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NUR 325 > E2 Pain > Flashcards

E2 Pain Flashcards

1
Q

Acute pain is ____

A

protective –> promotes withdrawal from painful stimuli, allows injured parts to heal, and teaches avoidance

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2
Q

What are the 3 parts of the nervous system involved in the sensation, perception, and response to pain?

A
  1. Afferent pathway: begin in PNS, travels to CNS (Sensation)
  2. Interpretive centers: Cortical and subcortical areas of brain- Brain stem, midbrain, cerebral cortex (Interpret sensation)
  3. Efferent Pathway: CNS back to PNS
    (elicit physical and mental response to pain)
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3
Q

Define Nociception

A

Process of feeling pain or sensation

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4
Q

Decine Nociceptors

A

Pain receptors

Free nerve endings in afferent PNS that when stimulated calls nociceptive pain

We target these pain receptors when we give pain meds

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5
Q

Nociceptive stimuli

A

stimuli of a certain intensity that cause or are close to causing tissue injury

Sharp objects, electric current, heat, coldness, chemical stimuli (pain meds)

With low intensity may not be activated (prick finger)

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6
Q

Where are nociceptive receptors located?

A

skin, dental pulp, periosteum, meninges, some internal organs

None or very few in brain, alveoli, deep tissues

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7
Q

Neurotransmitter modulate control related to the _____ of pain impulses and can be _____

A

transmission

inhibitory or excitatory

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8
Q

Endorphins

A

Natural neurochemicals or endogenous opioids that aid in inhibiting the pain response
-Produced in brain
-Produce sense of exhilaration that dulls or inhibits pain

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9
Q

What are the 4 steps in the physiology of pain (nociception)?

A
  1. Transduction
  2. Transmission
  3. Perception
  4. Modulation
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10
Q

Transduction

A

Painful stimuli concerted to action potentials at the sensory receptor: occurs at A-DELTA fibers and C FIBERS
-Substances/chemical mediators released as a result of a direct injury and inflammation (prostaglandin)

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11
Q

Define prostaglandin

A

important mediator that when activated lowers the pain threshold

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12
Q

A delta

A

-Small diameter
-Less of these
-Myelinated: rapid transmission of pain
-Pain is sharp, stinging, cutting, pinching
-Localized

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13
Q

C Fibers

A

-Small diameter
-More of these
-Unmyelinated: slow transmission of pain
-Dull, burning, aching
-Poorly localized

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14
Q

A alpha and A beta

A

Large diameter
Don’t transmit pain signals

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15
Q

Transmission

A

Process where action potentials move from peripheral receptors to the spinal cord and then the brain
-A delta and C-fibers are responsible for this transmission

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16
Q

Perception

A

Brain then receives these signals adn interprets them as painful

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17
Q

What are the factors that influence perception of pain

A

-Attention
-Distraction
-Anxiety
-Fear
-Fatigue
-Previous experiences
-Genetics
-Age
-Cultural impact
-level of health

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18
Q

Pain tolerance

A

-Greatest intensity of pain a person can handle
-Varies greatly overtime
-Childbirth: Tolerance is way up

-Increase: Alcohol, persistant opioid use, hypnosis, distracting, strong faith

-Decrease: fatigue, anger, bordem, sleep deprivation, apprehension

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19
Q

Pain threshold

A

-Lowest intensity of pain that a person can recognize
-Perceptual dominance occurs
-Intense pain at one location may increase threshold in another location

-Increase threshold: stress, sex, exercise, physical exertion, acupuncture

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20
Q

Opioid tolerance

A

state of adaptation in which exposure to a drug causes changes in drug receptors that result in reduced drug effects overtime

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21
Q

Modulation

A

Synaptic transmission of pain signals in altered
-Can be amplified or dampened
-endorphins mediate pre-synaptic transmission
-Morphine mimics the effect of endorphins

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22
Q

What is the gate control theory

A

Theory that if we can block the pain before it gets to the thalamus/cortex we can stop or lower pain perception (stimulate A delta and C-fibers)

Touch, rubbing skin, massage, distraction, acupuncture, getting active

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23
Q

Signs and symptoms of inflammation are produced by

A

chemical mediators

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24
Q

What are the S/S of chemical mediators

A

pain, swelling, redness, heat, immobility

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25
Q

Chemical mediators begin to be present in the plasma and activated by _______

A

tissue injury

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26
Q

What are 2 examples of chemical mediators?

A

Histamine & Arachidonic Acid Metabolites (prostaglandins & leukotrienes)

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27
Q

What do prostaglandins do?

A

Promote inflammation, pain, and fever
COX-1 & COX-2

-Protect the lining of the stomach from the effects of acid
-Promote blood clotting by activating platelets
-Affect kidney function–> dilate blood vessels that lead to the kidneys

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28
Q

How long does acute pain last?

A

Transient, can last seconds to months (no longer than 3 months)

Pain stops when chemical mediator or injury is gone

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29
Q

How long does chronic pain last?

A

more than 3-6 months

30
Q

Acute pain stimulates the ___ causing

A

ANS
physcial response to pain such as Increased HR & BP, diaphoresis, dilated pupils, anxiety

31
Q

Chronic pain serves no _____ and has no ____ response

A

No purpose

No ANS response

32
Q

Acute pain is mostly ____ while chronic pain is mostly _____

A

Tissue input

Emotions

33
Q

Chronic pain stimulas is ____ the CNS

A

within

34
Q

Nociceptive pain: Cutaneous/somatic pain
Involves? Complaints? Location?

A

Involves MS system

Complaints: constant and achy

Location: Well-Localized (muscles, blood vessels, connective tissue)

Delta fiber (mostly)
C-fibers (some)

35
Q

Nociceptive pain: Visceral Pain
Involves? Complaints? Location?

A

Involves Organs & inflammation sometimes present

Complaints: cramping, splitting, N/V, Diaphoresis

Location: Poorly-localized (internal organs, diffuse, deep)

C fibers

36
Q

Neuropathic pain: Neuropathic pain
Involves? Complaints? Location?

A

Involves Nerves

Complaints: shooting, burning, electric shock, sharp, numb, motor weakness

Location: Poorly localized (peripheral nerves, spinal cord, brain)

37
Q

Referred pain:

A

Pain is felt at a distance from the actual pathology

Common in Visceral pain

Ex. MI pain felt in chest/jaw/left arm
Ex. Pancreatitis –> shoulder pain

38
Q

Phantom pain:

A

Sensation of pain that originates from an amputated part
-Constant (Chronic)

39
Q

Who should not take tramadol?

A

If Seizure hx
If taking CNS depressants (SSRIs & MAOIs)

40
Q

What pain med can only be partially reversed by narcan?

A

Gabapentin

41
Q

Gabapentin is used specifically for

A

neuropathic pain

42
Q

NSAIDs

A

Non-steroidal anti-inflammatory drugs

Nonselective COX inhibitors and Selective COX inhibitors

43
Q

What NSAID is not a true NSAID

A

Acetaminophen/ Tylenol

44
Q

What NSAID do people take to reduce formation of thromboxane?

A

Aspirin (reduces platelet activation)

45
Q

Which type of NSAIDs has serious cardiovascular thrombotic events and has a 87% chance of developing a long-term ulcer?

A

Selective COX-2 inhibitors

46
Q

What are the 2 black box warnings for NSAIDS?

A

Increased risk of Cardiovascular thrombotic events such as stroke or heart attack

Increased risk of GI adverse effects (Elderly at great risk)

47
Q

Salicylate poisoning/ toxicity

A

Aspirin side effect if taken too long or overdose

Acute: N/V, Seizures, cerebral edema
Chronic: N/V, tinnitus, hearing loss

48
Q

Reye’s syndrome

A

-Aspirin Side effect
-NO aspirin for Kids
-Can cause severe brain/liver damage, high mortality rate

49
Q

What is the most potent NSAID?

A

Ketorolac (IV or IM)

Used 5 days or less

50
Q

What are the limitations of acetaminophen (Tylenol)?

A

-Ceiling effect (won’t feel above 1000mg)
-No anti-inflammatory properties (choose other NSAID if inflammation)

51
Q

What is the adult dose restriction of acetaminophen?

A

4grams/ 24 hours

52
Q

What is the acute ingestion antidote for acetaminophen?

A

acetylcysteine- may cause vomiting

53
Q

Chronic alcohol users should limit acetaminophen (tylenol) use to ____

A

<2 g/ 24 hrs

54
Q

Avoid taking acetaminophen in patients who have

A

hepatitis or liver dysfunction

55
Q

When do you use IV tylenol (ofirmev)

A

-Acute pain/ post op pain
-Usually in combination with opioids
-Sometimes first dose given at the time of incision or in pre-op and continued post off

56
Q

What are the opioids?

A

-Morphine
-Hydromorphine
-Fentanyl
-Meperdine
-Codeine
-Oxycodone
-Hydrocodone

57
Q

All opioids are

A

High Alert Drugs

58
Q

What do you need to assess prior to giving an opioid?

A

LOC, BP, HR, RR
If RR <10/min, assess level of sedation (Don’t give)

59
Q

What are the interactions for morphine?

A

Alcohol & CNS depressants (like benedryl)

60
Q

Nursing considerations for Opioids

A

-May impair mental or physical abilities required for operating machinery or car
-PO dose is higher than IV dose

61
Q

Common and serious adverse reactions of opioids

A

CONSTIPSATION
Drowsiness/ fatigue
Confusion, dry mouth, itching

Respiratory depression
CNS depression

62
Q

What opioid do opioid abusers want?

A

Hydromorphone (dilaudid)

63
Q

What opioid is EXTREMELY potent?

A

Fentanyl
0.1mg IV fentanyl = 10mg IV morphine

64
Q

What opioid is not given often but is given usually in ED for migrane or shivering?

A

merperidine

65
Q

What are important things to known about merperidine?

A

-Lots of drug/drug interactions
-With repeated doses it breaks down to toxic metabolite
-Can cause seizures

66
Q

What opioid do alot of people say they are allergic to due to GI problems?

A

Codeine

67
Q

Which opioid is a cough suppressant?

A

Hydrocodone

68
Q

What is the opioid of choice for detoxification treatment in opioid addiction?

A

Methadone

Longer half-life (1 or 2 x a day)

69
Q

What are the adverse effects of naloxone?

A

-Abrupt reversal of opioid effects with recurrent pain
-Increased BP

70
Q

Strength of Opioids from lowest to highest

A

LOWEST strength
Codeine
Hydrocodone
Oxycodone
Merperidine
Morphine
Hydromorphone
Fentanyl
HIGHEST

NUR 325 (21 decks)

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