Comfort and Pain Management Flashcards
What are the steps in the pain process?
- Transduction (conversion of energy into electrical impulse)
- Transmission
- Perception (the point at which the person feels the pain)
- Modulation [(Inhibition or nullification of pain) moving body away from painful stimuli]
What is Nociception?
The ability to feel painful stimuli.
What is the most potent endorphin for analgesic effect?
Dynorphin.
Characteristics of Acute Pain.
- Protective
- Identifiable
- Short duration
- Limited emotional response
Characteristics of Chronic Pain.
- Not protective
- No purpose
- May or may not have an identifiable cause
What is Chronic Episodic Pain?
Pain that occurs sporadically over an extended duration.
What is Idiopathic Pain?
Chronic pain without identifiable physical or psychological cause.
What are some unique factors that affect pain?
- Fatigue
- Attention
- Age
- Anxiety and fear
- Pain tolerance
- Cultural
- Past experiences
What are some nonpharmcological pain-relief interventions?
- Cognitive and behavioral approach
- Relaxation and guided imagery
- Distraction
- Music
- Cutaneous (skin) stim/TENS
- Acupuncture & Acupressure
- Cold/Heat packs
- Transcutaneous E-Stim (TENS)
- Herbals
- Reducing pain perception and reception
- Elevation of edematous extremities
What is Patient-Controlled Analgesia?
Med admin system that allows patient to self-administer safe doses of opioids.
What are frequently used meds in PCA?
- Morphine
- Fentanyl
- Hydromorphone
How do you prevent inadvertent overdose with PCA?
Patient is the only one allowed to push the button.
What symptom is most indicative of acute pain?
Increased blood pressure.
Aside from oral medication, what other routes can opioid medication be administrated?
- Parenteral
- Intramuscular
- Transdermal
- Rectal
What are the most common routes of administration for PCAs?
- IV
- Subcutaneously
- Epidural
PCA Facts.
- Dose interval programmed into system (usual 6-8 minutes)
- Lock-out interval programs system to deliver a specific amount within a given time interval (usually hourly)
- Safeguards limit the possibility of over-medication
What types of individuals are suitable for PCA?
Alert and oriented.
What types of individuals are not suitable for PCA?
- Confused older adults
- Infants
- Very young children
- Cognitively impaired patients
- Patients w/ conditions for which over-sedation poses a significant health risk (i.e. asthma/sleep apnea)
PCA Advantages.
- Consistent analgesic blood level
- Faster and more predictable absorption than IM
- Patient in charge
- Less medication is used
- Allows for earlier ambulation
- Patient is more satisfied and improved pain relief
What is the best method to monitor patients for respiratory depression during PCA?
- Pulse Ox
- Capnography (CO2 measurement)
Which opioid neuromodulators block pain and produce euphoria?
- Endorphins
- Enkephalins
What does seratonin help regulate?
- Mood and social behavior
- Appetite and digestion
- Sleep
- Memory
- Sexual desire and function
What does dopamine help control?
Reward and pleasure.
Where does visceral pain originate?
- Cranium
- Abdomen
- Thorax
Where does somatic pain develop from?
- Muscles
- Tendons
- Joints
Describe how neuropathic pain is experienced.
For days, weeks, or months after the source of pain has been treated and resolved.
What type of feeling is somatic pain?
- Aching
- Throbbing
What type of feeling is visceral pain?
- Aching
- Throbbing
- Cramping
- Pressure
- Deep
- Radiating
What type of feeling is neuropathic pain?
- Tingling
- Itching
- Burning
- Cold
- Prickly
- “Shocklike”
What type of pain serves no purpose?
Persistent pain.
What does the Gate Theory explain?
Why mechanical and electrical interventions or heat and pressure may provide effective pain relief.
What are the most common side effects of opioid use?
- Sedation
- Nausea
- Constipation
What is Neuropathic Pain?
Pain that originates from abnormal or damaged pain nerves.
What types of medication would you use for neuropathic pain?
Adjuvant medication.
What are substances that increase pain transmission and cause an inflammatory response?
- Substance P
- Prostaglandin
- Bradykinin
- Histamine
What are substances that decrease pain transmission and produce analgesia?
- Serotonin
- Endorphins
Which vital signs and symptoms will acute pain affect and exhibit?
- Blood pressure
- Pulse
- Respiratory rate
- Dilated pupils
- Diaphoresis
What is Hyperalgesia?
Heightened sense of pain.
What is Allodynia?
Patients experiencing pain from experiences that are not usually painful (lightly touching your skin or wind blowing).
What are the 3 types of analgesics?
- Opioid
- Non-opioid
- Adjuvants
Which route is best for immediate, short-term relief of acute pain?
Parenteral route.
Which route is best for chronic, non-fluctuating pain?
Oral route.
What kind of analgesics would you use for mild to moderate pain?
Non-opioid/NSAIDs.
What type of medication is used to treat the respiratory depressant effect from opioids?
Naloxone.
What are the 3 types of nociceptive pain?
- Somatic
- Visceral
- Cutaneous
What are the different levels on the sedation scale?
- S: Sleeping, but easy to arouse
- 1: Alert and awake
- 2: Slightly drowsy, but easy to arouse
- 3: Frequently drowsy, arousable, but drifts off mid-conversation
- 4: somnolent with minimal or no response to stimuli; discontinue the opioid and consider use of naloxone
What are the principles guiding treatment for cancer pain?
- Administer meds around the clock
- Giving oral meds for convenience
- Assessing pain every visit
- Contacting health care provider if client reports unrelieved pain
How should the bed be positioned during epidural therapy?
The head of the bed should be elevated by 30 degrees.
What are the therapeutic effects of laughter?
- Activating the immune system
- Increases pain threshold
- Reduces arterial wall stiffness
- Improves endothelial function
At what ages do you use the FLACC scale?
2 months to 7 years.
What is the priority for admitting a dying patient?
Pain Management.
At what ages do you use the CRIES scale?
0-6 months.
What are the 3 types of endogenous opioids?
- Endorphins
- Enkephalins
- Dynorphins
What is referred pain?
Pain originating at one part of the body but perceived in a different area.
What does it mean when pain is intractable?
Pain is resistant to therapy and persists despite a variety of interventions.
What organ function is suppressed by pain?
Kidney.
What is the action of ibuprofin?
Have an antiprostaglandin effect on the CNS.
Which clients are best candidates for epidural therapy?
- Terminal cancer
- Hip surgery
- Spinal surgery
- LE surgery
What is a paradoxical effect of hypnotics?
Stimulating effect or mental changes.
Which fibers are responsible for dull and poorly localized pain?
C-fibers.
Which fibers are responsible for sharp and well localized pain?
A-delta.
What are common examples of physiologic responses to pain?
- Increased BP
- Increased muscle tension
- Increased rigidity
