class 2 Flashcards
pain
pain following stroke is
-common
-often overlooked (d/t lack of expression)
-prevents optimal recovery
-varies amongst clients
-poorly understood
-poorly managed
-unique to each pt
chronic pain post stroke is found in
up to 1/2 of patients
-as many as 70% experience pain daily
what is central post stroke pain
-rare
-stroke affects thalamus + parietal lobe
-causes misfiring & brain interprets sensations incorrectly
-heat, cold, emotional distress, and touch interpreted as pain
-usually occurring with loss of sensation in face/legs/arms
treatment reccomendations for central post stroke pain
-anticonvulsant (1st line)
-tricyclic antidepressant (2nd line)
-opioids (use with caution)
what is hand edema pain
-paralysis of arm/hand
-dec hand mobility but inc pain
-stiffness
-can occur alone or part of CRPS
what is hemiplegic shoulder pain
-common
-shoulder looks dislocated/withdrawn
-important to dec pressure to area, positioning is key
-usually d/t subluxation or mishandling(may be able to reduce at bedside)
other post stroke pain conditions
-post stroke headache
-tendonitis
-pain from pre-existing conditions
what is complex regional pain syndrome
-more common in females
-2-49% of pts experience this
-neuropathic pain that can lead to chronic pain
-edema
-vasomotor changes: cool, impaired, skin colour changes, hyperesticia, allodynia, dec ROM
-patchy bone demineralization
diagnosis criteria for CRPS
-pain
-tenderness in metatarsels
-edema in dorsum of hand
-stiffness
-trophic changes
-dec ROM
-burning pain
-all other dx ruled out
dx scan for CRPS
-triple phase bone scan
-will show increased uptake of isotrope in osseous structures and blood pooling
how to prevent CRPS
-early mobilization (passive/active assisted/active ROM)
-tailored rehab plan
-early management
early tx for CRPS
-PO 30-50mg corticosteroids once daily for 3-5 days then slowly tapered over 3-5 weeks
assessment best practice guidelines
- early signs and symptoms
2.specialized pain assessment
3.basis of CRPS diagnosis
PQRSTU assessment
-allows for pain assessment
-can be used with NO communication barriers
special considerations for assessing stroke pain
-determine verbal com ability->can extend to writing so that may not be accurate
-SLP referral
-FACES scale, NV cues, point to 1-10 scale, Y or N q’s if able to shake head
-remaining calm and patient
best practice CRPS diagnosis guidelines
-defining characteristics: dec blood flow/blood pooling, inc uptake of isotope in affected bone/joints
-diagnostics tools: budapest diagnostic criteria, triple phase bone scan
goals of tx for crps
1.pain relief
2.functional restoration
3.psychological stabilization
management of CRPS best practice guidelines
-continual assessment d/t dec communication skills
-acknowledge pain
-assist with movement and positioning, gentle handling of the limb
-medication administration
-refer to pain management specialist
considerations for IV ketamine for CRPS
-used for REFRACTORY pain which can occur with CRPS
-try all other conservative measures first
-therapeutic range makes it very safe, given in low doses for analgesia
-inc HR, SBP, DBP, salivary/trachobronical secretions
dose for IV ketamine
0.5-2mg/kg
-must weigh them before
-requires independent double check
-usually infusing with an NSAID or opioid
RN role in administering ketamine infusion
-must complete self-learning module and follow clinical policy
-vitals, MAP, sedation lvl and pain score assessed prior then:
q15m for 1h, q2h for 4h, then q4h for the duration of infusion then q4h for 12h after discontinuation
-has to restart assessments with any changes to ketamine infusion
