Comfort Flashcards
what is the only intervention a pt with pain usually wants?
pain relief
How is pain classified?
According to the duration, source, mode of transmission, and its etiology
What is acute vs chronic pain?
What is remission vs exacerbation?
What classification of pain is this?
Acute pain is rapid onset, variable intensity pain that is the bodies way of telling you there is tissue damage or disease. After the underlying problem is solved acute pain disappears.
Chronic pain lasts beyond normal healing period often greater than 6 months and interferes with functioning and often causes depression
People with chronic pain experience remission where there is no symptoms and exacerbation where there is symptoms
duration
What type of pain is caused by uncontrolled cancer?
chronic malignant pain
what type of pain is very resistant to treatment ?
chronic non malignant
what are some problems in treating chronic pain?
pts have a hard time describing it because of poor localization
its often perceived as meaningless, causing withdrawal, depression, anger, frustration, and dependency
Care giver bias
What is cutaneous, somatic, and visceral pain?
What classification is this?
Cutaneous is superficial usually involving the skin
Somatic pain is diffuse or scattered and originates in tendons, ligaments, bones, blood vessels, and nerves.
Visceral pain is poorly localized and originates in body organs in thorax, cranium, and abdomen
source of pain
What is guarding?
its a reflex contraction or spasm of the abdominal wall that tries to prevent additional trauma to underlying tissues
What is nociceptive pain?
How is it treated?
somatic, visceral, cutaneous pain
Its normal processing of pain that damages normal tissues
Opiates and synthetics
What is neuropathic pain?
is pain that is caused by injury to or abnormal functioning of peripheral nerves or the CNS
What are some characteristics of neuropathic pain?
burning or stabbing in varying durations
Allodynia - pain that occurs after a normally weak or nonpainfull stimuli
What is pain called that is resistant to therapy?
intractable
What is phantom pain?
pain that remains after a body part is removed
What is psychogenic pain?
Pain that doesnt have a identifiable physical source
Does pain always have a pure origin?
no, it often has physical and psychogenic properties
what is referred pain?
pain that can originate in one part of the body but be perceived in an area distant from tits point or origin.
what are some behavioral (voluntary) responses to pain?
moving away from stimuli grimacing, moaning, crying restlessness protecting the area and refusing to move speech will slow down or speed up depending on the pain unpurposeful body movements changing postures
What are some physiologic ( involuntary responses to pain) sympathetic responses
increased blood pressure, increased pulse an respiratory rates
pupil dilation
muscle tension and rigidity
pallor
increased adrenaline
increased blood glucose
What are involuntary responses when pain is deep and severed (parasympathetic)
Nausea and vomiting fainting or unconciousness decreased blood pressure decreased pulse rate prostration (lying stretched out on the ground) rapid and irregular breathing
What are some affective (psychological) responses to pain?
exaggerated weeping and restlessness withdrawl stoicism anxiety depression fear anger anorexia fatigue hopelessness Powerlessness
if the patient doesnt have an obvious response to pain, does that mean they are not experienceing pain?
no
what are some factors that affect pain?
culture
age/developmental stage
support/environment
past experiences
meaning of pain ( are they being punished )
emotions/ fatigue
communication or cognitive development
what main emotion can exacerbate pain, and what can we do to minimize it?
anxiety
pts who were taught preoperatively about what to expect post op required less pain medication
how often should you assess for pain?
whenever a person takes vitals
what are some basic methods to assess pain given by McCaffery and Pasero?
patients self report
report of person close to them
nonverbal behaviors
physiologic measured signs
what is PQRSTU?
what are some questions you would ask to go with each letter of the anacronym?
Provocative (what were you doing when the pain started?)
Quality ( describe your pain for me)
Region/radiating (where is your pain?)
Severity ( pain scales)
Timing ( onset, frequency, duration)
You ( how does this pain affect you?)
In addition to PQRSTU, what other things are important to assess regarding pain?
relieving factors
concomitant symptoms - symptoms that appear along side the pain
patients expectations for pain relief
Can a childs pain affect them into adulthood?
how early can a child affectively indicate that pain is present?
it can affect their response in adulthood
as early as 2 years
when would you use the wong baker faces scale?
adults and children >3 years old, especially older adults
when would you use the comfort scale?
in critically ill pediatric patients, adults, and infants who cannot use the NRS scale or faces
When would you use the cries scale?
neonates 0-6 months
when would you use FLACC
infants and children 2mos - 7 years who cannot validate the presence or quantify their pain
0-10 NRS
Adults and children greater than 9 years old
when would you use a checklist of nonverbal indicators?
adults who are unable to validate the presence or quantify pain using faces or NRS
when would you use the oucher pain scale?
helpful with older children that can point to a face
when would you use PAINAD?
dementia patients
when would you use FPS-R
young children with a 0-10 faces scale
When would you use a payen behavioral scale
usefull when you have intubated adults
what are some nonpharmacological relief measures?
Give examples?
distraction ( Lamaze)
Humor ( funny shows)
Music (anything that helps them relax)
Imagery (happy thoughts)
relaxation (progressive muscle relalxation)
Cutaneous stimulation ( massage, acupuncture, TENS, etc)
Acupuncture
PENS ( acupuncture with electricity)
BIOFEEDBACK
THerapeutic touch
what is the difference between physical dependence, tolerance, and addiction?
Physical dependence is where the body physiologically becomes accustomed to the opioid and suffers withdrawl symptoms if stopped
Tolerance is when the body needs a higher dose to achieve the same effect
Addiction is a pattern of use other than for pain control
when are the characteristics of addiction?
craving
compulsive use
lack of control over it
continued use despite harm
how long does it take for tolerance and physical dependence to take place with opiates?
about 4 weeks
What pain medication schedule is best for chronic cancer pain?
What about for post operative pain?
Regular administration (ATC) not p.r.n.
Continuous IV
What are the types of breakthrough pain?
What is the best way to treat Breakthrough pain?
Incident is treated with short activating opiates P.r.n
End of dose is treated by increasing ATC dose or shortening the interval between doses
Idiopathic (uknown cause) requires treatment with dosage and intervals
