Exam 2 | Pain & Opioids

Question 1

Pain tolerance vs. Pain threshold

Answer 1

• Pain Tolerance: Maximum amount of pain person can tolerate
• Pain Threshold: Lowest amt of pain needed to feel a stimulus

Question 2

Pain pathway steps

Answer 2

• Pain transduction: taking pain stimulus (mechanical, thermal, chemical) and making it to electrical physical activity via first-order neurons to be transmitted
  
  • First order neurons: A-Delta, C polymodal, A-Beta
• Pain transmission: taking signal from periphery and sending it to thalamus and then to cortex via secondary-order neurons
  
  • Secondary-order neurons: relay messengers: “hey we need to send message from spinal cord to left and right sides of brain”
• Pain Modulation: cerebral cortex of brain receives message → interprets pain and its location via third-order neurons
  
  • Third-order neurons: interprets pain, intensity, and where it’s coming from
• Descending pain modulation:
  
  • Release of pain facilitators: helps facilitate signaling of pain
  • Release of pain inhibitors: natural body pain inhibitors so body doesn’t constantly feel pain
  • Can release serotonin and norepinephrine ⇒ reduces amt of pain by reducing stress and anxiety

Question 3

Fibers of Pain Pathway

Answer 3

• First-order neurons:
  
  • A-Delta Fibers: transmits fast, immediate, sharp, instant pain
    
    • Myelinated/covered ⇒ faster signal transmission
  • C Polymodal Fibers: transmits dull, achy, burning, slow pain
    
    • Non-Myelinated/uncovered ⇒ slower signal transmission
  • A-Beta Fibers: transmits vibrating, pressure, touch non-nociceptive signals (more abt proprioception/where you are in space)
    
    • Myelinated/covered ⇒ faster signal transmission
• Secondary-order neurons: relay messengers: “hey we need to send message from spinal cord to left and right sides of brain”
• Third-order neurons: interprets pain, intensity, and where it’s coming from

Question 4

Nursing Considerations for Patient-Controlled Analgesia

Answer 4

• Patient education: tell pts how system works
  
  • Look at amount of times pt pressed it: tell them they need to wait for pain relief bc it takes time for meds to hit receptors to work
  • Tell family they can’t press it
• Monitor respiratory status, pulse oximetry, LOC bc breathing and CO2 should always be monitored, esp respiratory depression
• Check safety lockout interval:
  
  • Lockoutinterval: set time between doses to prevent overdose
  • Pressing it too much ⇒ no med administered

Question 5

Neonatal response to opiate exposure (acute)

Answer 5

• Neonates exposed to opiates during pregnancy or immediately after birth: baby can experience…
  
  • Neonatal abstinence syndrome (NAS): group of withdrawal symptoms bc newborn no longer receiving opioids from mom’s bloodstream
  • Drug may also stay circulating after baby is born
  • Respiratory depression, tremors, CNS depression, long-term developmental effects, etc.

Question 6

Patient response to opiate tolerance

Answer 6

• Drug/Opiate tolerance: large amts of meds needed to elicit a response
• Nursing considerations:
  
  • Start slow on meds → increasing dosage if it still doesn’t work (“go low, go slow”)
  • If pt have been on opiates for a long time → decreased response to med → needs higher dose
  • Look at pt’s previous med dosages and results to have baseline

Question 7

Effects of prolonged opiate therapy

Answer 7

• Toxicity (class triad): if anything respiratory/airway circulation inhibited → fix that first
  
  • Miosis: pinpoint pupils
  • Respiratory depression
  • Coma-like sedation
• Drug dependency / Addiction
• Withdrawal symptoms when they don’t get it or get a decrease in dosage they usually take
• Need for higher drug dosages

Question 8

Common GI side effects of opioids

Answer 8

Constipation bc they slows peristalsis