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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
opioid side effects - psych
addiction - compulsive craving and need for the euphoria
26
physical dependence/physical tolerance of opioids
long term use renders opiods less effective. NOT the same as addiction.
27
respiratory depression sfx of opioids
life-threatening sfx. treat with narcotic antagonist (naloxone/narcan)
28
hallucination sfx of opioids
some very distrubing (change medication), some very nice
29
narcotics do not mix with...
many meds, alcohol, psych meds, sleeping pills, etc - any depressants
30
Morphine
the "gold standard" - most powerful pain reliever - highest addiction potential - causes respiratory depression and constipation - routes: PO, IM, IV, rectally, patch
31
Codeine
- moderately effective pain reliever - addictive - mostly for moderate pain and cough suppression - routes: PO, IM, IV, rectally
32
Codeine examples
- Tylenol #3 - Percocet with Tylenol - Percodan (with aspirin) - Vicodin
33
Meperedine/Demerol
- 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
Naloxone (Narcan)
- narcotic antagonist - used to reverse narcotic induced respiratory depression or overdose - route IV, spray
35
Equianalgesic chart
conversion chart that lists equivalent doses of analgesics
36
assessment prior to administration of narcotics
- 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
administration guidelines
- 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
Controlled substances
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
substance abuse affects...
all ages, races, sexes, and socioeconomic groups
40
psychological dependence
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
physiological dependence
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
withdrawal peak and duration
usually 1-3 days after stopping = peak usually 5-7 days duration
43
commonly abused drugs
opioids, stimulants, depressants, alcohol, nicotine
44
NSAIDs
non-steroidal anti-inflammatory medications
45
how does injury lead to inflammation?
injury --> release of arachidonic acid --> metabolized in either prostaglandin or leukotriene pathways.--> inflammation (fever, headache, edema, redness) and pain
46
cox enzyme-1 and cox enzyme-2
cox enzyme-1: maintains mucosa | cox enzyme-2: produces inflammation
47
traditional NSAIDS block...
both Cox enzymes (reason why it upsets your stomach)
48
actions of NSAIDs
1. relieve pain 2. decrease fever 3. decrease inflammation 4. anti-coagulant (stop 2 wks prior to surgery)
49
Number one side effect of NSAIDs
Gastrointestinal distress (heartburn, pain, bleeding)
50
other common side effects of NSAIDs
decreased platelet function, tinnitus. allergies are common.
51
aspirin (acetylsalicylic acid)
"the old prototype" actions: analgesic, anti-pyretic, anti-inflammatory, and anticoagulant names: aspirin, ecotrin, ASA, etc route: PO, rectal #1 sfx: stomach upset - 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
Ibuprofen
"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
COX-2 Inhibitors
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
Acetaminophen
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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