Module 3: Pain

Question 1

acute pain

Answer 1

recent/sudden onset, can become chronic, associated with systemic injury and decreases with healing, lasts few days-months

Question 2

chronic pain

Answer 2

persistent pain beyond expected tissue healing time, 6+ months, can become pts primary health problem

Question 3

cancer - related pain

Answer 3

most feared outcomes, poor management d/t cancer moving into bone and nerve compression tumours

Question 4

pain syndromes & unusual severe pain

Answer 4

fibromyalgia, peripheral neuropathies, pain assessment would be more complex

Question 5

gate control theory

Answer 5

proposed that stimulation of skin causes nervous impulses transmitted by 3 systems in spinal cord

Question 6

factors influencing pain response

Answer 6

past experiences, anxiety & depression, age

Question 7

pain assessment

Answer 7

OPQRSTUV

Question 8

behavioural pain scales

Answer 8

face, legs, activity, cry, consolability (FLACC)

Question 9

pain rating scales

Answer 9

wong-baker FACES pain rating scale

Question 10

pain plan

Answer 10

relieve, reduce, manage pain

Question 11

non-pharmacological interventions

Answer 11

acupuncture/massage, heat & cold, medication/relaxation therapy, art/music therapy

Question 12

non-pharmacological physical care interventions

Answer 12

fresh linens, positioning in bed with supportive pillows, personal care

Question 13

non-pharmacological support persons interventions

Answer 13

social work, religious/spiritual

Question 14

adjuvant analgesics

Answer 14

drugs that are added for combined therapy with a primary drug

Question 15

example of adjuvant analgesics

Answer 15

NSAIDs, non-opioid analgesics, anticonvulsants, antidepressants, corticosteroids

Question 16

acetylsalicylic acid (ASA)

Answer 16

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)

Question 17

ibuprofen (advil)

Answer 17

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

Question 18

acetaminophen (tylenol)

Answer 18

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

Question 19

gabapentin

Answer 19

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

Question 20

amitriptyline

Answer 20

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

Question 21

THC

Answer 21

cause feelings of euphoria, “high” analgesic efforts

Question 22

CBD

Answer 22

reduce inflammation, relieve pain, treat anxiety, insomnia, nausea

Question 23

cannabis

Answer 23

antiemetic, treatment of spasticity in MS, seizures, neuropathic pain

Question 24

nabilone

Answer 24

antiemetic, helps prevent nausea, may increase appetite (pill form)

Question 25

marijuana nursing considerations

Answer 25

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)

Question 26

type of opiates/narcotics

Answer 26

codeine, morphine, hydromorphone, fentanyl, methadone

Question 27

morphine indication

Answer 27

moderate-severe pain, pain associated with MI

Question 28

methadone indication

Answer 28

moderate-severe chronic pain in opioid-tolerant pts needing 24/7 opioid tx

Question 29

hydromorphone indication

Answer 29

moderate-severe pain, moderate to severe chronic pain in opioid-tolerant pts needing 24/7 long-term opioid tx

Question 30

codeine indication

Answer 30

mild-moderate pain, antitussive

Question 31

fentanyl

Answer 31

parenteral, pre/post anesthesia, transdermal, moderate-severe chronic pain needing 24/7 opioid tx

Question 32

opioid MOA

Answer 32

binds to opiate receptors in CNS and alters perception and response to painful stimuli while producing generalized CNS depression

Question 33

opioid side effects

Answer 33

respiratory distress, CNS depression, constipation

Question 34

opioid pre/post assessments

Answer 34

allergies, pain assessment, resp status and depth, LOC, BP

Question 35

fentanyl patches

Answer 35

for pts who are opioid tolerant, no heat over patch, patches are disposed into sharps container

Question 36

naloxone

Answer 36

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