Mod 10 - Pain Meds Flashcards
where does pain occur
where there is tissue damage
what are nociceptors
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
what is the pain pathway
nociceptor to the spinal cord to the hypothalamus to the cerebral cortex
what is the pain signal transmitted to the brain through
A-delta and C fibres
what is the dorsal horn used for
relay station from the A-delta and C fibers
what does the thalamus do
relay station for sensory stimuli
where is pain percieved
cerebral cortex
what is endogenous analgesia
CNS suppression of pain signals by opioid peptides interacting with opioid receptors to inhibit perception and transmission of pain signals (endorphins, enkephalins, dynorphins)
describe acute pain
sudden start
known cause (injury, surgery)
gets better as body heals
less than 3 months
describe chronic pain
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
Pain nursing process: assessment
what are you giving and why
ask OPQRSTTU, faces
Pain nursing process: implementation
5 rights allergies best route at this time right med for pain scale rule of thumb: use least invasive anticpated anticipate SE
Pain nursing process: evaluation
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
what are opioid analgesics perscribed for
mod-severe pain
why is morphine at the top of the ladder
no celing effect so higher the dose, higher the level of anesthesia
patient controlled analgesia
push button to release, lockout to prevent OD (hydromorphone, morphine, fentanyl)
Concerns with morphine and what is the guideline
- determine when to initiate or continue opioids for chronic pain
- opioid selection, dosage, duration, follow-up, discontinuation
- considerations for follow up and discontinuation of opioid therapy
what are the components of the experience of pain
- 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
how many times stronger than morphine is fentanyl
100x
how many times more stronger than morphine is hydromorphone
5-7x more potent
what is the most common route for pain meds and why
oral, b/c consistent, noninvasive, can take at home
what route is most likely used for palative
transdermal but it is hard to manage and manipulate
morphine class
opioid agonist
morphine types
morphine IR and morphine contin (extended release)
morphine uses
severe pain
morphine action
- 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
morphine OE
respiratory depression, sedation, constipation, urinary retention, nausea/vomiting
morphine considerations
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
what is the purpose of using a pain scale
assess pain before and after giving meds and to evaluate your care
has 7/10 pain what to give? both at once?
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,
ondansetron class
antiemetic (serotonin antagonist)
ondansetron uses
nausea/vomiting associated with chemo, post-op, pregnancy
ondansetron action
blocks serotonin in the GI tract (vagus nerve), CTZ, VC (CNS)
ondansetron O/E
CNS manipulation - headache, dizziness, fatigue
GI (vagus nerve) - constipation, diarrhea, upset
ondansetron considerations
monitor for SS if on other serotonin medications, assess nausea/vomiting and BM, drowsiness, PO or injection route, can cause QT prolongation
naloxone class
opioid antagonist
naloxone action
attach to opioid receptors to block a response (initiating a pain response)
naloxone OE
tremors, drowsiness, sweating, dec RR, HTN, nausea/vomiting
naloxone considerations
may cause withdrawal, repeated doses may be required, parentally or inhaled route
physical dependence def
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.
psychological dependence def
e emotional and mental processes that are associated with the development of, and recovery from, a substance use disorder or process addiction
tolerance def
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
addiction def
a chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences. need to drug to function
Docusate class
stool softener
Docusate uses
constipation
Docusate action
facilitates the movement of water and fats into the stool to make it soft and improve regularity of BMs
Docusate OE
diarrhea, cramps
Docusate considerations
BM within 12-72hr, stomach cramps
