Chapter 21 Notes Flashcards
Is it an unpleasant sensation caused by noxiousness?
(injurious to physical health) stimulation of the sensory nerve endings
Definitions of Pain?
Is an unpleasant sensory and emotional experience associated with actual or protein tissue damage or describe in terms damage
Referred pain?
Is felt a site other than the injury or disease organ or part of the body
Acute Pain ?
is intense and of short duration usually lasting less than 6 months
Chronic Pain ?
Generally is characterized as pain lasting longer than 6 months
Fatigue,sleep disturbance and depression may act in this type of ?
Synergistic relationship in which actions of two or more substance or organs achieve an effect that cannot be achieved by individual substance or organ
The gate control theory ?
of pain suggests that pain impulses are regulated and even blocked by gating mechanism locate along the central nervous system
The body produces morphine-like substance called ?
Endorphins potent polypeptides composed of many amino acid found in the pituitary gland and other area of CNS
Transcutaneous electric nerve stimulation?
A special pain relief system (TENS ),
-entails the use of a pocket -sized , battery
- operated device that provides a continuous , mild electric current to the skin via electrodes attached to a stimulator by flexible wires
-invasive means that enters the body
Nonopioid analgesics ?
Acetaminophen and nonsteroidal antiinflammatory drugs (NSAIDs ) the nonopioid analgesics are the most widely available and frequently used analgesic group
-available without any prescription such aspirin and ibuprofen
Opioid analgesics ?
-such morphine ,meperidine
-act on higher centers of the brain to modify perception and reaction to pain
-Opioids decrease the perception of pain by binding to pain receptor sites in the CNS.
-Tolerance and addiction opioid tolerance and physiological dependence are usually short terms
-preventing and managing opioid -induced constipations
Adminstrains routes for analgesics ?
-The IV route is best for administration of opioid analgesics after major surgery.
-This route provides a rapid onset of pain relief and best manages escalating pain.
-Intramuscular administration of opioids is associate wife fluctuations absorption
Patient-controlled analgesia?
A drug delivery system called patient-controlled analgesia (PCA) allows patients to self-administer analgesics whenever needed.
Epidural analgesia?
-Another method of delivery of analgesia is the insertion of an epidural catheter and the infusion of opiates into the epidural space .
-Contain is a “ potential “ space ( there is no free - flowing fluid in ing blood vessels , fat , and nerves , the epidural space it ) between the walls of the vertebral canal and the dura mater of the spinal cord
-diffuse slowly
There are three methods of administering epidural analgesia?
by bolus doses , by continuous infusion , and by patient - controlled epidural analgesia
With the visual analog scale ?
the patient marks a spot on a horizontal line to indicate pain intensity (intensity increases as the line moves from left to right)
Drugs used for epidural analgesia are?
Morphine,fentanyl and hydromorphone
-side effect including urinary retention postural hypotension,pruritus ,nausesa ,vomiting and respiratory depression
-controlling acute pain during labor and for relieving chronic pain,such as patients with advanced cancer
Elastomeric pumps ?
-pains balls are used to administer local anesthetic medications
-medication inside the balls -administered through small catheter that has been placed beneath the skin during a surgical procedure
-average time single pump to be used 2 to 5 days -removed easily patient and caregiver
With the visual analog scale ?
the patient marks a spot on a horizontal line to indicate pain intensity (intensity increases as the line moves from left to right)
Objective sign of pain physiologic signs ?
Pulse: Increased rate
Respirations: Increased depth and frequency Blood pressure: Increased systolic and diastolic The body seeks equilibrium. In an hour or less, vital signs usually return to what they were previously , even if the patient is still in severe pain .
Continuous severe pain sometimes causes vital signs to increase again from time to time, but they rarely remain elevated . Diaphoresis , pallor Dilated pupils Muscle tension (face , body) Nausea and vomiting (if pain is severe)
Objective sign of pain BEHAVIORAL SIGNS?
Rigid body position
Restlessness
Frowning Grimacing
Clenched teeth
Clenched fists
Crying Moaning
Factors of Affecting Sleep ?
-physical illness
-anxiety and depression
-drug and substances
-lifestyles -sleepatterns
-stress
-environment
-exercise and fatigue
-nutrition
NON - RAPID EYE MOVEMENT (NREM ) SLEEP Stage 1?
-Lightest level of sleep Lasts a few minutes
-Decreased physiologic activity, beginning with a gradual fall in vital signs and metabolism Person is easily aroused by sensory stimuli such as noise If person awakes , feels as though daydreaming has occurred
-Reduction in autonomic activities (e.g. , heart rate )
NON - RAPID EYE MOVEMENT (NREM ) SLEEP Stage 2?
-Period of sound sleep Lasts 10 to 20 minutes Relaxation progresses
-Arousal is still easy Body functions are still slowing Stage 3 Initial stage of deep sleep Lasts 15 to 30 minutes
- Arousal is difficult , movement is rare Muscles are completely relaxed Vital signs decline but remain regular
-Hormonal response includes secretion of growth hormone
NON - RAPID EYE MOVEMENT (NREM ) SLEEP Stage 3 ?
Initial stage of deep sleep Lasts 15 to 30 minutes Arousal is difficult , movement is rare Muscles are completely relaxed Vital signs decline but remain regular
-Hormonal response includes secretion of growth hormone
NON - RAPID EYE MOVEMENT (NREM ) SLEEP Stage 4 ?
Deepest stage of sleep Lasts approximately 15 to 30 minutes Arousal is very difficult If sleep loss has occurred, sleeper spends most of night in this stage Restores and rests the body
-Vital signs are significantly lower than during waking hours Sleepwalking and enuresis are possible Hormonal response continues
RAPID EYE MOVEMENT ( REM ) SLEEP?
-Stage of vivid, full-color dreaming consistent with sensory experiences less vivid dreaming sometimes in other stages
-First approximately 90 minutes after sleep has begun , thereafter at end of each NREM Duration increasing with each cycle and averaging 20 minutes
-Typified by autonomic response of rapidly moving eyes, fluctuating heart and respiratory rates , and increased or fluctuating blood pressure Loss of skeletal muscle tone Responsible for mental restoration Stage in which sleeper is most difficult to arouse
Sleep -wake cycle across life spain?
-Infant 40 %
-Adults 20% of total sleep time is spent REM sleep
-Older adults total sleep time slightly reduced, REM sleep continues to make up 20% of total
Rapid eye Movement REM and Non rapid eye movement NREM?
-REM sleep i about 90 minutes
-the dream of REM sleep is believed to be functionally important
-NREM provides a period of body maintenances -REM is important for brain and cognitive restorstion
-arises from damage to or inflammation of tissue, which is a noxious stimulus that triggers the pain receptors called nociceptors and causes pain.
-It is usually throbbing , aching, and localized . -This pain typically responds to opioids and non-opioid medications?
Nociceptive Pain
TYPES OF NOCICEPTIVE PAIN?
- Somatic : In bones , joints , muscles , skin, or connective tissues .
-Visceral: In internal organs (the stomach or intestines). It can cause referred pain in other body locations separate from the stimulus.
-Cutaneous : In the skin or subcutaneous tissue.
-arises from abnormal or damaged pain nerves.
-It includes phantom limb pain, pain below the level of a spinal cord injury, and diabetic neuropathy.
-Neuropathic pain is usually intense, shooting, burning, or described as “pins and needles-This pain typically responds to adjuvant medications ( antidepressants?
Neuropathic pain
Types of Pain?
- Mild or severe
-Chronic or acute
-Intermittent or intractable
-Burning , dull, or sharp
-Precisely or poorly localized
-Referred
Definition of Pain?
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (McCaffery and Pasero , 2003).
Gate Control Theory ?
-Theory suggests that pain impulses can be regulated or even blocked by gating mechanisms located along the central nervous system
-The proposed location of gates are in the dorsal horn of the spinal cord
-Pain and other sensations of skin and muscle travel the same pathways through the large nerves in the spinal cord
-If cutaneous stimuli other than pain are transmitted , the “ gate” through which the pain impulse must travel is temporarily blocked by the stimuli
Theories of Pain Transmission Endorphins ?
-The body contains a natural supply of morphine like substance called endorphins -Stress and pain activate endorphins
-Analges results when certain endorphins attach to opioid receptor sites in the brain and prevent the release of neutroasmitties thereby inhibiting the transmission of pain impulses
Nursing Assessment of Pain Collection of subjective data and objective date ?
-Characteristics and description
-Collection of objective data,
-Tachycardia -Increased rate and depth of respirations
-Diaphoresis Increase systolic or diastolic blood pressure Pallor Facial expression Increased muscle tension
-Possibly nausea or weakness Withdrawal
Requirements of the Joint Commission for Pain Control?
- Routine and PRN analgesics are to be administered as ordered
-Discharge planning and teaching will include continuing care based on the patient’s need at the time of discharge, including the need for pain management
Pain as the fifth Vital Sign ?
-Making pain a vital sign-along with pulse, temperature, blood pressure, and respirations
-would ensure that pain is monitored on a regular basis
-Appropriate pain management will typically bring about quicker recoveries, shorter hospital stays fewer readmissions, and improved quality of life
-Unrelieved pain has harmful physical effects as well as psychological effects
Pain Relief Techniques Noninvasive pain relief techniques?
-Transcutaneous electrical nerve stimulation
-Distraction
-Relaxation
-Guided imagery
-Hypnosis
-Biofeedback
Pain relief techniques Invasive approaches to pain?
-Nerve blocks
-Epidural analgesics
-Neurosurgical procedures
-Acupuncture
Synergistic Impact of Fatigue, Sleep Disturbance, and Depression?
- The actions of two or more factors achieve an effect that cannot be achieved by an individual factor
-Can become a vicious cycle, making the pain difficult to treat
Pain Scales?
- Use of a pain-rating scale allows patients to clearly articulate their pain and makes them more likely to receive proper treatment
-Visual analog
-Numeric -Verbal descriptive
Pain Scales?
- Use of a pain-rating scale allows patients to clearly articulate their pain and makes them more likely to receive proper treatment
-Visual analog
-Numeric -Verbal descriptive
Medications for Pain Management Nonopioids ?
Exert analgesic effects through the inhibition of prostaglandin production
Medications for Pain Management Adjuvant analgesics?
Composed of diverse classes of drugs that relieve pain via a variety of mechanisms
Responsibility of Nurse in Pain Control?
-Pain management is a challenge that every nurse must face, regardless of the practice setting
-The nurse’s role in pain management is probably more important than that of any other member of the health care team
-The nurse should advocate for the patient by clarifying concerns, answering questions, supplying all the information the patient needs to make decisions about care, and supporting the patient’s decisions
Sleep and Rest ?
-A patient at rest feels mentally relaxed, free from worry, and physically calm, free from physical or mental exertion
-Sleep is a state of rest that occurs for a sustained period
-The reduced consciousness during sleep provides time for repair and recovery of body systems for the next period of wakefulness
-Sleep restores a person’s energy and feeling of well being
Promoting Rest and Sleep ?
-Determine the patient’s usual rest and sleep patterns , decide whether they are sufficient , and note why the patient is not getting sufficient rest
-A plan should be developed to provide for more rest
-Limit interruptions during the night -Provide a quiet environment with a comfortable room temperature
-Limit the number of visitors and duration of visits -Carry out all procedures within a given time frame
Sleep Deprivation?
-Deprivation involves decreases in the amount , quality , and consistency of sleep
-When sleep is interrupted or fragmented , changes in the normal sequence of sleep stages occur , and cycles cannot be completed
