Mod 10 - Pain Meds

Question 1

where does pain occur

Answer 1

where there is tissue damage

Question 2

what are nociceptors

Answer 2

nerve endings that selectively respond to painful stimuli and send pain signals to the brain and spinal cord. they are barely present in internal organs

Question 3

what is the pain pathway

Answer 3

nociceptor to the spinal cord to the hypothalamus to the cerebral cortex

Question 4

what is the pain signal transmitted to the brain through

Answer 4

A-delta and C fibres

Question 5

what is the dorsal horn used for

Answer 5

relay station from the A-delta and C fibers

Question 6

what does the thalamus do

Answer 6

relay station for sensory stimuli

Question 7

where is pain percieved

Answer 7

cerebral cortex

Question 8

what is endogenous analgesia

Answer 8

CNS suppression of pain signals by opioid peptides interacting with opioid receptors to inhibit perception and transmission of pain signals (endorphins, enkephalins, dynorphins)

Question 9

describe acute pain

Answer 9

sudden start
known cause (injury, surgery)
gets better as body heals
less than 3 months

Question 10

describe chronic pain

Answer 10

last longer than 6 months
causes by disease or condition (injury, treatment, inflammation) or unknown
can continue after healed
some have no cause
can have tense muscles, limited ability, lack of energy, appetite changes, MH problems, interruption of daily life

Question 11

Pain nursing process: assessment

Answer 11

what are you giving and why

ask OPQRSTTU, faces

Question 12

Pain nursing process: implementation

Answer 12

5 rights
allergies
best route at this time
right med for pain scale
rule of thumb: use least invasive anticpated
anticipate SE

Question 13

Pain nursing process: evaluation

Answer 13

dec. in pain 30 mins after IV, 60 mins after oral
not gone investigate other modailites (aromatherapy, repositioning, hot/cold, music)
adverse effect of opioids - respiratory depression, RR and pulse ox check

Question 14

what are opioid analgesics perscribed for

Answer 14

mod-severe pain

Question 15

why is morphine at the top of the ladder

Answer 15

no celing effect so higher the dose, higher the level of anesthesia

Question 16

patient controlled analgesia

Answer 16

push button to release, lockout to prevent OD (hydromorphone, morphine, fentanyl)

Question 17

Concerns with morphine and what is the guideline

Answer 17

1. determine when to initiate or continue opioids for chronic pain
2. opioid selection, dosage, duration, follow-up, discontinuation
3. considerations for follow up and discontinuation of opioid therapy

Question 18

what are the components of the experience of pain

Answer 18

• emotional response
• learned experience (esp. w/ chronic pain) -> what it was like before influences how you deal with pain now
• cultural factors
• individual tolerance (gender) ->question if they’re having pain after what should be a painful experience? check their body language
• placebo effect -> if you believe it will work, it works better

Question 19

how many times stronger than morphine is fentanyl

Answer 19

100x

Question 20

how many times more stronger than morphine is hydromorphone

Answer 20

5-7x more potent

Question 21

what is the most common route for pain meds and why

Answer 21

oral, b/c consistent, noninvasive, can take at home

Question 22

what route is most likely used for palative

Answer 22

transdermal but it is hard to manage and manipulate

Question 23

morphine class

Answer 23

opioid agonist

Question 24

morphine types

Answer 24

morphine IR and morphine contin (extended release)

Question 25

morphine uses

Answer 25

severe pain

Question 26

morphine action

Answer 26

- binds to opioid receptors in the CNS and stimulates a response - alters our perception of pain with generalized CNS depression and increases our tolerance - interferes with processing pain impulses

Question 27

morphine OE

Answer 27

respiratory depression, sedation, constipation, urinary retention, nausea/vomiting

Question 28

morphine considerations

Answer 28

know RR before giving and if its <10 breaths stop and think, give laxatives/stool softeners, antiemetics if needed, nalaoxone= antidote, can lead to dependance, watch concurrent use of other CNS depressants, assess LOC and BM, extended release lasts 12 hrs and takes longer to work

Question 29

what is the purpose of using a pain scale

Answer 29

assess pain before and after giving meds and to evaluate your care

Question 30

has 7/10 pain what to give? both at once?

Answer 30

can give a short acting and long acting morphine at once bc the short action can be given every 4 hours and the long acting wont start working until 12 hours after administration. give short acting until the long acting kicks in and then stop giving short acting - base dose off of what they were getting before, if first time start LOW - reassess in 30 mins with oral meds,

Question 31

ondansetron class

Answer 31

antiemetic (serotonin antagonist)

Question 32

ondansetron uses

Answer 32

nausea/vomiting associated with chemo, post-op, pregnancy

Question 33

ondansetron action

Answer 33

blocks serotonin in the GI tract (vagus nerve), CTZ, VC (CNS)

Question 34

ondansetron O/E

Answer 34

CNS manipulation - headache, dizziness, fatigue | GI (vagus nerve) - constipation, diarrhea, upset

Question 35

ondansetron considerations

Answer 35

monitor for SS if on other serotonin medications, assess nausea/vomiting and BM, drowsiness, PO or injection route, can cause QT prolongation

Question 36

naloxone class

Answer 36

opioid antagonist

Question 37

naloxone action

Answer 37

attach to opioid receptors to block a response (initiating a pain response)

Question 38

naloxone OE

Answer 38

tremors, drowsiness, sweating, dec RR, HTN, nausea/vomiting

Question 39

naloxone considerations

Answer 39

may cause withdrawal, repeated doses may be required, parentally or inhaled route

Question 40

physical dependence def

Answer 40

A condition in which a person takes a drug over time, and unpleasant physical symptoms occur if the drug is suddenly stopped or taken in smaller doses.

Question 41

psychological dependence def

Answer 41

e emotional and mental processes that are associated with the development of, and recovery from, a substance use disorder or process addiction

Question 42

tolerance def

Answer 42

person's reduced reaction to a drug following its repeated use. need a larger dose to make the same effects as a smaller dose once did

Question 43

addiction def

Answer 43

a chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences. need to drug to function

Question 44

Docusate class

Answer 44

stool softener

Question 45

Docusate uses

Answer 45

constipation

Question 46

Docusate action

Answer 46

facilitates the movement of water and fats into the stool to make it soft and improve regularity of BMs

Question 47

Docusate OE

Answer 47

diarrhea, cramps

Question 48

Docusate considerations

Answer 48

BM within 12-72hr, stomach cramps