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NURS 2500 > Class 4 - Pain > Flashcards

Class 4 - Pain Flashcards

1
Q

Unrelieved pain impacts

A
  • Decreased personal autonomy
  • Increases perception of vulnerability
  • Dignity of human person is undermined
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2
Q

Impacts of pain

A
  • Significant physical, social, emotional, psychological, spiritual, and financial consequences
  • Slows recovery, creates burden for family and increases costs to the system
  • Most common reason individuals seek health care
  • Chronic pain is the most common cause of long-term disability
  • As the population ages, the number of people who will need treatment from pain is expected to rise
  • Major cause of absenteeism, underemployment, and unemployment
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3
Q

Transduction

A

Noxious stimuli cause cell damage with the release of sensitizing chemicals
- Prostaglandins
- Serotonin
- Bradykinins
- Substance P
- Histamines
These substances activate nociceptors and lead to generation of action potential

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4
Q

Transmission

A

Action potential continues from
- Site on injury to spinal cord
- Spinal cord to brain stem and thalamus
- Thalamus to cortex for processing

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5
Q

Perception

A

Conscious experience of pain

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6
Q

Modulation

A

Neurons originating in the brain stem descend in the spinal cord and release substances (eg endogenous opioids that inhibit nociceptive impulses)

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7
Q

Sources of nociception

A

SOMATIC - Joints, muscles, bone, tissue pain
NEUROPATHIC - Damage to nerve cells (neuropathic pain)
VISCERAL - From the organ, leading to dull, cramping pain
REFERRED - From an organ, but felt elsewhere

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8
Q

Acute pain

A
  • Abrupt, sudden onset
  • SNS response (HR, BP, diaphoresis)
  • Cause/source can be determined
  • Time-limited (brief) - dissipates with time
  • Variations in the intensity, frequency, and duration of pain between individuals
  • Can be associated with acute anxiety
  • Hope of recovery
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9
Q

Chronic pain

A
  • Ongoing pain > 3-6 months to years
  • No effect on SNS
  • Cause is difficult to pinpoint
  • Depression, anxiety
  • Behaviour is adapted to modify pain
  • Sense of hopelessness and helplessness
  • Interferes with quality of life, ADL
  • Varies in intensity, frequency, and duration
  • People with chronic pain can experience acute pain at the same time
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10
Q

Somatic pain

Nociceptive pain

A

Arises from nerve receptors in the skin or close to the surface (bones, muscles, joints, or connective tissue)
Sharp and well localized, or dull and diffuse
Often accompanied by nausea and vomiting

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11
Q

Visceral pain

Nociceptive pain

A

Arises from organs
Tumor involvement of the organ capsule causes aching and localized pain
Obstruction of hollow organs causes intermittent cramping and poorly localized pain

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12
Q

Referred pain

Nociceptive pain

A

Perceived in a distant area
Commonly with visceral pain

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13
Q

Centrally generated pain

Neuropathic pain

A

Deafferentation pain - injury to either the peripheral or CNS (phantom pain)
Sympathetically maintained pain-associated with dyregulation of the ANS

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14
Q

Peripherally generated pain

Neuropathic pain

A

Painful polyneuropathies (pain felt along the peripheral nerves - diabetic neuropathy)
Painful mononeuropathies (associated with peripheral nerve injury - nerve root compression, trigeminal neuralgia)

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15
Q

Normal findings for acute pain

A
  • numeric pain score >4
  • mild to moderate severity
  • should be able to ID how much they can tolerate
  • assess for nausea, vomiting, and pruritis
  • consider medications for pain before painful procedures

- increased Hr or BP
- hypoventilation or hypoxia
- joint stiffness

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16
Q

Normal findings for neuropathic pain

A
  • may have increased or decreased sensation over affected area
  • inspect skin and tissue for colour, warmth, deformity, masses
  • may have increased neuropathic pain during night

- lesions
- open wounds
- changes in hair distribution
- tissue damage

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17
Q

Normal findings chronic pain

A
  • pain present for extended time after acute phase
  • should be managebale
  • should be able to participate in ADLs
  • social supports in place
  • financial and psychological supports in place
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18
Q

Other normal findings for chronic pain

A
  • fear, anxiety, depression
  • isolation
  • limited mobility
  • family distressed
  • decrease QOL
  • hard time completing tasks
  • reports increased levels of fatigue
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19
Q

Pain assessment method

A

OPQRSTUV

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20
Q

Intensity assessment scale

A
  • Scales
  • Wong-Baker FACES
  • FLACC (infants and toddlers)
21
Q

FLACC

A

Facial expression
Leg movement
Activity
Crying
Consolability

22
Q

Who would not be able to report pain during self-assessment?

A
  • Cognitively impaired
  • Critically ill
  • Comatose
  • Imminently dying
  • Language
  • Sedated
  • Too young
23
Q

Things to look at when observing the patient

A
  • Position of comfort
  • Guarding area of pain
  • Facial expression
  • Movement/gestures
  • Behaviour
  • Vital signs (HR, BP, pupils)
24
Q

Social determinants of health-cultureal assessment

A
  • Cultural preferences
  • Fears about pain and pain management
  • Traditional remedies you have used for your pain
  • What is typical behaviour when you’re in pain?
  • Why do you think the pain is happening?
  • Do you talk to anyone about your pain?
  • Is there anyone who heps you when you’re in pain?
25
Q

Hierarchy of pain assessment

A
  1. Attempt to obtain self-report
  2. consider underlying pathology/condition that might be painful (assume pain present)
  3. Observe behaviour
  4. Evaluate physiologic indicators
  5. Conduct an analgesic trial
26
Q

Analgesic ladder for pain management

A
  1. Non-opioids +/- adjuvants
  2. Moderate opioids +/- non-opioids, +/- adjuvants
  3. Strong opioids +/- non-opioids, +/- adjuvants
    THEN
    Freedom from pain
27
Q

WHO step ladder (1-3)

A

MILD
- ASA
- Acetaminophen
- NSAIDs

+/- Adjuvants

28
Q

WHO step ladder (4-6)

A

MODERATE
- Acetaminophen(A)/Codeine
- A/Hydrocodone
- A/Oxycodone
- A/Dihydrocodeine
- Tramadol

+/- Adjuvants

29
Q

WHO step ladder (7-10)

A

SEVERE
- Morphine
- Hydromorphone
- Methadone
- Levorphanol
- Fentanyl
- Oxycodone

+/- Adjuvants

30
Q

6 components for nurses treating patient pain

A
  1. 10 rights of medication administration
  2. Accurate assessment
  3. Knowledge of medication-safe dose, side effects, contraindications
  4. Anticipate adverse effects
  5. Evaluate patient
  6. Patient teaching
31
Q

Non-opioids: Drugs

A

First rung of WHO step ladder
NSAIDS
- Salicylates (Aspirin)
- Propionic acid derivatives (Ibuprofen, Naprosyn)
- Selective COX-2 inhibitors (Celcoxib - Celebrex)

Acetaminophen - similar to NSAIDs but not anti-inflammatory

32
Q

Non-opioids: Info

A
  • Used for mild pain
  • Available OTC
  • Has a ceiling effect
33
Q

NSAIDs

A

Blocks Arachidonic Acid (above COX 1 and 2): ASA, Ibuprofen
- Do not cause tolerance or dependence
- Blocks prostaglandin
- Inhibits COX 1 and 2
- COX is in all tissues

Selective COX 2 inhibitors: Celcoxib

2 generations of NSAIDs
1. Old generation (ASA, Ibuprofen)
2. 2nd generation (Celcoxib) but causes MIs longterm

34
Q

Acetaminophen

A
  • Max dose/day = Children (65 mg/kg/day), Adults (4 gm/day)
  • Alcohol precautions
  • Interactions
  • Hidden in many OTC meds
  • Safety profile in pregnancy
  • OD is fatal (single dose of 10 gm)
  • Can be with or w/o codeine
35
Q

Opioids with non-opioids

A
  • Second rung on the pain ladder
  • Most effective and primary drugs for moderate to severe pain
  • Weak opioids with Acetaminophen
  • Can cause sedation, euphoria, constipation, respiratory depression, urinary retention
  • With continuous use, tolerance develops
  • Can also result in physical dependence
  • Physical dependence is not the same as addiction
36
Q

Pure opioid anlagesics

A
  • Binds primarily to the mu-type receptors in the CNS
  • First line for mild-moderate pain
  • No ceiling effect (increasing dosage produces increased pain relief)
  • Can adjust based on pain severity
  • Subject to abuse (rare when used appropriately)

MORPHINE, FENTANYL, HYDROMORPHONE

36
Q

Pure opioid anlagesics

A
  • Binds primarily to the mu-type receptors in the CNS
  • First line for mild-moderate pain
  • No ceiling effect (increasing dosage produces increased pain relief)
  • Can adjust based on pain severity
  • Subject to abuse (rare when used appropriately)

MORPHINE, FENTANYL, HYDROMORPHONE

37
Q

Morphine: Contraindications

A
  • Known drug allergies
  • Severe asthma
  • Caution in patients with:
  • Respiratory insufficiency
  • Elevated intracrnial pressure
  • Morbid obesity
  • Sleep apnea
38
Q

Morphine: Adverse effects

A
  • CNS = sedation, disorientation, euphoria
  • CVS = hypotension, palpitations, flushing
  • RESP = respiratory depression, asthma exacerbation
  • GI = nausea, vomiting, constipation, biliary tract spasm
  • GU = urinary retention
  • Integumentary = itching, rash
39
Q

Agonist-antagonist opioids

A

Partial agonist
- Binds to more than one type of opioid receptor
- Bind as agonists to the kappa opioid receptors to produce analgesia
- Binds to mu opioid rceptors as antagonists
- - Can trigger severe pain and opioid withdrawal syndrome
- Can produce dose ceiling effect (further increases in dose will not produce further relief)

40
Q

Opioid anatgonists

A
  • Acts as antagonists at mu and kappa
  • Bind to the opioid receptors but produce to analgesia (NALOXONE)
  • If present, it COMPETES with opioid molecules for binding sites on th opioid receptors
  • Has potential to block analgesia and other effects
  • Used most often to reverse opioid effects like sedation and respiratory depression
41
Q

Adjuvant drugs

A
  • Gabapentinoids
  • Pregablin
  • Tricyclic antidepressants (amitriptyline)
  • Benzodiazepines
  • Other opioids (Cannabinoid, Methadone)
42
Q

Tolerance

A
  • Occurs with prolonged opioid use
  • Develops to SOME pharmacologic effect but not to others
  • -Euphoria, respiratory depression, and nausea
  • No tolerance develops to constipation and constricted pupils
43
Q

Tolerance

A
  • Occurs with prolonged opioid use
  • Develops to SOME pharmacologic effect but not to others
  • -Euphoria, respiratory depression, and nausea
  • No tolerance develops to cinstipation and constricted pupils
44
Q

Physical dependence

A
  • Long term use produces physical dependence
  • Can develop “acute abstinence syndrome”
  • Withdrawal can last up to 10 days (unpleasant, but not dangerous)
45
Q

Addiction

A

Substance-induced disorders
- Temporary and reversible caused by immeidate use of substance and the immediate effect that occurs when subsance is stopped

Substance use disorder
- As a result of continued, frequent use of a substance
- Combines abuse and dependence

46
Q

Substance use disorder

A
  • Direct effects of the substance (cognitive, bhavioural, and physiologial physical symptoms)
  • Craving = describes the desire to use a substance and is a symptom of SUD
  • Tolerance = another symptom that increases the need for the substance to acheive its reward
  • Withdrawal = syndrome of symptoms that occurs from a sudden cessation of the substance
47
Q

Non-pharmacological interventions

A
  • Heat-ice
  • Massage
  • TENS
  • Physiotherapy
  • Imagery
  • Distraction
  • Deep breathing
  • Cultural practices

NURS 2500 (8 decks)

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