FON CH 11and CH 21 Flashcards
**Types of pain
MILD/SEVERE
CHRONIC/ACUTE. Chronic- usually the result of prior tissue damage. Pain lasting more than 6 months. Can be constant or intermittent increase/decrease
Acute-intense, usually of short duration therefore usually tx w/opioids and other analgesics
REFERRED PAIN-can radiate, felt at a site other than the injured or diseased part of the body
Acute pain response
Creates a response that starts in the sympathetic nervous system (SNS) flooding the body with epinephrine/fight or flight response. Associated w/ anxiety can be a warning of actual or potent tissue damage
**Chronic pain
Does not serve as warning of tissue damage in process. May be linked to arthritis, back injuries. Accidents, or neurological condition, cause may be unidentifiable **6months
**High risk of self injury, cause of depression, suicide
Chronic pain
**Gate control theory
Pain impulses can be regulated or even blocked by gating mechanisms along the central nervous center (CNS).
Location of the gate is in the dorsal horn of spinal cord. Pain and other sensations of the skin and muscles travel this route
**Endorphins
Morphine like substance produced by body(naturally occurring)
Activated by stress and pain
Attach to opioid receptors sites in brain
Prevent release of neurotransmitters
Inhibit transmission of pain impulses
Analgesia
People who feel less pain than others have a higher endorphin level
TENS , acupuncture and placebos may cause the relief of endorphins
Subjective data
Characteristics and descriptions of the pain where?, anywhere else?
Pain is what pt. says it is
**Objective data
Is measurable
Tachycardia
Increased rate and depth of respirations
Diaphorisi
Increased systolic / diastolic BP
Pallor
Facial expressions
Restlessness
Muscle tension
Pain assessment
Subjective and objective data (crucial)
Subjective:pain is what the pt. says it is
Objective data: is measurable
H I L D A
H- how does your pain feel?
Intensity
Location
Durations
Aggravating and alleviating factors
P Q R S T Pain assessment used by ATI
The Joint Commision Requiements for controlling pain
The management of pain is appropriate for all patients, not just dying patients
Routine and PRN analgesics are to be administered as ordered
Education of practitioners: assessment and management
Fifth vital sign
Pain is monitored on regular basis
Appropriate pain management brings about
Quicker recovery‘s
Shorter hospital stays
Fewer readmissions
Improved quality of life
Unrelieved pain
Harmful physical and psychological effects
**Noninvasive pain relief techniques
Removal of pain source
Distraction
Relaxation
Guided imagery
Hipnosis
Biofeedback
**Invasive approaches to pain
Higher risk than non-invasive strategies
Nerve blocks
Epidural analgesics
Acupuncture
Injections
Oral medications
Medication for pain management
ANALGESIC=Acting to relieve pain
Non opioids
Opioids
Compound analgesics
Non-opioid pain medication
NSAID= non steroidal anti inflammatory drugs used to relieve pain reduce inflammation
Antiprostaglandins= agains inflammation (?)
Ibuprofen= advil, Motrin, nupren (faster)
Naproxen= used for arthritis, swelling inflammation, stiffness joint pain
Aleve is Naproxen (longer lasting)
Rx versions= Celebrex, toradol, daypro
(?3200 mg -4equal doses daily?)
Tylenol= APAP. (metabolized in liver) is NOT a NSAID. is anti-pyrectic. It is acetaminophen treats pain and fever headaches
No more than 4000mg per day
Aspirin=ASA
Risk of bleeding
Do not give to children
Mechanism of action (meds)
Different analgesics relieve pain in different ways
NON OPIOIDS
TYLENOL= seems to inhibit prostaglandins (inflammation)
that may serve as mediators of pain and fever primarily in the central nervous system but they may also block pain impulses peripherally
ASPIRIN= blocks pain impulses in the central nervous system and reduces inflammation in
NSAIDS= TRAMADOL, IBUPROFEN=MOTRIN,ALEVE, TORADOL work in the CNS but their better characterized actions are peripheral ( at site of injury)
Mechanism of action
Opioids
Hopefully to leave pain mainly by action in the CNS Binding to the opioid receptor sites in the brain and spinal cords. When a drug attaches to these sites pain relief occurs
Narccan ( opioid antagonist)
Blocks/reverses the action of all opioids
Adjuvant analgesic=Diverse mechanisms of actions
Drugs meant to relieve one condition but also work on other conditions
Some antidepressants appear to relieve pain by blocking the way up take a serotonin some local anesthetics such as Mexitil in certain anticonvulsants such as Tegretol a sodium channel blocking agents and this part of the mechanism contributes to their ability to relieve certain pain. Neuropathic pain is difficult to treat and some antidepressants and anti-convulsant such as duloxetine which is Cymbalta are used
Antidepressants - Cymbalta
Anticonvulsants- tegretol, Neurontin, Lyrica
Opioids they REMOVE pain sensation (it does not exist)
Open voice being binds to receptors sites in the brain and spinal cord they decrease perception of pain they do not fix the cause of the pain
NAMES of some opioid medications
Morphine Dilaudid, Fentanyl, Percocet= Oxycodone, codeine,

Medication patches
Never apply any form of heat to a patch
Dangers of opioid medication
Respiratory depression rate and depth
Dangers of vary based on the route of administration
Abuse versus used
Addiction versus tolerance versus dependence
increase in rem sleep
PCA=Patient controlled analgesia
Patient has a button to administer bolus dolls
May also have a continuous rate
Timer to prevent overdose
Records number of button presses
Short acting IV push
Best for rapidly increasing Also known as breakthrough pain. last 3 to 6 hours
Extended release (Coated pills and capsules patches and pumps)
Last 24 to 72 hours or longer DO NOT crush extended release pills
IM (muscle) route
Good for quick administration
Nursing interventions forPrevention and management of constipation
Diet high fiber veggies and fruit
Fluid intake
Stool softeners/ stimulants
Causes of opioid induced constipation
Delayed emptying
Decreased peristalsis
Ileus impaction=peristalsis stops, no movement
Nursing principles: analgesics
No the patient
No the medication which is the best right now
No the dose
No the timing
Which route

Nursing principles: epidurals= Anesthetized at certain level of spine
Another method of delivery of analgesia is the insertion of an epidural catheter and infusion of opiates into the epidural space. The medication diffusers slowly epidural administration brings the drug close to the action site. Therefore relatively small doses are affective
Patients who receive epidurals may have or need
Dressings
Catheter
I&O
Vitals and O2 sat
 Bowel and bladder Elimination issues
Side effects
Patient may be unsteady on the feet after an epidural patients
Responsibility of nurse and pain control
Advocate for the patient. clarify concerns. answer questions. supply information the patient needs to make decisions about care. support patients decisions
Individualizing pain therapy
More interventions
Promoting patients rest and sleep
A patient feels at rest when
Mentally relaxed. free from worry physically calm. free from physical or mental exertion Sleep is a sustained period of rest
Reduced consciousness provides time for repair and recovery of body systems
Restores energy and feeling of well-being
Factors that influence sleep
Sleep deprivation
Decreases the amount quality or consistency of sleep
Sleep can be interrupted or fragmented
Sleep deprivation in the hospital can be caused by water pills long naps, or an invironment with too much stimuli
Effects of sleep deprivation
slowed response time
Cardiac dysrhythmias. Mood swings. Decreased mental acuity. Decreased reflexes. Tremors. Reduced word memory. Decressed reasoning. hypertension, heart disease, stroke
Patient self-determination act of 1991
HIPAA addresses privacy of all information received from or about the patient
When patient wishes to leave
Answer questions Directly
Offer information about care
Utilize therapeutic communication to offer support
Be kind caring and show empathy
**Common patient reactions
Fear of the unknown*
Helplessness
Loss of identity
Separation anxiety
Loneliness
Fear of never going home again
Disorientation from loss of appetite/disrupted sleep cycle*
Nursing interventions: ALWAYS PROVIDE PATIENT CENTERED CARE
Have a warm caring attitude,and be courteous.
show empathy
treat patients with respect
learn their names pronouns and preferences
Maintain their dignity
Involve them in the plan of care
Whenever possible, adjust hospital l routine to meet their preferences
What should be done in patient room
Room should be welcoming make an open bed
Place special equipment before patient arrives
Greet the patient
Give orientation to unit/room
Explain hospital routine
Non English speaking patient
Secure interpreter or translation services
Respect the patient as an individual
Practice cultural humility
Allow them to wear clothing of their choice
Assessment: patient problems. (Admission/transfer/discharge)
Potential for injury
Fearlessness R/T admission to faculty
Assessment (Admission /transfer/discharge)
Expected outcomes and planning
Patient will verbalize understanding of care Planned while in facility
Patient will not Suffer accidental injury while in facility
Admitting procedure
Check ID band and verify info
Assess immediate needs- pain, SOB, or severe anxiety
Introduce roommate
Ask family to take valuables home
Send home meds to pharmacy
Discharging a patient
Discharge patient with a written instructions and teaching(guide to use at home)
 Patient signs acknowledgment of understanding
Always send patient home with a discharge instructions

Discharge : against medical advice AMA
When patient leaves without an order for discharge notify the provider immediately
An AMA form must be signed by the patient
It is illegal to detain the patient
Nursing task(admission /transfer/discharge)
Take hx
RN performs initial assessment
The provider notified when patient has been admitted 
Transferring pt
Note condition of the pt.
Improved/critical
Transfer to another unit in hospital
Transfer to another facility
Preparation and careful documentation
Many injuries and errors occur during transfer process
Pain is the fifth vital sign
Unrelieved pain ha s harmful physical and psychological effects
Synergistic Impact
2 or more factors together(medications)
Achieve a greater effect
Cannot be achieved by one factor alone
Can become a vicious cycle: making pain difficult to treat
Pharmacology terminology
Desired effect- therapeutic effect
Side effect-problem occurs in addition to the therapeutic effect
Indication-what the drug is used(indicated) for
Adverse reaction-undesirable effects
*must be able to educate pts.about meds
2 Phases of sleep
- Non rapid eye movement NREM
Stage 1 light sleep few mins
Stage 2 sound sleep 10-20 mins
Stage 3 deep sleep 15-30 mins
Stage 4 deepest sleep 15-30 mins - Rapid eye movementREM
Dreaming full, color
90 mins(full sleep cycle) after sleep begins
After stage 4 of NREM
Duration increases with each cycle
Admission
*Assistive interventions