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Funds II Theory > Module 4: Comfort and Pain Management & Rest and Sleep > Flashcards

Module 4: Comfort and Pain Management & Rest and Sleep Flashcards

1
Q

Acute Pain

A

short term
less than 3 months

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2
Q

Chronic Pain

A

long term
more than 3 months

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3
Q

Effects of Chronic Pain on Patient

A

normal or decreased vital signs
depression is a major concern
anxiety, irritability, suicide

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4
Q

Patient responses to acute pain

A

increased vital signs
severe can cause reflex action to escape the cause
anxiety
pain is not all-consuming

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5
Q

Patient responses to chronic pain

A

normal or decreased vital signs
tends to consume entire person (demands total attention)
physically and emotionally exhausting
ongoing irritability, fear, isolation, anger, fatigue, helplessness, stress/anxiety, DEPRESSION

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6
Q

Somatic pain

A

pain perceived by muscles, joints, tendons/ligaments, bones

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7
Q

Visceral pain

A

pain perceived by internal organs

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8
Q

Cutaneous pain

A

pain perceived by skin
burn, incision, tear, bruise

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9
Q

Neuropathic pain

A

pain perceived by nerves/nervous system
diabetic neuropathy, phantom pain

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10
Q

Radiating pain

A

pain that travels from one body part to another

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11
Q

Referred pain

A

pain is perceived in an area distant from its point of origin
gallbladder/pancreas pain can refer to back
jaw pain during a MI (mainly females)

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12
Q

Rebound pain

A

pain upon removal of pressure
sign of peritonitis

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13
Q

Phantom pain

A

pain that often occurs with an amputated leg where receptors and nerves are clearly absent

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14
Q

Psychogenic pain

A

cause of pain cannot be identified
associated w/ psychological factors; mental or emotional problems can make pain worse
ex: back pain

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15
Q

Intractable pain

A

when pain is resistant to therapy and persists despite a variety of interventions

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16
Q

When should pain assessments be done/when are they warranted

A

when patient is complaining of pain
during vitals
upon admission
in ED

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17
Q

OPQRST scale

A

onset, provoking factors, quality, region/radiating, severity, time
used for adults when they are able to verbalize

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18
Q

Wong-Baker FACES scale

A

adults and children (>3 years) in all patient care settings

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19
Q

FLACC Scale

A

face, legs, activity, cry, consolability
infants and children (2 mo-7 yrs) who are unable to validate the presence of or quantify severity of pain

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20
Q

Numbers scale

A

adults/children (> 9 years) in all patient care settings who are able to use numbers to rate the intensity of their pain

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21
Q

Common pain responses: cardiovascular

A

increased HR and BP
increased need for oxygen
water retention, potential fluid overload

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22
Q

Common pain responses: respiratory

A

increased RR
shallow breathing
increased risk of infection

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23
Q

Common pain responses: immune

A

increased susceptibility to infection
increased or decreased sensitivity to pain
activation of HPA (hypothalamic, pituitary, adrenal) axis

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24
Q

Common pain responses: endocrine

A

increased BS
increased cortisol production (fight or flight)

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25
Common pain responses: gastrointestinal
reduced gastric emptying and intestinal motility nausea and vomiting constipation
26
Common pain responses: urinary
urge to urinate/incontinence
27
Common pain responses: musculoskeletal
tense muscles local to injury shaking or shivering pilo-erection (goose bumps)
28
Common pain responses: nervous
changes in pain processing risk of pain becoming chronic
29
Common pain responses: brain
anxiety/fear depression poor concentration inhibition or promotion of pain
30
Complications of pain/harmful effects that can be caused by unrelieved pain
decreased quality of life reduced productivity worsening of chronic disease psychiatric disorders (depression, anxiety, substance abuse disorders) hormonal abnormalities weaken the immune system fatigue
31
When are opioids appropriate?
moderate to severe pain preoperative meds analgesia during anesthesia
32
Side Effects of opioids
sedation, decreased RR and other vitals, constipation, pruritis orthostatic hypotension neurologic effects (light-headedness, dizziness, anxiety) urinary retention/hesitancy
33
Nursing interventions to help with opioid side effects
constipation: high fiber diet, increased fluid intake, increased physical activity, daily stool softener in addition to regular use of stimulant laxatives nausea: antiemetic if significantly affected sedation: reviewing and minimizing polypharmacy in older adults pruritis: antihistamines provide oxygen if SPO2 is low
34
Nursing considerations/concerns for opioids
allergies don't give for pt with diarrhea don't give for recent GI/GU surgery or GI problems oxycodone for pregnancy is okay respiratory dysfunction head injuries/CVD liver/renal dysfunction lactation/pregnancy addiction
35
When to reassess pt after opioid administration?
IV: 15-30 min PO: 45-60 min
36
What to do if pain was not relieved upon reassessment?
non-pharmacological (distraction, etc) talk to HCP about different route/type of opioid administer NSAID
37
antidote/medication used for reversal of opioid
narcan/naloxone
38
Physical dependence
Phenomenon in which the body physiologically becomes accustomed to an opioid and suffers withdrawal symptoms if the opioid is suddenly removed or the dose is rapidly decreased
39
Psychological dependence
The drug is so central to the person’s life that the need to keep using becomes a craving or compulsion, even if the person knows that using is harmful like addiction
40
Tolerance
Occurrence of the body’s becoming accustomed to an opioid and needing a larger dose each time for pain relief
41
When are NSAIDs appropriate?
acetaminophen/paracetamol - mild pain/fever ibuprofen/motrin - mild pain/anti-inflammatory aspirin - effective anticoagulant effect/mild pain
42
NSAID side effects
acetaminophen/paracetamol - risk of hepatotoxicity ibuprofen/Motrin - GI bleeding/ kidney damage aspirin - monitor use of other anticoags given along with aspirin/monitor for bleeding
43
Nursing considerations/concerns NSAIDs
acetaminophen/paracetamol - max daily dose 3,000 mg/24 hr period / lacks anti-inflammatory effects ibuprofen/Motrin - max daily dose 3,200 mg/24 hr period / lacks effective antipyretic effects aspirin - given in 81 mg or 325 mg doses
44
Appropriate nursing diagnoses for pain
should include type, etiology, pt's response acute pain, chronic pain, labor pain
45
Expected outcomes for pain
goals for acute and chronic pain decrease pain severity
46
Interventions for pain
establishing trusting nurse-pt relationship manipulating factors that affect pain experience initiating nonpharmacologic pain relief measures managing pharmacologic interventions reviewing additional pain control measures ensuring ethical and legal responsibility to relieve pain teaching pt about pain
47
What is the purpose of adjuvant meds?
enhance the effects of pain meds
48
Examples of adjuvant meds
anti-depressants/anti-anxiety anticonvulsants (gabapentin, pregabalin) muscle relaxers
49
Non-pharmacological pain relief measures
distraction humor music imagery relaxation cutaneous stimulation acupuncture hypnosis biofeedback therapeutic touch animal-facilitated therapy
50
Nursing interventions to promote sleep
Prepare a restful environment Promote bedtime rituals Offer appropriate bedtime snacks and beverages Promote relaxation and comfort Respect normal sleep-wake patterns Schedule nursing care to avoid disturbances Use medications to produce sleep Patient education to promote sleep
51
Questions to ask patient to assess sleep/rest
recent changes in sleep do you set an alarm and hit snooze before getting up? usual sleeping and waking times number of hours of undisturbed sleep quality of sleep number and duration of naps effect of sleep pattern on everyday functioning energy level (ability to perform ADLs) sleep aids bedtime rituals sleep environment sleep disturbances and contributing factors
52
Tools/ diagnostic tests used to diagnose sleep problems
Polysomnography: records brain waves, oxygen level, heart rate, breathing, eye and leg movements during sleep (aka sleep study) sleep study: dx narcolepsy, sleep apnea, rls sleep diary: dx insomnia and circadian rhythm disorders
53
Factors that affect sleep
Sleep patterns Motivation Culture Activity level Smoking Alcohol (decreases sleep quality) Stress Illness Certain meds Incontinence Pain Nausea Environmental factors (temp and humidity)
54
REM sleep
Eyes dart back and forth quickly Small muscle twitching, such as on the face Large muscle immobility, resembling paralysis Irregular RR; sometimes apnea Rapid/irregular pulse BP increases or fluctuates Increase in gastric secretions Metabolism increases; body temp increases Encephalogram tracings active REM sleep enters from stage II of NREM sleep and reenters NREM sleep at stage II: arousal from sleep is difficult Constitutes about 20 to 25% of sleep
55
Stage 1 NREM
Transitional stage between wakefulness and sleep Relaxed state but still somewhat aware of surroundings Involuntary muscle jerking may occur Stage normally only lasts minutes Person can be aroused easily Constitutes only about 5% of total sleep
56
Stage 2 NREM
falls into a stage of sleep person can be aroused with relative ease constitutes 50 to 55% of sleep
57
Stage 3 NREM
the depth of sleep increases, and arousal becomes increasingly difficult composes about 10% of sleep
58
Stage 4 NREM
Greatest depth of sleep (delta sleep) Arousal is difficult Slow brain waves, slower HR and RR, lower BP, muscles relaxed, slow metabolism, low body temp, constitutes about 10% of sleep
59
When do Alpha waves appear during sleep?
Early portion of stage 1 NREM relaxed/sleepy Low frequency, high amplitude waves
60
When do Beta waves appear during sleep?
REM sleep and waking awake
61
When do Delta waves appear during sleep?
stage 3/4 NREM (deep) sleep
62
When do Theta waves appear during sleep?
during stage 1/2 NREM (light) sleep
63
Patient education regarding sleep hygiene
Restricting intake of caffeine, nicotine, and alcohol, especially later in the day Avoiding mental and physical activities after 5 pm that are stimulating Avoiding daytime naps Eating a light carb/protein snack before bedtime Avoiding high fluid intake in evening so as to minimize trips to the bathroom at night Sleep in a cool, dark room Eliminating use of a bedroom clock Taking a warm bath before bed Trying to keep sleep environment as quiet and stress-free as possible
64
Hypersomnia
Condition characterized by excessive sleeping, especially daytime sleeping When awake are often disoriented, irritated, restless, slower speech and thinking processes MVA risk due to drowsiness or falling asleep while driving
65
Insomnia
Difficulty in falling asleep, intermittent sleep, or early awakening from sleep Feeling tired, lethargic, irritable, difficulty concentrating, delirium
66
Obstructive sleep apnea
Potentially serious sleep disorder in which the throat muscles intermittently relax and block airway during sleep, causing breathing to repeatedly stop and start Sleepiness, fatigue, insomnia, snoring, observed apnea, irritability, fall asleep during boring activities, difficulty concentrating, slower reaction times Risk of hypoxia
67
Narcolepsy
Condition characterized by an uncontrolled desire to sleep Hallucinations, sleep paralysis, cataplexy (loss of skeletal muscle tone lasting from seconds to 1 to 2 minutes) Can fall asleep quickly and during any activity
68
Parasomnias
Patterns of waking behavior that appear during sleep (sleepwalking, sleep talking, nocturnal erections) Risk for injury
69
Somnabulism
sleepwalking risk for injury/falls
70
Restless leg syndrome
A condition in which patients are unable to lie still and report experiencing unpleasant creeping, crawling, or tingling sensations in the legs Irresistible urge to move legs when sensations occur
71
Sleep deprivation
A decrease in the amount, consistency, and quality of sleep; results from decreased REM or NREM sleep Loss of concentration, inattention, irritability
72
What are effects of insufficient sleep?
obesity = increased appetite and decreased metabolism anxiety risk for: DM, HTN, stroke, substance abuse, depression, GI issues decreased alertness and response time (impaired driving) fatigue/sleepiness decreased immunity = increased risk of infections

Funds II Theory (7 decks)

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