Module 3: Pain Flashcards
acute pain
recent/sudden onset, can become chronic, associated with systemic injury and decreases with healing, lasts few days-months
chronic pain
persistent pain beyond expected tissue healing time, 6+ months, can become pts primary health problem
cancer - related pain
most feared outcomes, poor management d/t cancer moving into bone and nerve compression tumours
pain syndromes & unusual severe pain
fibromyalgia, peripheral neuropathies, pain assessment would be more complex
gate control theory
proposed that stimulation of skin causes nervous impulses transmitted by 3 systems in spinal cord
factors influencing pain response
past experiences, anxiety & depression, age
pain assessment
OPQRSTUV
behavioural pain scales
face, legs, activity, cry, consolability (FLACC)
pain rating scales
wong-baker FACES pain rating scale
pain plan
relieve, reduce, manage pain
non-pharmacological interventions
acupuncture/massage, heat & cold, medication/relaxation therapy, art/music therapy
non-pharmacological physical care interventions
fresh linens, positioning in bed with supportive pillows, personal care
non-pharmacological support persons interventions
social work, religious/spiritual
adjuvant analgesics
drugs that are added for combined therapy with a primary drug
example of adjuvant analgesics
NSAIDs, non-opioid analgesics, anticonvulsants, antidepressants, corticosteroids
acetylsalicylic acid (ASA)
classification: NSAID, antipyretic
indications: inflammatory disorders, mild-mod pain, fever, prophylaxis of TIA + MI
MOA: inhibits prostaglandin synthesis, decreases platelet aggregation
side effects: nausea, tinnitus, GI bleeding
assessments: allergies, pain
teaching: give with water or food (small dose = NOT for pain relief & big dose = FOR pain relief)
ibuprofen (advil)
classification: NSAID, antipyretic
indications: inflammatory disorders, mild-mod pain, fever
MOA: inhibits prostaglandin synthesis
side effects: nausea, GI bleeding, HF, MI, stroke
assessments: allergies, pain, GI bleeds hx, renal insufficiency
teaching: give with water or food, avoid ETOH
acetaminophen (tylenol)
classification: non-opioid analgesic, antipyretic
indications: treatment of mild-mod pain and fever
MOA: inhibits enzymes needed for prostaglandin synthesis
side effects: hepatoxicity
assessments: allergies, pain, liver fxn in susceptible populations
teaching: check other OTC meds for presence of acetaminophen, do not exceed 4g/day
gabapentin
classification: analgesic adjuncts, anticonvulsants
indications: neuropathic pain, migraines, anxiety, diabetic neuropathy
MOA: unknown
side effects: ↑ risk of suicidal/behaviours, confusion, drowsiness
assessments: allergies, pain, renal insufficiency
teaching: cause dizziness and drowsiness, do not take within 2 hours of antacid
amitriptyline
classification: antidepressant
indications: depression, anxiety, chronic pain syndromes
MOA: potentiates effects of serotonin and norepinephrine in CNS
side effects: ↑ risk of suicide attempt/ideation, sedations, lethargy, hypotension, constipation
assessments: allergies, pain, BP + pulse, renal insufficiency
THC
cause feelings of euphoria, “high” analgesic efforts
CBD
reduce inflammation, relieve pain, treat anxiety, insomnia, nausea
cannabis
antiemetic, treatment of spasticity in MS, seizures, neuropathic pain
nabilone
antiemetic, helps prevent nausea, may increase appetite (pill form)
marijuana nursing considerations
understand desired effects, assess before and after, low strains = used in medical realm to prevent side effects of feelings too high or analgesic effects, self-medication (talk to dr)
type of opiates/narcotics
codeine, morphine, hydromorphone, fentanyl, methadone
morphine indication
moderate-severe pain, pain associated with MI
methadone indication
moderate-severe chronic pain in opioid-tolerant pts needing 24/7 opioid tx
hydromorphone indication
moderate-severe pain, moderate to severe chronic pain in opioid-tolerant pts needing 24/7 long-term opioid tx
codeine indication
mild-moderate pain, antitussive
fentanyl
parenteral, pre/post anesthesia, transdermal, moderate-severe chronic pain needing 24/7 opioid tx
opioid MOA
binds to opiate receptors in CNS and alters perception and response to painful stimuli while producing generalized CNS depression
opioid side effects
respiratory distress, CNS depression, constipation
opioid pre/post assessments
allergies, pain assessment, resp status and depth, LOC, BP
fentanyl patches
for pts who are opioid tolerant, no heat over patch, patches are disposed into sharps container
naloxone
classification: opioid antagonist
routes: IV, IM, SC, nasal spray
MOA: structural analog or morphine that acts as an antagonist at opioid receptors and blocks opioid actions
indications: drug of choice for reversal of opioid overdose
side effects: agitation, restlessness, arrhythmias
assessments: allergies, pain, RR, BP, LOC
