieve pain
  • respect patient values and preferences
  • minimize/remove personal bias
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25
Q

PQRST of pain

A

P: Precipitating (makes it worse) or palliative (makes it better)
Q: Quality (stabbing, sharp, dull) or quantity (how bad)
R: Region (where is it) or radiation (traveling)
S: Severity scale (0-10)
T: Timing (when did it start/constant or intermittent)

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26
Q

Patients who cannot self-report pain are at higher risk for

A

under treated pain

  • Hierarchy of Pain Measures
  • Checklist of Nonverbal Pain Indicators (CNPI)
  • Pain Assessment in Advanced Dementia Scale (PAINAD)
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27
Q

drug therapy

A
  • Multimodal analgesia
  • Multiple routes of administration (oral, IV, IM, SQ, patches)
  • Around-the-clock dosing (keeps steady level of medication on board, ie order is q6h)
  • Patient-controlled analgesia (PCA)
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28
Q

non-opioid analgesics

A
  • Acetylsalicylic acid and acetaminophen are most common
  • Most are NSAIDs, including aspirin
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29
Q

side effects of non-opioid analgesics: NSAIDs and Aspirin

A
  • Can cause GI disturbances
  • COX-2 inhibitors for long-term use
  • Carry risk for cardiovascular and renal adverse effects
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30
Q

non-opioid analgesics: acetaminophen

A
  • Available in liquid form; can be taken on empty stomach
  • Preferable for patients for whom GI bleeding is likely
  • Can cause liver toxicity
    • Monitor for hepatotoxicity
    • Concomitant Alcohol use higher risk
31
Q

opioid analgesics

A
  • Block the release of neurotransmitters in the spinal cord
  • Drugs include: oxycodone, morphine, hydromorphone, fentanyl, methadone, tramadol, oxymorphone
32
Q

Key Principles of
Opioid Administration

A
  • Appropriate opioid analgesic
  • Titration
  • Dose range
  • Carefully assess older adults to avoid untreating pain
33
Q

the opioid epidemic

A
  • CAUSE: In 1995, American Pain Society declared pain as the 5th vital sign
  • PROBLEM: opioid scripts quadrupled from 2000-2010
  • opioid abuse declared a national public health emergency as of 2017 and remains so
  • Includes misuse of prescription opioids, and illicit drugs (illegal opioid, heroin, fentanyl)
  • Prevent secondary exposure
  • about 50 people die every day from opioid overdose
34
Q

Physical Dependence,
Tolerance, and Addiction

A
  • Physical dependence: Normal response
  • Tolerance: Normal response
  • Opioid addiction: Chronic neurologic and biologic disease
  • Pseudoaddiction: Mistaken diagnosis of addictive disease
35
Q

dependence

A

Physical dependence is predictable, easily managed with medication, and is ultimately resolved with a slow taper off of the opioid.

36
Q

physical dependence can be caused by

A

Many substances - such as caffeine, nicotine, sugar, anti-depressants, to name a few - can cause physical dependence, it is not a property unique to opioids. Physical dependence to opioids is normal and expected and a distraction from the real problem, addiction.

37
Q

addiction

A

abnormal and classified as a disease.
- a primary condition manifesting as uncontrollable cravings, inability to control drug use, compulsive drug use, and use despite doing harm to oneself or others.

38
Q

strong cravings are common to all addictions or dependences?

A

addictions

39
Q

opioid naïve

A

person who has not recently taken enough opioid on a regular basis to become tolerant to the effects

40
Q

opioid tolerant

A

person who has taken an opioid long enough at doses high enough to develop tolerance to many of the effects

41
Q

US department of HHS identifies 5 priorities for safe opioid use:

A
  • Public health surveillance
  • Improving access to treatment and recovery
  • Promoting use of overdose reversing meds
  • Providing support for research on pain and addiction
  • Advancing better practices for pain management
    • Multi-modal pain management
42
Q

patient education: opioid use

A
  • Risks of opioid medications
  • Expected time frame – short term if possible
  • Proper storage and disposal
    • Do not keep for another time
  • Alternatives to opioids to reduce risk for misuse and abuse
43
Q

drug formulation terminology

A

Short acting, fast acting, immediate release (IR), normal release
- Onset in about 30 minutes; short duration of 3 to 4 hours

Modified-release, extended release (ER), sustained release (SR), controlled release (CR)
- Release over a prolonged period
- Never crush, break, or have patients chew!

44
Q

opioids to avoid

A

meperidine & codeine
- cause severe side effects
- other opioid choices will work better

45
Q

WHO analgesic ladder

A

World Health Organization’s recommended guidelines for prescribing, based on level of pain (1-10, 10 is most severe pain)
Level 1 pain (1-3 rating)—Use non-opioids
Level 2 pain (4-6 rating)—Use weak opioids alone or in combination with an adjuvant drug
Level 3 pain (7-10 rating)—Use strong opioids

46
Q

Level 1 pain

A
  • 1-3 rating
  • use non-opioids
47
Q

Level 2 pain

A
  • 4-6 rating
  • use weak opioids alone or in combination with an adjuvant drug
48
Q

Level 3 pain

A
  • 7-10 rating
  • use strong opioids
49
Q

adverse effects of opioids

A
  • N/V
  • constipation
  • sedation
  • respiratory depression
  • pruritus
50
Q

pain management in end of life care

A
  • Opioid regimen should stay consistent with dose in weeks before last weeks of life
  • Generally believed that patient still feels pain when unconscious
  • Does not hasten death unless the dose was not properly and gradually titrated
51
Q

routes of opioid administration

A
  • can be administered by every route used
  • PRN range orders
  • PCA
52
Q

medical marijuana

A
  • Schedule I controlled substance
  • Some U.S. states have legalized medical cannabis (still federally illegal)
  • Medical use is legalized in Canada
  • Medical Marijuana Program (MMP)
  • Health care provider does not prescribe, but assesses and determines qualifying conditions
  • a lot of insurances do not cover the cost
  • Endocannabinoid system: THC (psychoactive component), CBD, CBN
53
Q

is medical cannabis regulated by the FDA?

A

no

54
Q

nurse can only administer medical marijuana if

A

specially authorized by jurisdiction law

55
Q

who can give medical marijuana if the nurse cannot?

A
  • patient or designated caregiver
56
Q

adjuvant analgesics

A
  • Anticonvulsants (gabapentin- neuropathy pain)
  • Tricyclic antidepressants
  • Local anesthetics
  • Local anesthesia
  • infusion pumps
  • Topical medications
57
Q

non-pharmacologic interventions of pain

A

*Used alone or in combination with drug therapy
- Physical measures
- Physical and occupational therapy
- Cognitive/behavioral measures

58
Q

physical measures

A
  • application of heat, cold, or pressure
  • therapeutic massage
  • vibration
  • transcutaneous electrical nerve stimulation (TENS unit)
59
Q

cognitive/behavioral measures of pain managment

A
  • Distraction
  • Imagery
  • Relaxation techniques
  • Hypnosis
  • Acupuncture
  • Glucosamine
60
Q

localized pain

A

localized to one area
ie right lower quadrant

61
Q

projected pain

A

not well localized- all over a general area
ie all over abdomen

62
Q

radiating pain

A

pain radiates through mutliple parts of body
ie sciatica

63
Q

referred pain

A

pain is not felt where it originated from
- ie gallbladder attack, pain is felt in scapula

64
Q

neuropathic pain

A

affects the nerve endings
- pain and burning in legs and feet (sometimes numbness)
- very common in diabetic patients

65
Q

considerations for pain medication use with older adults

A
  • start low and go slow with drug dosing
  • increasing doses to achieve adequate pain relief
66
Q

comprehensive pain assessment

A
  • location: where is it?
  • intensity: 0-10 scale
  • onset and duration: when did it start? how long does it last?
  • aggravating and relieving factors: what makes it worse/better?
  • effect of pain on function and quality of life
  • comfort-function (pain intensity) outcomes
  • other information: cultural considerations, values, beliefs
67
Q

pain assessment intensity scales

A
  • numeric rating scale 0-10
  • wong-baker faces pain rating scale, used with kids and non-verbal adults (ie. stroke patients)
68
Q

adapted hierarchy of pain assessment for patients who cannot self-report pain verbally

A
  1. be aware of potential causes of pain
  2. attempt to obtain self-report
  3. observe behaviors (grimacing, crying, fetal position, guarding)
  4. seek proxy reporting
  5. conduct an analgesic trial
69
Q

reversal agent for any opioid overdose

A

naloxone (narcan)
- nasal spray (carried by certain teachers, police officers, firemen)
- IV (hospital)
*both work very quickly: patient will wake up, breathing increases

70
Q

can you crush a med that is extended release?

A

no

71
Q

what is PCA?

A

patient controlled analgesia through an IV
can be basal or demand
- basal: small infused dose, dont have to push any buttons
- demand: patient pushes button and gets dose

72
Q

safety mechanisms of PCA

A
  • person needs to be A&O
  • patient is only one pushing the button
  • lockout dose
73
Q

monitoring and assessment when patient is on PCA

A

monitor RR*, HR, O2
- if RR and O2 drop, can give naloxone as antidote

74
Q

benefits of PCA

A

patient can control when they get medication
- patient cannot OD due to lockout dose
- always locked by a key- cannot change dose or medication without key

NU 340 (26 decks)

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