Med-Surge FON Chp 16 Pain management Flashcards
Key Terms
Pain Management
Acute pain- is intense and short duration, lasting less than 6 months, likely to be prescribed opioids and other analgesics.
Chronic pain- pain lasting longer than 6 months at times as intense as acute pain.
Endorphins- morphine like substances produced by the body during times of stress and pain, causing an analgesic effect.
Gate control theory- pain impulses are regulated and even blocked by gating mechanisms located along the CNS, proposed location of gates is the dorsal horns of the spinal cord. The brain does not have the capacity to acknowledge the pain while it is interpreting another stimuli.
Non-rapid eye movement (NREM)- 4 stages, Lightest level of sleep, period of sound sleep, initial stages of deep sleep, deepest stage of sleep.
Key Terms
Pain management
Noxious- injurious to physical health, stimulation of the sensory nerve endings.
Patient-controlled analgesia (PCA)- allows patients to self administer analgesics whenever needed.
Rapid eye movement (REM)- Stage of vivid full color dreaming, occurs @ 90 mins after sleeping has begun.
Referred pain- felt at a site other than the injured or diseased organ or part of the body.
Synergistic- the action of two or more substances or organs to achieve an effect of which each is individually in capable.
Transcutaneous electric nerve stimulation (TENS)- device that provides a continuous mild electric current to the skin via electrodes that are attached to a stimulator by flexible wires.
Visual analog scale- patient marks a spot on a horizontal line to indicate pain intensity, from 0 to 10, left to right.
Nature of pain
Pain is a cardinal symptom of inflammation.
Pain causes fatigue, decreases ability to cope physically, emotionally and mentally.
McCaffery and Pasero’s description of pain is “Pain is whatever the experiencing person says it is, existing whenever he says is does.”
PAS definition of pain- Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
Behavioral characteristics of pain
Pt. is self protective and guards painful area
Narrowed focus, cannot think of anything but the pain
Withdraws from social contact, avoids conversation
Impaired thought process
Demonstrates distraction behavior, includes moaning, rocking, crying
Presents facial mask of pain, eyes appear dull or lusterless
Experiences alterations in muscle tone
Exhibits diaphoresis, changes in blood pressure and pulse rate.
Sometimes demonstrates no outward expression of pain. Remember that lack of pain expression does not mean lack of pain.
Joint Commission standards
Pts. have the right to appropriate assessment
Pts. will be treated for pain or referred for treatment.
Pain is to be assessed and regularly reassessed.
Pts. will be taught the importance of effective pain management.
Pts. will be taught that pain management is part of treatment.
Pts. will be involved in making care decisions.
Routine and prn analgesics are to be administered as ordered.
Discharge planning and teaching will include continuing care based on the pts. needs at the time of discharge, including the need for pain management.
Non invasive pain relief techniques
Cutaneous stimulation (heat, cold, massage, and TENS), the removal of painful stimuli, distraction, relaxation, guided imagery, meditation, hypnosis and biofeedback.
Guided imagery, encourage pt. to concentrate on an image that helps relieve pain or discomfort.
These methods work by decreasing anxiety.
Invasive pain relief techniques
Anything that enters the body, never blockers, epidural analgesics, neurosurgical procedures, and acupuncture.
Nonopioids
Acetaminophen (Tylenol)- appears to be inhibit prostaglandins that may serve as mediators of pain and fever, primarily in the CNS but may also block pain impulses peripherally.
Aspirin- blocks pain impulses in the CNS and reduces inflammation by inhibition of prostaglandin synthesis.
NSAIDs tramadol (Ultram), ibuprofen (Motrin), naproxen (Naprosyn), ketorolac tromethamine (Toradol), celecoxib (Celebrex)- work in the CNS, but their better characterized actions are peripheral, exert analgesic effects through the inhibition of prostaglandin production.
Opioids
Relieve pain mainly by action in the CNS, binding to the opioid receptor.
Opioid antagonist naloxone (Narcan), blocks or reverses action of all opioids.
Adjuvant analgesics
Work with non opioids and opioids to relieve pain.
Antidepressants block the reuptake of serotonin, anticonvulsants are sodium channel blocking agents.
carbamazepine (Tegretol) anticonvulsant sodium channel blocker
gabapentin (Neurontin) chronic neuropathic pain
duloxetine (Cymbalta) antidepressant used for diabetic neuropathy,
pregabaline (Lyrica) anticonvulsant
Epidural analgesia
Infusion of opiates into the epidural space, between the walls of the vertebral canal and the dura mater of the spinal cord.
Drugs used for epidural analgesia are morphine, fentanyl, and hydromorphone.
Side effects: urinary retention, postural hypotension, pruritus nausea, vomiting, and respiratory depression.
Monitor respirations every 15 minutes during infusion.
Responsibility of the nurse in pain control
Every pt. has the right to be free of pain; it is the nurses responsibility to do everything possible to alleviate the pts. pain.
The ultimate goal of pain management is to provide pain relief and enable the pt. to carry on with activities of daily living in as comfortable a manner as possible.
Collections of subjective data
Characteristics worth noting are the site, severity, duration and the location of pain.
Pain rating
Most pts. require a pain level of 3 or less to function well.
Collection of objective data
Possible objective data are tachycardia, increased rate and depth of respirations, diaphoresis, increased systolic or diastolic blood pressure, pallor, dilated pupils and increased muscle tension.
