Chapter 18 Flashcards
What to assess for pain
grimace, crying, shaking, splinting
assess location, duration, intensity, quality (dull, sharp), what brings it on, what decreases it, effects on ADL
need to provide coping strategies
Physiologic consequences of unrelieved pain
increased HR, increased SNS, adrenaline
decreased sleep, mobility, strength,
decreased immune reactions and can lead to disease
Psychologic consequences of unrelieved pain
depression anxiety decreased QOL dependence suffering
Acute pain
abrupt onset
short duration
Chronic pain
3-6 months
can indicate a life threatening underlying disease like cancer
acute pain without treatment becomes chronic pain
Intractable pain
no cure at this time
Nociceptor Pain
Due to injury to tissues
Sharp, localized
Dull, throbbing, aching
Neuropathic Pain
Due to injury to nerves
Burning, shooting, numbing
Cutaneous pain
skin, paper cut
Somatic pain
caused by trauma to ligament, tendon, bones, blood vessels, nerves
Visceral pain
associated with an organ
stretched tissues, ischemia, muscle spasm- pain receptors deep in the abdominal cavity or brain or thorax
(appendicitis, kidney stone, pancreatitis, cancer, heart attack)
Radiating pain
extends beyond painful affected area (jaw from MI)
Referred pain
felt in remote part of the body
Neuropathic pain
along nerve fibers: diabetic neuropathy, painful fingers & toes, plantar fasceitis
Phantom pain
can be reduced by treating pain before amputation using neuropathic pain medication Gabapentin or pregambin (lyrica)
Transmission of pain
Nociceptor stimulated by noxious stimuli
Spinal cord receives pain impulse through
A∂ fibersand C fibers
Pharmacological Techniques
Analgesics
CNS level (Opioids)
Narcotic
Analgesics
meds used to relieve pain
NSAIDS
CNS level (Opioids)
natural or synthetic Obtained from opium from poppy plant with >20 chemicals
Opium consists of 9%-14% morphine & 0.8%-2.5% codeine (natural opiates)
Narcotic
refers to morphine like drugs that produce analgesia & CNS depression
Opioid agonist drugs
interact with 6 opioid receptors: mu, kappa, sigma, delta, epsilon
Opioid antagonist drugs
block receptors
Naloxone (Narcan) inhibits mu & kappa receptors
Mixed Opioid Agonist-Antagonist
Pentazocine (Talwin) mixed agonist/antagonist (analgesia w/o withdrawal s/s)
Opioid drug route
IV PO or SQ
no IM
Opioid (Narcotic) Analgesic mechanism of action
bind to opioid receptors throughout CNS & peripheral tissues
Opioid (Narcotic) Analgesic use
to relieve moderate to severe pain; some used for anesthesia
Suppress cough reflex
Slow motility of GI tract
May increase intracranial pressure
Opioid (Narcotic) Analgesic monitoring
severe heart, liver or kidney disease, respiratory disease or seizures, ELDERLY
VS, LFTs, BUN, Cr, GFR
caution in pregnancy: Cross blood-brain barrier, placental barriers and enter breast milk
Fentanyl ½ life
1-2hr
Dilaudid ½ life
2-4 hr
Morphine ½ life
3-4hr
Meperidine ½ life
2.5-4hr
Phenergan
must be diluted in 10mL of NS and given over 2 minutes
can cause phlebitis
Adverse Effects of Opioids
Respiratory depression
Increased ICP
Constipation, nausea, urinary retention, depression
Orthostatic hypotension
Opioid Toxicity
Pinpoint pupils ↓ BP ↓ O2 sat Coma
Priority action is to open airway, give oxygen and give opioid antagonist ASAP
Addiction
craving substances for mood altering effect rather than pain relief – continue to use the substance despite harmful or negative consequences
Tolerance
need for more medication to control pain over a period of time
occurs within 2 weeks
Dependence
physiological need for the drug the body needs the drug to feel OK-abrupt withdrawal results in S&S
Pseudoaddiction
iatrogenic syndrome of abnormal behaviors developing as a direct consequence of inadequate pain management
