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NRSG 213 > Lecture 3 > Flashcards

Lecture 3 Flashcards

1
Q

what is pain?

A
  • highly subjective
  • may have actual or potential tissue damage
  • difficult to define
  • unpleasant sensory and emotional experience
  • individualized w different thresholds and tolerances
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2
Q

acute pain

A

sudden onset and short duration; we are very good at treating this type of pain.

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3
Q

chronic pain

A

persistent or recurring; dificult to treat; long duration.

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4
Q

somatic pain

A

originates from muscles, ligaments, and joints. localized, constant, and described as “aching/throbbing”.

responds best to NSAIDs

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5
Q

deep (visceral) pain

A

originates from organs. often described as “dull/aching/referred”

hard to pin down exactly where it is

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6
Q

phantom pain

A

pain in a missing body part - amputation

described as burning, itching, tingling, or stabbing.

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7
Q

referred pain

A

originate in one place but felt in another.

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8
Q

neuropathic pain

A

caused by peripheral nerve injury, not stimulation. described as “shooting, burning, tingling”

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9
Q

Gate Control Theory

A

suggests that the spinal cord contains a neurological ‘gate’ that either blocks pain signals or allows them to continue on to the brain. (THIS FLASHCARD DOES NOT COVER THIS THEORY IN DETAIL; REVIEW IN NOTES)

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10
Q

assessment for pain

A

subjective - ask patient to describe it. rate on a scale of 1-10. BELIEVE YOUR PATIENT

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11
Q

objective signs pt is in pain

A
  • tachycardia
  • hypertension
  • restlessness
  • complaints
  • insomnia
  • difficulty concentrating
  • pallor
  • sweating
  • withdrawal
  • tense muscles
  • difficulty walking/slowly moving, etc
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12
Q

WHO Analgesic Ladder - what is it and what are its three main principles

A

strategy to provide adequate pain relief

  1. by the clock
  2. by the mouth
  3. by the ladder
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13
Q

Step 1 of WHO Analgesic ladder

A

Non-opiod and adjuvant:

  • acetaminophen
  • NSAIDs
  • antidepressants
  • anticonvulsants
  • corticosteroids
  • antispasmodics
  • topical agents
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14
Q

Step 2 of WHO Analgesic Ladder

A

add opioid or mild to moderate pain

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15
Q

Step 3 of WHO Analgesic Ladder

A

add opioid for moderate to severe pain

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16
Q

Step 4 of WHO Analgesic Ladder

A

add opioid via invasive treatment pain

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17
Q

opioid analgesics are…

A

very strong, narcotics. originally derived from opium, but now many are synthetic.

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18
Q

opioid mechanism of action

A

binds to receptors and blocks the pain response. also causes sedation and euphoria. releases histamine, causing BP and skin sfx

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19
Q

opioid side effects - CNS

A

sedation, disorientation, lightheadedness, cough suppression (codeine)

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20
Q

opioid side effects - CV

A

orthostatic hypotension, flushing

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21
Q

opioid side effects - respiratory

A

respiratory depression, death (morphine)

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22
Q

opioid side effects - GI

A

n/v (nausea and vomiting), constipation (lomotil)

23
Q

opioid side effects - GU

A

urinary retention

24
Q

opioid side effects - skin

A

itching, rash, redness along vein or at place of injection, facial flushing

25
Q

opioid side effects - psych

A

addiction - compulsive craving and need for the euphoria

26
Q

physical dependence/physical tolerance of opioids

A

long term use renders opiods less effective. NOT the same as addiction.

27
Q

respiratory depression sfx of opioids

A

life-threatening sfx. treat with narcotic antagonist (naloxone/narcan)

28
Q

hallucination sfx of opioids

A

some very distrubing (change medication), some very nice

29
Q

narcotics do not mix with…

A

many meds, alcohol, psych meds, sleeping pills, etc - any depressants

30
Q

Morphine

A

the “gold standard”

  • most powerful pain reliever
  • highest addiction potential
  • causes respiratory depression and constipation
  • routes: PO, IM, IV, rectally, patch
31
Q

Codeine

A
  • moderately effective pain reliever
  • addictive
  • mostly for moderate pain and cough suppression
  • routes: PO, IM, IV, rectally
32
Q

Codeine examples

A
  • Tylenol #3
  • Percocet with Tylenol
  • Percodan (with aspirin)
  • Vicodin
33
Q

Meperedine/Demerol

A
  • synthetic narcotic
  • highly addictive
  • does not usually cause respiratory depression
  • contraindicated for the elderly or renal dysfunction
  • moving in and out of favor due to so many complications
  • routes: PO, IM, IV
34
Q

Naloxone (Narcan)

A
  • narcotic antagonist
  • used to reverse narcotic induced respiratory depression or overdose
  • route IV, spray
35
Q

Equianalgesic chart

A

conversion chart that lists equivalent doses of analgesics

36
Q

assessment prior to administration of narcotics

A
  • assess pain
  • scale of 0-10
  • assess RR before and after administration (if <12 RR do not administer)
  • assess alcohol and drug use
  • note that these meds decrease alertness - NO DRIVING
  • do not crush if “extended release” form
37
Q

administration guidelines

A
  • assess for respiratory depression, constipation, and urinary retention afterwards
  • oral narcotics better tolerated with food
  • controlled substances have special counting and documentation procedure
  • raise siderails after (patient must stay in bed d/t disorientation)
  • have naloxone/narcan available
  • narcotics work better if taken before pain becomes too much
  • pain goal: 3 or less
38
Q

Controlled substances

A

Narcotics

  • kept in Omnicell/Pyxis machine
  • must be counted per hospital policy
  • counted by 2 RNs
  • wasting a dose must be witnessed by another RN other than the one wasting
39
Q

substance abuse affects…

A

all ages, races, sexes, and socioeconomic groups

40
Q

psychological dependence

A

need for pleasant feeling is extremely strong. without the drug, cravings and physical symptoms develop.

drug seeking behaviours
body does not need drug to survive.

41
Q

physiological dependence

A

physiological reliance on a substance. if substance is stopped, withdrawal symptoms will develop. increasing tolerance to meds – need more and more to get fx

42
Q

withdrawal peak and duration

A

usually 1-3 days after stopping = peak

usually 5-7 days duration

43
Q

commonly abused drugs

A

opioids, stimulants, depressants, alcohol, nicotine

44
Q

NSAIDs

A

non-steroidal anti-inflammatory medications

45
Q

how does injury lead to inflammation?

A

injury –> release of arachidonic acid –> metabolized in either prostaglandin or leukotriene pathways.–> inflammation (fever, headache, edema, redness) and pain

46
Q

cox enzyme-1 and cox enzyme-2

A

cox enzyme-1: maintains mucosa

cox enzyme-2: produces inflammation

47
Q

traditional NSAIDS block…

A

both Cox enzymes (reason why it upsets your stomach)

48
Q

actions of NSAIDs

A
  1. relieve pain
  2. decrease fever
  3. decrease inflammation
  4. anti-coagulant (stop 2 wks prior to surgery)
49
Q

Number one side effect of NSAIDs

A

Gastrointestinal distress (heartburn, pain, bleeding)

50
Q

other common side effects of NSAIDs

A

decreased platelet function, tinnitus. allergies are common.

51
Q

aspirin (acetylsalicylic acid)

A

1 sfx: stomach upset

“the old prototype”

actions: analgesic, anti-pyretic, anti-inflammatory, and anticoagulant
names: aspirin, ecotrin, ASA, etc
route: PO, rectal

  • approved for use in children over 3 yo; should not be given to children recovering from chickenpox, anyone with bleeding, anyone with ulcers
  • often mixed with other meds, such as cold meds
52
Q

Ibuprofen

A

“the new prototype”

actions: analgesic, anti-pyretic, and anti-inflammatory
names: motrin, nuprin, advil
route: PO
sfx: not many

  • OTC strength: 200 mg/tab
  • not given to pts with asthma, renal disease, hepatic disease
53
Q

COX-2 Inhibitors

A

action: analgesic, anti-pyretic, and anti-inflammatory. inhibits cox-2 (required for synthesis of prostaglandin), but not cox-1
names: celecoxib, celebrex
route: PO, once daily
sfx: less GI distress than other NSAIDs

  • no change in platelets
  • very expensive - approx 250c/capsule
54
Q

Acetaminophen

A

NOT AN NSAID

action: analgesic and antipyretic only
names: tylenol
route: PO, rectal, IV
sfx: few sfx unless you take the whole bottle, but can still overdose

  • no change in platelets or cardiac/respiratory system
  • contraindicated for pts with anemia, renal disease, hepatic disease

NRSG 213 (9 decks)

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