Comfort and pain Flashcards
Occult
hidden
Cutaneous
skin or subq tissue
ex: sunburn
Somatic
deep in bones, tendons, ligaments and vasculature
ex: sprained ankle
Visceral
from organs
ex: cramping, throbbing, nausea, angina, IBS
Neuropathic
from damaged or malfunctioning nerves
Nociceptive
originates in nociceptors taking pain in from outside
ex: finger prick
Physical Pain
can be identified
Psychogenic Pain
cause of pain cannot be identified
Referred Pain
pain is perceived in an area distant from its point of origin
What side of the brain is pain transmitted to?
the opposite
Proprioceptive Reflex
activity stops when feeling pain
ex: touching a hot stove
Substance P
sensitive fibers on nerves to feel pain and increase firing rate of nerves, assists in transmission of impulses across synapse
Transduction
nociceptors can be excited by stimuli which triggers release of biochemical mediators and cause movement of ions across cell membrane which excites nociceptors
Modulation
when neurons in thalamus send signals back down dorsal horn of spine; fibers release opoids, norepi, serotonin. sensation of pain is limited or modified
Opioid neuromodulators
endorphins and enkephalins
Which neuromodulator is more potent
endorphins
What endorphin has the most potent analgesic effect?
dynorphin
Bradykinin
powerful vasodilator that increases capillary permeability and constricts smooth muscle
Prostaglandins
important hormone-like substance that sends pain stimuli to CNS; if increased can cause severe menstrual cramps
Gate Control Theory
non-painful input closes “nerve gate” to painful input which prevents pain sensation from traveling to CNS
Pain Threshold
minimum of intensity of stimulus that is perceived as painful
Adaptation
can effect patients perception of pain
ex walking into a pool vs jumping into it
Wong Baker FACES
for adults and kids older than 3
Beyer Oucher
for kids who are able to point to a face to indicate the level of pain; pictures of real kids faces
CRIES Pain Scale
for neonates, uses vital signs
FLACC
for infants and kids 2 months - 7 years who are unable to give pain a number
F- ace
L-egs
A-ctivity
C-ry
C-onsolability
Painad
for patients with dementia
COMFORT
for patients who cant use numeric rating or faces
Non Opioids
acute and chronic, mild to moderate pain, inflammation, fever; OTC
NSAID
non opioid, can cause gastric irritation and kidney damage
Tylenol
NOT NSAID, reduces pain and fever can cause liver toxicity
Asprin
impairs clotting, dont take w blood thinners
Opioids
stimulate opioid receptors or bind with pain receptors to block pain impulse
mu agonist
opioid, good for break through pain; no max daily dose; cannot be taken with agonist-antagonist
Agonist-antagonist
stimulate some opioid receptors but block others
less risk of respiratory depression
Adjuvants
may be used as primary therapy in conjunction with opioids
WHO Anelgesic Ladder 1
mild or moderate pain w/ non opioid and/or adjuvant therapy
ex Tylenol with lidocaine patch
WHO Anelgesic Ladder 2
mild or moderate pain with opioid and possible addition of non opioid/ adjuvant therapy
WHO Anelgesic Ladder 3
increase dose/strength of opioid, can also include adjuvant or non opioid
Numeric Sedation Scale S
sleepy, easy to arouse, no action
Numeric Sedation Scale 1
Awake and alert; no action
Numeric Sedation Scale 2
occasionally drowsy, but easy to arouse; no action
Numeric Sedation Scale 3
Frequently drowsy, drifts to sleep during conversation; decrease dose
Numeric Sedation Scale 4
somnolent with little to no response to stimuli; discontinue opioid and consider narcan
Paradoxical Reaction
patient has opposite effect; more pain
How many breaths per minute does a patient need to have to give pain meds?
12
How many breaths per minute does a patient need to give narcan?
less than 8
PCA Pump
has a lockout, ONLY PATIENT CAN PRESS BUTTON
Nerve Blocks
regional anesthesia, injected around nerve plexus that supply sensation to rest of body
Intraspinal and Epidural Catheter
catheter placed in subarachnoid/ epidural space
Spinal Headache
5 days post spinal procedure, CSF will leak out decreasing amount of fluid around brain; patient needs to lay flat
