class 2

Question 1

pain following stroke is

Answer 1

-common
-often overlooked (d/t lack of expression)
-prevents optimal recovery
-varies amongst clients
-poorly understood
-poorly managed
-unique to each pt

Question 2

chronic pain post stroke is found in

Answer 2

up to 1/2 of patients
-as many as 70% experience pain daily

Question 3

what is central post stroke pain

Answer 3

-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

Question 4

treatment reccomendations for central post stroke pain

Answer 4

-anticonvulsant (1st line)
-tricyclic antidepressant (2nd line)
-opioids (use with caution)

Question 5

what is hand edema pain

Answer 5

-paralysis of arm/hand
-dec hand mobility but inc pain
-stiffness
-can occur alone or part of CRPS

Question 6

what is hemiplegic shoulder pain

Answer 6

-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-shoulder looks dislocated/withdrawn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)

Question 7

other post stroke pain conditions

Answer 7

-post stroke headache
-tendonitis
-pain from pre-existing conditions

Question 8

what is complex regional pain syndrome

Answer 8

-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

Question 9

diagnosis criteria for CRPS

Answer 9

-pain
-tenderness in metatarsels
-edema in dorsum of hand
-stiffness
-trophic changes
-dec ROM
-burning pain
-all other dx ruled out

Question 10

dx scan for CRPS

Answer 10

-triple phase bone scan
-will show increased uptake of isotrope in osseous structures and blood pooling

Question 11

how to prevent CRPS

Answer 11

-early mobilization (passive/active assisted/active ROM)
-tailored rehab plan
-early management

Question 12

early tx for CRPS

Answer 12

-PO 30-50mg corticosteroids once daily for 3-5 days then slowly tapered over 3-5 weeks

Question 13

assessment best practice guidelines

Answer 13

1. early signs and symptoms
   2.specialized pain assessment
   3.basis of CRPS diagnosis

Question 14

PQRSTU assessment

Answer 14

-allows for pain assessment
-can be used with NO communication barriers

Question 15

special considerations for assessing stroke pain

Answer 15

-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

Question 16

best practice CRPS diagnosis guidelines

Answer 16

-defining characteristics: dec blood flow/blood pooling, inc uptake of isotope in affected bone/joints
-diagnostics tools: budapest diagnostic criteria, triple phase bone scan

Question 17

goals of tx for crps

Answer 17

1.pain relief
2.functional restoration
3.psychological stabilization

Question 18

management of CRPS best practice guidelines

Answer 18

-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

Question 19

considerations for IV ketamine for CRPS

Answer 19

-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

Question 20

dose for IV ketamine

Answer 20

0.5-2mg/kg
-must weigh them before
-requires independent double check
-usually infusing with an NSAID or opioid

Question 21

RN role in administering ketamine infusion

Answer 21

-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