Sudden. Short term. Sympathetic nervous system

LP 12: Pain & Comfort Flashcards by Mercedes Garduno

What are the consequences of poor pain management?

-Sleep deprivation
-Poor nutrition
-Depression
-Anxiety
-Agitation
-Decreased activity
-Delayed healing
-Lower overall quality of life

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What is the Nature of Pain?

“Whatever the experiencing person says it is, existing whenever he/she says it does”

Highly subjective
5th vital sign

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What are the 3 types of location of pain?

-Radiate
-Reffered
-Visceral

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What is Radiate Pain?

Pain that spreads to other areas (Low back pain spreads to legs).

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What is Reffered Pain?

Pain that appears to to arise in different areas of the body (cardiac pain is felt in left shoulder or arm)

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What is Visceral Pain?

Pain that arises from organs or hollow viscera.

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What is Acute Pain?

Sudden. Short term.

*<3months
*Mild to severe
*Resolves with healing
*Abnormal VS (increased RR,PR,BP) ->Sympathetic nervous system

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What is Chronic Pain?

Prolonged. Long term.

*>3months
*Mild to severe
*Continues beyond healing
*Pt. appears depressed and withdrawn

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What are the intensity types of pain?

*Mild 0-3
*Moderate 4-6
*Severe 7-10

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What is the Etiology of pain?

*Physiological (Nociceptors)
- Somatic (paper cut; sprained ankle)
- Visceral (obstructed bowel)

*Neuropathic (Nerves damaged)
- Peripheral neuropathic pain
- Central

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What is Threshold?

Least amount of stimuli needed for pain sensation.

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What is Pain Tolerance?

Max amount of pain a person is willing to withstand.

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What is Hyperpathia/Hyperalgesia?

Heightened responses to a painful stimuli (severe pain to a paper cut)

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What is Allodynia?

When non-painful stimuli produces pain (light touch, contact with linens, wind)

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What is Dysesthesia?

Unpleasant abnormal sensation (needles, pinds, itching, burning)

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What is Sensitization?

Increased sensitivity of a receptor after repeated activation by a noxious stimuli

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What is Windup?

Progressive increase pain.
Pain gets out of control.

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What are Nociceptors?

The make up the physiology of Pain

-Transduction
-Transmission
-Perception
-Modulation

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Transduction

Harmful stimuli trigger the release of biochemical mediators which sensitize nociceptors.

-Affect PNS.
-NSAIDs are used (Ibuprofen, aspirin, naproxen)

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Transmission

Process of transmiting pain from site of incident to the brain.

Pain travels through the spinal cord to the brain.

Opioids/Narcotics are used

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Perception

Becoming consious of pain. (Brain)

Distraction is used (nonpharmacological intervations)

Modulation

Descending system (Antidepressants)

Pain signals are sent back down through the dorsal horn to the spinal cord.

What are some responses to unrelieved pain?

-Affects appetite
-Decresed mobility
-Emotional disorder
-Interferes with sleep
-Lowers qualit of life
-Slows healing
-Windup phenomenon occurs.

What factors affect pain experience?

-Ethnic and cultural values (Some show emotions or pain, some others don’t)

-Developmental stage (babies can’t talk)

-Environment and support people (Having someone to talk to)

DEVELOPMENTAL STAGES OF PAIN

Infants

-Perceive pain Relieved with sweet pacifiers, or tactile stimulation.

Toddler/Preschool

Respond to pain with crying and anger Relieved with distractions. Get down to their level and distract them

School-age

Try to be brave Relieved with imagery, behavioral rehearsal.

Adolescents

Want to be brave in front of peers. Provide privacy

Adults

Fear of what pain means may prevent from taking actions. Focus on client's control

Older adults

Multiple conditions. Fear of treatment. Clarify misconceptions

What does History of Pain consist of?

-Location (Where does it hurt) -Intensity (Pain scale) -Quality (Description of pain) -Patterns (Onse; What triggers it; What makes it better

What is FLACC scale?

Pain scale used for children 2 months of age to 7 years old -Facial expretions -Leg movement -Activity -Cry -Consolability

What is PAINAD Scale?

Pain Assessment IN Advanced Dementia

What does OLDCARTS stand for?

Onset Location Duration Characteristics Aggravating factors Relieving factors Treatment Severity

What are the Observations of Behavioral and Physiological Responses?

-Facial expressions -Vocalization -Purposeless body movements -Rhythmic body movements

What is Drug Tolerance?

Decreased sensitivity to a drug's analgesic effect.

What is Physical Dependence?

An expected physical response when a patient with long-term opioid therapy has a significantly decrease or withdrawal.

What is Addiction?

A chronic, relapsing treatable disease influenced by genetic, psychosocial and environmental factorss

What is Pseudoaddiction?

When the pt becomes angry and demanding for the undertreatment of pain.

What are short-term CDC guidelines for opioids?

-Start low, go slow -3 days or less; rarely over 7 days -Do not prescribe ER/LA opioid for acute pain (Extended Release; Long Acting)

Nonopioids/NSAIDs

-Work on PNS ->Ibuprofen, naproxen, aspirin (anti-inflammatory, analgesics, and antipyretics) ->Acetaminophen works on CNS (analgesic and antipyretics)

Opiods/ Narcotics

-Work on CNS ->Morphene, Fentanyl, Oxycodone, Tramadol

Coanalgesics

Medication used for another reason, but has been found to reduce pain

What are types of Coanalgesics?

-Antidepressants ->Amitriptyline; Nortriptyline -Anticonculsants ->Gabapantin; Pregabalin -Topical Local Anesthetics ->Lidoderm

What are the Combinations of Opioids and Nonopioids Analgesics?

*Vicodin: 5mg hydrocodone and 300mg acetaminophen. *Percocet: 5mg oxycodone and 325mg acetaminophen *Tylenol #3: 30mg codeine and 325mg acetaminophen.

What are the side effects of Nonopioids?

-NSAIDs: GI distress; such gastric ulcers, bleeding, renal insufficiency. -Acetaminophen: Hepatotoxicity (limit to 4g/day)

What are the side effects of Opioids?

-Constipation (stool softner) -Respiratory depression (Narcan) -Sedation -Urinary retantion (cath) -Nausea and vomiting (antiemetic) -Pruritus (Benedryl)

What is Capnography?

Monitors the conentration of CO2 in resp gasses.

What are some physical intervantions for pain?

-Cutaneous Stimulation -Reflexology -Immobilization -Transcutraneous Electrical Nerve Stimulation (TENS)

What are some Cognitive-Behavioral Interventions for Pain?

-Distraction (TV, musicl, pet) -Relaxation Response -Repatterning unhelpful thinking -Facilitationg coping, spiritual interventions

What is a Nonpharmacological Invasive Technique?

Nerve blocking - When meds go directly into the nerve to block pain