L2: pain, etc... Flashcards
Define 3 types of pain according to pathology
- Nociceptive: Somatic or visceral pain as a response to injury.
- Neuropathic: injury to or improper functioning of nervous system that causes pain. Damage can be in CNS or PNS
- Nociplastic pain: An amped up nervous system that over-sensitizes normal stimuli into pain.
Action when you suspect resp distress
- call for help
- Alertness, Breathing, Circulation (pulse)
- Take glucose levels
Specific interventions would be check airway, reposition child, apply suction, oxygen, manual ventilation,
How do you know if you’re doing compressions right
check pulse, appropriate colour comes back
What should you look for when assessing IV site
- Touch: feels warm, dry, pain free
- Look: dry, uncovered, not red
- Compare: to other arm
Check TLC every hour (even during sleep) and during HEAL checks. Teach pt when to call nurse
What is HEAL check
A safety check that stands for:
- High alert and all infusions
- Equipment: all safety equipment is in the room (resp mask, etc..)
- Armband: check if it is on patient and identify
- Lines: all infusions lines are good
What is gold-standard of pain report and what else is used
Self-report, behaviour, and physiological data
What are the symptoms of nociceptive pain? and How’s it treated?
- Localized aching and throbbing pain if somatic
- Cramping intermittent pain if visceral
- Treated with Opioids and non-opioids
What are symptoms of Neuropathic pain
- burning
- Paresthesia: pins/needles feeling
- hyperalgesia: Heightened pain experience
- Allodynia: pain from touch/pressure to deep tissues
- Treated with analgesics that depress NS activity (anti-depressants and anti-convulsant)
- Opioids do not work
Symptoms for nociplastic pain
- Other symptoms associated with an overstimulated NS
- Mix bw nociceptive and neuropathic pain
3 types of pain according to longevity
- Acute: lasts 3 months and is caused by an identifiable cause. Pain management subsides with healing.
- Chronic : lasts longer than 3 months. Pain outlasts healing of the source and because of this chronic pain can be classified as a disease as well as a symptom. Can be neuropathic or nociplastic. The focus shifts to functioning and rehabilitation.
- Persistent post-surgical pain (PPP): Surgical pain that continues (beyond expected healing time). Younger pts and pts with poor pain management are more at risk for developing this pain.
LMNOPQRST in pain
location, mechanism of pain (causes), neuropathic (type), onset, palliative/proactive, quality, region, severity, timing
Describe NIPS scale
Used on infants up to 2m. Uses observable data. Highest pain is 7/7 intensity
Describe FLACC scale
- Age range is 2m-7yrs.
- Also used for cognitive impaired pts. and those who cant speak
- uses observable data
- Stands for Face, legs, activity, cry, consolability. All rated out of 2
- overall 0-10 intensity rating
Describe Revised FACES scale
- Show faces to pt that show comfort expressions.
- More realistic than modified FACES or Wong-Baker tool.
- Depicts less emotion and more discomfort
- 0-10 intensity scale
Describe Modified FACES scale
- Show faces to pt that show comfort lvl.
- Problem is that kids may confuse discomfort expressions for emotional expressions
Describe the WHO pain ladder
A 3 step ladder that explains what medications to give based on pain scores.
- If pain score is 1-3 (mild pain), we give non-opioid (Tylenol or ibuprofen) with or with or without adjuvant
- If pain is 4-6 (moderate pain), we give weak opioids with or without non-opioids or adjuvant
- If pain is 7-10 (severe pain), we give strong opioids, with or without non-opioids or adjuvant
What is multimodal analgesia
Using multiple analgesics at smaller doses to maximize pain control and minimized drug-induced adverse effects
What are the 3 p’s to pain relief
Pharmacology, physiotherapy, psychology
What is ATC medication scheduling
“Around the clock” which means scheduled dosing. It is considered when pt is in pain for more than 12hr is in the day. It keeps pain level stable
Cons of PRN medication scheduling
Patient will have reoccurring breakthrough pains when their analgesia blood levels are low. So medication adm will have to be ASAP after request
What is the non-pharm support framework/ladder
- Mild to mod pain involves physical therapy
- mod to severe pain involves behavioral therapy
- severe pain involves Cognitive therapy
What patient teaching about pain management can you give to a post-op pt
- give pain pamph;et at discharge
- Encourage them to take Tylenol +/- NSAID for the first 48-72 hrs post-op
- Teach them when to uses their opioids. when pain reaches 4/10 or 30 min before activity (if oral)
- ## Tell them that good pain control = faster recovery
